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MECH (10-0874)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: 10-00000874 Property Address: 78855 MERIDIAN WY APN: 609-480-063-17 -23773 - Application description: MECHANICAL Property Zoning: LOW DENSITY RESIDENTIAL Application valuation: 3100 Applicant T-i&t 4 4 Q" Architect or Eng' er: BUILDING & SAFETY DEPARTMENT BUILDING PERMIT LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 70001 of Divisi a Business and Professionals Code, and my License is in full force and effect. License Class: B- 0-C20 LicenseNo.: 856936 Date: Contractor: - OWNER -BUILDER DECLARATION I hereby affirm unde ty of perjury that I am exempt from the Contractor's State License Law for the following reason (Sec. 7031 .5, Business and Professions Code: Any city or county that requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).: (_ 1 1, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who does the work himself or herself through his or her own employees, provided that the improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for the purpose of sale.). (_ 1 I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who contracts for the projects with a contractors) licensed pursuant to the Contractors' State License Law.). ( 1 I am exempt under Sec. , B.&P.C. for this reason Date: Owner: CONSTRUCTION LENDING AGENCY I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.). Lender's Name: _ Lender's Address: LQPERMIT VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 25920 IRIS AVE, STE 13A-4 MORENO VALLEY, CA 92551 (951)486-0337 Lic. No.: 856936 WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: _ I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers' compensation insurance carrier and policy number are: Carrier STATE FUND Policy Number 0059112009 _ I certify that, in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree that, if I should become subject t the workers' compensation provisions of Section 370 or Code, I shall wi mply with those provisions. Date: Applicant: WARNING: FA URE TO SECUR RKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN E LOYER T IMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS (5100,0 ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. APPLICANT ACKNOWLEDGEMENT IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on this application. 1 . Each person upon whose behalf this application is made, each person at whose request and for whose benefit work is performed under or pursuant to any permit issued as a result of this application, the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City of La Quinta, its officers, agents and employees for any act or omission related to the work being performed under or following issuance of this permit. 2. Any permit issued as a result of this application becomes null and void if work is not commenced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and state tha a information is correct. I agree to comply with all city and county mance state laws relati o bu' construction, and hereby authorize representatives of this count to enter upon the bove-men ' pr for inspection purposes. Date: V Signature (A pl' Date: 9/08/10 Owner: ADAMS DAVID 78855 MERIDIAN WAY LA QUINTA, CA 92253 (760)312-7916 PSEP Contractor:TELFORDJONES, INC. 0 8 2010 25920 IRIS AVE, STE 13A-4 MORENO VALLEY, CA 92551 (951)486-0337 Lic. No.: 856936 WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: _ I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers' compensation insurance carrier and policy number are: Carrier STATE FUND Policy Number 0059112009 _ I certify that, in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree that, if I should become subject t the workers' compensation provisions of Section 370 or Code, I shall wi mply with those provisions. Date: Applicant: WARNING: FA URE TO SECUR RKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN E LOYER T IMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS (5100,0 ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. APPLICANT ACKNOWLEDGEMENT IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on this application. 1 . Each person upon whose behalf this application is made, each person at whose request and for whose benefit work is performed under or pursuant to any permit issued as a result of this application, the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City of La Quinta, its officers, agents and employees for any act or omission related to the work being performed under or following issuance of this permit. 2. Any permit issued as a result of this application becomes null and void if work is not commenced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and state tha a information is correct. I agree to comply with all city and county mance state laws relati o bu' construction, and hereby authorize representatives of this count to enter upon the bove-men ' pr for inspection purposes. Date: V Signature (A pl' -L Application Number . . . . . 10-00000874 Permit MECHANICAL Additional desc . . Permit Fee . . . . 51.00 Plan Check Fee 12.75 Issue Date . . . . Valuation . . . . 0 Expiration Date . . 