MECH (10-1042)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
10-00001042
Property Address:
77550 CALLE MONTEREY
APN:
774-051-023-12. -000000-
Application description:
MECHANICAL
Property Zoning:
COVE RESIDENTIAL
Application valuation:
5695
Tiht .4 4v Q"
Applicant: Architect or En ineer:
X4
BUILDING& SAFETY DEPARTMENT
BUILDING PERMIT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Owner:
MUNOZ NORMA
77550 CALLE MONTEREY
LA QUINTA, CA 92253
(760)564-7854
Contractor:
GRAHAM RICKER AIR COND, INC IU
P.O. BOX 2831 U
PALM SPRINGS, CA 92263
(760)329-7797 P
Lic. No.: 750141
Date: 10/06/10
LA3 U in
GSC 0 C72010 IL
CITY OF LA QUINTA
F1';YA, . F_ DEPT.
ICENSED CONTRACTOR'S DECLARATION - WORKER'S COMPENSATION DECLARATION
I hereby affirm under pe ty of perjur�th t 1 amicen ed under provisions of Chapter 9 (commencing with I hereby affirm under penalty of perjury one of [he following declarations:
Section 70001 of Divisio 3 of the Busand ofe sionals Code, and my License is in full force and effect. _ I have and will maintain a certificate of consent toself-insure for workers' compensation, as provided
License Class: C20License No.: 750141 for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
` - — issued.
\a tor: I have and will workers' compensation insurance, as required by Section 3700 of the Labor
Datel-6'L4� Contractor
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 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 sate. 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 _ 1 1, 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.).. - I—) 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:
LQPER 11`
Code, for the performance of the work for which this permit is issued. My workers' compensation
insurance carrier and policy, number are: -
Carrier PREFERRED EMPLY Policy Number WKN1361582
_ I certify that, in t rforma ork for which this permit is issued, I shall not employ any
person in anner so s to becom subject to the workers' compensation laws of California,
and a at, if I should ome ject to the. workers' compensation provisions of Section
370 of he Labor Code, I hwith comply with those provisions.
Datt o -(e —toAPPlican .
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 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 issuaneofpermit, or cessation of work for 180 days will subject
permit to cancellation.
I certify that I have read this application and stateve infor on is cor ect. I agree. to comply with all
city and county ordinances and state laws relatingconst: tion,and hereby authorize representativesofthiscounty to enter upon the above-mentioned inspect p ses.
Date: —J'p4Oignature (Applicant or Agent
Application Number . . . 10-000010.42
Permit MECHANICAL
Additional desc .
-Permit Fee 33.00
Plan Check Fee'.
8.25
'Issue Date . . .
Valuation .
. 0
Expiration Date 4/04/11
Qty Unit Charge Per
Extension
BASE
FEE
15.00"
1.00 9.000.0 EA MECH
APPL REP/ALT/ADD
9.00
1.00 9.0000 EA MECH.B/C
<=3HP/100K BTU
9.00
Special Notes and Comments
REPLACE HEAT PUMP CONDENSING UNIT
4 TON
13 SEER 2007 CODES.
Other Fees . . . . . . . . . BLDG STDS ADMIN (SB1473)
1.00
f _
Fee summary.' Charged
-Paid. Credited
Due
Permit Fee Total 33.00
.00 .00
33.00
Plan Check Total_ 8.25
.00 .00
8.25
Other Fee Total 1.00
.00 .00
1.00
Grand Total. 42.25
.00 .00
42:25
LQPERM[T
led Prescriptive Certificate of Compli
Zones 10 to 15
1410/21",4- 0141n),l 7_
. l
2008 Residential HVA C Alteradons CF -1R -ALT -HVAC
Site s:
A,_ /�
',,�'
Enforcement Agency:
Date:
Permit f!:
Equipment T ' Conditioned Floor
List Minimum Efficien 2 Duct insulation requirement Area Thermostat
❑ Packaged Unit -
❑ Furnace O AFUE ❑ COP Over 40 ft of ducts added or
e
ndoor Coil OSEER� ❑ HSPF _ replaced in unconditioned space Served by system (if not already
pondensing Unit O EER ❑Resistance OR 6 (CZ 10-13)
sf present, mu t be
O Other ❑ R 8 (CZ 14-/5) installed)
L Equipment Type: Choose the equipment being installed. if more than one system. use another CF -IR -ALT -HVAC .
