MECH (14-0436)or.
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Appli01)
p can ,"
Ti4t 4 4 Q"
Architect or Engineer:
Nff
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
LICENSED CONTRACTOR'S DECLARATION
1 hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with
Section 7000) of Division 3 of the Business and Prof sionaI Code, and my License is in full force and effect.
License lass: C20 License No.: 771254
—a^��
Contracto
OWNER -BUILDER DECLARATION
I hereby affirm under penalty 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 I, 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.).
(_) 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 contractor(s) licensed
pursuant to the Contractors' State License Law.).
I _ 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
Owner:
HILL TIM & BARBARA
56710 MERION
LA QUINTA, CA 92253
Contractor: rr
ALL KNIGHT HEAT & AIR CONDJr I
PO BOX 5232
LA QUINTA, CA 92248
(760) 772 -4 94 7
Lic. No.: 771254
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 4/15/14
w u if
_1L APR s_ 5s �0_i11 0
CITY QF LA QUINTA
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 GUARD INS Policy Number BRWC910742
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 becom subject to the workers' compensation laws of California,
and agree that, if I sho d become s ject to the workers' compensation provisions of Section
I 370(yof the Lalor C ue, I s$all thwith comply with those provisions.
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS ($100,000). IN 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 Ouinta, 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 that the above information is correct. I agree to comply with all
city and county ordinances and state laws relating to building constructing' and hereby authorize representatives
of this co ty to en/tjgF upon the above-mentioned propert r ins
p ti fi purposes.
1� / I
Date: Signature (Applicant or Agentf:
Application Number•:714-00000436
Property Address:
56710—MERION
APN:,
762 -032 -004 -
Application description:
MECHANICAL
Property Zoning:
LOW DENSITY RESIDENTIAL
Application valuation:
25000
Appli01)
p can ,"
Ti4t 4 4 Q"
Architect or Engineer:
Nff
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
LICENSED CONTRACTOR'S DECLARATION
1 hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with
Section 7000) of Division 3 of the Business and Prof sionaI Code, and my License is in full force and effect.
License lass: C20 License No.: 771254
—a^��
Contracto
OWNER -BUILDER DECLARATION
I hereby affirm under penalty 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 I, 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.).
(_) 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 contractor(s) licensed
pursuant to the Contractors' State License Law.).
I _ 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
Owner:
HILL TIM & BARBARA
56710 MERION
LA QUINTA, CA 92253
Contractor: rr
ALL KNIGHT HEAT & AIR CONDJr I
PO BOX 5232
LA QUINTA, CA 92248
(760) 772 -4 94 7
Lic. No.: 771254
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 4/15/14
w u if
_1L APR s_ 5s �0_i11 0
CITY QF LA QUINTA
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 GUARD INS Policy Number BRWC910742
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 becom subject to the workers' compensation laws of California,
and agree that, if I sho d become s ject to the workers' compensation provisions of Section
I 370(yof the Lalor C ue, I s$all thwith comply with those provisions.
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS ($100,000). IN 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 Ouinta, 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 that the above information is correct. I agree to comply with all
city and county ordinances and state laws relating to building constructing' and hereby authorize representatives
of this co ty to en/tjgF upon the above-mentioned propert r ins
p ti fi purposes.
1� / I
Date: Signature (Applicant or Agentf:
Application Number . . . . . 14-00000436
J Permit . . . MECHANICAL 2013
Additional desc .
Permit Fee . . . . 166.84 Plan Check Fee .00
Issue Date . . . . Valuation . . . . 0
Expiration Date . . 10/12/14
Qty Unit Charge Per
Extension
2.00 35.7500 EA MECH FURNACE
71.50
2.00 11.9200 EA MECH APPL REP/ALT
23.84
2.00 35.7500 EA MECH CONDENSER/COMP
71.50
----------------------------------------------------------------------------
Special Notes and Comments
`
REPLACE (2) FURNACE,COIL & CONDENSERS
16.5 SEERS, BOTH (3) TON UNITS.PER 2013
MECHANICAL CODE.
