13-0085 (MECH)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
IT, 4 ihf'4 4 a"
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Application Number: 13-00000085 Owner:
Property Address: 79615 CETRINO GEORGE STOSS
APN: 772-330-036- - - 79615 CETRINO
Application description: MECHANICAL LA QUINTA, CA
Property Zoning: LOW DENSITY RESIDENTIAL (
Application valuation: 8250
Applicant:
Architect or Engineer:
�JA
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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.
License Class: C20 License No.: 686310
Dater Contractoq/c�SLA� �-
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).:
1 _ I 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.).
(_) 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.).
(_ 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: qr�/
Lender's Address:
LQPERMIT
VOICE (760) 777-7012
FAX '(760) 777-7011
INSPECTIONS (760) 777-7153
Date: 1/28/13
92253 D !J A u
JAN 209 2013
Contractor:
GENERAL AIR CONDITION N CITY OF LA QUINTA
31170 RESERVE DRIVE FINANCE DEPT.
THOUSAND PALMS, CA 922
(760)343-7488
Lic. No.: 686310
-----------------------------------------------
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 Z071741502
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
3700 of the Labor Code, I shall forthwith comply with those provisions.
Da I `1 Applicant:✓.�ti2� �� r�
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 (5100,0001. 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 hereby authorize representatives
of this county to enter upon the above-mentioned property for inspection purposes.
Dat Signature (Applicant or
Application Number . . . . . 13-00000085
Permit . .
. MECHANICAL
Additional desc .
Permit Fee
40.50
Plan Check Fee
10.13
Issue Date
Valuation . . . .
0
Expiration Date
7/27/13
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
Special Notes and
Comments
REPLACE 4 TON A/C
& 110K BTU FURNACE
----------------------------------------------------------------------------
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
sin.� of La Quinta
Bupdfig 8r Safety Divlslon
Pennif # P.O. Box 1504,70-495 Calle Tampico
l.a..Quinta, CA 92253 .:(760) 777-7012
Building Permit -Application and Tracking Sheet
ProjectAddtcss 7 Q(o�rJ C2.1CC ir�p Owner's Name:. VCO C C sioss
A. P. Number. Address: -% a) b l5 Celt O
Legal Description:
city. ST, lap: t' a C A Q 2-ZS3 '
y
Telephone: -
Contractor. A"t- d� t.
Address: -;P t11p 5e
Project Description:
city, $T, tip. ^ Yy)s qZ Z-16
2�amc- 4.' tlob�- 1�iU
Telephone: -7(a0-'343 - l tgg
, vs
State Lic. #: city Lie.. C.
Ar,6., PAW, Designer.
Address:
City. ST. Zip.
Telephone: :
Stade Lic g:
Construction Type:. Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
FL: # Stories: q Units:
Name of Caatad Person:Sq.
Telephone d of Coated Person
Estimatcd Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
H Submittal Req'd . Reed TRACMG PERMIT FEES
Plan Sets
Pian Chectc submitted Item Amount
Structural Coles.
Reviewed, ready for corrections Plan Chc& Deposit.
Truss Cala.
Called Contact Pcoon Plan Check Balance_
Tide 24 Cala.
Plans picked up Construction
Flood plain plan'
Plans resubmitted.' . Mcch2rilcal
Grading plan
Gra
2'! Review, ready for corcutionslissue Electrical
Subcoataetor List
Called Contact Person Plumbing
Grant Deed
Plans picked up S M,L
H.O.A. Approval
Plans resubmitted Grading
IN HOUSE: -
Review, ready for correcdonslrssuc Developer Impact Fee
Piaaaing 4proval
CaticA Coatact Person AA.P.P.
