13-0109 (MECH)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
13-00000109
Property Address:
52595 AVENIDA RUBIO
APN:
773-2.82-017-4 -000000-
Application description:
MECHANICAL
Property Zoning:
COVE RESIDENTIAL
Application valuation:
8738
Applicant: Architect or Engineer:
LICENSED CONTRACTOR'S DECLARATION
i t! 4
BUILDING & SAFETY DEPARTMENT �J
BUILDING PERMIT
Owner:
CYNTHIA DUNCAN
52595 AVENIDA RUBIO
LA QUINTA, CA 92253
I -hereby affirm under penalty of perjury that 1�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.
License Class: C20 License No 686310
..l ,.>r
`Date:' Contra"tor: 4;iiC•
OWNER -BUILDER DECLARATION
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
perinit-to file assignedstatement4hat he or she is licensed pursuant to the provisions of the Contractor's State
LicenseLaw (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 applicadrto a civil penalty of not more than five hundred dollars($500).: .
(_ 1 1, as owner of the property, or my employees with wages as their sole compensation, will'do the work, and
the'structure is notintended or offered for sale (Sec. 7044, Business and Professions Code: The
Contractors'. �State.L'icense Law doe!Not apply to anownerof property who builds or improves thereon,
and who -dos the work, himself or herself through his or her.own employees, provided that the
improvements are not intended or offered for sale. If, however, thebuilding,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.).
d _ 1 1, as owner of the propeity, am exclusively contracting with licensed contractors to'constructthe project (Sec.
7644, 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. , BAP.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:
LQPERA9IT
Contractor:
GENERAL AIR COND
31170 RESERVE DR
THOUSAND PALMS,
(760) 343 - 74 88
Lic. No.: 686310
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760):777-7153
Date: 2/04/13
WORKER'S COMPENSATION DECLARATION
Thereby affirm under penalty of perjury one of the following declarations:.
_ I have and will maintain a certificateof consent to self -insure for workers' compensation, as provided
for. by Section 3700 of the Labor Code, focthe performance: of the work for which this permit is
issued. -
_ ('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 ZENITH INS CO Policy Number Z071741502
.--41I 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 LaborCode, I shall forthwith comply with those,provisions. ..
�Daie: Z =i )3 Applican�:.~•
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 1$106,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3766 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 purposes. -
iDDa e- �'�' IJ Signature (Applicant or Agent): f. A
Application Number 13-00000109
Permit MECHANICAL
Additional desc .
Permit Fee . . . . 33.00 Plan Check Fee
8.25.
Issue Date . . . . Valuation
0
. Expiration Date 8/03/13
Qty Unit Charge Per
Extension
BASE FEE
1'5.00
2.00 9.0000 EA . MECH APPL REP/ALT/ADD
18.00
Special'Notes and Comments
REPLACE 4 TON A/C'&.47K BTU FURNACE.
2010 CODES..
-----------------_-_--------------------------------------------------------
Oth-er, Fees BLDG STDS ADMIN .-:(SB1'473)
1.00
Fee summary Charged Paid, Credited
Due...
a' --- -------------- ---------- --------- ---------- --------
Permit Fee Total 33.04' .00- .001.
33':00
: Plan Check Total 8.25 .00 .0.0
8:25'
Other Fee Total 1.00. .00 00
1-:00 ..
Grand Total 42.25 .00 .00.
42.25
LQPERMIT
Bin. #
BuflQlrig BT Safety Divtdon ti .
Permit # P.O. Boz",1504;=78-495 CMM Tamp1w
VL 4.Quin4 CA 92251 (146)'7777012
Building Permrt Appl catlon,and Tracking Sheet .
Project Address ZG 9S AV e'h CIO-' p Owner's Nark.
, v %, c -,v,
A: P. Number.
'Address: szs�s Av,-y
Legal Description:
CiST Zi C
ry P' LG vitti.' ci .( Zzs-3
Coauactor. Gen I
C -p ; i
Telephohe:, '?( . •..
Address: 3 -e -Se -r,v �.: r .
Project Descripaon:
City, ST, Trp: 7ja0uSd .
�m5'CA Gt•Z27(o
ox— e— IT
Telephone: 7(�d— 3y3- 7 y0.3; -
rh
state:Lic. # : iO8(o i
City Lie. 6, .
ArdL, Eng.;:Designer
Address
.. .
City., ST, Zip:
Telephone:
Static Lic. #:
Mame of CodMa �Person:
, serer
CoasoructioreType: , . , Occupancy
Project type (circle_one) New Add'n Alter Repair Demo
Sv` Ft :
#'Stories
# Units::
Telephone # of Contact Person: Q51
Estimated Value of,Project: 7 3.2 _ CU
;APPUCANT:
q Sabmlttal Req'd'Reed
Pian Self
DO NOT WRITE BELOW. THIS UNE;
.,
TRACKING PEkbUT FEES
Plan Check'sabmitted - Item Amount
Strudami Cales
Reviewed; ready [or corrections.