----------------------------------------------------------------------------
Other Fees . . . . . . . . . BLDG STDS ADMIN (SB1473)
1.00
PERMIT ISSUANCE M/P/E
90.57
PLAN CHECK, MECHANICAL
104.86
Fee summary Charged Paid Credited
-----------------
Due
----------------------------------------
Permit Fee Total 166.84 .00 .00
166.84
Plan Check Total .00 .00 .00
.00
Other Fee Total 196.43 .00 .00
196.43
Grand Total 363.27 .00 .00 c
363.27
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Simplified Prescriptive Certificate of Compliance: 2008 Residential HVAC Alterations CF-1R-ALT-HVAC
Climate Zones 10 - 15
Site Address:
Enforcement Agency:
Date:
Permit #:
56710 Merion - Bedrooms La Quinta, CA 92253
City of La Quin ta
Apr 9, 2014
Dud insulation
Conditioned Floor
Equipment Type1
List Minimum Efficiency2
requirement
Area
Thermostat
❑ Package Unit
Fumace
{Indoor Coil
❑ AFUE
® SEER 13.0
❑ COP
ElHSPF
❑ R 6 (CZ 10-13)
Served by system
® Setback
If not already' present, must be
® Condensing Unit
[3 EER
El Resistance
[I R 8 (CZ 14-15)
1300 sf
installed)
❑ Other
1. Equipment Type: Choose the equipment being installed, if more than one system, use another CF-IR-ALT-HVAC for each system.
2. Minimum Equipment Efficiencies: 13 SEER, 78% AFUE, 7.7HSPF for 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. The inspector also verifies that each appropriate CF-611 and registered CF-411
forms (no hand filled CF-4Rs allowed) are filled out and signed. Beginning October 1, 2010, a registered copy of the CF-111
and CF-611 shall also be on site for final inspection.
® 1. HVAC Changeout
Required Forms:
. All HVAC Equipment
CF-6R forms: MECH-04, MECH-2I-HERS and (for split systems) MECH-25-HERS
replaced
CF-4R forms: MECH-21 and (for split systems) MECH-25
. Condenser Coil and /or
. Indoor Coil and /or
CF-611 forms: MECH-04, 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. P ckaged U..OW DuLA leakage i 19 n nt
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
❑ 4. The system will not be Ducted (ie. Ductless Mini-Split System) (Also Exempt from Refrigerant Charge)
❑ 2. New HVAC System
Required Forms:
. Cut in or Ctiangeotit,with
CF-6R`fo�ms:•MECH-04, MECH-20-HERS, and (for split systems) MECH-22-HERS, and
new ducts:'(all new
d
ducting and all new
MECH-25-HERS r , . .
P' J� %,.�
equipment)
CF-4R forms: MECH-20, and (for split systems)�MECH-22,."and MECH-25
For Split Systems: Duct leakage < 6 percent; RC, CCA >_ 350 CFM/ton; FWD, TMAH;rSTMS, and either HSPP or PSPP.
For Packaged Units: Duct leakage,< 6,percent��
❑ 3. New Ducts with/or without F
Required Forms:
Replacement
. Includes replacing or installing all new
ducting and/or outdoor condensing unit
CF-6R forms: MECH-04, MECH-20-HERS, and (for split systems) MECH-25-HERS
and/or indoor coil and/or furnace. No or some
CF-4R forms: MECH-20 and (for split systems) MECH-25
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
CF-6R forms: MECH-04, MECH-2I-HERS
linear feet of duct in unconditioned space.
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.
. I 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 1 and 6 of the California Code of Regulations.
. The design features identified on this Certificate of Compliance are consistent with the information documented on other applicable compliance
forms, worksheets, calculations, plans and specifications submitted to the enforcement agency for approval with the permit application.