3/07/11 Qty Unit Charge Per Extension BASE FEE. 15.00 2.00 9.0000 EA MECH FURNACE <=100K 18.00 2.00 9.0000 EA MECH B/C <=3HP/100K BTU 18.00 ---------------------------------------------------------------------------- Special Notes and Comments HVAC CHANGE OUT LIKE FOR LIKE SAME LOCATION (2) A/C 4 TON 17 SEER.FAV 75K BTU .95 AFUE. 2007 CODES. ---------------------------------------------------------------------------- Other Fees . . . . . . . . . BLDG STDS ADMIN (SB1473) 1.00 Fee summary Charged Paid Credited ---------------------------------------- Due ----------------- Permit Fee Total 51.00 .00 .00 51.00 Plan Check Total 12.75 .00 .00 12.75 Other Fee Total 1.00 .00 .00 1.00 Grand Total 64.75 .00 .00 64.75 LQPERMIT Simplified Prescriptive Certificate of Compliance: 2008 Residential HVACAIterations CF -IR -ALT -HVAC Climate Zones 10 to 15 Site A�ir s: Enforcement Agency: Permit 4 Equipment Ty e' Li5t Minimum Efficiency z Duct insulation requirement Conditioned Floor Area Thermostat ❑ Paf�aged Unit C�J�I' ace AFF E 7s ❑COP Over 40 ft of ducts added or replaced in unconditione Served by G]�S back e LYlyddorCoiI ER= ❑ HSPF pace ❑ R 6 (CZ 10-13) s tem sf (If not already must be Condensing Unit ❑ EER ❑ Resistance ❑ R 8 (CZ 14-15) present, installed) ❑ Other I /. Equipment Type: Choose the equipment being installed; if more than one system, use another CF -/R -ALT -HVAC for each system. 2. Minimum Equipment Efficiencies: 13 SEER, 78%AFUE, 7.7HSPFfor typical residential systems. HERS VERIFICATION SUMMARY Listed below are four HVAC alteration Options. The installer decides what work is being done and picks one of the appropriate Options. Each Option lists the HERS measures that must be conducted. A copy of the forms shall be left on site for final inspection and a copy given to the homeowner. At final, the inspector verifies that the work listed on this form was in fact the work completed by the installer.T4e inspector also verifies that each appropriate CF -6R and registered CF -4R forms (no hand filled CF-4Rs allowed) are filled out and Signe eginning October 1, 2010, a registered copy of the CF -IR and CF -61R shall also be on site for final inspection. HVAC Changeout Required Forms: • All HVAC Equipment replaced CF -6R forms: MECH-04, MECH-2I-HERS and (for split systems) MECH- 25 -HERS CF -4R forms: MECH- 21 and fors lit systems MECH-25 • Condenser Coil and /or • Indoor Coil and/or CF -6R forms: MECH-2I-HERS and (for split systems) MECH- 25 -HERS • Furnace CF -4R forms: MECH- 21 and (for split systems) MECH-25 For Split Systems: Duct leakage < 15 percent; RC, CCA > 300 CFM/ton(Minimum Air Flow Requirement), TMAH For Packaged Units: Duct leakage < 15 percent Exempted from duct leakage testing if: ❑ 1. Duct system was documented to have been previously sealed and confirmed through HERS verification, or ❑ 2. Duct systems with less than 40 linear feet in unconditioned space, or ❑ 3. Existing duct systems are constructed, insulated or sealed with asbestos ❑ 2. New HVAC System Required Forms: • Cut in or Changeout with new CF -6R forms: MECH-04, MECH-20-HERS,and (for split systems) MECH-22-HERS, and MECH-25-HERS ducts: (all new ducting and all CF -4R forms: MECH 20-, and (for split systems)MECH-22, and MECH 25 new equipment) For Split Systems: Duct leakage < 6 percent; RC, CCA >_ 350 CFM/ton, FWD, TMAH, SIMS, and either HSPP or PSPP. For Packaged Units: Duct leakage < 6 percent 113. New Ducts-with/or without Replacement Required Forms: • Includes replacing or installing all new ducting CF -6R forms: MECH-04, MECH-20-HERS,and (for split systems) MECH-25-HERS and/or outdoor condensing unit and/or indoor coil CF -4R forms: MECH-20 and (for split systems) MECH-25 and/or furnace. No or some equipment changed. For Split Systems: Duct leakage < 6 percent, RC, CCA >_ 300 CFM/ton, TMAH For Packaged Units: Duct leakage < 6 percent ❑ 4. New Ducting over 40 feet Required Forms: • Includes adding or replacing more than 40 linear feet of duct in unconditioned space. CF -6R forms: MECH-04, MECH-2I-HERS CF -4R forms: MECH-21 For split system or packaged units: Duct leakage < 15 percent ❑ EXCEPTION: Existing duct systems constructed, insulated or sealed with asbestos. Contractor (Documentation Author's /Responsible Designer's Declaration Statement) • I certify that this Certificate of Compliance documentation is accurate and complete. • I am eligible under Division 3 of the California Business and Professions Code to accept responsibility for the design identified on this Certificate of Compliance. • 1 certify that the energy features and performance specifications for the design identified on this Certificate of Compliance conform to the requirements of Title 24, Parts I and 6 of the California Code of Regulations. • The design features identified on this Certificate of Compliance are consistent with the information documente n plicable compliance forms; worksheets. calculations, plans ands specifications submitted to the enforcement agency approval with e e t a t Name.- Signatu +µ P Company: %(� /�/G Date: c /' Address-s�® . License - City/State/Zip: Wnv, Adn.. A Min Bin # Qty of La Quints Building 8T Safety Division P.O. Box 1504, 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Permit # ®' Project Address �� Owl' Owner's Name: A. P. Number: Address: Legal Description. WTW/% X773—Z City, ST, Zip: Contractor:� Telephone: Address: 07O IX?b Project Descrip ion: vv CityST, Zip: • ezzTelephone: Qi CS�-- State Lic. #: City Lic. #; F �� jv Arch., Engr., Designer: Address: City, ST, Zip: Telephone: h e one: P XX Construction ton Type: Occupancy: P Y• State Lic. #: Project e ct tYPe (circle cle one) • New Ad d'n Re Demo Name of Contact Person: Sq. Ft. # Stories: #Units: Telephone # of Contact Person: Estimated Value of Project: e5cf)_ APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Req'd Recd TRACKING PERMIT FEES Plan SetsPlan Check submitted Item Amount Structural Calcs. Reviewed, ready for corrections Plan Check Deposit Truss Calcs. Called Contact Person Plan Check Balance Title 24 Calcs. Plans picked up Construction Flood plain plan Plans resubmitted Mechanical Grading plan 2 Review, ready for corrections/issue Electrical Subcontactor List Called Contact Person Plumbing Grant Deed Plans picked up S.M.I. H.O.A. Approval Plans resubmitted Grading IN HOUSE: '^' Review, ready for corrections/issue Developer Impact Fee Planning Approval Called Contact Person A.I.P.P. Pub. Wks. Appr Date of permit issue School Fees Total Permit Fees