09-0104 (MECH)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application description
Property Zoning:
Application valuation:
Applicant:
.. I T4ht 4 4 Q"
09-00000104-
78722 HIGHWAY 111
643-220-015-16 -000000-
MECHANICAL
REGIONAL COMMERCIAL
40000 -
Architect or Engineer:
olk
BUILDING & SAFETY -DEPARTMENT
BUILDING PERMIT
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 -C38 LicenseNo.: 632098
ate: C ractor:
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury t 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, 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:
LQPERMIT
Owner:
RED ROBIN INTERNATIONAL
6312 GREENWOOD VILLAGE
GREENWOOD VILLAGE, CO 8
Contractor:
J V S REFRIGERATION
6725 BARKDALE LANE
RIVERSIDE, CA 92509
(800)869-8218
Lic. No.: 632098
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 2/11/09
WORKER'S COMPENSATION DECLARATION .
I hereby affirm under penalty of perjury one of the following declarations:
_ 1 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 AMGUARD INS Policy Number JVWC910224
_ 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 abor Code, I shall forttAith comply with those provisions.
Date: 09 pplicant: -
WARNING: FAILURE TO SECURE WO S' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS 1$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 hereby authorize representatives
of this county to enter upon the above-mentioned prop y for inspecti ur oses.
�{jate; 2- 'A 01 Signatu Applicant or Agentl:
Application Number 09-00000104
Permit . . . MECHANICAL
Additional desc .
Permit Fee 168.00 Plan Check Fee
42.00
Issue Date Valuation . .
0
Expiration Date .. 8/10/09
Qty Unit Charge Per
Extension
BASE FEE
15.00
6.00 9.0000 EA •. MECH FURNACE <=100K
54.00
6.00 16.5000 EA MECH B/C >3-15HP/>100K-500KBTU
99.00
----------------------------------------------------------------------------
Special Notes and Comments
REPLACEA/C UNITS TO 6 HIGH EFFICIENCY
.6
A/C 13 SEER, 410 REFRIGERANT
----------------------------------------------------------------------------
Other Fees . . . . . . . . BLDG STDS ADMIN (SB1473)
2.00
Fee summary Charged Paid Credited
---------------------------------------------------------
Due
Permit Fee Total 168.00 .00 •.00
168.00
Plan Check Total 42.00 -.00 .00
42.00
- Other Fee Total 2.00 .00 .00
2.00
Grand Total 212.00 .00 ..00
212.00
LQPERMIT
City of La Quinta
Building U Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
0
Project Address: ZZ�
Owner's Name:
A. P. Number:
Address:
Z
Legal Description:
Contractor-
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City, ST, Zip:
Telephone: [] j
Address: 7 lil JAr 6—Smte
Project Description:
City, ST, Zip:
S 2 �v 9(A-c,
L iAJ
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Telephone: 800 _ _
State Lic_ # : O 9 FA
Arch., Engr., Designer:
tsoon=
City Lic. #:�
23 (d
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3
Address:
City, ST, Zip:
Telephone:
State Lic. #.
Name of Contact Person: _�
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Construction Type: Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
Sq. Ft_: # Stories: # Units:
Telephone # of Contact Person:
80,o 82_(gEstimated
Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req-'-d
Reed- TRACKING PERMIT FEES
Plan Sets
Plan Check submitted Item Amount
Structural Cales.
Reviewed, ready for corrections Plan Check Deposit
Truss Calls.
Called Contact Person Plan Check Balance
Energy Calcs.
Plans bicked up Construction
Flood plain plan
Plans resubmitted Mechanical
Grading plan
2"" Review, ready for corrections/issue Electrical
Subcontactor List
Called Contact Person Plumbing
Grant Deed
Plans picked up S.M.I.
H.O.A. Approval
Plans resubmitted Grading
IN HOUSE:-
'"' Review, ready for corrcetionsrssue Developer Impact Fee
Planning Approval
Called Contact Person " A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees
This Certificate of Complianae lists the building features and performance SPecificatims needed to comply With T-" Z4. rans 1 arra o w uw
California Code of Regulations. This certificate applies only to building mechanical requirements.
