13-0411 (MECH)4 P.O. BOX 1504 a! r : V '" i, VOICE (760) 777-7012
78-495 CA'LLE TAMPICO . ' FAX (760) 777-7011
LA QUINTA -CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 4/04/13
Application Number: 13-00000411 Owner:
Property Address: 81637 RUSTIC CANYON DR CANDACE ANTOSZ
_ APN: 764-280-999-31 300237- 81637 RUSTIC CANYON DRIVE '
Application description: MECHANICAL LA QUINTA, CA 92253
Property Zoninq: MEDIUM HIGH DENSITY RES', (
Application valuation: 10987
Contractor:
Applicant: Y Architect or Engineer: GENERAL AIR CONDITIONING
cN�31170 RESERVE DRIVE
I" \ THOUSAND PALMS, CA 92.276.
(760)343-7488 D d
Lic. No.: 686310
APR 04 2013 .
• LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSA ION DECL��F Ml rr�T,�,
I hereby affirm under penalty of perjury. that I am licensed under provisions of Chapter 9 (commencing with - I hereby affirm under penalty of perjury one of the following declarati ANC ` L) • .
Section 7000) of Division 3 of the Business and Professionals Code, and m License is in full force and effect. _ I have and will maintain a certificate of consent to self -insure for worker Ze on, as rovid
Y P
License Class: C20 License No.: 686310 for by Section 3700 of the Labor Code, for the performance of the work for which t is zmpi '
l�- hissued.
Date-' Contract0ave
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
OWNER -BUILDER DECLARATION insurance carrier and policy number are: '
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the Carrier ZENITH INS CO Policy Number Z071741502
following reason (Sec. 7031 .5, Business and Professions Code: Any city or county that requires a permit to_ I certify that, in the performance of the work for which this permit is issued, I shall not employ any -
construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the _ person in any manner so as to become subject to the workers' compensation laws of California,
permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State - and agree that, if 1 should become subject to the workers' compensation provisions of Section
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or 3700 of the Labor Code, I shall forthwith comply with those provisions. . .
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).: Datei4 'r'I I3 Applicant:
1 _ 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 WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
Contractors' State. License Law does not apply to an owner of property who builds or improves thereon, SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND '
and who does the work himself or herself through his or her own employees, provided that the. DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
improvements. are not .intended or offered for sale. If, however, the building or improvement is sold within - SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. -
one year of completion, the owner -builder will have the burden of proving that he or she did not build or - -
- improve for thepurpose of sale.). - APPLICANT ACKNOWLEDGEMENT
as owner 6f the property, am exclusively contracting with licensed contractors to construct the project (Sec. IMPORTANT Application is hereby made to the Director of Building and Safety.for a permit subject to the a
7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of conditions and restrictions set forth on this application. -
property who builds or improves thereon, and who_contracts for the projects with a contractors) licensed' 1. Each person upon whose behalf this application is made, each person at whose request and for
pursuant to the Contractors' State License Law.). - • whose benefit work is performed under or pursuant to any permit issued as a result of this application,
1 _ I I am exempt under Sec. B.&P.C. for this reason, 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 omissionrelated to the work being •�' +
performed under or following issuance of this permit. -
Date: Owner: 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 ,
CONSTRUCTION LENDING AGENCY permit to cancellation. -
I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the 1 certify that I have read this application and state that the above information is correct. 1 agree to comply with all
work for which this permit is issued (Sec. 3097, Civ. C.). 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 purposes. e—
,
Lender's Name: r_,-,--� �S.�
- Date: � 13 Signature (Applicant or Agentl:° �,tiag)7� 17��
• Lender's Address
r
' LQPERN1IT -
:Appli.cation Number 13-00000411—
Permit . . . . . MECHANICAL
Additional desc .
Permit Fee 42.00 Plan Check Fee
12.38
Issue..Date : .. Valuation
0
Expiration Date 10/01/13
Qty Unit Charge Per
Extension
BASE FEE
15.00 .
2.00 9.0000 EA MECH FURNACE <=100K
18.00
UU 9 : UUUU EA MELH AMYL REP/AL'1'%All1J
U
1.00 9.0000 EA MECH B/C <=3HP/100K BTU
9.00
.00 16.5000 EA MECH B/C >3-15HP/>100K-500KBTU
.00
-------------------------------------------------"---------------------------
Special Notes and Comments
HVAC CHANGE OUT (1) 4 TON 18SEER,
REPLACE (1) FURNACE 90,000BTU, AND
(1) 1.5 TON MIN -SPLIT SYSTEM
[2008 ENERGY] 2010.._CALIFORNIA BUILDING
CODES.
----------------------------------------------------------------------------
-Other Fees . . . . .". . . . BLDG STDS ADMIN (SB1473)
1.00
Fee.summary Charged Paid Credited
Due.
Permit Fee Total 42.00 .00 .00
42.00
Plan Check"Total 12.38 .00 .00
12.38
Other Fee Total 1.00 .00 .00
1.00
Grand Total 55.38 .00 .00
55.38
04/04/2013 01:42PM 8187353575 IPERMIT ERATERS PAGE 04/11
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•
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ANDACE
ANYON DR,
ACA92253NERAL
-OUT (1) 4–ON A/C, 18 SEER,
90,000 BTUS.
