MECH (12-1155)P.O. BOX 1504
78-495 CALLE TAMPICO
LA.QUINTA, CALIFORNIA 92253
Application Number, _121-00-0-01155-1 `-
Property Address: 5792 MERION
APN: 762 -031 -031 -
Application description: MECHANICAL
Property Zoning: LOW DENSITY RESIDENTIAL,
Applicationvaluation: 1825
Tiht 4 44�rw
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
JOHN TRACEY
57292 MERION
LA QUINTA, CA 92253
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 10/02/12 -
0
IF 7c-, --ic _2 2 � 10
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: pir
LQPERMIT
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 that the above inf a ion is correct. I agree to comply with all
city and county ordinances and state laws relating to building constr i n, and hereby authorize representatives
of this county to enter upon the above-mentioned property for inspe i purposes.
Date f 0 2 Sure (Applicant or Agent):
Contractor. CITY ®� QUINTA
Architect or Engineer:
DCS AIR CONDITIONING FINANCE DEPT
.72078 CORPORATE WAY, '#10.1
THOUSAND PALMS, CA 92276
(760)343-5562
/pplicant
Lio. No.: '968141
LICENSED CONTRACTOR'S DECLARATION
- WORKER'S COMPENSATION DECLARATION
- I hereby affirm under penalty of perjury that I am I ensed under provisions of Chapter 9 (commencing with
I hereby affirm under penalty of perjury one of the following declarations: .
Section 7000) of Division 3 of the Business and r fessionals Code, and my License is in full force and effect._
I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided
Lic nse Class: C20 - License No.: 968141,
Date: Z_ Contractor:
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
- - WNER-BUILDER DECLARATION -
insurance carrier and policy number are:
" I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the -
Carrier _ ZENITH INS Policy Number Z071741501
• following reason (Sec. 7031.5, Business and Professions Code: Any city or county that requires a permit to_
I certify that, in the performance of the work for which this permit is issued, I shall not employ any
• construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the
person in any manner so as to become su ect to the workers' compensation laws of California,
permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State
and agree that, if I should become subje o the workers' compensation provisions of Section
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or
3700 of the Labor Code, I shall forthv i comply with those provisions.
- ' 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).:ate:
I0(2 icant: -
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
WARNING: FA URE C) SECURE WORKERS' Ct4SATION COVERAGE IS UNLAWFUL, AND SHALL
Contractors' State License Law does not apply to an owner of property who builds or improves thereon,
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
and who does the work himself or herself through his or her own employees, provided that the
DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
improvements are not intended or offered for sale. If, however, the building or improvement is sold within
SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
_
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.).
APPLICANT ACKNOWLEDGEMENT
(_) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.
IMPORTANT . Application is hereby made to the Director of Building and Safety for a permit subject to the
" 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of
conditions and restrictions set forth on this application.
property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed
1. Each person upon whose behalf this application is made, each person at whose request and for
pursuant to the Contractors' State License Law.).
whose benefit work is performed under or pursuant to any permit issued as a result of this application,
(_) I am exempt under Sec. , 8.&P.C. for this reason
the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City
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: pir
LQPERMIT
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 that the above inf a ion is correct. I agree to comply with all
city and county ordinances and state laws relating to building constr i n, and hereby authorize representatives
of this county to enter upon the above-mentioned property for inspe i purposes.
Date f 0 2 Sure (Applicant or Agent):
LQPERMIT
Application Number . . . 12-00001155
Permit . . . MECHANICAL
` Additional desc
' Permit Fee 21.50. Plan Check Fee
5.38
' Issue Date . . . . Valuation'
0
Expiration Date 3/31/13
Qty Unit Charge Per
Extension
BASE FEE
15.00
`1.00 6.5000 EA MECH OTHER MECH EQUIPMENT
6.50
Special Notes and Comments
HVAC CHANGE -OUT: WARRANTY REPLACEMENT OF
�:.. A/C COIL AND ONE LINE SET. 2010 CODES.
