14-0893 (MECH)4 •,� P.O. BOX 1504 ^' VOICE (760) 777-7012
78-495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 6/19/14
Application Number: 14-00000893 Owner: O
Property Address: 79815 LIGA DONS ZIEMBA
APN: 772-230-047- - - 79815 LIGA
Application description: MECHANICAL LA QUINTA, CA 92253
Property Zoning: LOW DENSITY RESIDENTIAL ( Q
Application Valuation: 29699
Contractor.
Applicant: Architect or Engineer: RIGHTIME AIR CONDITIONING AND
3030 MYERS STREET
RIVERSIDE, 92503
(951)276-974444
Lic. No.: 878533 .
--------------- -
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 C e, and my License is in full force and effect.
License Class: C20 nseNo.: 878533
Date• Contractor
V
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 1$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 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—) 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
-----------------------------------------------
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.
1-gove and will maintain workers' compensation insurance, as required by Section 3700 of the Labor
e, for the performance of the work for which this permit is issued. My workers' compensation
insurance carrier and policy number are:
Carrier INS CO OF WEST Policy Number WVE502266101
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
37,001 of the Labor Code, I shall fa with comply with those provisions.
Date: C 1—. t pplicant:
WARNING: FAILURE TO SECURE WORKERS' CQPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL 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 construction, and hereby authorize representatives
of this county to enter upon the above-mentioned property for inspection purpose
Date: to —�Q- Signature (Applicant or Agent):
Application Number . . . . . 14-00000893
Permit . . . MECHANICAL 2013
Additional desc .
Permit Fee . . . . 166.84 Plan Check Fee
.00
Issue Date . . . - Valuation . . .
. 0
Expiration Date 12/16/14
Qty Unit Charge Per
Extension
2.00 35.7500 EA- MECH FURNACE
71.50
2.00 11.9200 EA MECH APPL REP/ALT
23.84
2.00 35.7500 EA MECH CONDENSER/COMP
71.50
----------------------------------------------------- -----------------------
Special Notes and Comments
HVAC CHANGE OUT - (2) 16SEER/80AFUE
SPLIT SYSTEM [2008 ENERGY) CARBON
MONOXIDE ALARM(S) TO BE INSTALLED PRIOR
TO FINAL INSPECTION. 2013 CALIFORNIA
BUILDING CODES.
----------------------------------------------------------------------------
Other Fees . . . . . . . . . PERMIT ISSUANCE M/P/E
90.57
PLAN CHECK, MECHANICAL
119.16
Fee summary Charged Paid Credited
---------------------------------------------------------
Due
Permit Fee Total 166.84 .00 .00
166.84
Plan Check Total .00 .00 .00
.00
Other Fee Total 209.73 .00 .00
209.73
Grand Total 376.57 .00 .00
376.57.
LQPERMIT
Simplified Prescriptive Certificate of Compliance: 2008 Residential RVA C Alterations CF -IR -ALT -HVAC
Climate Zones 10 to 15
Site Address:
Enforcement Agency:
Date. 6-19-14
Permit#:
Conditioned Floor
Equipment Type'
List Minimum Efficiency2Duct
insulation requirement
Area
Thermostat
Packaged Unit
Furnace
AFUEe
�EER112
❑ COP
Over 40 ft of ducts added oretback
re laced in unconditioned space
Served by system
(isnot already
Indoor Coil
HSPF
(R 6 (CZ 10-13)
i� sf
present, must be
Condensing Unit
[JEER®Resistance
ILII❑JJJJ R 8 (CZ 14-15)
installed)
Other
I. Equipment Type: Choose the equipment being installed, • if more than one system, use another CF -IR -ALT -HVAC jor each system.
2. Minimum Equipment Efficiencies. 13 SEER, 78% AFUE, 7.7HSPF jor 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 fortes 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 -611 and registered CF4R forms (no hand filled CF4Rs allowed) are filled out and
signed. Beginning October 1 2010 a registered copy of the CF -1R and CF -611 shall also be on site for final Inspection.
1. 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 lit stems MECH-25
• Condenser Coil and /or
an
• Indoor Coil and
CF -6R forms: MECH-2I-HERS and (for split systems) MECH- 25 -HERS
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
132. New HVAC System
Required Forms:
• Cut in or Changeout with new,
ducts: (all new ducting and all
CF -6R forms: MECH-04, MECH-20-HERS,and (for split systems) MECH-22-HERS, and MECH-25-HERS
new equipment)
CF -4R forms: MECH 20-, and (for split systems)MECH-22, and MECH 25
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/or without 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 coil
CF4R forms: MECH-20 and (for split systems) MECH-25
and/or furnace. No or some 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
�Re uired Forms:
• Includes adding or replacing more than 40
linear feet of duct in unconditioned space.