-SPLIT SYSTEM
Oty.Of• La Quinta
M Bax f 50 4,"78495 Cab TaLqQL*" CA92253 -x(760) 7'77-70
Building Permit Application'and Tra
RUSTIC CANYON DR. owncesxaettm.ANTOSZ,
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AIR CONDITIONING
0 Reserve Drive PtgjeetDssail>tlon CHANG
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'= 760.343-7488 ALSO, (1) 1.5 TON MIN
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04/04/2013 01:42PM 8187353575 IPERMIT ERATERS PAGE 05/11
Simplified Prescriptive Certificate of Compliance: 2006 Residential HVAC A
terations- CF-IR-AI,T-HVAC
Climate Zones 10 - 15
Site Address;
Enforcement Agency:
Date:
Permit #;
81637 RUSTIC CANYON DR La Quinta, CA 92253
City of La Quinta
Apr r, 2013
Duct insulation
Conditioned
EquipmentTypel
List Minimum Efficiency2
requirement
Area
Thermostat
13 Package
e
® Furnace
® Indoor Coil
H AFUE 784/6
N SEER _3.0
0 COP
C3 HSPF
D R 6 (CZ 10-13)
R g
Served by sy
1965 sf
tem
®Setaack
If not already present, must be
® Condensing Unit
[IEER
0 Resistance
0 (CZ 14-15)
Installed)
❑ Other
1. Equipment Type: Choose the equipment being installed; If more than one system, use another CF -1R-
T -HVAC oreac system.
2. Minimum Equipment EYffclencles: 13 SEER 78% AFUt:, 7.7HSPF for typical residential systems.
HERS VERIFICATION SUMMARY Listed below are FOUR HVAC alteration Options. The instE
ller 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 an site for final inspection and a copy given to the homeowner. At final, the inspector
terifies that the work listed on this
form was in fact the work completed by the installer. The inspector also verifies that each a
ropriate CF -6R and registered CF -4R
forms (no hand filled CF -4R6 allowed) are filled out and signed.Beglnning October 1, 2010
a registered copy of the CF -1R
and CF -6R shall also be on site for final Inspection.
0 1. HVAC Changeout
Required Forms;
■ All HVAC Equipment
CF -611 forms: MECH-04, MECH-2I-HERS and (for split systems)
ECH-25-HERS
replaced
CF -4R forms: MECH-21 and (for split systems) MECH-25
. Condenser Coll and /or
CF -6R forms: MECH-04, MECH-2I-HERS and (for split Systems)
ECH-25-H =RS
. Indoor Coil and /or
CF -4R forms: MECH-21 and (for split systems) MECH-25
. Furnace
For Split Systems: Duct leaikag6< 15 percent; RC, CCA 5 300 CFM/ton (Minimum Air Now
Requlremect), TMAH
Exempted from duct leakage testini .if:
p S:-DuctsySti^ni'was documen"d to have been previously sealed and confirmed throw
h HERS ver�ication; or
02..Ducf systems with less th4i 40 linear feet in unconditioned space, or
'0.`3:-Existlhg duct systems. are CQbstructed, insulated_ or sealed with asbestos
E3"4..The "Il not be Du .. -(le, :..... ... xe __...
r9e)
❑ 2. Ne 5y RAgUI:"; 19;,: yi,:n•,, ,.::
;;„
Sngeoutw �,y�,.
- CCH -04, P l R5 IIC sy s
ME ..ERS; ltd
new (all new .«:.. *,
ducti all n
%TECH- 0, fors `[
equip.,
For Spilt: Vii, s.,,.... ; ,..:.;•.,i�.:,.•.,:,• %
and l x
; .:1..:.5
>For Padceged llni 9a Due It kagiY;3 •:!§ percen'
L3 1ry t#i/or'wlthouE '';.'
Required Forms:
. Includes replacing or Installing dlls`new
ducting and/or outdoor c6ndensl6g unit
CF -611 forms: MECH-04, MECH-20-HERS,
d (for split systems) MECH-25-HERS
and/or indoor toll and/or furnaci , W or some
CF -4R forms: MECH-20 and (for split syst
s) MECH-15
equipment changed. "
For Split Systems; Duct leakage < 6 percent; RC, CCA ,�!! 300 CFM/ton, TMAH
For Packaged Units: Duct leakage < 6 percent
la d. New Ducting over 40 feet lRequired Foams;
. Includes adding or replacing more than 40 CF -6R forms: MECH-04, ME -CH -21 -HERS
linear feet of duct in unconditioned space. CF -4R forms: MECH-21
For split system or packaged units; Duct leakage < 15 percent
0 EXCEPTION: Existing duct systems constructed, insulated or sealed with asbestos.
Contractor Documentation Author's /Responsible Designer's Declaration Stateme
)
• I certify that this Certificate of Compliance documentation is accurate and Complete.
■ I am eligible under Division 3 of the Califomia Business and Professions Code to accept responsibility fc
r the design identifiedon this Certificate of
Compliance.
• I certify that the energy features and performance specifications for the design identified on this Cettlfl
to of Compliance conform to the
requirements of Tltle 24, Parts 1 and 6 of the Califomla Code of Regulations.
• The design features identified on this Certtf(cate of Compliance are consistent with the Information doci
mented on other applicable compliance
forms, worksheets, calculations, plans and specifications submitted to the enforcement agency for appy
oval with the aemlit application.
Name: Danielle Garcia Signature: Danielle 6arcla
Company: HARRISON ENTERPRISES INC
Date: Apr 4, 2013
Address: 31-170 RESERVE DRIVE STE A
License: 686310
City/State/Zip: THOUSAND PALMS / CA / 92276
Phone: (760) 343-7488
Reg: 213-A0020130A-000000000-0000 Registxatiou Date/Time: 2013/04/04 16:21
2006 Residential Compliance Forms
HERS Providez': Ca10ERTS, Inc.
July 2010