MECH (12-0632)PVO. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
12-,00000632 '
Property Address:
81215 NATIONAL DR
APN-
767-500-010- -
Application description:
MECHANICAL
Property Zoning:
LOW DENSITY RESIDENTIAL
Application valuation:
12475
Tavl- °F 4Qu«tw
Applicant: Architect or Engineer:
I �
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
------------------------------------------------
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am license under provisions of Chapter 9 (commencing with
Section 7000) of Division 3 of the Business and Profess nals Code, and my License is in full force and effect.
Lice se Class: C20 License No.: 686310
Date: 6 ntractor:
UILDER 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, 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, 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:
KUMP. FAMILY /
81215 NATIONAL
LA QUINTA, CA
PETER E KUMP
D'.
92
Contractor:
GENERAL AIR COND
31170 RESERVE DR
THOUSAND PALMS,
(760)343-7488
Lia. No.: 686310
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 6/07/12
-----------------------------------------------
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 'ZENITH INS CO Policy Number Z071741501
_ I certify that, in the performance of the rk for which this permit is issued, I shall not employ any
person in any manner so as to beco subject to the workers' compensation laws of California,
and agree that, if I should become act to the workers' compensation provisions of Section
3700 of the Labor Code, I shall fo ith comply with those provisions.
ate: 6 JJ Applicant:
WARNING: FAILURE TO SECURE WOR RS' C PENSATION 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, indemnity 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 abov information is correct. I agree to comply with all
city and county ordinanc s and state laws relating to building struction, and hereby authorize representatives
of this county to enter on the above-mentioned property f pection purposes.
/late: Signature (Applicant or Agent):
LQPERMIT
Application Number. . . . . . 12-00000632
Permit . . . MECHANICAL
Additional desc .
Permit Fee . . . . 40.50 Plan Check Fee
10.13
Issue Date Valuation . . . .
0
Expiration Date 12/04/12
Qty Unit Charge Per
Extension
BASE FEE
15.00
1.00 9.0000 EA MECH FURNACE <=100K
9.00
1.00 16.5000 EA MECH B/C >3-15HP/>100K-500KBTU
16.50
Special Notes and Comments
HVAC CHANGE -OUT: INSTALL NEW 5 TON SPLIT
SYSTEM FURNACE, CONDENSER, INDOOR COIL.
2010 CODES.
------------------------------------------------------,---------------
Other Fees . . . . BLDG STDS ADMIN (SB1473)
1.00
Fee summary Charged Paid Credited
--------
Due
----------------- ----------
Permit Fee Total 40.50 .00 .00
40.50
Plan Check Total' 10.13 .00 .00
10.13
Other Fee Total 1.00 .00 .00
1.00
Grand Total 51.63 .00 .00
51.63
LQPERMIT
Simplified Prescriptive Certificate of Compliance: 2008 Residential HVAC Alterations CF-1R-ALT-HVAC
Climate Zones 10 - 15
Site Address:
Enforcement Agency:
Date:
Permit #:
81215 NATIONAL DRIVE La Quinta, CA 92253
City of La Quinta
Jun 6, 2012
Equipment Typel
List Minimum Efficiency2
Duct insulation
requirement
Conditioned Floor
Area
Thermostat
❑ Package Unit
® Furnace
® Indoor Coil
® AFUE 78%
® SEER3
❑ COP
❑ HSPF
13 R 6 (CZ 10-13)
13 R 8 CZ 14-15)
�
Served by system
2088 sf
® Setback
If t ald
noalready
y present, must be
®Condensing Unit
❑EER
❑Resistance
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-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-611 forms: MECH-04, MECH-2I-HERS and (for split systems) MECH-25-HERS
replaced
CF-411 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 z,15 percent; RC, CCA 5 300.CFM/ton (Minimum Air Flow Requirement), TMAH
Exempted from duct leakage testin"g,if:
[11. 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 dud systems are constructed, insulated or sealed with asbestos
❑ 4. The system will not be Ducted-•(ieDucties�Min Split S,ystem)1(Also Exempt fromTRefrigerantjCha.rge)
❑ 2. NewAHVAC System
Requir"_ed
.Cut inor�Changeout with -
new ducts; (all new
ductinw= all new
,•rt
CF"6�t forms: MECH-04, MECH 20-HERS,. and (for split systems) MECH 22-HERS, and
MEC H;25-HERS �;� = "
�&�2,a
equipment)
CF-4R'forms: ME 20, and (for split systems) MECH=MECH=25"
aid ; a.y.
For Split Systems: Ductleakage co),perce�nt;LRCmCCA32:1350;CFM/ton FWD,"AH STMS, and'either:HSPP'on�PSPP:
For Packaged Units: Dud leakagek< 6:percent
❑ 3. New�Ducts with/or without..
Required Forms:
Replacement .
. Includes replacing or installing all new
ducting and/or outdoor condensing unit
CF-611 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-611 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 dud 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: Danielle Garcia Signature: Danielle Garcia
Company: HARRISON ENTERPRISES INC Date: Jun 6, 2012
Address: 31-170 RESERVE DRIVE STE A License: 686310
1
City/State/Zip: THOUSAND PALMS / CA / 92276. I Phone: (760) 343-7488
Reg: 212-AO02915OA-00000000-0000
2008 Residential Compliance Forms
Registration Date/Time: 2012/06/06 18:05:32 HERS Provider: Ca10ERTS, Inc.
July 2010
en #
City of La Quinta
Building a Safety Division
Box 1504,=78-495 Calle Tampico
4.QlBnta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Perinit #P.O.
Project Address: 6 1 2l C, C\1j U qQ �
Owner's Name:. t .1
A. P. Number.
Address Saw
Legal Description:
Contractor.Telephone
City; ST, Zip:
3¢"
Address:
Project Description: V e r� ` Cj
City ST, Zip:
S .
Telephone:
State Lic. # : City Lic. #,
Arch., Engr., Designer
Address:
City., ST, Zip:
Telephone: , . -
State Lic. #: y;'
Name of Contact Person:
Construction Type:. Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
Sq. Ft.: 2 # Stories:
# Unita:
Telephone # of Contact Person:Estimated
Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS UNE
#
Submittal
Req'd
Recd
TRACKNG
PERMIT FEES•
Plan Sets
Plan Cheek submitted
Item Amount
Structural Calm
Reviewed, ready for corrections
Plan Cheek Deposit. .
Truss Calcs.
Called Contact Person
Plan Check Balance
Title 24 Calm
Pians picked up
Construction
Flood plain plan
Plans resubmitted'
Mechanical
Grading plan
2i4 Review, ready for correctionsfissue
Electrical
Subcontattor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN ROUSE:-
'"` Review; ready for correetionsfissue
Developer Impact Fee
Planning Approval
Called Contact Person
A.LP.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees