10-1246 (MECH)'d s
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
T4`i�l 4 4Qu&rw
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Application Number: 10-00001246 Owner:
Property Address: 48025 CASITAS DR PURSLEY TOM
APN: 649-381-036- - - 480.25 CASITA DR
Application description: MECHANICAL LA QUINTA, CA 92253
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 6200
Applicant: Architect or Engineer:
�bIL#
r
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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.
Licensel
C20 -C36 License No.; 7794
Date>< 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 requiresihe applicant for the.
permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors 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 forthe 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).:
(_) I,.as owner of the property, ormy employees with wages as theirsole 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 buildsorimprovesthereon,
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" orshe did rimbuild or
improve for the purpose of sale.).
( _,) I, asowner of the property, am exclusively contracting with licensed contractors to construmthe 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 coniractor(s) licensed
pursuant:to the Contractors' State License Law.).
I—) Lam exempt under°Sec: B.&P.G, for this reason
Date:
Owner:
CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of perjury that there is,s construction lending agency for the performance of the
work for which this permit is issued (Sec.'3091, Civ. C.).
Lender's Name: _
Lender's Address:
LQP6RMIT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 11/15/10
Contractor:
J ANTHONY PLUMBING HEAT I NOV 152010
7221.6 NORTH SHORE STRE
THOUSAND PALMS, CA 922' cniQt
fAU1 TA
( 760 ).343 - 2121 alit:@:,
Lie. No.: 777794
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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 ,permitis
issued.
I have -and willmaintain 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 STATE FUND Policy Number 1.932451
_ 1 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 Iaws.of California,
and agree that, if I should become subject to the workers' co neation provisions of Section
0 of the Labor Code, I all forthwith. comply with th rovisions:
Date. -1///,V-16 Applicant:
WARNING: FAILURE To SECURE'WORKERS' COMPENSATION COVERAGE IS -.UNLAWFUL, AND SHALL
SUBJECT AN EMPLOY ER�to CRIMINAL PENALTIES AND CIVIL FINE&�UPITO 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 fora 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 .ofthis 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 oromissionrelated 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 dateof issuance of such permit, or cessation ohwork 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'ell
city and county ordinances and state laws relating to building construction, and hereby authorize represent •
of this count to enter upon the above-mentioned property
yffor
�inspection purposes _
Date �� �a Signature (Applicant orAgentj:. Cf��•
Application Number . . . . . 10-00001246
Permit . . . MECHANICAL
Additional. desc . .
Permit Fee . . . .
33.00
Plan Check Fee
8.25
Issue Date . . .
Valuation . . .
. 0
Expiration Date
5/14/11
Qty Unit Charge
Per
Extension
BASE
FEE
15.00
1.00 9.00.00
EA MECH
FURNACE <=100K
9.00
1.00 9.0000
EA MECH
B/C <=3HP/100K BTU
9.00
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Special Notes and Comments
HVAC CHANGE OUT 3 TON
'14 SEER SPLIT
SYSTEMS 2007 CODES-
ODES.------------------
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Other Fees . . .
- -
. . . . BLDG STDS ADMIN (SB1473)
1.00
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
1.0.0
.00 .00
1.00
Grand Total
42.2.5
.00 .00
42.25
,,.
' fCity
of La Quints
BWlcft sr fety Dtvhlc�l
P.O Sox 1504, 7Sa8-495'Cage TamPko
La Qubtay C.A 92253 - (760) 777-7012.
BuiicUng Permit APPlication anO Tracking Sheet
Permit
HhntniAddress: ljc�—<OZ. C - XZ_
owmeoNmw -T0f , OV.,S LE V
A P. Number.
Address:
Legal _Desaiption.city,
ST, Zip:
Contraeiar. d AN"ONY SERVICES122110 NUM I H SHORE ST.
Adds= THOUSAND PALMS CA Ow- 6
T hone:
Ned p8=
City. ST. Zip:
Telephone?60' 343 `' 4Z �:
state Lie. .: "tZ1Z R L;e . I055 USy
�,�� AN (7 IF cx,t
�0j. t 1 S c— 6 n S u --v,
Arch.,.Bngr.. Desipw.S
Addns:
City. ST, zip:
State Lic. #:Project
Now of Contact Persons
Canshuction Type: Occupancy:
typo (cirrJe one): New Add'n Alien Repair Demo
Sq. Ft.: # Stories: #Unites
Telephone # of Comact Person: ROmated Value of Pmjc=
APPLICANT:. DO NOT WRITE BELOW THIS LINE
U,
-Submittal
b
Rsc'd
TRACMG
rSRIVIITFm
Item "Out
:c:cde&
Reviewed, ready for corrections
Plan Chxk Depodt
Tf= Cala.
Called Contact Pennon
Plan Check Balance.
Mde 24 Calm
Places piela d up
Cana medon
Flood plain plan
Plain reeal►miftM
mKhaAw
Grading plan
2" Review, ready for eonvedomMmm
Electrical
SabeontsctorIast
Called ContaetPerson
Plumbing
GrantDeed
Pism pielual up
SALL.
H.Q.A. Approval
Plaus rewbmitted -
Grading
94 HOUSE;-
"' Revtew, ready for correcdonvIone
Developer Impact Fee
Phuslag Approval al
Caned contact Person
A.LP.P.
