12-0447 (MECH)r - 4
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: —
'12Z00000447�
Property Address:
79258 CETRINO
APN:
772 -110 -018 -
Application description:
MECHANICAL
Property Zoning:
LOW DENSITY RESIDENTIAL
Application valuation:
6500
Applicant:
T4ht 4 4Qumrw
Architect or Engineer:
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
LANGENWALTER
79258 CETRINO
LA QUINTA, CA
RESIDENCE
92253
Contractor:
AIR EXPERTS AIR CONDITIONG-
PO BOX 94
�lk LA QUINTA, CA 92247
(760)777-1724
Lic. No.: 725283
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 4/24/12
_�/,Al � -D
APRn 24 2012
C'TM OF LA OI alar.
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:
LOPERMIT
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?theove information is correct. I agree to comp) with all city and co y o inances and state laws relating construction, an represntatives
of this y to n�tfer_upon the above-mentioned r ' purposes.
Date^ Sinature (Applicant or Agent
UC ED CONTRACTOR'S DECLARATION
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perju that m licensed under provisions of Chapter 9 (commencing with
I hereby affirm under penalty of perjury one of the following declarations:
Section 7000 of'Division 3 of the B sines and Professionals Code, a icense is in full force and effect.
_ I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided
License Clas . 0 o.: 725283
for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
Date Contractor:
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
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 NORGUARD INS Policy Number PAWC334856 '
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 ecome 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
agree that, if I sho bec a subject to the workers' co e"eml"7151onsrof Section
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or
0 of the Labor Co e, I all forthwith co os; provisions.
that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by
4FAILURE
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars IS500).:
Date:'�nt:
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
WAR TO SECURE WO
KERS' 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 offerbd 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
(_ 1 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,
(_) I am exempt under Sec. , B.&P.C. for this reason
the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City
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:
LOPERMIT
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?theove information is correct. I agree to comp) with all city and co y o inances and state laws relating construction, an represntatives
of this y to n�tfer_upon the above-mentioned r ' purposes.
Date^ Sinature (Applicant or Agent
Application Number . . . . . 12-00000447
Permit . . . MECHANICAL
Additional desc .
Permit Fee . . . . 24.00
Plan Check Fee
6.00.
Issue Date . . . .
Valuation . . .
. 0
Expiration Date 10/21/12
Qty Unit Charge Per
Extension
BASE
FEE,
15.00
1.00 9.0000 EA MECH
B/C <=3HP/100K BTU
9.00
------------ ----------------------------------------------------------------
Special Notes and Comments
REPLACE.HVAC SYSTEM. 2010 CODES
-------------------------=--------------------------------------------------
Other Fees . . . . . BLDG STDS ADMIN (SB1473)
.1.00
Fee summary Charged.
Paid Credited
Due
Permit Fee Total 24.00
.00 .00
24.00
Plan Check Total 6.00
.00 .00
6-.00
Other Fee Total 1.00
.00 .00
1.00
Grand Total 31.00
.00 .00
31.00
LQPERMIT
Simplified Prescriptive Certificate of Compliance: 2008 Residential HVAC Alterations CF-iR-ALT-HVAC
Climate Zones 10 - 15
Site Address:
Enforcement Agency:
Date:
Permit #:
79-258 Cetrino La Quinta, CA 92253
City of La Quinta
Apr 23, 2012
Duct insulation
Conditioned Floor
Equipment Typel
List Minimum Efficiency2
requirement
Area
Thermostat
❑ Package Unit
❑ Furnace
® Indoor Coil
❑ AFUE
10 SEER 16.0
❑ COP
❑ HSPF
❑ R 6 (CZ 10-13)
8
Served by system
sf
® Setback
If not already present, must be
® Condensing Unit
[I EER
❑ Resistance
❑ R (CZ 14-15)
2000
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-611 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.
10 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-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:
❑ 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
❑ 4. The system will not be Ducted (ie. Ductless, Mini-Split-System.)-(Also Exempt ifrorn ,Refrigerant Charge)
_
❑ 2. New HVAC System Required Forms: V " f 1 j ' V
. Cut inlor Changeout with:' 'k / '—`
CF-6R forms: MECH-04, MECH-20,HERS, and (for split systems) MECH-22-HERS, and
ducts: (all new
new MECH-25tiHERS
ducting and all new
%; CF-4R forms: MECH-20 and (for split systems) MECH-22, and MECH-25
equipment) /f <`1 �/ r �r :� .- • .i ( � j
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-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-411 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 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: Paul Van Vlymen Signature: Paul Van Vlymen
Company: AIR EXPERTS AIR CONDITIONING-HEATING Date: Apr 23, 2012
Address: PO BOX 94 License: 725283
City/State/Zip: LA QUINTA / CA / 92247-0094 Phone: (760) 777-1724
Reg: 212-A0020105A-00000000-0000 Registration Date/Time: 2012/04/23 19:18:09 HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms July 2010
Bin.#:
City of La Quo:
Building 13T Safety Division
P.O. Box 1504,•78-495 Calle Tampico
LA -Quanta, CA 92253 -:(760) 777-7012
Building Permit Application* and Tracking Sheet
Permit #
Project Address:
f
wner's Name:.za
A. P. Number.
T.Address:
. / 4Legal
Description:
ity, ST, Zip:
Contractor. r
Telephone:
Address: g
Project Description:
City, $T, Zip: -
4 ce
y�
Telephone: ?(,c)227 —/L
State Lie. # :7?—
City Lie. #;
Arch., Engr., Designer.
Address:
City., ST, Zip:
�.
Telephone:
State Lie. #:
Name of Contact Person:
, u Construction Type; Occupancy:
c. :. h; Project.type (circle one): New Add'n Alter Repair
Sq. Ft-. #Stories : #Units
Demo
Telephone # of Contact Person:
Estimated Value of Project
APPLICANT: DO NOT WRITE BELOW THIS UNE
q
Submittal
Req'd
Recd
TRACMG
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Cale&
Reviewed, ready for corrections
Plan Check Deposit. .
Truss Calcs.
Called Contact Person
Plan Cheek Balance
Title 24 Calci.
Pians picked up
Construction
Flood plain ptau
Plans resubmitted..
Mechanical
Grading plan
2ad Review, ready for correctionsfissue
Electrical
Subcoutactor List
Called Contact Person
Ylumbfng
Grant Deed
Plans picked up
S.M.L
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
'^' Review, ready for corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person
A.LP.P.
Pub: Wks. Appr
Date of permit issue
School Fees
Total Permit Fees