11-1149 (MECH)f f
P.O. BOX 1504
78-4951 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: <11-00001149
Property Address: -78570 HIGHWAY 111
APN: 604-050-037-19 -000000-
Application description: MECHANICAL
Property Zoning: REGIONAL COMMERCIAL
Application valuation: 8500
c&ht 4 4 Qum&
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Architect or Engineer:
P lA
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 B i fessionals Code, and my License is in full force and effect.
License lass: C20 License No.: 438781
ate]Q antractor:
OWNER- ILDER DECLARATION
I hereby affirm under penalty of perjur hat I am exempt from the Contractor's State License Law for the
following reason (Sec. 7031.5, ' ass 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, 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 ProfessionsCode: 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 lendingagency for the performance of the _
- work for which this permit is issued (Sec. 3097,' Civ. C.).
Lender's Name:
Lender's Address: P 11-1
LQPERMIT
Owner:
WASHINGTON ADAM PARTNERSHIP
43692 PIASANO PL
TEMECULA, CA 92592
Contractor:
COOL FLO INC
79469 COUNTRY CLUB DR,,
BERMUDA DUNES, CA 9220
(760)345-6606
Lic. No.: 438781
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 10/19/11
inj U
e -r I9 2-i1
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 NORGUARD INS Policy Number COWC239005
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 becon a subject to the workers' compensation provisions of Section
.. 370
at 0 of the Labor call f with comply with those provisions.
plicant:
WARNING: FAILURE TO SECUW RKERS' COM SATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TOC VIAL 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 construe io and hereby authorize representatives
of this c my o enter up n the above-mentioned pr r pection osas.
aB"tei a �� Signature (Applicant or Agent
Application Number . . . 11-00001149
Permit . . . MECHANICAL
Additional desc .
Permit Fee . . . 40.50 Plan Check Fee
10.13
Issue Date Valuation
0
Expiration Date 4/16/12
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
INSTALL NEW HVAC EQUIPMENT, NEW 5 TON
PACKAGE UNIT, HEAT PUMP. 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
'S'plified Prescriptive•Cei-tificate of Compliance: 2008 Residential. HVACAIterdtions CF -IR -ALT -HVAC
,Climate Zones)(_ is
Site A ddless:
11
Enforcement Agency:
Da
Pernut #:
ui ment Type'
List
Minimum McienCY2. Conditioned Floor Area
Thermostat
Packaged Unit
Furnace
AFUE
COP tj Ik
Indoor Coil
Condensing Unit
F9SEER 7,G)
EER
jHSPF�� Z- Sery d system
Resistance sf
Setback
flf not already present, mast be installed)
Other
I. Equipment Type: Choose the equipment being installed if more than one system use another CF -I R -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 three 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 -IR 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- 25 -HERS
replaced
CF -4R forms: MECH-25
• Condenser Coil and/or
CF -6R forms: MECH- 25 -HERS
• Indoor Coil and/or
CF -4R forms: MECH-25
• Furnace
For Split Systems: RC, CCA > 300 CFM/ton, TMAH
For Packaged Units: No testing required
0 2. New HVAC System Required Forms:
• Cut in or Changeout with CF -6R forms: MECH-04, MECH- 25 -HERS
new ducts: (all new ducting
CF -4R forms: MECH-25
And all new equipment)
For Split Systems: RC, CCA >_ 300 CFM/ton, TMAH.
For Packaged Units: No testing required
0 3. New Ducts with Replacement
Required Forms:
• Includes replacing or installing all new
CF -6R forms: MECH-25-HERS
ducting and/or outdoor condensing unit
CF -4R forms: MECH-25
and/or indoor coil and/or furnace. Not all
equipment changed.
For Split Systems: RC, CCA > 300 CFM/ton, TMAH
For Packaged Units: No testing required
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 I and6 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
ennit application.
Name:14 ll/t�
l/��
Signature: -
Comp y: o f !
(�
Date:
��—
Add s
r o��
W
License: �� I
City/State/Zip:
� �
Phone.
2008 Residential Compliance Forms March 2010
Bin .#
City. of La Quints
Building at Safety Division
.O. Box 1504, 78-495 Calle Tampico
La.Quinta, CA 92253 - (760) 777-7012
Building Permit' Application and Tracking Sheet
Permit #P
\J1~
\�
Project Address:10 Gj—�Q S 11
Owner's Name:.14L/ &b
A. P. Number.
Address: — 5
Legal Description:
City, ST, Zip: 3
'r�
Contractor: V
.cr q:•;.. s^ "
Telephone? -W 3 s 3N
Project Descriptio
Address:�
(Q U� l Q OA J
City, ST, Zip: VD
l u
Telephone:
//° � ':. ,l.. �:8
City Lie. #;
QAMP .
State Lie. # :
Arch., Engr., Designer:
Address:
City., ST, Zip:
Telephone: :�
State Lie. #: :!
—VIA,
Name of Contact Person:
Construction T.ype: Occupancy:
Project type (circle one): New Add'n Alter a Demo
Sq. Ft.:
# Stories:
#Units:
Telephone # of Contact Person: o7;q-!;--93
Estimated Value of Project: t#1A 15�0 0.
APPLICANT: DO NOT WRITE BELOW THIS LINE .
#
Submittal
Req'd
Recd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item Amount
Structural Cales.
Reviewed, ready for corrections
Plan Check Deposit. .
Truss Calcs.
Called Contact Person
Pian Check Balance
Title 24 Calcs.
Plans picked up
Construction '
Flood plain plan
Plans resubmitted '
Mechanical
Grading plan
r' Review, ready for correctionstissue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN ROUSE:-
'"' Review; ready for corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr '
Date of permit issue
School Fees
Total Permit Fees