MECH (10-0872)f W • . �n�
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Application Number: __10-000_.0.087-2-
Property Address: 80155 MERION
APN: 762-191-005- - -
Application description: MECHANICAL
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 3475
Appli nt: Architect or Enginee :
Y111
----------------------------- --------------------
LICENSED CONTRACTOR'S DECLARATION
I 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 Professionals Code, and my License is in full force and effect. .
LicensCs
Y D
License Class: C20 ` Lice No.: 374937
le
Da: /•�
7T7-
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 countythat 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 ($5001.:
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.).
(_ 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 contractor(s) 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
Owner:
LEDERMINE FRANCINE
80-155 MERION
LA QUINTA, CA 92253
(310) 600-.1250
Contractor:
PALM DESERT AIR COND CO
42081 BEACON HILL
PALM DESERT, CA 92211
(760)346-0677
LiC. No.: 374937
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 9/08/10
SEP 0`18 2010
CITY OF LA QUINTA
T FINANCE DEPT.
----------=-----------------------------------—
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 SOUTHERN INS Policy Number WSIO03802-01
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 to the workers' compensation provisions of Section
p,3700 of the Labor Code, I shall forthwith comply pffh those provisions.
-Date: / Applicants
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 J$ 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 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 information is correct. I agree to comply with all
city and county ordinances and state laws relating to building construction, and here authorize representatives
of this county to enter upon the above-mentioned property for inspection purpose
Date: 'r (2 .Signature (Applicant or Agerltt�=-�
LQPERMIT
Application Number. . . . . . 10-00000872
Permit MECHANICAL
Additional desc .
Permit Fee . . . . 24.00
Plan Check
Fee
6:00
Issue Date
Valuation
0
Expiration Date 3/07/11
Qty Unit Charge Per
Extension
BASE
FEE
15.00
1.60 9.0000 EA MECH
APPL REP/ALT/ADD
9.00
Special Notes and Comments
'
-REPLACE REPLACE INDOOR COIL LIKE
FOR
LIKE.2007 CODES.
--------------- - ---------------------------------
Other Fees . . . . . . . . BLDG STDS ADMIN (SB1473)
1.00
Fee summary Charged
Paid Credited
`Due'.
Permit Fee Total 24.00
.00
.00
24.00
Plan Check Total 6.00
.00
.00
6.00
Other Fee Total 1.00
.00
.00
1.00
Grand Total 31.00
-.00
.00
31.00
LQPERMIT
Sim pli.fiodtPtescriptivi&-.Cettirteiite-6fCorm D]iaiice::2008'Residentidl.'HVAC.Alterado.ns CF -1:R -ALT -HVAC
Climate Zones 10 to 15,
LEDERMAN, FRANCINE System: #1.
Site Address:
En orcementAggn
Date:
Permit'#:
80-155 MERION, LA QUINTA, CA 92253
City of 'La Quin6
9/8/2010
Conditioned, -Floor
Equipm6nt-Typej
List Minimum E I fficiency2
Duct insulation requirement
Area.
El Packaged Unit
0 Fumace
11 AFUE_
0.00P-
Over 40 A of ducts added or
*Served
—Thermostat
®Setback
ED Indoor
OSEtR
0 HSPF
replaced in unconditioned space
by system
(Ifndt already
.
0 Condensin . 9:lJnit
0 '.EER*—
El Resistance
0 �R 6 :(CZ 1043)
R 8 (U.1.445)
sf
p resent, Must be
installed)
0 :Other.0
J.: EquipmePuType..-- Choose the: equipment-beinginstal/qd; More than one.systi�m, use another CF -1R -ALT -HVAC for each system:
.if
.2.. Minimum Equipment E 13, SEER, 78%AFUE, 7.7HSPPfortypical revid,,intialystems.
HERS I VERIFICATION SUM.MWY. . Listed b.plowarei'four RVAC.alteration The i I nst4 . ller-cl,et , ides what. work is b6ing,done and
, I .
.:picks oof the app r* ria
iw tithis EAc
h op Option. lists the -HERS-measures-that must be conducied. Acopy bfthe -forms shall -beleft owsitef6rfinal
te:'Op
inspection diidacboygiydii:tt)tLhehomdo)Wner. At,final, the inspector verifies that the work listed on this f6im.Was in fact the, w6fkdomoleted by-tbe
installer. TheInspiec.tor also verifies that cath appropriate CF -6R and registered CF4R. forms (no band filled CF-4Rsallowed) are filled -out and
signed. Bieginninj;�Ottob& 1, 2010, a reUi.stered copy of the CF -Mand CF -6R. shall also be on site for Anal inspection.
0 1. HVAC..C44ngeout
Required Forms::
El All HVAC Equipment replaced:
CF76Rfdrms:.MECH_Q4 MECR=21-HERS arid. (156T split systems) MECH!- 25 -HERS
. , I . .
CFAR f6rms: MECH 21 and fors lit systems) MECH-25
0 Condenser Coil and /or
0 Indoor Coil and /or
CF -6R% forms: MECH-21 -HERS and (for split systems) MECH- 25 -HERS
ITFuinace
CF -4 t forms: MEM 21. and (forsplitsystems) MECH-25
I
For ,Split Systems: Duct4eakage < 15 Oerc6ht;. RC, CCA >_ 300 CFWton,(Minimum Air Flow Requirement), TMAH
Foi?ackaged. Unitsi Duct leakage 4`15- percent
Exempted from. dpctieakage testing if.
0 1. Duct system was documented to have been previously sealed and confirmed. through, HERS verification, or
0 2. DOctsystems with lessIhan 40 lin6ai feetin unconditioned spice,i or.
