13-1594 (MECH)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
13-00001594
Property Address:
79603 POMO
APN:
772 -180 -061 -
Application description:
MECHANICAL
Property Zoning:
LOW DENSITY RESIDENTIAL
Application valuation:
2500
Applicant: Architect or Engineer:
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Zk U
:nrr- 1 0 2013
TY OF _LA QUIMT
FINANCE DEPT.
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.
Licrs!.Class: C20 LicenseNo.: 686310
k_�'
Date: 12-11D113conif/acZr:
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 therefro m 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.).
I am exempt under Sec. _, B.&P.C. for this reason
Date:
Owner:
I 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:
W/"��.RMIT
Owner:
BRONSON CJ
79603 POMO
LA QUINTA, CA 92253
(760)771-9612
Contractor:
GENERAL AIR CONDITIONING
31170 RESERVE DRIVE
THOUSAND PALMS., CA 92276
(760)343-7488
Lic. No.: 686310
VOICE (760) 777-7012
FAX (7i&0) 777-7011
INSPECTIONS (760) 777-7153
Date: 12/10/13
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
_j6 ed -
1:-S-1-haysuand will maintain workers' compensation ins6rance, 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 ZENITH INS CO Policy Number Z071741503
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 comply with those provisions.
____1
D J�t_ol 11 ' Ape ri-ant:
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 ($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 wo rk 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 construciion, and hereby authorize representatives
of th!,s,�nty to enter upon th b ntioned property for inspection purposes.
Signature�(=pplicant
Date: or Agent): LAAAJZ—
LQPERMIT
Application Number . . . . . 13-00001594
Permit . . . . . . MECHANICAL 2013
Additional desc . .
Permit Fee . . . . 35.75 Plan Check Fee
.00
Issue Date . . . . Valuation . . .
. 0
Expiration Date 6/08/14
Qty Unit Charge Per
Extension
1.00 35.7500 EA MECH FURNACE
35.75
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Special Notes and Comments
HVAC CHANGE OUT - 5 TON HVAQ CHANGE OUT
(COIL ONLY) (2008 ENERGY] CARBON
MONOXIDE ALARM(S) TO BE INSTALLED PRIOR
TO FINAL INSPECTION. 2010 CALIFORNIA
BUILDING CODES.
----------------------------------------------------------------------------
Other Fees . . . . . . . . . BLDG STDS ADMIN (SB1473)
1.00
PERMIT ISSUANCE M/P/E
90.57
PLAN CHECK, MECHANICAL
23.83, -
Fee summary, Charged Paid Credited
---------- ---------- -----------
Due
--------------- ----------
Permit Fee Total 35.75 .00 .00
35.75
Plan Check Total .00 .00 .00
.00
Other Fee Total 115.40 .00 .00
115.40
Grand Total 151.15 .00 .00
151.15
LQPERMIT
Din#
.City of La Quinta
-Building &r 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: -7 q C>
Owner's Name:
A. P. Number:
Address: -7960--%
Legal Description:
City, ST, Zip: CA (�I LZJG�3,
Contractor: Gc-y\ c_� A-;,
Telephone:
Address: -10
Project Description:
City,ST,Zip: CA q 7- ZS --:s
ov, \��j
Telephone: -7�0_ -7 -7 1— q
.......................
State Lic. # : (0 (0 10
City Lic.
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: scc:>
APPLICANT: DO NOT WRITE BELOW THIS LINE
M
Submittal
Rcq'd
Rec1d
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural CaIcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss CaIcs.
Called Contact Person
Plan Check Balance.
Title 24 CaIcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2,d Review, ready for corrections/issue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Planspicked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
3d Review, ready for corrections/issuc
Developer Impact Fee
Planning Approval
Called Contact Person,
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees
Simplified Prescriptive Certificate of Compliance: 2008 Residential HVACAlterations CF-lR-ALT-HVAC
Climate Zones 10 - 15
Site Address:
Enforcement Agency:
Date: 7ermit
79603 FOMO La Quinta, CA 92253
City of La Quinta
Dec 3. 2013
'Duct insulation
Conditioned Floor
Equipment Typel
List Minimum Efficiency2
requirement
Area
Thermostat
L] Package Unit
[3 Furnace
[3 AFUE
E3 COP
[3 R 6 (CZ 10-13)
Served by system
Setback
to Indoor Coil
[3 SEER
[I HSPF
[3 R 8 (CZ 14-15)
397.1 sf
If not already present, must be
13 Condensing Unit
[3 EER_
Q Resistance
installed)
[30ther_ 1
, -
I
1. Equipment Type: Ch;o- the equipment being installed; if more than one system, use another CF -1R -ALT -HVAC for each system.
2. Minimum Equipment Efficiencies. 13 SEER, 78% AFUE, 7.711SPF 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 tothe homeowner. At final, theinspector 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.Beginning October 1, 2010, a registered copy of the CF -111
and CF -611 shall also be on site for final inspection.
9 1.- HVAC Changeout
Required Forms -
.All HVAC Equipment
CF -611 forms: MECH-04, MECH-21-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-21-HERS and (for split systems) MECH-25-HERS
• Furnace
CF , -411 -forms: MECH-21 and (for split systems.) MECH-25
For Split Systems: Duct leakagel<:15 percent; RC, CCA :5 300 CFM/ton (Minimum Air Flow Requirement), TMAH
For. Par.16aged Uni M.-19
pereeRt
Exempted from duct leakage testing"..1f
bl."Duct% system iWi s documeikied to have been previously sealed and confirmed through HERS verification, or
0 2. Duct systems with less th A'A',40.1inear feet in unconditioned space, or
0 3. Existing duct systems are, 4structed, insulated or sealed with asbestos
O.A. Th��T, not be Duet6d1ie,;',,., ni7 T. r:ge)
�p
El 2. Nejn�S
.. ..... ... .
Requil�,, 0.6
IM,
Cut inr' KtAlibrigeout
new
:CH -04,
ducunq.�,and all new.
R.-
equip _1V
For Sp fit's V01ems'C,:.,.
.0 MS an ei e
Forfackagied nift: Duct
leiaka,
113. New--Ducts`-"�With/or
Required Forms:
Includes replacing or iriltt:alling a - It r i ew
ducting and/or outdoor condens-itig.,unit
CF -6R forms: MECH-04, MECH.-20-HERS, and (for split systems) MECH-25-HERS
and/or indoor coil and/or hirnac`:e:`:�':':'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 a- 300 CFM/ton, TMAH
For Packaged Units: Duct leakage < 6 percent
13 4. New Ducting over 40 feet
Required Forms:
Includes adding or replacing more than 40
CF -6R forms: MECH-04, MECH-21-HERS
I
linear feet of duct in unconditioned space.
CF -411 forms: MECH-21
For split system or packaged units: Duct leakage < 15 percent
. [3 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 informatio , n documented on other applicable compliance
forms, worksheets, calculations, plans and specifications submitted to the enforcement agency for approval with the permit application.
Name: Dayana Valdez ISignature: boyana Valdez
Company: HARRISON ENTERPRISES INC dba GENERAL AIR CONDITIONING Date: Dec 3, 2013
Address: 31-170 RESERVE DRIVE STE A License: 686310
,City/State/Zip: THOUSAND PALMS / CA / 92276 Phone: (760) 343-7488
Reg: 213-AO090289A-000000000-0000 Registration Date/Time: '2013/12/03 15:-08:22
.2008 Residential Compliance Forms
HERS Provider: CalCERTS, Inc.
July 2010
I
I