12-0879 (MECH)In
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:1.g2 0"0000.8-7-9!Il!!=—
Property Address: 79253 LIGA
APN: 772 -130 -066 -
Application description: MECHANICAL
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 3521
T4&t 4 XP Q"
Applicant: Architect or Engineer:
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.
Licens�AeyClass: C20 Li a No.: 374937
/Date:-ontractb7 --�E
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, 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.).
(_ 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:
Lender's Address: A
LQPERMIT
Owner:
GIRGIS DOROTHY V
C/O TAWFIK F GIRGIS
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 8/07/12
60521n Contractor: 20112 Ili �(
PALM DESERT AIR COND CO I C
42081 BEACON HILL CITY AFLAQuINTA
PALM DESERT, CA 92211 EPT
(760)346-0677
LiC. No.: 374937
-----------------------------------------------
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 MID CENTURY Policy Number A09454905-12
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 ply with those provisions.
ate( /1 [iLplicanf:—��
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 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 ",county ordinances and state laws relating to building construction, and hereby authorize representatives
7s county to enter upon t above-mentioned property for inspectio poses.
l`
Date: 0 7 L S' ature (Applicant or Agent�
LQPERMIT '
Application Number . . . . . 12=00000879
Permit . . . MECHANICAL
Additional desc . .
Permit Fee 31.50 Plan Check Fee
7.88
Issue Date . . . . Valuation . . . ..
0
Expiration Date.. 2/03/13
Qty Unit Charge Per
Extension
BASE FEE
15.00
1.00 16.5000 EA MECH B/C >3-15HP/>100K-500KBTU
16.50
---------------------------------------------------------------------------
Special Notes and Comments
REPLACE (1) AIR CONDITIONING CONDENSER.
2010 CODES.
-----------------------------------------=--------------------------------=-
Other Fees . . . . . . . . . BLDG STDS ADMIN (SB1473)
1.00
Fee summary Charged Paid Credited
Due
Permit Fee Total 31.50 .00 .00
31.50
Plan Check Total 7.88 .00 .00
7.88
Other Fee Total 1.00 .00 .00
1.00
Grand Total 40.38 .00 .00
40.38
Simplified Prescriptive Certificate of Compliance: 2008 Residential HVAC Alterations CF-lR-ALT-HVAC
Climate Zones 10 - 15
Site Address:
Enforcement Agency:
Date:Permit
#:
79-253 LIGA La Quinta, CA 92253
City of La Quinta
Aug 6, 2012
Equipment Typel
List Minimum Efficiency2
Duct insulation
requirement
Conditioned Floor
Area
Thermostat
❑ Package Unit
❑ Furnace
❑ Indoor Coil
❑ AFUE
p SEER 13.0
—
❑ COP
❑ HSPF
❑ R 6 (CZ 10-13)
❑ R 8 (CZ 14-15)
Served by system
1600 sf
p Setback
If not already present, must be
8 Condensing Unit
[3EER
❑ Resistance
installed)
❑ Other
1. Equipment Type: Choose the equipment being installed; if more than one system, use another CF -IR -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 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 -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 -6R shall also be on site for final inspection.
D 1. HVAC Changeout
Required Forms:
• All HVAC 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 and (for split systems) MECH-25
For Split Systems: Duct leakage < 15 percent; RC, CCA 5 300 CFM/ton (Minimum Air Flow Requirement), TMAH
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 duct systems are constructed, insulated or sealed with asbestos
04. The system.w,ill not be Ducted (ie.,,Ductless.mini -Split S_ystem),(Also -Exempt :from, Refrigerant Charge)
❑ 2. New HVAC System
Required Forms:
. Cut in�or Changeout with,,
new ducts: (all new/'°
' R 'y y C f j
CF -6R forms: MECH-04, MECH-20;HERS, and (for split systems) MECH-22=HERS, and
ductingn all ne
MECH-25 HERS i j '� ' y �'
CF 4R forms: MECH-20, and (for split systems) MECH-22, and MECH-25
-�
equipment)
For Split Systems: Duct leakage <•6,percent; RC; CCA•>_t350 CFM/ton; FWD, TMAH, SIMS, and either HSPP or PSPP,
For Packaged Units: Duct leakagei< 6 percent
❑ 3. New -Ducts with/or without
Required Forms:
Replacement
. Includes replacing or installing all new
ducting and/or outdoor condensing unit
CF -6R forms: MECH-04, MECH-20-HERS, and (for split systems) MECH-25-HERS
and/or indoor coil and/or furnace. No or some
CF -4R forms: MECH-20 and (for split systems) MECH-25
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
linear feet of duct in unconditioned space.
CF -4R forms: MECH-21
For split system or packaged units: Duct leakage < 15 percent
❑ EXCEPTION: Existing duct systems 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 and specifications submitted to the enforcement agency for approval with the permit application.
Name: Karl Brown Signature: Karl Brown
Company: PALM DESERT AIR CONDITIONING CO INC Date: Aug 6, 2012
Address: 42-081 BEACON HILL License: 374937
City/State/Zip: PALM DESERT / CA / 92211 Phone: (760) 346-0677
Ek eg: 212-A0042361A-00000000-0000 Registration Date/Time: 2012/08/06 14:48:57 HERS Provider: Ca_1C_ERTS, Inc.
-2008-Residential-Compliance Form -f, _ July 2010
�W a�WTNW
—GEM fal DFSERT —
-
. T4,91v44a"
P.O. Box 1504. 78-495 Calle Tampico, • La Quinta, California 92211
Tel: (760) 777-7012 • Fax: (760) 777-7112
Website: www.La-Quinta.Org • Email: Building@La-Quinta.Org
Bin #: JPermit#:/;b1q Building Permit Application & Tracking Sheet
Project Address: 79-253 LIGA
Owner's Name: GIRGIS, DOROTHY
A.P. Number:
Address: 79-253 LIGA
Legal Description:
City, State, Zip: LA QUINTA, CA 92253
Contractor: Palm Desert Air Conditioning & Heating Company
Telephone: (
Address: 42-081 Beacon Hill
Project Description:
City, State, Zip: Palm Desert, CA 92211
REPLACE (1) AIR CONDITIONING CONDENSER.
Telephone No.: (760) 346-0677
State: Lic. #: 374937
City Lic. #: 100886
Arch./Engr./Designer:
Address:
City, State, Zip:
Telephone No::
Construction Type:
Occupancy:
State: Lic. #:
Project Type: 0 New • ® Add'n • O Alter • 0 Repair • 0 Demo
Name of Contact Person: KARL BROWN
Sq. Ft.:
# Stories:
# Units:
Contact Telephone No.: (760) 346-0677
Estimated Value of Project: $3,521.00
APPLICANT:
DO NOT WRITE
BELOW THIS LINE
#
Submittal
Req'd
Recd
Tracking
Permit Fee's
Plan Sets
Plan Check Submitted
Item
Amount
Structural Calcs.
Reviewed, Ready for Corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance
Title 24 Calcs.
Plans Picked Up
Construction
Flood Plain Plan
Plans Resubmitted
Mechanical
Grading Plan
2nd Review, Ready for Corrections
Electrical
Subcontractor List
Called Contact Person
Plumbing
Grant Deed
Plans Picked Up
S.M.I.
H.O.A. Approval
Plans Resubmitted
Grading
IN HOUSE
3n' Review, Ready for Corrections
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Works Appel
Date of Permit Issue
School Fees
Total Permit Fee's