0: 3. Ekigting duct systehis are construct6dj6sulated. or sealed with asbestos
0 2. New HVAC -System Required Forms:'
El Cut in or Chan eout with new CF -6k f6rms: MECH-04 MECH-22 0-BERS,and (for split systems). MEM22-HERS, andAECH-15-HERS
ducts: (all new, ducting and all CF -4R forms:MECK20, and(for'split systems)MECH-22, and MECH 25
new quipment)
percent;
For I Split Systems.:, . Duct leakage <.6 percent;..RC,CCA.�:. .35 . 0 1 CF.M/ton, F . WD, TMAH, S--TmS,: andeither.H,8PP_',or PSPP.
`For Packaged Units: Duct leakage <,6.percent
113. New Ducts4ith/Pir without Replacement Required Forms:.
0 InclWO,replacing or installing all new'ducting: CF.46Rforms: ME.CH-04,;ME�CH-20-HERS,and(for -split systems) MECH-25=HERSI
and/or outdoor condensing unit. and/or indoor Coil CF4Rf0rms:.MEQ1H720-and (for split.systems) MECHw25
and/or furnace. No or some equipment changed.
For: Split' Systems: Ductleakage < 6 percent.,. RC, CCA 2! 300 CFM/ton, TMAH
For PukagW Units: -Duct leaks ge i< 6 oercerit
114. Newbuctingep.ver 40. kit.
Required 1. Forms:
El includesadding-or 'replacing more than 40
CF -6R. forms: MECH-04,:MECH=21 44ER5 'CF4R.forms- MECR-21
lin6ar:.fCetofduct:in,unconditioned gjli .,
For split s system,or packaged. units: Dudtleaka -<15-percent
y leakage
0 EXCEPTION: Existing.ducts ystems, constructed; .insulated -or sealed with asbestos.
.Conttactot..(D.6cuineritzition.Authdt's../RespoiAible:D6ig,ner'gDeelgrgtion:Stateinent)
0 tcerfifylihatibis'Cer6ficatebftompliancedocumentaiion:isacclitiit6and compl6te.
0 1 am eligibli.under Division 3 of the California Business and.Professioms Code to,accept responsibility for the design identified -on tMi Certificate of Compliance.
I certify that the energyTcatures and performance specifications for:the design identified on this Ceffificato of Compliance conform to the requirements of Title 24,
Parts'l and'6 of the California Code of Regulations.
The design f6turcs identified on thiste.r6ticate of compflince.are with the information document.ed'on other applicable compliance forms, worksheets;:
2consistent
calculati6ns,,Olang�hd'smiticdfiohs-§ubiniti6d t6.tife:6jiforcem6j6t�ikency...f.. lirovil with the #emalicafion.
Name: KARL BROWN
rsignature: Z
.company'* Palm Desert Air Conditioning & Heating Company
Date:, 9/8/2010
-Address-..
42-081 Beacon Hill
License: 374937
City/state/zip- Palm Desert, CA 92211
Phone: (760) 346-0677
2008,Resideniial:!C,bhipliiinC6 Forms: March 2010
PA.:Box 1:504 •:78 495:;Calle Tampicd, ; La Quinta;.Cal1f0rr ia:9221 f-
Tel (760) 777-7012 • Fax:. (760):777-7.* 12
VNetslte www La=Quetta Org,• Email: Building@La=Quetta Org
A•*FG&N �do+DFSERT'.''.xa : _ ... , : ., .:. ... ... ..
BIn #:� Permtt #= BU
il,di'ng Permit,.Appl cat on &,Tracking S°hetet:
Project Address:< 80-155 MERION
Owner's.'Names' LEDERMAN, FRANCINE
A P Number:
Address: 80-155 MERION
Legal ID tion:
City, State, Zip: LA QUINTA, CA 92253
Contra"Ctor. Palm Desert Air Conditioning & Heating Company
Telephone:(310)600-1250
Address: 42-081 Beacon HillJ
Pro ect Deseriptton.:
y, State, Zip Palm Desert, CA 92211Q
L 4.Q
Telephone No:; (760) 346-0677
� : ;, • �`
:State: Li&. # < 374937
'City Lic:-#:: 100886
ArchIEng:/Designer
'Address:
City.State, Zip:'
Telephone No::
ConshvcGon;;Type:
Occupancy:,
State:.:Lic .#;k„
.. ...
.r -$✓w ... , .
», ,Ay..sA....x,
Project Type: .D: New;'®-Add:n'• O.Alfer�:0 Repair`�)O>Demo
Name:of Contact Person; KARL BROWN
SqLta
#'stones'
#Units:
:Contact:Telephone:No :.. (760) 346-0677
Estimated Value.of`Project ' $3,475.00
APPLICANT
:DO'NOT:WRITE.BELOW'THIS;LINE
Submittal
Re "d.
_
Recd
Tracking
Permit Fee's.
Plan Sets
Plan` Check.Submitfed.
Item
Amount
Sfructural Calcs
Reviewed;- Ready: foe Correction's .
Plan Check Deposit
TrwwCalig:.
Calied;Contact P?erson:
plan'Check:Balance.
Title 24 Calcs.
Pians Plcked U'p
Construction
Plood ..ainsPlane
Plans ResubnAed
Mechanical
Grading Plan,:
2nd Review, Ready forGorrec4ons
Electrical
Subcontractor.Llst
GaII®d .Contacf Person ,
Ptumtiing
Grant DeedPlans°Picked
Up
S:M'.t:
W:QA. Approval'
PlaftResubmitted
Grading
IN HOUSE,
Tn , Review, Ready Corrections
Developer Impact Fee
Planrnng.Approval
Called:Contact Person.
AJ P.P.:..
Pati. W&ki Appr'I
Date'& Permit Issue
School: Fees:
Total Permit,Fes's.