11-0466 (MECH)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: C-11-00000466\_1
Property Address: 1'--78001—LAGO-DR
APN: 658-270-001-1 -3941 -
Application description: MECHANICAL
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 5778
c&t!t-4,40"
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
BLANDA GEORGE F
78001 LAGO DRIVE
LA QUI NTA, CA 92253
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 5/05/11
Contractor: �i9r ^
Applicant: Architect or Engineer: PREEFERRREDPLUMB G HT A� C 1✓,
P5�
PALM SPRINGS, 9226
(760)322-3173
aq a
Lic. No:: 457554
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LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury that I am 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 Busines nd Professionals Code, and my License is in full force and effect. _ I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided
License Class: CIO C16 C2 is N .: 457554 for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
issued.
Date: (�,) 7 ontractor: 1 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
OW ER- UILDER DECLARATION insurance carrier and policy number are:
I hereby affirm under penalty of perjury that 1 a mpt from the Contractor's State License Law for the Carrier EVEREST NATL Policy Number 7600006445111
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 ork 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 as to be a subject to the worke s' 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 and agree that, if I should beco subject to�m " 'kers' mp nsation provisions of Section
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or 3700 of the Labor Code, I sh forthwit gdmply ith o p visions.
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).: Kate: L% plicant:
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 WARNING: AILURE TO SECURE WORKERS' COMPENS TION 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 AN 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 offered 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.l.
(_ 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 contractorls) 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: SIX
Lender's Address: ! `
I:QPERMIT
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 ouinta, 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. gree to comply with all
city and county ordinances and state laws relating to buildin onstruction, and hereb a honze representatives
of thi§ county o enter upon the above-mentioned property, inspection
bat/e:��Sl� �'gI a�ture (Applicant or Agent): –
LQPERN11T
Application Number . . . . . 11-00000466
Permit . . .. MECHANICAL
Additional desc .
Permit Fee . . . . 40.50 Plan Check Fee
10.13
Issue Date . . . . Valuation . . . .
0
Expiration Date 11/01/11
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 EXISTING FURNACE (80o AFUE), AC
& COIL, 13 SEER. 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
LQPERN11T
Sim lifted Prescriptive Certificate of Compliance: 2008 Residential HVAC Alterations CF -IR -ALT -HVAC
Climate Zones 10 to 15
Site �- Addre s:
�v � t_,/�Ga 2..
Enforcement Agency:
L!� v � ►-�
Date:
pis" zv ll
Permit #:
Conditioned Floor
Equipment T el
List Minimum Efficiency,
Duct insulation requirement
Area
Thermostat
❑ ackaged Unit
Furnace
_�_�
®'AFUE �
11 COP
Over 40 ft of ducts added or
Se ack
��
L�Indoor Coil
GIBEER I
❑ HSPF
replaced in unconditioned space
Served by system
(If not already
Condensing Unit
❑ EER ��
❑ Resistance
❑ R 6 (CZ 10-13)2
sf
present, must be
❑ Other
❑ R 8 (CZ 14-15)
installed)
1. Equipment Type: Choose the equipment being installed; if more than one system, use another CF-/R-ALT-HVACjor 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.Xeginning October 1, 2010, a registered copy of the CF -111 and CF -6R shall also be on site for final inspection.
. HVAC Changeout
Required Forms:
• All HVAC Equipment replaced
CF -6R forms: MECH-04, MECH-2I-HERS and (for split systems) MECH- 25 -HERS
CF -4R forms: MECH- 21 and fors lits stems MECH-25
• Condenser Coil and /or
CF -6R forms: MECH-2I-HERS and (for split systems) MECH- 25 -HERS
• Indoor Coil and/or
CF -4R forms: MECH- 21 and (for split systems) MECH-25
• Furnace
For Split Systems: Duct leakage < 15 percent; RC, CCA > 300 CFM/ton(Minimum Air Flow Requirement), TMAH
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
❑ 2. Duct systems with less than 40 linear feet in unconditioned space, or
❑ 3. Existing ducts stems are constructed, insulated or sealed with asbestos
❑ 2. New HVAC System
Required Forms:
• Cut in or Changeout with new
CF -6R forms: MECH-04, MECH-20-HERS,and (for split systems) MECH-22-HERS, and MECH-25-HERS
ducts: (all new ducting and all
CF4R forms: MECH 20-, and (for split systems)MECH-22, and MECH 25
new equipment)
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 Replacement Required Forms:
• Includes replacing or installing all new ducting CF -6R forms: MECH-04, MECH-20-HERS,and (for split systems) MECH-25-HERS
and/or outdoor condensing unit and/or indoor CF -4R forms: MECH-20 and (for split systems) MECH-25
coil and/or furnace. Not all 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 CF -4R forms: MECH-21
linear feet of duct in unconditioned space.
For split system or packaged units: Duct leakage < 15 percent
❑ EXCEPTION: Existing ducts stems 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 andspecifications submitted to the enforcement agency for approval with the permit application.
Name:`�O nlr
Signature:
Company Date:
1' RE!I, ZWD ��It ��t��i �% c� ( ,0^' 5/ZW l�
Address: 5 l 5- 5 U r \ A t, / D wgg License: / r _ 7-7 ! �, /
City/State/Zip: Sp "S Phone: 16& •- 322
2008 Residential Compliance Forms March 2010
Bin #
City of La Quints
Building 8i Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
'Building Permit Application and Tracking Sheet
Permit #
Project Address:' J&)21 I,_A66 bk,
Owner's Namd: gET r L",O A
A. P. Number:
Address: ':� qool L 460 A if—
f—Legal
LegalDescription:
City, ST, Zip: L>� ( U1 A' r� 5'�
Preferred Air Conditioning dba
Contractor: P r e f e r r e d Plumbing. Heatin &A'i
Telephone:
Address:-PO Box 5120
Project Description: es C 5T-/n)
City,ST,Zip:pa•lm Springs, CA -92263
e.
Telephone: ( 760 ) 3 2 2.'3173
ro 9. L j ILY, 6 j20 Aj to Q t
State Lie. # : 4 5 7 5 54City Lic. #':
Arch., Eilgn, Designer.
j�
Address:
City, ST, Zip:
Telephone:
State Lie. #:
Name of Contact Person:
Construction Type: Occupancy:
Project type (circle one): New A.dd'n Alter Repair Demo
Sq. Ft.: '' # Stories:#Units:
Telephone # of Contact Person:
Estimated Value of Project: . b�
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd Recd
TRACKING ;
PERMIT FEES
Plan Sets
Plan Check submitted
Iten
Amount
Structural Calcs.
Reviewed, ready for corrections
Plai Check Deposit
Truss Calcs.
Called Contact Person
PlaT Check Balance
Energy Calcs.
Plans Ricked up
Con itruction
"
Flood plain plan
Plans.resubmitted
Mee Innical
Grading.plan'
2nd Review, ready foc correetlousfissue
Ele deal
Subcontactor List
Called Contact Perjon
Plu bing
Grant Deed
Plans picked up
S.M I.
H.O.A. Approval
Plans resubmitted
Gra ing
IN HOUSE:-
''d Review, ready for corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I..P.
Pub. Wks. Appr
Date or permit issue
school Fees '
T.tj Permit Fees