-----------------_----------------------------------------------------------
Other Fees . . . . . ... BLDG STDS ADMIN (SB1473)
1.00 '
Fee summary Charged- Paid x Credited
Due
----------------- - - - - - - - - - - ----------- ----------- ----------
---------Permit Fee Total 21.50 .00 .00
Permit
21.50 t
Plan Check Total 5.38 .00 .00
5.38
.Other Fee Total 1.00 .00 .00
1.00
Grand Total 27.88 .00 .00
27.88
x
LQPERMIT
Simplified Prescriptive Certificate of Compliance: 2008 Residential HVAC Alterations CF-1R-ALT-HVAC
Climate Zones 10 - 15
Site Address:
Enforcement Agency:
Date:
Permit #:
57292 MERION La Quinta, CA 92253
City of La Quinta
Oct 1, 2012
Duct insulation
Conditioned Floor
Equipment Typel
List Minimum Efficiency2
requirement
Area
Thermostat
0 Package Unit
❑ Furnace
® Indoor Coil
❑ AFUE
0 SEER
❑ COP
❑ HSPF
❑ R 6 (CZ 10-13)
Served by system
® Setback
If not already present, must be
❑ CondensingUnit
❑EER
❑Resistance
❑ R 8 (CZ 14-15)
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-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-111
and CF-6R 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
CF-611 forms: MECH-04, MECH-2I-HERS and (for split systems) MECH-25-HERS
• Indoor Coil and /or
CF-4R forms: MECH-21 and (for split systems) MECH-25
• Furnace
For Split Systems: Duct leakage < 15 percent; RC, CCA <_ 300 CFM/ton (Minimum Air Flow Requirement), TMAH
Exempted from dud leakage testing if:
❑ 1. Dud system was documented to have been previously sealed and confirmed through HERS verification, or
❑ 2. Dud systems with less than 40 linear feet in unconditioned space, or
❑ 3. Existing duct systems are constructed, insulated or sealed with asbestos
❑ 4. TheAystecnwill not be Ductgd (ie. Ductless Mini;:Spfit SyStem) {AlsorExempt frorrl<•Refrigeuat Charge)
❑ 2. NewRVAC System
Required FatmsE I'' i �t ": z :, �W
• Cut in or,Changeout with .
r
}M�„$1'cd
GF 6R frms o,MECH-04, MACH HERS,;,antl (for split systems) MECH 22�HER5, and
new duFtS: (all new
ducting�all newtl
,2a7
MECH ry25FiERS s,w is
a �.° f j25-. `;
CF-4R forms:: MECH 20, artd (or split systems) MECH-22„and MECH ,
equiph-ignt i T
x.'w
For Split Systems: Duct leakage-°<: 6. p6c'ent;:RC CCAZ��-350:CFM/tons FWD, TMAH;'STMS, and eitherHSPP' 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
Q 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: LESLIE ROGAN Signature: LESLIE ROGAN
Company: HARRISON ENTERPRISES INC Date: Oct 1, 2012
Address: 72078 CORPORATE WAY #101 License: 968141
City/State/Zip: THOUSAND PALMS / CA / 92276 Phone: (760) 343-5566
Reg: 212-A0054446A-00000000-0000 Registration Date/Time: 2012/10/01 10:27:38 HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms July 2010
Ca10ERTS - CF -1R Registration Page 1 of 1
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CONGRATULATIONS
Your CF -IR -ALT -HVAC Registration is complete!
You may want to print this page for your records.
Site Address: 57292 MERION
La Quinta, CA 92253 _..__._....
_..__.._........_._....._._...__......_.�_._-...;_...._..._._ ......_ _
.CEC Registration:l212-A0054446A-00000000-0000
_..._.... ....._....................__............._._._...._..._._......_..._....._...__.._........_._......_._._....._.._.....__.............__......._......._.._I........._.........
_......_
CF -1R -ALT -HVAC: I CLICK HERETO DOWNLOAD
Assigned Com
CA LLC
[CLICK HERE] to do another OR you can [OPEN and EDIT] this project you just created.
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Office: 916-985-3400,TollFree: 877 -HERS -RSR, (877-437-7787)
Fax: 916-985-3402 Contact Us
_ i•
��p� .eteracca' V
httns://www.calcerts.com/vublic cf1R.cfin?project id=217625 10/1/2012
Bin #
City of La Quinta
Building 8r Safety Division
Permit # P.O. Box 1504, 78.495 Calle Tampico
,1`� La Quinta, CA 92253 - (760) 777-7012
.� � Building Permit .Application and Tracking Sheet
Project Address: Owner's Name:
A. P. Number: Address:
Legal Description: City, ST, Zip:
Contractor. S - Telephone:
Address: �2O Project Description: C
Construction Type: Occupancy:
Project typeMOO- �M/MMPIMXMMA "WAS
e((circle one): New Add'n Alter Repair Demo
Sq. (' # Stories: i # Units:
Telephone # of Contact Person: 'S
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Cates.
Called Contact Person
Plan Check Balance.
Title 24 Calcs.
Pians picked up
Construction
Flood plain plan
Plans resubmitted .
Mechanical
Grading plan
21" Review, ready for corrections/issue
Electrical
Subcontsctor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.L
H.O.A. Approval
Plans resubmitted.
Grading
IN HOUSE:-
'"' Review, ready for corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person
A.LP.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees