12-0771 (MECH)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: 7/12/12
Application Number: 12--00000771 Owner: _-
Property Address: 800_9.O—CEDAR CREST BRUNN-ANDERSEN, LARS D e
APN: 762-051-019- - - 80090 CEDAR CREST
Application description: MECHANICAL LA QUINTA, CA 92253 11
Property Zoning: LOW DENSITY RESIDENTIAL JUL J -9 2012
Application valuation: 6250
CITY OF LA QUINTA
f�
Contractor: FINANCE napir
Applicant: Architect or Engineer: PALM DESERT AIR COND CO
42081 BEACON HILL
PALM DESERT, CA 92211
�I (760) 346-0677
Lic. No.: 374937
------------------
LICENSED CONTRACTOR'S DECLARATION
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 Lic No.: 374937
/ate7-LI ti ontracto
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).:
(_) 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.).
(_ 1 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 contractor(s) licensed
pursuant to the Contractors' State License Law.). _
(_ ) 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: PIE
LQPERMIT
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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 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 MID CENTURY Policy Number A09454905-12
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
y 3700 of th Labor Code, I -shall forthwit ply with those provisions.
ate: L pplicant: G -
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 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 Vreby authorize representatives
of thi aunty to enter upo he above-mentioned property for inspection pur es.
�"1 gnature (Applicant or Agent)Y
Application Number . . . . 12-00000771
Permit . . . MECHANICAL
Additional desc . .
Permit Fee . . . . 40.50
Plan Check Fee
10.13
Issue Date . . . .
Valuation . . . .
0
Expiration Date . . 1/08/13
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
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Special Notes and Comments
REPLACE (1) GAS ELECTRIC PACKAGED
SYSTEM. 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-lR-ALT-HVAC
Climate Zones 10 - 15
Site Address:
Enforcement Agency:
Date:
Permit #:
80-090 CEDAR CREST La Quinta, CA 92253
City of La Quinta
Jul 5, 2012
1
Duct insulation
Conditioned Floor
Equipment Typel
List Minimum Efficiency2
requirement
Area
Thermostat
p Package Unit
❑ Furnace
0 AFUE 78%
❑ COP
❑ R 6 (CZ 10-13)
Served by system
0 Setback
❑ Indoor Coil
9 SEER 13.0
❑ HSPF
❑ R 8 (CZ 14-15)
1400 sf
If not already 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-SR-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-111
and CF-611 shall also be on site for final inspection.
D 1. HVAC Changeout
Required Forms:
. All HVAC Equipment
CF-6R forms: MECH-04, MECH-2I-HERS
replaced
CF-4R forms: MECH-21 and (fei: split systems) 114_GH-2
. Condenser Coil and /or
CF-6R forms: MECH-04, MECH-21-HERS and (f9F plat ...,..teffls) M1=04 25_WEoF,
. Indoor Coil and /or
CF-4R forms: MECH-21 @Rd (f„- split systems) MECH-2&
. Furnace
For. Split Systems- 4 19 peFeeRti PC., Q;A 15 999 GF04i4teR (P4iRi--_-FRAiF RSW RequiFemeRt), TMAW
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
[12. 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: Refrigera nt'Charge)
El 2. New HVAC System Required Forms: >+ p
. Cut inror Changeout with' CF-6R-forms: MECH-04, MECH-20 HERS land (for split system's) MECH=22=HERS, and "
new ducts:' (all new
ducting all new MECH-25 -HERS 1 / . *- a • -; '
CF-4R forms: MECH-20, and (for split systems) MECH:22„and MECH-25 J,
equipment)- .moi _ '/ z� -. .+ u I • ,.1''�f,.
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: Duct leakage < 6 percent
❑ 4. New Ducting over 40 feet
Required Forms:
• Includes adding or replacing more than 40
CF-6R 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 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, calculations, plans and specifications submitted to the enforcement agency for approval with the permit application.
Name: Karl Brown Signature: Korl Brown
Company: PALM DESERT AIR CONDITIONING CO INC Date: Jul 5, 2012
Address: 42-081 BEACON HILL License: 374937
City/State/Zip: PALM DESERT/ CA/ 92211 Phone: (760) 346-0677
Reg: 212-A0035575A-00000000-0_000 Registration Date/Time: 2012/07/05 14:07:57 HERS Provider: Ca10ERTS, Inc.
2008 Residential Compliance Forms J July 2010
x
Tits' Ot
-- P.O. Box 1504.78-495 Calle Tampico, • Lainta, California 92211 f
W >_,
Tel: (760) 777-7012 •Fax: (760) , 77-7112
_GEM 41). DESERT _ Website: www.La-Quinta.Org • Email: Build. ng@La-Quinta.Org �``'�+�oNria�°
Bin #: Permit #: Building Permit Application & Tracking Sheet
Project Address: 80-090 CEDAR CREST
Owner's Na
e: BRUUN-ANDERSEN, LARS E.
A.P. Number:
Address:
80-090 CEDAR CREST, 7.8%
Legal Description:
City,.State,
ip: LA QUINTA, CA 92253
Contractor: Palm Desert Air Conditioning & Heating Company
Telephone:
(
Address: 42-081 Beacon Hill I
Project Description:
City, State, Zip: Palm Desert, CA 92211
REPLACE
) GAS ELECTRIC PACKAGED SYSTEM.
Telephone No.: (760) 346-0677
State: Lic. #: 374937
City Lic. #: 100886
Arch./Engr./Designer:
Address:
City, State, Zip:
Telephone No.:
Constructio.
i Type:
Occupancy:
State: Lic. #:
Project Type:
0 New • ® Add'n • O Alter • 0 Repair • 0 Demo
Name of Contact Person: KARL BROWN
Sq. Ft.:
# Stories:
# Units:
Contact Telephone No.: (760) 346-0677
Estimated
lue of Project: $6,250.00
APPLICANT:
DO NOT WRITE
BELOV
THIS LINE
#
Submittal
Req'd
Recd
Tracking
Permit Fee's
Plan Sets
Plan Check Submitted
Item
Amount
Structural Calcs.
Reviewed, Ready for Corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance
Title 24 Calcs.
Plans Picked Up
Construction
Flood Plain Plan
Plans Resubmitted
Mechanical
Grading Plan
2nd Review, Ready for Corrections
Electrical
Subcontractor List
Called Contact Person
Plumbing
Grant Deed
Plans Picked Up
S.M.I.
H.O.A. Approval
Plans Resubmitted
Grading
IN HOUSE
3`d Review, Ready for Corrections
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Works Appel
Date of Permit Issue
School Fees
Total Permit Fee's