MECH (13-0720)4 P.O. BOX 1504 �^' VOICE (760) 777-7012
78-495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 6/06/13
Application Number: 13-00000720 Owner:
Property Address:_ 51555 AVENIDA NAVARRO DAVE HECKMAN
APN: 773-144-027-3 -000000- 51555 AVENIDA NAVARRO
Application description: MECHANICAL LA QUINTA, CA 92253
Property Zoning: COVE RESIDENTIAL (760) 564-5180
Application valuation: 4500 a
DContractor:
Applicant: - Architect or Eng jum O 2013 J ANTHONY PLUMBING HEAT/AIR
72216 NORTH SHORE STREET, #101
THOUSAND PALMS, CA 92276
�F1�IAUINiA (760)343-2121
FINAHCEPEpl LiC. No.: 777794
--------------------------------------------------------------------------------------------------
LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury that 1 m licensed under provisions of (commencing with I hereby affirm under penalty of perjury one of the following declarations:
Section 7000) of Division 3 of the Business nd Professionals Code, a my License is in II force and effect. _ I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided
License as . C20 -C36 _ Licen o.: 777794 for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
17 issued:
fDa�te: Contractor: r l have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor
\I �% Code, for the performance of the work for which this permit is issued. My workers' compensation
OWNER -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 WESCO INS Policy Number 3051016
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 a to become subject 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 ecome subject tothe workers' compensation provisions of Section
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or3700 of the Labor C shall forthw' y with t e 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).: Date: .Applicant:
(_ 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 WARNING: FAILURE TO SECURE WORKERS' COMPENSATION 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,
(_ 1 I am exempt under Sec. , BAP.C. for this reason 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.
Date: Owner: 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
CONSTRUCTION LENDING AGENCY permit to cancellation.
I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the I certify that I have read this application and st to tha he above information is correct. I agree to comply with all
work for which this permit is issued (Sec. 3097, Civ. C.). city and c nt ordinances and state laws rel ing to uilding o ruction, and hereby authorize representatives
of this ao o enter upon the above -menti ed pr perty r inspe n purposes.
Lender's Name: /5//_ - - --
Date:. Signature (Applicant or gent)
Lender's Address:
LQPERMIT
'Application Number . . . . . 13-00000720
Permit . . . MECHANICAL 2013
Additional desc .
Permit Fee 35.75 Plan Check Fee
.00
Issue Date . . . . Valuation . . .
. 0
Expiration Date 12/03/13
Qty Unit Charge Per
Extension
1.00 35.7500 EA MECH CONDENSER/COMP•
35.75.
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Special Notes and Comments
HVAC CHANGE OUT - 14 SEER. HVAC CHANGE
OUT 5 TON, COIL & CONDENSOR ONLY. 2010
CALIFORNIA BUILDING CODES.
-----------------_---------------------------------------------------
Other Fees . . . . . . . BLDG STDS ADMIN (SB1473)
-- -
1.00
PERMIT ISSUANCE M/P/E
90.57
PLAN CHECK, MECHANICAL
23.83
Fee summary Charged Paid Credited
--------------------
Due
-------------------------------------
Permit Fee Total 35.75 .00 .00
35.75
Plan Check Total .00 .00 .00
.00
Other Fee Total 115.40 .00 .00
115.40
Grand Total 151.15 .00 .00
151.15
LQPERMIT
City of La Quinta
Building 8t Safety Division
Pe�"'f P.O- Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit APPlication and Tracking Sheet
�C Project Address: 5-' S /�,/ ^ ,
. - . , ` t' Yt'v Okl)wner's Name: h,�L I tv - - -
--dress: Stevie
ity, ST, Zip:
:lephone: -76,9
oject Description:
S--/ eo
Ta AJ / c
Total Permit Fees
Construction Type:
S tate Lic. # •
Oc cu anc �-
P � -
Name of Contact Person:
Project type (circle one): Ne- Add' n Alter Repair Demo
C�> .�- ( �l1 1 ✓{�Lt S Sq.
Ft.:
Telephone # of Contact Person: `% � p 3 �(3 ;Z,( Z(
#
Stories:
#
Units:
Estimated Value of Project:
YVe O
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
TRACKING
Plan Sets
PERMIT FEES
J�d
Plan Check submitted
Structural Calcs.
Reviewed, readv for
Item
Amount
Truss Cates.
corrections
Plan Check Deposit
Called Contact Person
Title 24 Calcs.
Plan Check Balance
Plans picked up
ain plan
Construction
Plans resubmitted
ffGradingplan
Mechanical
2" Review, ready for correclion �ssue
actor List
Electrical
Called Contact Person
Grant Deed
Plumbing
Plans picked up
ILO.A. Approval
S.1%1.1.Plans
resubmitted
IN HOUSE:-
Grading
Planning Approval
Review, ready for corrections/issueDeveloper
Impact Fee
Called Contact Person
Pub. Wks. Appr
A. 1. P. P.
Date of permit issue
School Fees
Total Permit Fees
Simplified Prescriptive Certificate of Compliance: 2008 Residential HVAC Alterations CF -IR -ALT -HVAC
Climate Zones 30 - 15
Site Address:
Enforcement Agency:
Date:
Permit #:
51555 AVE NAVARRO La Quinta, CA 92253
City of La Quinta
]un 6, 2013
Duct insulation
Conditioned Floor
Equipment Typel
List Minimum Efficiency2
requirement
Area
Thermostat
❑ Package Unit
❑ Furnace
® Indoor Coil
❑ AFUE
® SEER 13.0
❑ COP
[3HSPF
13 R 6 (CZ 10-13)
Served by system
® Setback
If not already present, must be
® Condensing Unit
[3EER
❑ Resistance
❑ R 13 (CZ 14-15)
1800 sf
installed)
❑ Other
I
I
I
I.
1. Equipment Type: Choose the equipment being installed; if more than one system, use another CF -1R -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 -1111
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
• Indoor Coil and /or
CF -6R forms: MECH-04, MECH-2I-HERS and (for split systems) MECH-25-HERS
• Furnace
CF -4R forms: MECH-21 and (for split systems) MECH-25
For Split Systems: Duct leakage < 15 percent; RC, CCA <_ 300 CFM/ton (Minimum Air Flow Requirement), TMAH
Exempted from duct leakage testing 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 duct systems are constructed, insulated or sealed with asbestos
❑ 4. The system will not be Ducted (ie. Ductless Mini -Split System) (Also Exempt from Refrigerant Charge)
❑ 2. New HVAC System Required Forms; .
. Cut in or Changeout with 6-61k forms: MECH-04, MECH-20-HERS, and (for split systems) MECH-22-HERS, and
new ducts: (all new
MECH-25-HERS
ducting and all new CF -4R forms: MECH-20, and (for split systems) MECH-22, and MECH-25
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/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: Dud 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: Dud 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: Kevin Robinson Signature: Kevin Robinson
Company: I ANTHONY PLUMBING HEATING & AIR CONDITIONING Date: ]un 6, 2013
Address: 72216 NORTH SHORE ST #101 License: 777794
City/State/Zip: THOUSAND PALMS / CA / 92276 Phone: (760) 343-2121
Reg: 213-A0035045A-000000000-0000
2008 Residential Compliance Forms
Registration Date/Time: 2013/06/06 12:31:27 HERS Provider: CalCERTS, Inc.
July 2010