09-0710 (MECH)4/
P.O. BOX 1504 4
78-495 CALLE TAMPICO
LA QUINTA,. CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
("Application Number: 09-0000071'0 7 Owner:
`Property Address:-- -_--79895-LIGA" ANDERSON RESIDENCE
APN: 772-230-039- - - 79895 LIGA
Application description: MECHANICAL LA QUINTA, CA 92253
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 14450
Contractor:
Applicant: Architect or Engineer: PREFERRED PLUMBING HT
P.O. BOX 5120
�t PALM SPRINGS, CA 9226
(760) 322-3173
VVV LiC. No.: 457554
NAN
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 pd Professionals Code, and my License is in full force and effect.
License Class: C10 C16 C2 Li se 457554
Date: Q % O Contractor: _
NER-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$5001:
(_ 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 hot build or
improve for the purpose of sale.).
1 _ 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.).
( 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:
LQPERMIT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 7/07/09
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 DELOS INS CO Policy Number 02DKRM12002143
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 ecomeect toorkers' compensation provisions of Section
3700 of the Labor Cod shal orthw h y ith those rovisions.
,qq
Date fl% Applicant:i
C L- -_
WARNING: FAILURE TO SECURE WIOR RS' OMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL EN TIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS ($100,000). IN ADDITION TO 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 1 have read this application and state that the above information is correct. I i ree to comply with all
city and county ordinances and state laws relating to building o struction, a ereb u ori representatives
of this county to enter upon the above-mentioned property f r __peion p rpo es
Oate:d Signature (Applicant oror Agentl"
LQPERMIT
Application Number . . . . . 09-00000710
Permit . . . MECHANICAL
Additional desc .
Permit Fee . . . . 33.00
Plan Check Fee
8.25
Issue Date . . . .
Valuation . . .
. 0
Expiration Date 1/03/10
Qty Unit Charge Per
Extension
BASE
FEE
15.00
2.00 9.0000 EA MECH
----------------------------------------------------------------------------
FURNACE <=100K
18.00
Permit . . . MECHANICAL
Additional desc .
Permit Fee . . . . 24.00
Plan Check Fee
6.00
Issue Date . . . .
Valuation . . .
. 0
Expiration Date 1/03/10
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 2 A/C GROUND UNITS 5 TON
Fee summary Charged
-------------------------------------
Paid Credited
--------------------
Due
Permit Fee Total 57.00
.00 .00
57.00
Plan Check Total 14.2.5
.00 .00
14.25
Grand Total 71.25
.00 .00
71.25
LQPERMIT
CERTIFICATE OF COMPLIANCE: RESIDENTIAL (Page 1 of 1) CF -1R -A
ProjectTitle
14 0 / g Q
Date
Building Permit #
Project Address
Documentation Author
Telephone
Plan Check / Date
Existing duct systems that are extended, which are constructed, insulated or sealed with asbestos?
3'1
❑
Field.Check/ Date. .
Compliance Method (Prescriptive — HVAC and/
Climate Zone
Enforcement Agency Use Only
or Duct System Alteration - § 152(b)1C, D, and E)
High EER
HVAC SYSTEMS
Heating Equipment Type
and Capacity (furnace, heat
pump, boiler, etc.
Minimum
Efficiency
(AFUE or HSPF)
Distribution Type
and Location (ducts,
attic, etc.
Duct or Piping
Insulation
R Value
Thermostat Type Configuration
(setback) (split or package)
(split or package)
pump, evap cooling) (SEER or EER)
❑
Existing duct systems that are extended, which are constructed, insulated or sealed with asbestos?
3
❑
Duct systems with less than 40 linear feet of ducts in unconditioned space.
.®'
Refrigerant Charge
CF -.61Z pages 3, 5 and 6 of 12
CF -411 pages 3 and 4 of 8
High EER
CF -6R pages 3 and 8 of 12
CF -411 page 5 of 8
Cooling Equipment Type Minimum Duct Location Duct Insulation
Thermostat Type
Configuration
and Capacity (A/C, heat Efficiency (attic, etc.) R -Value
(setback)
(split or package)
pump, evap cooling) (SEER or EER)
❑
Existing duct systems that are extended, which are constructed, insulated or sealed with asbestos?