6R forms: MECH-04, MECH-2I-HERS CF -4R forms: MECH-21
For splits stem 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)
• 1 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 tans and specifications submitted to the enforcement age forapproval with the permit application.
Name:.Jane Recktenwald
Signature:
Company`Venvest Ballard Inc., DBA Rightime Air
e'6-19-2014
Address:
Myers Street
License:
Lieens. 878533
City/State/Zip:Riverside, CA 92503
Phone: 951-276-9744
.nun .`oo.nonnn/ r Knrmo kr^n •t, inin
Simplified Prescriptive Certificate of Compliance: 2008 Residential HVAC Alterations CF -IR -ALT -HVAC
Climate Zones 10 to IS
MIN
Site Address:
Enforcement Agency:
Date: 6-19-14
Permit #.
Conditioned Floor
Equipment Typel
List Minimum Efficiency,
Duct insulation requirement
Area
Thermostat
Unit
Furnace
fAFUE2 o
❑ COP
Over 40 ft of ducts added or
re laced in
Served by
12setback
IPackaged
Indoor Coil
EERL�
® HSPF
unconditioned space
R 6 (CZ 10-13)_
system
sf
(If not already
present, must be
Condensing Unit
❑ EER
Resistance
Other
R 8 (CZ 14-15)
irutalled)
,.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, 7.7HSPFfor 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 -611 and registered CFVR forms (no hand filled CF4Rs allowed) are filled out and
signed. Beginning October 1 2010 a registered copy of the CF -1R and CF -611 shall also be on site for final inspection.
[31. HVAC Changeout
Required Forms:
• All HVAC Equipment replaced
CF-611forms: MECH-04, MECH-2I-HERS and (for split systems) MECH- 25 -HERS
CF -4R forms: MECH- 21 and fors lit stems MECH-25
• Condenser Coil and /or
• Indoor Coil and/or
CF -6R forms: 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 >_ 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
13 2. New HVAC System
Required Forms:
• Cut in or Changeout with new
ducts: (all new ducting and all
CF -611 forms: MECH-04, MECH-20-HERS,and (for split systems) MECH-22-HERS, and MECH-25-HERS
new equipment)
CF4R forms: MECH 20-, and (for split systems)MECH-22, and MECH 25
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/or without 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 coil
CF4R forms: MECH-20 and (for split systems) MECH-25
and/or furnace. No or some equipment changed.
For Split Systems: Duct leakage < 6 percent, RC, CCA> 300 CFM/ton, TMAH
For Packaged Units: Duct leakage < 6 percent
El 4. New Ducting over 40 feet
Required Forms:
• Includes adding or replacing more than 40
linear feet of duct in unconditioned s ace.
CF -6R forms: MECH-04, MECH-2I-HERS CF -4R forms: MECH-21
For splits stem 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)
• 1 certify that this Certificate of Compliance documentation is accurate and complete.
• 1 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 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,
calculationsplans and specifications submitted to the enforcement a enc roval with the permit application.
Name:Jane Recktenwald
gnature:
T
°mpany'Venvest Ballard Inc., DBA Rightime Air
e'6-19-2014
7ddress:3030 Myers Street
License: 878533
City/State/Zip:Riverside, CA 92503
Phone:951-276-9744
7fInR Rocidvnitnl rU,-0 ,-o Rnrme l,f~eh Mln
Din #
Permit #
A
Project Address: g C.
City of La - Quinta
' Building 8t Safety Division
P.O. Box 1504, 78-495 Calle Tampico .
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and TrackingSheet
Owner's Name:
A. P. Number „ _ �
Address: S
Legal Description:
City, ST, zip: jt q53
Contractor:
Telephone:
Address: p S
Project Description:
City, ST, Zip:IM
Telephone: •'1(a —SIN'
S
State Lic. # :
FcityLic-fl, 'j
. 5
Arch., Engr., Designer ly
Address:
2
City., ST, Zip:
tJ
Telephone:
State Lir #:
Name of Contact Person:
Construction type: Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
Sq. Ft.: # Stories: # Units:
Telephone #.of Contact Person:
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
tl
Submittal
Req'd
Recd
TRACMG
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Cities.Reviewed,
ready for corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person
Plan Cheek Balance
Title 24 Calcs.
Plans pickid up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2'! Review, ready for correctionslissue
Electrical
Subeontactor List
Called Contact Person
Plumbing
Grant Deed
Pians picked up
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
int Review, ready for eorrecilonsfissue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Feu
Total Permit Fees