F -1R -ALT -HVAC. for each system.
Minimum EquipmentE,a'iclendes: 13 SEER, 78•0AFUE, 7_7HSPFfartypical resid¢_ntial_syatems.._
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
I2.
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 fad the work completed by the
installer. The inspector also verifies that each appropriate CF -6R and registered CF4R forms
(no hand filled CF4Rs allowed) are filled out and
signeABeginning October l 2010 Aregistered copy of the CF -111 and CF -6R shall also be on for final
site hLVecdon.
1. HVAC Changeout Required Forms:
• All HVAC Equipment replaced CF-61kforms: MECH-04, MECH-2l-HERS and (for split systems) MECH- 25 -HERS
CF4R forms: MECH- 21 andfor 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 CF4R forms: MECH- 21 and (for split systems) MECH-25
For Split Systems: Duct leakage < 15 percent; RC, CCA 2:300 CFMhon(Minimum Air Flow Requirement), TMAH
For Packaged Units: Duct leakage < 15 percent
l.xempled fr duct leakage testing if:
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
O 3. Existing ducts stems are constructed, insulated or. sealed with asbestos
0 2. New HVAC System
Required Forms:
• Cut in or Changeout with new
ducts: (all new ducting and all
CF -6R forms: MECH-04, MECH-20-HERS;and stems) MECH-22-HERS, and MECH-25-HERS
systems) for split
plit sy
new e i menu
CF -4R forms: MECH 20-, and (for split systems)MEand MECH 25
For Split Systems: Duct leakage < 6 percent; RC, CCA >_ 350 CFM/ton, FWD,.TMAH, STMS, and either HSPP or PSPP.
For Packaged Units: Duct leakage < 6 percent
❑ 3. New Ducts with Replacement,
- ~Wfflis:
• Includes replacing or installing all new ducting
CF411 fortes: MECH-04, MECH-20-HERS,and (for split systems) MECH-25-HERS
and/or outdoor condensing unit and/or indoor
CF -4R forms: MECH-20 and (for split systems) MECH-25
coil and/or furnace. Not all equipment changed.
For Split Systems:- Duct leakage < 6 percent, RC, CCA >_ 300 CFM/ton, TMAH
For Packaged Units: Duct leakage < 6rcent
O 4. New.Ducting over 40 feet
Required Forms:
• l adding or replacing more than
linear feet
etof dud 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 dud systems cons 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.
• Fhe design features identified on this Certificate of Compliance are consistent wi the info tion documented on other applicable compliance forma, worksheets,
calcyWVns, plW and specificans submitted to the enforcement yeM for val with Vie mmit n.
Name:
Signa
Comp
-U�
Date:
Li .
^ to
Address
02�
License 7-50/L /_.
[CiStati3fZip:
C-�
Ph
2008 Residential Compliance Forms March 2010
1
in #
City Of La Quinti
804ing & Safety Division
/ P.O. Box 1504, 78-495 Calle Tampico
La Qldhta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Peimif #
�, h
-Project Address:
Owner's Name:
A. P. Number:
Address:
Legal Description:
City, ST, Zip
• p-�_ LV
Contr: -
elephone: a• .k':•.:...,..a.,..:r,
telephone:
Project Description:
c
_—
Addre1.ss; _ �— --- - - --
Cit; ST, zip:
Sidi Liz. #--j b- -
City Lic. #•:
Arch.; Eng.:; Designer .
Address:
City, ST, zip:
Telephone: "! `?s•� x> rte.. - . , } }
<✓.a�; :;`%95:7
State Lic. # fi, :,.;• :.x4;'?`l:
- :: -;>>-% ,:v,.F ,J�• /r`.2
Name of Contact Person:_
Construction Type: Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
Sq. FL:
# Stories:
# Units:
=Telephone #-af Contact,Pirson:
Estimated Value of Project: rQ
APPUCANT:
DO NOT WRITE BELOW THIS LINE
#
Submittal —
Req'd
Recd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Cales.
Reviewed, ready for corrections
Plan Check Deposit
1Yass Calcs.
Called Contact Person
Plan Check Balance
Tide 24 Cala:
Plans picked up
Construction
Flood plain plan
Pians resubmitted
Mechau[eal
Grading plan
21 Review, ready for correctionstissue
Electrical
SubcontactorList
Called Contact Person _
Pinmbiug
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. wk`s. App;
Date of permii issue
School Fees
Total Permit Fees