3
❑
Duct systems with less than 40 linear feet of ducts in unconditioned space.
.®'
Refrigerant Charge
CF -.61Z pages 3, 5 and 6 of 12
SEALED DUCTS, REFRIGERANT CHARGE (TXV) AND EER
Before the permit can be finalized, a signed CF -6R Form and CF -411 Form must be provided to the building department for any of the
foil ing compliance requirements that are ✓
✓ Compliance Requirements
Sealed Ducts (Climate Zones 2 and 9-16) - Installer testing and HERS Rater field verification required
TXV (Climate Zones 2 and 8-15) - Installer testing and HERS Rater field verification required'
❑ Refrigerant Charge (Climate Zones 2 and 8-15) - Installer testing and HERS Rater field verification required'
❑ ALTERNTAVE to Duct Testing: High EER as indicated in Table 8-3 of the Residential Compliance Manual (SEE Table 8-3 for
additional requirements and available Compliance Options) - Installer testing and HERS Rater field verification re uired
' The prescriptive requirement for either a refrigerant charge or a TXV does not apply to packaged units.
EXCEPTIONS
rf anu of rhe fnllnwino three eXcentions are ✓_ the duct system is exempt from sealed ducts
#
✓
Exceptions
1
❑
Duct systems that are documented to have been previously sealed as confirmed through field verification and diagnostic
testing in accordance with procedures in the Residential ACM Manual.
2
❑
Existing duct systems that are extended, which are constructed, insulated or sealed with asbestos?
3
❑
Duct systems with less than 40 linear feet of ducts in unconditioned space.
Z Duct alterations are exempt from duct sealing ONLY if they meet Exception 2 above.
SPECIAL FEATURES REQUIRING HERS RATING VERIFICATION
A ✓ indiratea which cmmpliance requirements are nart of this nroiect and need HERS rater verification
✓
Compliance Requirements
Installer Forms (inapplicable)
HERS Rater Forms (if applicable)
❑
Duct Sealing
CF -611 pages 3 and 4 of 12
CF -4R page 1 of 8
[R
Thermostatic Expansion Valve (TXV)
CF -611 pages 3 and 5 of 12
CF -411 page 3 of 8
.®'
Refrigerant Charge
CF -.61Z pages 3, 5 and 6 of 12
CF -411 pages 3 and 4 of 8
High EER
CF -6R pages 3 and 8 of 12
CF -411 page 5 of 8
*July 2008
Bi" #
City of La QU'inta
Building U Safety Division
P.O. Box 1504, 78-495 Calle Tampico
fa Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
Project Address:'
Owner's Name:%X��V
A. P. Number:
Address: �G
Legal Description:
r coferred Air Conditioning db
Contractor: a
Preferred Plumbin Heatin &Ai
City, ST, Zip: J09aVIA
Telephone: -
Address: PO Box 5120
Project Description:
City, ST, Zip:paIrn Springs, CA' 92263
Telephone: ( 7 6 0) 322-'3173
T0�
State Lic. # : 45755-4
City Lic. #: ao� 0� 9
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone:
Construction Type: Occupancy:
State Lic. #:
Project type (circle one): New Add'n Alter Repair Demo
Name of Contact Person:
Sq. Ft.:
# Stories:
# Units:
Telephone # of Contact Person:
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACKING •
PERMIT FEES
Plan Sets
Plan Check submitted
Ite
Amount
Structural Calcs.
Reviewed, ready for corrections
Pla Check Deposit
Truss Calcs.
Called Contact Person
Plar Check Balance
Energy Calcs.
Plans picked up
Con truction
Floodplain plan
Plans -resubmitted
Mechanical'
Grading.plaw
2n1 Review, ready foi•'correctionsfissue
Ele rival
Subcontactor List
Called Contact Person
Plu bang
Grant Deed
Plans picked up
S.M I.
H.O.A. Approval
Plans resubmitted
Gra ling
IN HOUSE:-
''d Review, ready for correctionsrissue
Deyi toper Impact Fee
Planning Approval
Called Contact Person
A.I..P.
Pub. Wks. Appr
Date of permit issue
School Fees '
Total Permit Fees