Pub. talcs. Appr
Date of permit Issue
School Fees
Total Permit Fees
Simplified Prescriptive Certificate of Compliance: 2008 Residential HVAC Alterations CF-IR-ALT-HVAC
imate Zones 10 - 15
Site Address:
Enforcement Agency: Date:
Permit:
79615 CETRINO La Quinta, CA 92253
City of La Quinta Jan 26, 2013
Duct insulation
Conditioned Floor
Equioment Type1
List Minimum Efflciency2
requirement
Area
Thermostat
p Package Unit
® Furnace
® Indoor Coll
® AFUE 78%
® SEER 13.0
0 COP
❑ HSPF
E3 R 6 (CZ 10-13)
Served by system
H Setback
If not already present, must be
® Cordensing Unit
p EER
p Resistance
R 8 (CZ 14-IS)
sf
installed)
E3 Other
1. Equipment Type: (hoose the equipment being Installed; if more than one system, use another CF-IR-ALT-MVAC for each system.
2. Minimum Equipment Elfidlendes: 13 SEER, 78% AFUE, 7.7HSPF for typical residential systems.
HERS VERIFICATION SUMMARY Listed below are FOUR HVAC alteration Options. The Installer derides 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-1R
and CF-GR shall also be on site for final inspection.
® 1.1 HVAC Changeout
Required Forms:
• AIIHVAC 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-611 forms: MECH-04, MECH-2I-HERS and (for split systems) MECH-25-HERS
• Furnace
CF-4R forms: MECH-21 andfors lit
( P systems) MECH-25
For Spilt Systems: Duct leakage-.5.15 percent; RC, CCA:5 300 CFM/ton (Minimum Air Flow Requirement), TMAH
Exertpted..from duct leakage testin'gif:
.p 1:7Duct system was doeumetked to have been previously sealed and confirmed through HERS verification, or
2. Duct-systems with less th$n 40 linear feet in unconditioned space, or
® 3. Existing duct systems are constructed, insulated or sealed with asbestos
p'4. The 11 rot be Ducked (ie:: :. _..: �..' ... e)
. il
out W ECH-04, . �r ERS split syr ) MEC . ERS' �d -
I new
• Cut it-r)
�.
du`diall new 1r1ECH;20, fir s� ?t M _
equi '' .; �.. s
For Split _tom.; :_._ _9 f /tOn,; S, an' P o -PS P:
4 :. rye ��
For Packaged;Units: Duct leakay6 percent �.
�X
0.3y:Ne�uf�5=with/or withouE�:
Required Forms:
Replaceiiient`-
. Includes replacing or installing AW--new
ducting and/or outdoorcondensing unit
CF-6R forms: MECH-04, MECH-20-HERS, and (for split system) MECH-25-HERS
and/or indoor coil and/or fumaoe >No or some
CF-411 forms: MECH-20 and (for split systems) MECH-25
equipment changed.
For �plit Systems: Duct leakage < 6 percent; RC, CCA 2 300 CFM/ton, TMAH
For Packaged Units: Dud leakage < 6 percent
E3 4i New Ducting over 40 feet
Required Forms:
. Includes adding or replacing more than 40
CF-611 forms: MECH-04, MECH-2I-HERS
lidear feet of dud in unconditioned space.
CF-4R fortes: MECH-21
For split system or.padcaged units: Dud leakage < 15 percent
p EXCEPTION: Existing dud systems constructed, insulated or sealed with asbestos.
Contractor (Documentation Author's /Responsible Designer's Dedaration Statement)
• I gwtify 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 6ertlfy 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.
• Tile design features identified on this Certificate of Compliance are consistent with the Information documented on other applicable compliance
fort s, worksheets, calculations, plans and specificatlons submitted to the enforcement agency for approval with the permit application.
Name: Danielle Garcia Signature: banidk Garcia
Company: HARRISON ENTERPRISES INC Date: Jan 26, 2013
Add[ess: 31-170 RESERVE DRIVE STE A License: 686310
City/State./Zip: THOUSAND PALMS / CA/ 92276 Phone: (760) 343-7488
Req:; 213-A0005644A-000000000-0000 Registration Date/Time: 2013/01/26 10:19:30 HERS Provider: Ca10ERTS, Inc.
2006 Residential Compliance Forms July 2010