'Plaa.Chcck Deposit. .
Truss Cdes.
Called'Contaet Penou-
Plan Cheek $alaace• .0
Mde 10 Calci.
Plans picked up
Coasanctloa'
Flood plain plea
Platy rembmitted
Mcchariicsl
Giadtag plan
Z'` Review, ready.tor correctiaaslissbe
Electrical
Subeontaetor List
Cal led,Coatact Pcrton ..
Plumbing
Grant Deed
---------------
Pians packed up
_
S ItiLL
ELOAL A vat
Pio
Plana raabmitted
-.Gr to
IN HOUSE:-
.
s^.W!tew,.ready,for eorreetlonsrmue
'Developer Impact Fee
Plaaolag Approval
Called Contact Person
Pab. %Yb. App.''—Dart
of permit issue
Stbool Fees
Fl.
focal Per6iit Fees
Simplified Prescriptive Certificate of Compliance: 2008 Residential HVAC'Alterations • CF-lR-ALT-HVAC
Climate Zones 10 - 15
Site Address:
Enforcement Agency: Date:
Permit #:
52595 AVENIDA RUBIO La Quinta, CA 92253
City of La Quint`a Feb 2, 2013
Duct insulation
Conditioned Floor
Equipment Type1
List Minimum Efficiency2
requirement
Area
Thermostat
[]Package Unit
® Furnace
® AFUE 78%
l] COP
Q R 6 (CZ 10-13)
Served by system
® Setback
be
® Indoor Coil
® SEER 13.0
p HSPF
0 R 8 (CZ 14-15)
1200 sf
If not already present, must
® Condensing Unit
Q EER .
❑ Resistance
installed)
0 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.i, 2010, a registered copy of the CF-IR
and CF-6R shall also.be on site for final inspection.
® 1. HVAC Changeout
Required Forms:,,
• All HVAC Equipment
CF-611 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
CF-6R forms: MECH-04, MECH-2I-HERS and (for split systems) MECH-25-HERS
• Indoor Coil and /or
CF-4R forms: MECH-21 and (for split systems) MECH-25
. Furnace
For Split Systems: Duct leakagez15 percent; RC, CCA 5300 CFM/ton (Minimum Air Flow Requirement), TMAH
Exempted from duct leakage testing ii::
b.1: Duct system.itias docurri6, ted to have been previously sealed and confirmed through HERS verification, or
2. Duct'systerns with less thari:'40 linear feet in unconditioned space, or
p 3. Existing duct systems are constructed, insulated or sealed with asbestos
❑ 4: Th ystem will not be Duct d (ie:. uet�ess Mita Splttr5yste (Also Exetn}�t�ftotn Refrigerant*.. harge)
... ..
❑ 2. New@Wstem RequrEedFortns:
. Cut mea EGh'angeout witty= >.�.>;=: ......,
new d :ail newt 6R forhl MECH-04, i�lEC2fiH) RS and far split systems) MECH-22 HERS, artd
t
ductrttgai all new r Cf-4R forms MECH-2b and=>for split sytstem EEH 32��and ,RgECH-:25.<:A::�
For Split5ff Systems duet lealtageX<Y percent, RC; CCA�.>F3CFM/tali; FWD, MAii, STMS and etCier ttSPP or PSPP. "' -
For Packaged`Units:Ductleakag=..'percent:..'`:':`::<':''; >;
-3:.PLew<Ducts?iivtth/or without;:;:::.
Required Forms:
. Includes replacing or installing alt.liew
ducting and/or outdoor eon4ensi.rig::unit
CF-6R forms: MECH-04, MECH-20-HERS, and (for split systems) MECH-25-HERS
and/or indoor coil and/or f ' iaci=_'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 Z 300 CFM/ton, TMAH
For Packaged Units: Duct leakage < 6 percent
0 4. New Ducting over 40 feet
Required Forms:
. Includes adding_or replacing more than 40
CF-;6R forms:. MECH-04, MECH-2I-HERS
ICF-'4R
linear feet of dud in unconditioned space.
forms: MECH-21
For split system or packaged units: Dud leakage < 15 percent
E3 EXCEPTION: Existing dud 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: Danielle Garcia Signature: Danielle Garcia
Company: HARRISON ENTERPRISES INC Date: Feb 2, 2013
Address: 31-170 RESERVE DRIVESTE A License: 686310
City/State/Zip: THOUSAND PALMS / CA / 92276 Phone: (760) 343-7488
Reg: 213-A0007140A-000000000-0000 Registration Date/Time: 2013/02/02 02:43:17 HERS Provider: Ca10ERTS, Inc_
2008 Residential Compliance Forms July 2010
1.