10-0546 (MECH)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 110-00000546
Property Address:
79253 LIGA
APN:
772 -130 -066 -
Application description:
MECHANICAL
Property Zoning:
LOW DENSITY RESIDENTIAL
Application valuation:
3400
Tiht 4 4& Q"
Applicant:Architect or Engineer:
,4�
LICENSED CONTRACTOR'S DECLARATION
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
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 �CIcense No.: 374937
Date: �% �-�- Contracfur.—�-� F- i�(//��
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, 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.).
( ) 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: T� Ilk
LQPERMIT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 6/22/10
Owner:
GIRGIS DOROTHY V
79253 LIGA
LA QUINTA, CA 92253
(
Contractor: r
PALM DESERT AIR CO
42081 BEACON HILL
PALM DESERT, CA 92 1 JUN 2 2 2 10
(760)346-0677
Lic. No.: 374937 CITYgFI,q
f�UiNTA
FIM1l.ANC F) PT.
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 SOUTHERN INS Policy Number WSIO03802-01
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
cc9J)Jply with those provisions.
Date: G Applicant:/��j•-
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, ANDSHALL
SUBJECT AN EMPLOYER TO CRIMINAUPENALTIES 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 LaQuinta, 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.
1 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
riinspection
Lpurposes.
Date: V/ 1 Signature (Applicant or Agenc,: �c ,/' J'
Application Number . . . . . 10-00000546
Permit . . • MECHANICAL
Additional desc .
Permit Fee . . . . 24.00 Plan Check Fee
6.00
Issue Date . . . . Valuation . . .
. 0
Expiration Date 12/19/10
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 ONE (1) 4.0 TON AIR CONDITIONING
--CONDENSER 1:3 ."0 0.'--"--
.•--•------------------------------------------------------------------------------
------------------------------ ----------------------------------------------
Other Fees . . . . . . . . . BLDG STDS ADMIN (SB1473)
Other
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 lee Total " 1.00 .00 .00
1.00 -
Grand Total . 31.00 .00 .00
31.00
11
LQPERMIT
0
Prescriptive Certificate of Compliance: Residential CF -1R -ALT -
Residential Alterations Page 1 of 1
Project Name: Climate Zone # of Stories
GIRGIS, DORTHY 15 1 1
General Information:
Site Address: 79-253 LIGA, LA QUINTA, CA 92253
Date
6/21/10
Enforcement Agency:
Building Type: M Single Family ❑ Multi Family
Front Orientation: ❑ N ❑ E ❑ W ❑ S
Project Type: ❑ Alteration 15 HVAC Replacement ❑ Duct Replacement ❑
Conditioned Floor Space (CFS): NOTE:
This form is not to be used for new construction or additions.
HVAC Systems — Heatin
:
Equipment Type
Capacity
AFUE
HSPF
Duct Insulation
R -Value
Thermostat
Type
Configuration (Split
or Package)
N/A
SETBACK
SPLIT
HVAC Systems — Coolin
:
Equipment Type
Capacity
SEER
EER
Pipe Insulation
R -Value
Thermostat
Type
Configuration (Split
or Package)
9)
AC CONDENSER
60,000
13.00
0.00
N/A
SET BACK
SPLIT
HERS Verification Summary:
Duct Sealing & Testing — HERS verification is required for this measure.
❑ Yes 0 No In Climate Zones 2 and 9-16, if more than 40 linear feet of new or replacement ducts are installed in unconditioned
space, the ducts are to be sealed per §152(b)1 Dii and the newly installed ducts are to be insulated per §151(f)10.
O Exception: Existing duct systems that are extended, which are constructed, insulated or sealed with asbestos.
❑ Yes 0 No In Climate Zones 2 and 9-16, if the existing space -conditioning system (HVAC equipment and ducting) is replaced,
the ducts are to be sealed per §152(b)1 Di.
L9 Yes ❑ No In Climate Zones 2 and 9-16, if the existing HVAC equipment is replaced (including the replacement of the air
handler, outdoor condensing unit of a split system, cooling or heating coil, or the furnace heat exchanger) the ducts
are to be sealed per §152(b)1 E.
❑ Exception: Duct systems that are documented to have been previously sealed confirmed through HERS
verification in accordance with procedures in the Reference Residential Appendix RA3.
D Exception: Duct systems with less than 40 linear feet in unconditioned space.
❑ Exception: Existing duct systems are constructed, insulated or sealed with asbestos.
Refrigerant Charge — Split System — HERS verification is required for this measure.
Ell Yes ❑ No In Climate Zones 2 and 8-15, when the existing HVAC equipment is replaced (including the replacement of the air
handler, outdoor condensing unit of a split system A/C or heat pump, cooling or heating coil, or the furnace heat
exchanger) a refrigerant charge measurement shall be verified per §152 b 1 F.
Central Fan Integrated (CFI) Ventilation System and Fan Watt Draw
The ventilation requirements of §150(o) do not apply to existing residential homes.
Ducted Split Systems — Air Conditioners and Heat Pumps: Airflow — HERS verification is required for this measure.
❑ Yes EI No In Climate Zones 10 through 15, when the existing space -conditioning system (HVAC equipment and ducting) is
replaced, the airflow and fan watt draw shall be verified per 152 b 1 Ci to meet the requirements of §151(f)713.
Documentation Author's Declaration Statement
I certify that this Certificate of Compliance documentation is accurate and corn lete
Name: KARL BROWN
Signature:
Company: PALM DESERT AIR CONDITIONING & HEATING COMPANY
Date: 6/21/10
Address:42-081 BEACON HILL
City, State, Zip Code: PALM DESERT, CA 92211
Phone: (760) 346-0677
Registration Number: Registration Date & Time: HERS Provider:
2008 Residential Compliance Forms PDAC January 2010
Bin #
City of La Quinta
Building 8r Safety Division
P.O. Box 1504, 78.495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit # }}
Lv�\Q
'
Project Address: 79-253 LIGA
Owner's Name: GIRGIS, DORTHY
A. P. Number:
Address: 79-253 LIGA
Legal Description:
City, ST, Zip: LA QUINTA, CA 92253
Contractor: Palm Desert Air Conditioning & Heating Com an
9 9 P Y
Address: 42081 Beacon Hill
Telephone:
Project Description:
City, ST, Zip: Palm Desert, CA 92211
EPLACE ONE 1 4.0 TON AC
760
Telephone: 346 0677
( )
4:$}r::n:J'.:?:>iiiliiiii':::>)•}$iii:i$'.'iif:'
............
CONDENSER.
State Lie. # : 374937
City Lie. #: 100886
Arch., Engr., Designer:
Address:
City., ST, Zip:
Telephone:
State Lie. #:
Name of Contact Person: KARL BROWN
Construction Type: Occupancy:
P P Y:
Project ct (circle one):
type Add'n Alter Repair Demo
Sq. Ft.: # Stories: # Units:
Telephone # of Contact Person: (760) 346-0677
Estimated Value of Project: $3,400
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Cates.
Reviewed, ready for corrections
Pian Check Deposit
Truss Cates.
Called Contact Person
Plan Check Balance
Title 24 Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2n° Review, ready for correctionsfissue
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 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