Pub. Win. Appr
Date of permit taut
School Fen
Tow PUMU Fen
Ske Add
rs Citi i nv 'fin--
o Agency:
V1
Date:
� 1 15 i !')
'permit A
Conditioned Floor
FAukq=ftTW'
List Minimum Efflcimcy2
Duct insulation requirement
Area
ernrostat
O Packaged Unit
®'Furnace
o�
1S�.AFIJE
O COP
Over 40 g of ducts added or
Setback
>S indoor Coil
SEER
i].HSPF
replacedin unconditioned spas
Served by system
Waot already
Bl nsiag Unit
O EER
O Resistance
O R.6 (CZ 10-13)
O R 8 (CZ 14-15)
sf
prereet must be
InSWU Jther
O Other.
L Equipment Toe: Choose tlteequipment being htstafkd,• iftnore than oneayslem, use another CF-1R,ALT-HVACforeach system.
2. Miium m Ega(perenl F4pphw des: 13 SEER. 78%ARIZ 17HVFfortypical t andettllal system,&
HERS'VERMCATLON SUMMARY Listed below are: frnu RVAC alteration Options. The mstslter decide& what work is being done and
picks one of the appropriate Options. Each Option:lists the HM measures that mast be conducted. A copy of the forms alta be left on site for final
inspection and a copy given to the homedwna: At final, the inspector verifies that the work listed on this form was in baft work completed by the
installer. The inspectoralso verifies that each appropriate CF 6R and registered CF.4R.forms (no hand fined CF4Rs allowaQ arodill-W out and
si ed ndnOctober 1201 a of the CF•18 and C1:6R ahafl she be on site Por final txdoa.
1. HVAC Cbangeout.
RequIredTotms:
• All [{VAC Equipment replaced
�-6R forms: MECH-04,. MECH=21-HERS and (for split systems) MECH- 23 -HERS
CF4R forms: MECH- 21 and for split MEM -25
• CondenserCoil_ and/or
• IndoorrCoil and /or
Indo
CF -6R torous: MECH-214MRS and (for split systems) MECH- 25 -HERS
CF4R.farms: MECH 21 and (for split systems) MBCH--25
• Furnace
For Split Systems: Duct leakage < 15 Percent; RC, CCA -a 300 CFM/ton(Mioimum Air Flow Retluirement), TMAH
For Packaged Units: Duct leakage < I S percent
Exempted from duct leakage testing if
.❑ 1. Dun system was documented to have been previously sealed and confirmed through HERS verification, or
O 2. Duct systems with less than 40 linear feet in unconditioned space; or
D 3. - ".duct are instdated or started with:asbestos -
O 2: New. HVAC System
Requited Forms:
• Coit is or Chi with new
duan: (all new ducting RUMS all
CF -6R forms: 1VJECH-04, MECH-204ERS,and (fbr split system) MECH,224IERS. and MECH: 25 -HERS
CF -4R forms: MECH 2O,, and (for split d anKEC 4
new
--- -- _... -
For Split Systems: Duct leakage < 6 percent; RC, CCA >_ 350 CFMhM.FWD, TMAH, SIMS, and eidw HSPP or PSPP.
For Packaged Units: Duct l •- 6 percent
O 3. New-Ducb w[th Re p laceinent'
Required Forms:
• includes repladng or.insteU6rg all now ducting
CF -6R forms: MECH-04, MECH-� (far split systems) MECH-25-HERS .
and/or outdoor condaurog unit and/or indoor
-CF-4R forms: MF.CH2O'and (for aplitsystems) MEt;H-25 .
Coil and/oi fianace. Not all,egtupanent changed.
For Split.Systems: Duo! leakage < 6 pereeat,'RC, CCA > 300 CFM 6)% TMAH
= For Pa - Units: Duct l < 6.::e'r0ent
O 4. New.Duc oxer 419 feet
Forms::
• Includes. adding or replacing mora than 40
linear ti:et of dunin unconditioned -
CF -a limns: MECH44. MECH-21-HERS CF4R fid .MECFI 21.
For split system orpackaged units Duct leakage < 15 parcent
:duct
O EXCEPTION: stems iasirlaeed ar sealed whh asbesoos. :: - -
Contma Wr(Doeunien tit Antler's/R.esponsiblk'DeafgneeA:Declarstlon'Staiemeat)''
• 10,nify dmf this CerMCM of QW*ianor ri is accurate oomp�te ;
• 1 am eligible uiei-WiMon 3 of the iaaltfom®-Husiness agd Piorwors.cade:to accept respotaiblli4Y for tt Vi alp identified on'this Eerdfloste of ComptW=
1 cen tint the- - .feattaes artd omm�oe tbrthe
° if p design nkntdied on this Catif bate of Compliance c form io the regwreoieius of Tate 24.
fatsi and 6oftheCalifoinieCodi ofRegttletaoas
• iln design reawrrs uleaufced on this Ceras a of Complianot are ooasiueat with tliz infosroaaan docutna►tad on other applicable
catculati and 'ficfltiobs adontoid to the wzaioemm ;for with
- -
Name: ` • i ►v ` ": C /J .
Company: - Dale»`
CJ
Address: T1216 t10RTH SHORE t3T W—E 101- :' License • . .
City/State/Zip: - :: Phone... Z�Z�
a008 -Resider Aid Conrpltgrece"Foiws :March .2010,-