13-0185 (MECH)f.
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Application Number: 13-00000185
Property Address: 52640 AVENIDA RUBIO
APN: 773-283-028-17 -00000.0-
.Application description: MECHANICAL,
Property Zoning: COVE RESIDENTIAL
Application valuation: 6000
Applicant: Architect or Engineer:
�s.anWP
SCO ACTOR'S DECLARATION _
I hereby affirm under penalty of perjury -'arn�licen under provisions of Chapter 9 (commencing With
.
Section 70001,of; ivision 3 of the Bu neessionals-Code, "and my Licen - reeend-effect: "
License Cla s: 0 x3»' .:..Li - 3'
Date. '� Contracto r
OWNER -BUILDER DECLARATION;
1 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,'improv.e, demolish,or repair any structure, prior to its issuance,. also" requires the applicant for the
permit to file a signed -statement that he oc,she is licensed pursuant to the provisions of the Contractor's State
License Law (Chapter 9,(commencing with,Secuon:7000),of Division'3 of the Business and Professions *Code) or
that he or she is exempt therefrom -and the basis forthe 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 tiuricired dollars ($500)::
(_) I, as owner, of -the property, or rry employees with wages,as theirsole compensation will do the work,'and
the structureiis n& intehded 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 whodoes the.work.himself or herself through his or her own employees, provided that the
improvements are not intended or offered for sate. If, however, the building:or improvement is'sold within
oneyear of completion; the owner -builder will have the burden of proving that heor she didttot build or
improve for the purpose of sale.l. -
f _ 1 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 Lawdoesnot apply to ar°owner of,.,
property',who builds orimproves thereon, and who contracts for, the projects :with a contractors) licensed
pursuant to the Contractors' State License Law.).
1 _ f 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
Owner:
LARRY JONES
LA :QUINTA, CA 929RI
(
Contractor:
AIR.EXPERTS AIR
PO BOX 94
LA QUINTA, CA 92
(760)777-1724
Lic.'' No.: 725283"
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 2/20/13
WORKER'S COMPENSATION DECLARATION
.I hereby affirm under penalty of perjury one.of the following declarations:
-' • - I haj{ and will maintain a certificate of consent to self -insure -for workers' compensation, as provided
/. Vor 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'insu'rance, 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 NORGUARD INS Policy Number, PAWC334856
I certify that, in the performancebf the wor which this permit is issued, I shall not employ any
person in any manner so.as to be a subjec o the workers' compensation laws.of California,
an agree that, if I.should bec a subje o the workers'. compensation r -
37 0 of the Labor Code, l s all fo ith.compl jsions.
..V- APPtcant:'
WARNING: •FAILURE OSECURE 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,'indemnity and hold harmless the City
of La Quinta, its officers, agents and employees for any act or omission related to the work being
performedunder 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 cons and hereby authorize representatives
of this coun to nter upon the above-mentioned property f nspection rposes.
Date Signature (Applicant or Agent -)!T:
1�
Application Number 13-00000185
Permit . . . MECHANICAL
Additional desc .
Permit Fee . . . . 35.00
Plan Check Fee-.
8.75
Issue Date . . . .
Valuation
0
Expiration Date 8/19/13
Qty Unit Charge Per
Extension
BASE
FEE
15.00
1.00 11.0000 EA MECH
FURNACE >100K
11.00
1."00 9.0000 EA _'. MECH
B/C <=3HP/100K BTU
9.00
Special-- Notes- andY"Comnients
REPLACE..A/C &--HEATING EQUIPMENT
CONDENSER AND COIL.•2010.`C6DES..
Other:Fees BLDG STDS ADMIN (SB1"473.)
1.00
" Fee summary Char' d� "
Paid Credited
Due .
Permit.Fee.Total 35.00.-
00 .00
35.00:
Plan Check Total -8,.75
00: .00.
8'..75
Other Fee Total 1.00
.0'0. ."00
1.00
. Grand Total 44.75
.0.0 .00
44.75
LQPERA1IT
Bin. #
Qtr r Of La.,Quinta
Building 8T Safety Division
P.O. B.ox,1504, 76-495 Cane Tampico
i.a.Quinta, CA,92253 - (760) 777-7012
BAding.'Permit -Application and Tracking Sheet
Permit #
Project Address: AUE. ZA, c' •
= Ovmer's Name:. , a,/-/0- E S
.A. P. Number.
