12-0790 (MECH)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
12-00000079,_d=
Property Address:
79613 POMO
APN:
772 -180 -060 -
Application description:
MECHANICAL
Property Zoning:
LOW DENSITY RESIDENTIAL
Application valuation:
6085
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
MARY STRITMATTER
79613 POMO
LA QUINTA, CA 92253
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 7/17/12
Contractor: ✓U4
1
Applicant: Architect or Engineer: PALM DESERT AIR COND O
42081 BEACON HILL
PALM DESERT, CA 92211 iH yc�Qoi
(760)346-0677 p�pNTq
LiC. 'No.: 374937
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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.
Lic
ense Class: C20 y� enseNo.: 374937
e: 1 / Contractor:`Z�r
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 acivil penalty of not more than five hundred dollars (5500).:
(_) 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: A
Lender's Address: r
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. '
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 Ishould become subject to the workers' compensation provisions of Section
3700 of the Labor Code, I shall forrthwith/c/o/c�tv with those provisions.
ate:% 7 :Z�plicant:--�` g i��
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 work being
r 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 hereb thorize representatives
of t is county to enter.up n the above-mentioned property for ins�peecctionnnpurposes
at. _L 7 :. ignature (Applicant or Agent):
Application Number . . . . . 12-00000790
Permit . . . MECHANICAL
Additional desc .
Permit Fee . . . . 40.50. Plan Check Fee
10.13
Issue Date . .". . Valuation . . . .
0
Expiration Date 1/13/13
Qty Unit Charge Per,
Extension
BASE FEE
15.00
1.00 9.0000 EA MECH FURNACE <=100K
9.00
1.00 16.5000 EA MECH B/C >3"-15HP/>100K-500KBTU
16.50
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Special Notes and Comments
HVAC CHANGE -OUT: REPLACE (1) AIR
CONDTTIONING SPLIT SYSTEM. 20 0.CODES.
----------------- _------------------------- -
Other Fees BLDG STDS ADMIN (SB1473),
1-00
Fee summary Charged Paid Credited
Due"
Permit 'Fee Total' 140:50 :.00 .0,0
40.50
Plan Check Total 10.13 00 .00
10.13
Other Fee Total 1.00 .00 .00
1.00
Grand Total 51.63 00 00
51:63
LQPERMIT
Simplified Prescriptive Certificate of Compliance: 2008 Residential HVAC Alterations CF-IR-ALT-HVAC
Climate Zones 10 - 15 - A -
Site Address: '
Enforcement Agency:
Date:
7
Permit #:
79-613 POMO La Quinta, CA 92253
City of La Quinta
Jul 17, 2012
-
Duct insulation
Conditioned Floor
Equipment Type1
List Minimum Efficiency2
requirement
Area
Thermostat
❑ Package Unit
p Furnace
p Indoor Coil
•[a AFUE 78%
[3 SEER 13.0
❑ COP,
❑ HSPF
❑ R 6 (CZ 10-13)
Served by system
0 Setback
If not already present, must be
p Condensing Unit
❑ EER
❑ Resistance
❑ R 8 (CZ 14-15) '
1400 sf
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-611 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-1R
and CF-6R shall also be on site for final inspection.
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-6R 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 <_ 300 CFM/ton (Minimum Air Flow Requirement), TMAH
..t
FGF Packaged Units, Duct leakage ".; 15
p
Exempted from duct leakage testing if:.
[j-l'.-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
0'4. The -system will not be Ducted:(ie: Ductless,r ini-Split_System)A( lso�Exempt4rom�Refrigera ntCharge)
112. New:HVAC System
Required-
. Cut moor Changeout with
new ducts,(all new :
ducting ..
,a.*r
CF 6R formsiMECH-04, MECH-20 HERS * anflfor, split systems) MECHti22 HERS, and -
MECH 25'HERS °' {
a 1 ie tir s r k �x
all new +-
CF=4R forms.IMECH 20, and°(for split systems) MECH-22, and MECH=25 ' -e
equipment)' .,
d�# n�= *►u:. `ti .. � ., 1;a. r. J rx A.
For Split Systems:;Duct leakage, <i6'percent RC -CCAiz+350 CFM/ton; FWD TMAH' STMS, and'either.HSPP or PSPP. "
Duct
leakage;< 6 percent-
For Packaged Units: ercentY i
❑ 3.,New.Ducts with/or without, �^
03.
Required Forms:
Replacement'„ ?:1 i„• E-
. 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-411 forms: MECH-20 and (for split systems) MECH-25
equipment changed.
For Split Systems: Duct leakage < 6 percent; RC, CCA 2:.300 CFM/ton, TMAH
For Packaged Units: Duct leakage < 6 percent
114. 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-411 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: Jul 17, 2012
Address: 42-081 BEACON HILL License: 374937
City/State/Zip: PALM DESERT/ CA / 92211 Phone: (760) 346-0677
Reg! 212-A0037773A-00000000-0000— Registration Date/Time: 2012/07/17 11:38:55 HERS Provider: CalCERTS, Inc. Ij
2008 Residential Compliance -Forms"', t July -2010,
•'
— # A.
` P.O. Box 1504 •78-4'95 Calle.,T;ampico, •' La'Quinta, California 92211'
Tel: (760")777-7012 • Fax: (760).777-7112
Website: www.La-Quinta.Org -Email: Building@La=Quinta.Org �rn1ofl��°��
--GF.\f lime DESERT -- 1r '
Bin #: 77Permit M&.140 Building Permit Application & Tracking Sheet
Project. Address: 79-613 POMO
Owners Name: STRITMATTER, MARY
A.P. Number:
Address: 79-613 POMO "
Legal Description:
City, State,'Zip: LA QUINTA, CA 92253
Contractor: Palm Desert Air Conditioning & Heating Company
Telephone: (760) 564-4608
Address: 42-081 Beacon Hill
Project Description:. '
,City, State, Zip: Palm Desert, CA 92211
REPLACE (1) AIR CONDITIONING SPLIT SYSTEM.
_
'
Telephone No.: (760) 346-0677
State: Lid. #: 374937
City Lic. #: • 100886
Arch./Engr./Designer.
Address:
City, State, Zip:
Telephone No;:Y
ti{ L{
`Construction Type: _
Occupancy:
State: Lic. #:
*� 4 ^�°,x
Project Type:. O New • ®Add'n.• O Alter :• O Repair • O Demo
Name of Contact -Person: KARL BROWN
Sq. Ft.:
#'Stories:
#Units:
Contact Telephone:No;: (760) 346-0677
Estimated Value of.Project: $6,085.00
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
`
V, 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