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14-0588 (MECH)- 'C', P.O. BOX 1504 78-495 CALLE TAMPICO - LA QUINTA, CALIFORNIA 92253 Application Number: 14-00000588 Property Address: 53480 AVENIDA RUBIO APN: 774-073-011-14 -000000- Application description: MECHANICAL Property Zoning: COVE RESIDENTIAL Application valuation: 2150 Tit!t " BUILDING & SAFETY DEPARTMENT BUILDING PERMIT Applicant: Architect or Engineer: ------------------ LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that Ilam licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business/and Prof io s Code, and my License is in full force and effect. License CI �C10f C16 C2 / nse No.: 457554 Date�L,� /i y Contractor•.. G C ER -BUILDER DECLARATION, I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the following reason ISec. 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 statementthat 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 a civil penalty of not more than five hundred dollars 155001.: (_) 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 _ 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 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 Liddi1SB Law.). ( 1 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 VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 ----------------------------------------------- WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: 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: ave 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 EVEREST NATL Policy Number 7600005445141 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 o become subject to the workers' compensation laws of California, and agree that, if I should come subject to the w ers' compensation provisions of Section 3700 of the Labor Code I shall forth �ctose p�� Oate-�� Applicant: WARNING: FAILURE TO SEC• E WORKERS,�OM NSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES ND 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 v:h000 bonofit v:erh io porformod under or pL,rs:"nt 1o'ny p -mit iccnerf as a msidt of this annliration. 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 followingissuance 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 a v information is correct. I agree to comply with all city and county ordinances and state laws relating to buil n onstruc and a by thorize representatives of this county to enter upon the above -m boned grope or in ection p r os Dates . /� Signature (Applicant or Agent Date: 5/06/14 Owner: CAROLE BREITHAUPT 53480 AVENIDA RUBIO LA QUINTA, CA 92253 ( D t74 p n MAY 020J%! �1 20 J% ! Contractor: PREFERRED PLUMBING HT A/ P.O. BOX 5120 Ci1iY OF 1.A QUpIITA PALM SPRINGS, CA 92263 FIN.4NCEDEPT. - (760)322-3173 Lic. No.: 457554 ----------------------------------------------- WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: 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: ave 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 EVEREST NATL Policy Number 7600005445141 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 o become subject to the workers' compensation laws of California, and agree that, if I should come subject to the w ers' compensation provisions of Section 3700 of the Labor Code I shall forth �ctose p�� Oate-�� Applicant: WARNING: FAILURE TO SEC• E WORKERS,�OM NSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES ND 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 v:h000 bonofit v:erh io porformod under or pL,rs:"nt 1o'ny p -mit iccnerf as a msidt of this annliration. 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 followingissuance 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 a v information is correct. I agree to comply with all city and county ordinances and state laws relating to buil n onstruc and a by thorize representatives of this county to enter upon the above -m boned grope or in ection p r os Dates . /� Signature (Applicant or Agent 0 LQPERJWT Application Number . . . . . 14-00000588 Permit . . . MECHANICAL 2013 Additional desc . Permit Fee . . . . 35.75 Plan Check Fee .00 Issue Date . . . . Valuation 0 Expiration Date 11/02/14 Qty Unit Charge Per Extension 1.00 35.7500.EA MECH AIR HANDLER 35.75 ---------------------------------------------------------------------------- Special Notes and Comments HVAC CHANGE OUT - 13SEER 3 TON HVAC SPLIT SYSTEM (REPLACE AIR HANDLER) [2008 ENERGY] CARBON MONOXIDE ALARM(S) TO BE INSTALLED PRIOR'TO FINAL INSPECTION. 