Name: April Knight Signature: April Knight
Company: ALL KNIGHT HEATING & AIR CONDITIONING INC Date: Apr 9, 2014
Address: P O BOX 5232 License: 771254
City/State/Zip: LA QUINTA / CA / 92248 Phone: (760) 772-4947
Reg: 214-A0024122A-000000000-0000 Registration Date/Time: 2014/04/09 12:25:11 HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms July 2010
Simplified Prescriptive Certificate of Compliance: 2008 Residential HVAC Alterations CF-lR-ALT-HVAC
Climate Zones 10 - 15
Site Address:
Enforcement Agency:
Date:
Permit #-
56710 Merion - Living Area La Quinta, CA 92253
City of La Quinta
Apr 9, 2014
Duct insulation
Conditioned Floor
Equipment Typel
List Minimum Efficiency2
requirement
Area
Thermostat
❑ Package Unit
13 Furnace
Indoor Coil
❑ AFUE
® SEER 13.0
❑ COP
❑ HSPF
❑ R 6 (CZ 10-13)
Served by system
® Setback
If not already present, must be
® Condensing Unit
[3EER
❑ Resistance
❑ R g CZ 14-15)
1300 sf
installed)
❑ Other
1. Equipment Type: Choose the equipment being installed; if more than one system, use another CF-IR-ALT-HVAC for each system.
2. Minimum Equipment Efficiencies: 13 SEER, 78% AFUE, Z 7HSPF for 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. The inspector also verifies that each appropriate CF-6R and registered CF-4R
forms (no hand filled CF-4Rs. allowed) are filled out and signed. Beginning October 1, 2010, a registered copy of the CF-1111
and CF-611 shall also be on site for final inspection.
® 1. HVAC Changeout
Required Forms:
. All HVAC Equipment
CF-6R forms: MECH-04, MECH-2I-HERS and (for split systems) MECH-25-HERS
replaced
CF-4R forms: MECH-21 and (for split systems) MECH-25
. Condenser Coil and /or
• Indoor Coil and /or
CF-611 forms: MECH-04, MECH-2I-HERS and (for split systems) MECH-25-HERS
. Furnace
CF-411 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- Pai k aged Units- Didw# leakage. 4 15 r .aF
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
❑ 4. The system will not be Ducted (ie. Ductless Mini-Split System) (Also Exempt from Refrigerant Charge)
❑ 2. New HVAC System Required Forms:
. Cut in or Changeout with CF-6R forms: MECH-04, MECH-20-HERS, and (for split systems) MECH-22-HERS, and
new ducts: (all new
MECH-25-HERS
ducting and all new
equipment) CF-4R forms: MECH-20, and (for split systems) MECH-22, and MECH-25
For Split"Systems: Duct leakage < 6 percent; RC, CCA ;,:t CFM/ton, FWD, TMAH, STMS, and either HSPP or PSPP.
For Packaged Units: Duct leakage < 6 percent
❑ 3. New Ducts with/or without
Required Forms:
Replacement
. Includes replacing or installing all new
ducting and/or outdoor condensing unit
CF-6R forms: MECH-04, MECH-20-HERS, and (for split systems) MECH-25-HERS
and/or indoor coil and/or furnace. No or some
CF-4R forms.: MECH-20 and (for split systems) MECH-25
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
CF-6R forms: MECH-04, MECH-2I-HERS
linear feet of duct in unconditioned space.
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.
• I 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 1 and 6 of the California Code of Regulations.
• The design features identified on this Certificate of Compliance are consistent with the information documented on other applicable compliance
forms, worksheets, calculations, plans and specifications submitted to the enforcement agency for approval with the permit application.
Name: April Knight Signature: April Knight
Company: ALL KNIGHT HEATING & AIR CONDITIONING INC Date: Apr 9, 2014
Address: P O BOX 5232 License: 771254
City/State/Zip: LA QUINTA / CA / 92248 Phone: (760) 772-4947
Reg: 214—A0024118A-000000000-0000 Registration Date/Time: 2014/04/09 12:18:11 HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms July 2010