Address: -ZG'/o AvEm ox Zu& d
Legal Description:
Contractor. I
City, ST;. zip: LA. 0. 'CA 4 -Z-ZS-
Z S 3
Telephone: _ h
telephone:
Address: x 4j
Project Description:
City, ST, Zip: LA Qui rj '9ZZ1 :
iAG
Telephone: '7(,,o
State Lie. # : ZS Z'V3City Lic. C.
Arch., Engr.; Designer.
Address:
City., ST. Zip:
Telephone:°.Construction Type:,.. Occupancy:
State Lie. #: ' f 'jProject ".(circle one): New Add'n Alter Repair Demo
Name of Contact Person: Sq. -Ft.: #. Stories: # Unit;:
Telephone # of Contact Person: Estimated Value of Project 06 _0
APPLICANT: DO NOT WRITE BELOW THIS UNE
N
Submittal
RN'd
Recd
TRAC G
PERMET FEES
Plan Sets
Plan Cheek submitted,,
Item Amount
Structural Calcs.
Reviewed, ready for'correcdons
Plan Check Deposit. .
Truss Calcs:
Called Contact Person
'Plan Check Balance.
Title 24 Cala.
Plans picked up
Caastrnctlon
Flood plain pias
Plans resubmitted
Mechanical
Grading plan
21! Review, ready for-,eorreefionsfissue
Electrical'
Subcontactor List
:Called Contact Person .
Plumbing
Grant Deed
Plans pieked.up
S3LL
H.O.A. Approval
Plaus`resubmitted
Grading e
IN HOUSE:-
'" Review; ready for corrections/issue
Devdopei Impact Fee
Planning Approval
,Called Contact Person
Pub. Wks. Appr
Date'of permit issue
School Fees
TotalTermit Pees
Simplified Prescriptive Certificate of Compliance: 2008 Residential HVAC Alterations CF -1R -ALT -HVAC
Climate Zones 10 - 15
Site Address:
Enforcement Agency:
Date:
Permit #:
52640 Avenida Rubio La Quinta, CA 92253
City of La Quinta
Feb 20, 2013
Duct insulation
Conditioned Floor
Equipment Type1
List Minimum Efficiency2
requirement
Area
Thermostat
❑ Package Unit
® Furnace
❑ AFUE
❑ COP
❑ R 6 (CZ 10-13)
Served by system
® Setback
® Indoor Coil
® SEER 13.0
® HSPF 7.7
[3 R 8 (CZ i4 -i5)
1600 sf
If not already present, must be
® Condensing Unit
[3 EER
[3 Resistance
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 -111
and CF -611 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
. Indoor Coil and /or
CF -611 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
Exempted from duct leakage testing if:
❑ 1. 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
❑ 4. The system,, will not be Ducted (ie.,Ductless;Mini-Split-Sys tem)-(Also;Exempt from::Refrigerant°Charge)
❑ 2. New HVAC System
Required Forms: c+
. Cut in or Changeout with
x =°
CF 6R forms MECH-04, MECH'20-HERS and (for split systems) MECH=22 HERS and
"
new ducts: (all new
ducting and all new --'CF
z ', ,
MECH 25 HERS ,, ' #t �� s "W - r
equipment)
4R forms MECH 20, and (for split systems) MECH-22, andcMECH-25�L`
For Split Systems: Duct leakage < y6 percent, RC,,I�CCA'>" 350 CFM/ton, FWD; TMAH; STMS, and eith6rHSPP or PSPP.
For Packaged Units: Duct leakage ;'< 6 percent
113. New Ducts`with/or without
Required Forms:
Replacement
. Includes replacing or installing all new
ducting and/or outdoor condensing unit
CF -611 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 >_ 300 CFM/ton, TMAH
For Packaged Units: Duct leakage < 6 percent
❑ 4. 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 -4R 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: Paul Van Vlymen Signature: Paul Van Vlymen
Company: AIR EXPERTS AIR CONDITIONING -HEATING Date: Feb 20, 2013
Address: PO BOX 94 License: 725283
City/State/Zip: LA QUINTA / CA / 92247-0094 Phone: (760) 777-1724
ncg: 1-13 A0010832A 000000000 0000
2009 Resid—ri.al
cy.Ls,.ta iC; DatC C:C: 2013J0:./2 13:06: 24 ..ERS Fr-...idC.. ^.3}r+rnmc _.....
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