2013.CALIFORNIA BUILDING CODES. - ---------------------------------------------------------------------------- Other Fees . . . . . . . . . BLDG STDS ADMIN (SB1473) 1.00 PERMIT ISSUANCE M/P/E 90.57 PLAN CHECK, MECHANICAL 11.92 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 103.49 .00 .00 103.49 Grand Total 139.24 .00 .00 139.24 Bin ## City of La QC!(t1ta 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 'f Perm' l Project Address: Q Pv-0 Owner's Name:' A. P. Number: Address: yr 3 L `S-6 /9'(/0- /24/3/Q Legal Description: City, ST, Zip: I,A aL) -4-9- 9-. . �/3 9,2L .53 ' /eTele h / Telephone: — ;: ::tContractor:a : Address: Q 5 Project Description: City, ST, Zip: /'J- •'L./rvS �a2 3 /7iT�/C� Telephone:? ft 6A0 -O"k-3'Z State Lic. # : City Lie. #: 3 . 76 Aj Arch., Engr., Designer: Address: City, ST, Zip: Telephone: <i:»r:><»::>::s:::<.::::;::>::»>::>:«:><. xs;;.<.>;;. <:>;;.::;;;:;:;;;>;:;>< 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: P Estimated Value of Project: APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Req'd Recd TRACKING PERMIT FEES 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 Calls. Plans picked up Construction Flood plain pian Plans resubmitted Mechanical Grading plan 2"" Review, ready for corrections/issue Electrical Subcontactor List Called Contact Person Plumbing Grant Deed Plans picked up S.M.I. H.O.A. Approval Plans resubmitted Grading IN IiOUSE:- '"' Review, ready for correctionstissue 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 RVVACAlterations CF -IR -ALT -HVAC Clur:ate Zonos 10 to 15 2008 Residential Compliance Forms tLtnrrh 20 /n .. Site Address: Enforceme' tAgency: `Date: Perm ' Al.. 3 �-�`- 0 1 Conditioned Floor Equipment T et List Minimum Efficiency2. Duct insulation requirement Area Thermostat ❑ Packaged Unit ❑ Furnace ❑ AFUE Over 40 ft of ducts added or Setback ❑ COP ❑ Indoor Coil Condensing Unit OSEER I&ER replaced in unconditioned s ace Served b stem ❑ HSP pace _ P P y sY (If not already ❑ R 6 (CZ 10-13) �sf present, must be ❑ 2 Resistance Q R.8 (CZ 14-15) installed) er tyk ► *1. Equipment Type: Choose the equipment being installed; if more than one system, use another CF -1R ALT BVAC for each system. 2. Minimum Equipment Efficiencies: 13 SEER, 78% AME, 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 installdi. The inspector also verifies that each appropriate CF -6R and registered CF4R forms (no hand filled CF4Rs allowed) are filled out and signed. Beginning October 1, 2010, a registered copy of the C&M and CF -6R shall also be on site for final inspection. 1. HVAC Changeout Required Forms: • All HVAC Equipment replaced CF -6R forms: MECH-04, MECH-2I-HERS and (for split systems) MECH- 25 -HERS CF4R forms: MECH- 21 and (fors lits stems) MECH-25 • Condenser Coil and/or an • Indoor Coil and CF -6R forms: MECH-2I-HERS and (for split systems) MECH- 25 -HERS • Furnace CF4R forms: MECH- 21 and (for split systems) MECH-25 For Split Systems: Duct leakage < 15 percent; RC, CCA > 300 CFM/ton(Nlinimum Air Flow Requirement), TMAH For Packaged Units: Duct leakage < 15 percent Exempted from duct leakage testing if:, 1:11. 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 ❑ 2. New HVAC System Required Forms: • Cutin or Changeout with new CF -6R forms: MECH-04, MECH-20-HERS,and (for split systems) MECH-22-HERS, and MECH-25-HERS ducts: (all new ducting and all CF -4R forms: MECH 20-, and forslit stems new equipment) ( P sy )MECH-22, and MECH 25 For Split Systems: Duct leakage < 6 percent; RC, CCA 2:3 50 CFM/ton, FWD, TMAH, STMS, and either HSPP or PSPP. For Packaged Units: Duct leakage < 6 percent ❑ 3. New Ducts with Replacement Required Forms: • Includes replacing or installing all new ducting CF -6R forms: MECH-04, MECH-20-HERS,and (for split systems) MECH-25-HERS and/or outdoor condensing unit and/or indoor CF4R forms: MECH-20 and (for split systems) MECH-25 coil and/or furnace. Not all equipment changed. For Split Systems: Duct leakage < 6 percent, RC, CCA >_ 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 linear feet of duct in unconditioned space. CF -6R forms: MECH-04, MECH-2I-HERS CF -4R forms: MECH-21 For split system or packaged units: Duct leakage < 15 percent ❑ EXCEPTION: Existing ducts stems 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 er-pplicable compliance forms, worksheets, calculations, plans ands specifications submitted to the enforcement agency for a royal with the ve do Name: A t + 1 (D , - -Signature: CompanYP�r� ZED �M �l, t *� 1 AI ate: Address. Q VIA� 5-1 License: L i City/State/Zip: ` '-5 TV,(�� /l /l Phone: 360 2008 Residential Compliance Forms tLtnrrh 20 /n ..