The documentation preperer hereby certifies that the documentation is aoarate ano oampreme.
GATE
DOCUMENTATION AUTHOR 5! 111RE
Z./ii Io4
The Principes Mechanical Designer hereby certifies that the proposed building design represented in this set of construction documents Is consistent
with the other compliance forms and worksheets, with the specifications, and with any other calculations submitted with this permit application. The
proposed building has been designed to meet the mechanical requirements contained in the applicable parts of Sections 100.101,102, 11D (tough
115, 120 through 125, 142.144 and 145.
G The plans & specifications meet the requirements of Part 1 (Sections 10-103a).
The Installation certificates meet the requirements of Part 1 (10-103a 3).
`J The operation & maintenance information meets the requirements of Part 1 (10-103c).
Plaese check one- (These sections of the Business and Professions Code are printed an tutl in the Nonresidential Manual.)
I hereby affirm that i am eligible under the provisions of Division 3 of the Business and Professions Code to sign this
document as the person responsible for its preparation; and that I am licensed in the State of CaBfbmia as a civil engineer or
mechanical engineer, or I am a licensed atchitecl.
I affam that I am eligible under the exemption to Division 3 of the Business and Professions Code by Section 5537.2 or
6737.3 to sign tMs document as the person responsible for its preparation; and that 1 am a licensed contractor performtrg
amts work.
I affirm that 1 am eligible under the exemption to Division 3 of ttie Business and Professions Code to sign this docwwt
El because it pertains to a structure ortype of work described pursuant to Business and Professions Code sections 5537, 5538,
and 6737.1.
PRINCIPAL MECHAMCAL DESICedER-NAME DATE LIG tl
w V. S. �. �� z i
INSTRUCTIONS TO APPLICANT MECHANICAL COMPLIANCE & WORKSHEETS (check box if worksheet is lneluded)
C MECH-I -C Certificate of Compliance. Pact 1 of 3.2 of 3.3 of 3 are required on plans for all submittals
P Waaleri$ervic ater Pools Requirements Part 1 of 3.2 of 3.3 of 3 are required for all submittals. but may be on
C MECH 2 C
G MECH-3-C Mechanical Ventilation and Reheat is required for all submittals with mechanical ventilation, but may be on plans
MECH-4-C HVAC Misc. Prescriptive Requirements is required for al prescriptive submittals, but may be on plans.
2005 Nonresidential Compliance Fouls December 2005
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CERTIFICATE. OF COMPLIANCE (Part 2 of 3) MECH-1-C
PROJECT NAME DATE
Designer:
This form is to be used by the designer and attached to the plans. lasted below are all the acceptance tests for
mechanical systems. The designer is required to check the boxes by all acceptance tests that apply and list all
equipment that requires an acceptance test. If all equipment of a certain type requires a test, list the equipment
description and the number of systems to be tested in parentheses. The NJ number designates the Section in the
Appendix of the Nonresidential ACM Manual that describes the test. Also indicate the person responsible for performing
the tests (i.e. the installing contractor, design professional or an agent selected by the owner). Since this form wKI be
part of the plans, completion of this section will allow the responsible party to budget for the scope of work appropriately.
Building Departnents:
Systems Acceptance. Before occupancy permit is granted for a newly constructed building or space, or a new space -
conditioning system serving a building or space is operated for nomnal use, all control devices serving the building or,
space shall be certified as meeting the Acceptance Requirements For Code Compliance.
In addition a Certificate of Acceptance, MECH-I-A, Form shall be submitted to the building department that certifies
plans, specifications, installation certificates, and operating and maintenance information meet the requirements of §10-
103 b and Title 24 Part 6.
Test ascii fon Test Performed
MECH-24A: Ventilation System Acceptance Document
Variable Air Volume Systems Outdoor Air Acceptance
Constant Air Volume Systems Outdoor Air Acceptance
Test required on all New systems both New Construction and Retrofit.
Equipment requiring acceptance testing
✓ MECH-3-A: Packaged HVAC Systems Acceptance Document
Test required on all New packaged systems both New Construction and Retrofit.
