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MECH (13-0500)Y P.O. BOX 1504 78-495' CALL- E TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: 13-00000500 Property. Address: 81095 NATIONAL DR APN: 767-500-004- - Application description: MECHANICAL Property Zoning: LOW DENSITY RESIDENTIAL Application valuation: 9469 ll1:::::eo11u4tQa4m - - BUILDING & SAFETY DEPARTMENT BUILDING PERMIT Owner: BLOCK TERENCE E C/O TERRENCE E BLOCK 1 SQUIRES LN SAINT LOUIS,' MO 63131,✓-- - Applicant: .� Architect or Engineer: ------------------- 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. License Class: C20 i' License No.: 686310 Dater 22— `12�- Contractor: �_A_& � COWNER -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 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 contractors) licensed pursuant to the Contractors' State License Law.). (_) I am exempt under Sec. , BAP.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 Date: 4/22/13 D GEfltraClOr: APR 22 2013 GENERAL AIR CONDITION G 1'�( 31170 RESERVE DRIVE THOUSAND PALMS, CA 92 76 CIS QF LA QUINTA (760) 343-7488 ;114— . CEnFPT, LiC. No.: 686310 ----------------------------------------------— 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. 1 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 ZENITH ' INS CO Policy Number Z071741502 ,r '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 3700 of the Labor Codec) shall forthwith comply with those provisions. Date: -4L-7413 ApplicantV 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 construction, and hereby authorize representatives of this county to enter upon the above-mentioned property for inspection purposes. Date:- Signature (Applicant or Agent): G LQPERMIT Application Number . . . . . 13-00000500 Permit . . . MECHANICAL Additional desc . -Permit Fee . . . 42.50 Plan Check Fee 10.63 Issue Date Valuation . . . . 0 Expiration Date 10/19/13 Qty Unit Charge Per Extension BASE.FEE 15.00 1.00 11.0000 EA MECH FURNACE >100K 11.00 1.00 16.5000 EA MECH B/C >3-15HP/>100K-500KBTU 16.50 ------------------------------------------ Special Notes and Comments ----------Special HVAC CHANGE -OUT - 13 SEER [2008] ENERGY CODES] CARBON MONOXIDE ALARM(S) TO BE INSTALLED PRIOR TO FINAL INSPECTION. 2010 CALIFORNIA BUILDING CODES. ------------------------------------ ----------------------- Other Fees . . . . . . . . . BLDG STDS ADMIN (SB1473) 1:00 Fee summary Charged Paid Credited Due Permit Fee Total 42.50 .00 .00 42.50 Plan Check Total 10.63 .00 .00 10.63 Other Fee Total 1.00 .00 .00 1.00 Grand Total 54.13 .00 .00 54.13 LQPERMIT # City of La Quihta BuNdtng a Saky Division P.O. Box 1504,78-495 Calle Ta PICID Lil.Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Permit # �3 Project Address: ks N Owner's Name:. T2 ( Y lam. loc- A. P. Number. Address: g I Oct j N GJ' ,o n r_1 Lege! Description: Contractor. �e�ne rc. \ /a; �- City. ST, Zip: CA Q ZZ53 Telephone: -7(o©-5(0$- C)O 3 Address: 3n ­x) x) �e-Se_c ve �C ivL Project Description: City, ST, Zip: �hOv50.h C.�m C1ZZ 7(0 �� kLGe= Z A- As _k Telephone:'Xo0_ _ State Lia # : (,a(0310 City Lia # Arch., Engr., Designer: Address: CityST, Zip: Telephone: Construction Type:. Occupancy: State Lie. #: project type (circle one): New Add'n Alter Repair Demo Name of Contact Person: Sq. FL: # Stories: # Units: Telephone # of Contact Person: Estimated Value of Project Q i 41 (oCJ APPLICANT: DO NOT WRITE BELOW THIS UNE M Submittal Plan Sets Req'd Recd TRACIIMG PERMIT FEES Plan (heck submitted Ilan Amount Structural Cake. Reviewed, ready for corrections Plan Check Deposit. . Tress Cala. Called Contact Person Plan Check Balance Title 24 Calci. Plans picked up Construction Flood plain plea Plans resubmitted_'. Mechanical Grading plan 2" Review, ready for correctionsfrssue Electrical Subeontactor List Called Contact Person Plumbing Grant Deed Plans picked up S LL H.O.A. Approval Plans resubmitted Grading IPI HOUSE:- 1 '^' Review; ready for correetionslissue Developer Impact Fee Planning Approval Called Contact Person A.I.P.P. Pub. Wks. Appr Date of permit issue Sehodl Fees Total Permit Fees ve Simplified Prescriptive Certificate of Compliance: 2008 Residential HVACAIteradons CF -IR -ALT -HVAC Climate Zones 10 to 15 Site Address: Enforcemertt Agency: Date. Permit #: $1095 N cL�-i �,� ,�, i .4 1 Zd L-3 Conditioned Floor Equipment Type' List Minimum Efficiency 2 Duct insulation requirement Area Thermostat Packaged Unit _ Furnace � AFUE 0 COP Over 40 ft of ducts added or I@ Setback Indoor Coil SEER 1� HSPF laced m unconditioned space ie[RR 6 (CZ 10-13) Served by system sf (If not already present, must beOther Condensing Unit 9 ® EER Resistance 8 (CZ 14-15) installed) 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% AME, 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. The inspector also verifies that each appropriate CF -6R and registered CF4R forms (no hand filled CF-4Rs allowed) are filled out and signed. Beginning October 1 2010 a rej#stered copy of the CF -1R and CF -6R shall also be on site for final inspection. 1. 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 stems) MECH-25 • Condenser Coil and/or CF -6R forms: 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 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 ducts: (all new ducting and all CF -6R forms: MECH-04, MECH-20-HERS,and (for split systems) MECH-22-HERS, and MECH-25-HERS 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, STMS, and either HSPP or PSPP. For Packaged Units: Duct leakage < 6 percent 3. New Ducts with 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 CF4R 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 < 6 percent 4. New Ducting over 40 feet Required Forms: • Includes adding or replacing more than 40 linear feet duct in CF -6R forms: MECH-04, MECH-2I-HERS CF -4R forms: MECH-21 of unconditioned space. For splits stem 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, calculationsplans and specifications submitted to the enforcement agenc fora val with the permit application. Name: - Signature: i Company: �C 1 �r� Date: 4( u 1zh 3 exc..� IQ►: r Cl I Address: 311, o License: (o Z-(. 31 O City/State/Zip: T v 2—Z -7k0 Phone:—7(,o_3y.- 7gegi 2008 Residential Compliance Forms July 2010