Equipment requiring acceptance testing
✓ ❑ MECH-4-A: Air -Side Economizer Acceptance Document
Test required on all new air -side economizers for both New Construction and Retrofit. Units with
econornizers that are installed at the. factory and certified with the Commission.do not require
equipment testing but do require constriction inspection.
Equipment requiring acceptance testing
e
2005 Nonresiftntiat Compiiance Forms September 2005
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CERTIFICATE OF COMPLIANCE (Part 3 of 3) MECH-1-rC
PROJECT NAME DATE
Test Description Test Performed B
v ❑ MECH-S-A: Air Distribution Acceptance Document
This test required If the unit serves 5,000 ft2 of space or less and 25% or more of the ducts
are in nonconditioned orsemiconditioned space like an attic. New systems that meet the
above requirements. Retrofit systems that meet theabove requirements and either extend
ducts, replace ducts or replace the packaged unit.
Equipment requiring acceptance testing
❑ MECH--A : Demand Control Ventitation Acceptance Document
All new DCV controls installed on new or existing packaged systems must be tested. I..
Equipment requiring acceptance testing
v/ ❑ MECH-7-A: Supply Fan Variable Flow Control Acceptance Document
All new VAV fan volume controls installed on new or existing systems must be tested.
Equipment requiring acceptance testing
-/❑ MECH-B-A: - Hydronic System Control Acceptance Document
• Variable Flow Controls, Applies to chilled and hot water systems,
• Automatic Isolation Controls, Applies to new boilers and chillers and the primary
pumps are connected to a common header
• Supply Water Temperature Reset Controls, Applies to new constant flow chilled and •
hot water systems that have a de capacity greater than or equal to 500,000
Btulhr.
• Water -loop Heat Pump Controls, Applies to all new watertoop heat pump systems
where the combined loop pumps are greater than 5 hp.
• Variable Frequency Control, Applies to all new distribution pumps on new variable
Row chilled, hydronic heat pump or condenser water systems where the pumps
motors are greater than 5 hp.
Equipment requiring acceptance testing
2005 NonneskwAaaf Compliance Forms
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Apr# 2005
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4
2005 CERTIFICATE OF ACCEPTANCE (Part 1 of 2) MECH-1-A
11— 6`) - G /
BUILDING TYPE O NONRESIDENTIAL ❑ HIGH RISE RESIDENTIAL W HOTELlMOTEL GUEST ROOM
PHASE OF CONSTRUCTION ❑ NEW CONSTRUCTION 0 ADDITION W<TERATION ❑ UNCONDITIONED
STATEMENT OF ACCEPTANCE
This Certificate of Acoeptanoe summarizes the results of the acceptance tests related to building mechanical requirements per
Title 24, Part 6. (Sections 10-103.b, 1211, 122.h, 125.a, 125.b, 125.c, 125.c.5, 125.d)
Please check one: {
1 hereby affirm that 1 am eligible under the provisions of Division 3 of the Business and Professions Code to sign this
document as the person responsible for Ws preparation; and that I am licensed in the State of California as a civil engineer
or mechanical engineer, or I am a licensed architect.
1 affirm that I am eligible under the exemption to Division 3 of the Business and Professions Code by Section 5537.2.or
6737.3 to sign this document as the person responsible for its preparation; and that I am a licensed contractor performing:
this work.
I affirm that I am eligible under the exemption to Division 3 of the business and Professions Code to sign this document
because it pertains to a structure or type of work described pursuant to Business and Professions Code sections 5537,
5538, and 6737.1.
These sections of the Business and Professions Code are printed in full in the.Nonresidential Manual.
?torr_ At fn.rWITV _ uaelF ISIGNATURE n I JUATE LIC.#
I \�_.... �— 3 �f l Io lt'o3 2 O S Y
For Detailed instructions on the use of this and all Energy efficiency Standards acceptance forms, please refer to the
Nonresidential Manual published by the Califomia Energy Commission.
Part 1 of 2 - Statement of Acceptance
Part 2 of 2 - Summary of Acceptance Tests
2005 Nonresidential Acceptance Fors September 2005
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,jnns t_FRTIFICATE OF ACCEPTANCE (Part 2 of 2) MECH-1-A
o,NA - — - - DATE
l
1gT Ie)�te ( rj 3 A, /o 9
UMMARY OF ACCEPTANCE TESTS
SYSTEIU ACCEPTANCE DOCUMENT` g�dg, Dept: Use
TESTING AUTHOti1TY DATE OF TEST PASS 1 FAIL
6
is as necessary
2005 Nonresidential Complrence Forms
September 2005
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2005 ACCEPTANCE REQUIREMENTS FOR CODE COMPLIANCE MECH-2-A
1 Instrumentation to perform test incudes, but not limited to:
a. Watch
b. Means to measure airflow (hot wire anemometer or pilot tube)
2 Check one of the following:
O Variable Air Volume (VAV) - Check as appropriate:
a. Sensor used to control outdoor air flow must have calibration certificate or be field calibrated
O Calibration certificate (attach calibration certification)
C Feld calibration (attach results)
O Constant Air Volume (CAV) -Check as appropriate:
.0 System is designed to provide a fixed minimum OSA when the unit is on
CertMation Statement: I certify that all statements are true on this MECH-2-A form
including the PASSIFAIL Evaluation. 1 affirm I am eligible to sign this form under the provisions
described in the Statement of Acceptance on form MECH-I-A
Name. �b b-��n -ST-24 1-"S
Company: T l� $ 1� 2s • S S2rOL
Signature:
Date: 3 i /O
2005 Compliance Acceptance Forms December 2005
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PASS: All Construction Inspection responses are complete and Testing Calculations & Results responses are
❑ FAIL: Any Construction Inspection responses are incomplete OR there is one or more negative (N - no
responses in Testing Calculations & Results section. Provide explanation below. Use and attach additional
Inaaes if necessary.
2005 Compliance Acceptance Forms December 2005
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2005 ACCEPTANCE REQUIREMENTS FOR CODE COMPLIANCE MECH-3-A 1
1 Instrumentation to perform test includes, but not limited to:
a. None required
2 Inst Ilation
eT Thermostat or zone temperature sensor is located within the zone that the HVAC system serves
Thermostat or sensor is wired to the HVAC system correctly
3 Programming (check all of the following)
211Heating and cooling thermostats are capable of a 5°F deadband where cooling and hearing
at a minimum %M(b)3)
f2' Occupied, unoccupied. and holiday schedule have been programmed.
Er'�re-occupancy purge (at least lesser of minimum outside air or 3 ACH for one hour prior
t pancy) programmed (§121(c)2)
MZSand set back setpoints have been programmed as required
Certification Statement: i aertity that all statements are true on this MECH-3-A form including the PASS/FAIL Evaluation. I
affirm I am eligible to sign this form under the provisions described in the Statement of Acceptance on form MECH-1-A
Name: 3 -OS tA-s
j.
CompanytS . 22
Signature: Date:
December 2005
2005 Mechanical Acceptance Farms
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-2nru ArrVPTA1JCF RFOU1REMENTS FOR CODE COMPLIANCE MECH-3-A
-
Pack(a ediS lit HVAC Systems Acceptance Document
Form of
NJAI
I verify the following for each simulation mode requited
>upply fen operates continually
Supply fan tum s off
Supply tan cycles on and off
System reverts to "occupied mode to satisfy any condition
System turns off when manual override time period expires
Gas. fired furnace, heat pump,.or electric heater stages on
Neither heating or cooling is provided by the unit t
No heating is provided by the unit
No cooling is provided by the unit
Compressor stages on
Outside air damper is open to minimum position
Outside air damper closes completely
Svstem returned to initial operating conditions after all tests have been
C. Testing Results A B C O E F G
Indicate it Passed (P) Failed (F) or NIA (X} fit' In appropriate letter
Note: Shaded areas do not apply for particular test procedure
D. PASS I FAIL Evaluation cheek one):
0
PASS: All Construction Inspection responses are complete and all applicable Testng Results resoonses are "Passed" P
O
FAIL: Any Construction inspection responses are incomplete OR there is one or more "Failed" (F) responses in Testing es is
—.4",. rhe as Pynlanation below. Use and attach additional pages if necessary.
2005 Mechanical Acceptance Forms
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Decernber 2005
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