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12-1429 (MECH)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: Property Address: APN: Application description: Property Zoning: Application valuation: X1210.0.001429 , 54075 AVENIDA RUBIO 774-201-016-4 -000000- MECHANICAL COVE RESIDENTIAL 3200 T4ht 4 44ur«rw Architect or Engineer: plP BUILDING & SAFETY DEPARTMENT BUILDING PERMIT 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 BusinessProfessionals Code and my License is in full force and effect. Lic se Class: C10 C16 C2- ice o./ 457554 Dater /a oniractor: / N fR• 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 a civil penalty of not more than five hundred dollars ($500).: (_ 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 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 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_ 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: ,1 Q Lender's Address: LQPERMIT Owner: MARY ARCHER 54075 AVENIDA RUBIO LA QUINTA, CA 92253 Contractor: PREFERRED PLUMBING H P.O. BOX 5120 PALM SPRINGS, CA 922 (760)322-3173 Lic. No.: 457554 �j VOICE (760 7� JI FAX (760 7 #011 INSPECTIONS (760)f �i Date: 12/12/12 -p u 02L 12 2012 CITY QUINTA 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 EVEREST NATL Policy Number 7600006445121 _ 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 I should a om subject t workers' compensation provisions of Section 3700 of the Labor Code all f wit o ply ith those • ions. ate:I4/� / pplicant: WARNING: FAILURE TO SECUR -WORKE' C�'S PENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENAL AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS 1$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 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 1 have read this application and state that the above ' formation is correct. I agree to comply with all city an county ordinances and state laws relating to building c truction a d her uth rize representatives oft county to enter up the above-mentioned property for specY n ur ose ab te: / z / ignature (Applicant or Agent): Application Number . . . . 12-00001429 Permit . . . MECHANICAL Additional desc . . Permit Fee . . . . 40.50 Plan Check Fee 10.13 Issue Date . . . Valuation . . . . 0 Expiration Date 6/10/13 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 ---------------------------------------------------------------------------- Special Notes and Comments HVAC CHANGE -OUT: INSTALL NEW CONDENSER & AIR HANDLER. 2010 CODES. ----------------------------------------------------------------------------- Other Fees . . . . . . . . . BLDG STDS ADMIN (SB1473) 1.00 Fee summary ----------------- Permit Fee Total Plan Check Total Other Fee Total Grand Total LQPERA11T Charged Paid Credited Due 40.50 .00 .00 40.50 10.13 .00 .00 10.13 1.00 .00 .00 1.00 51.63 .00 .00 51.63 Bin # City of La Quinta Building U Safety Division P.O. Box 1504, 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet G Permit # Project Address: . .. .. �' Owner's Namd:M,49V AfC64e A. P. Number:' Address: 5"7 d 76 Legal Des.'cription:" City, ST, Zip: 1.17 4)VIAI % G' - 47a2 — prefer.red,:Air'Conditioning dba Contraetor:.Pr. e:ferfed � Plumbin • Heatin &Ai Telephon : Addiess: p0 . Box >5120.' .'Project Description: City, ST,ZiP:Pa'lm :`Springs, CA.•92263 cow0ows6w A'JYJ Telephone:.( _7 6.0) ` 3 2 2 = 317 3 / /2 iV4WY> 1 State Lie.:# :.;.. 4 5.7'5'5`4 :" City Lie. M d;L Arch.. Engr., Designer::- ...; Address: City, ST; Zip:.: . . Telephone;:. ; ... ,. State.Lip: #.f.: ::._ : - `. '.' Name of.Contact.Person:.CZ64*r. 1;A-XY&WS Construction Type: Occupancy: Pinjecf type (circle one): New Add'n Alter Repair Demo Sq. Ft.: # Stories: TUnits: Telephone.•# 'of contactFerso :7 �p d� g�p 3 "D 3 0� . Estimated Value of Project: a D D APPLICANT: DO NOT WRITE BELOW THIS LINE # .Sabmittal :` .... Req'd Reed TRACKING. PERM1<T FEES Plan.Sets . • .' . Plan Check bMwitted Ite Amount Structural:CgIcs.. Reviewed, ready for corrections Pla Check Deposit Truss CaIcs• .. Called Contact Person Plar Check Balance Energy Cald, Plans Dicked up Con itruction Flood plain plaq Plans.resubmitted Me'ehanical Gra'ding plan' 21d Review, ready for'correctionsrssue Ele icnl Subcoritnetor List Called Contact Person Plu bang Grant Deed ' Plans picked up S.M L H.O.A. Approval Plans resubmitted Gra ling IN HOUSE:- Review, ready for correctionsfissue Developer Impact Fee Planning Approval Called Contact Person A.I..P. Pub. Wks. Appr ' Date of permit Issue School Fees Tot Permit Fees Simplified Prescriptive Certificate of Compliance: 2008 Residential HVA C Alterations CF -IR -ALT -HVAC 'Climate Zones 10 to 15 Site A4dress: AvENio,� v3io I Eforcement A ency: EA �rA Date: Permit #; Equipment T e' List Minimum Efficiency2 Duct insulation requirement Conditioned Floor Area The ❑ Packaged Unit BTumace ❑ AF ❑ COp Over 40 ft of ducts added or etback ❑ Ind of _ � ❑ HSPF replaced in unconditioned space ❑ R6. CZ 10-13) 'Served by system (if not already D-155ndensing Unit EB'1r�R ❑Resistance ( � ADD sf present, must be ❑ Other ❑ R 8 (CZ 14-15) installed) 1. Equipment Type: Choose the equipment being installed; if more than one system, use another CF -IR -ALT -HVAC for each system. 1. Minimum Equipment Efficiencies: 13 SEER, 78%AFUE, 7.7HSPFfor 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 -6R and registered CF -4R forms (no hand filled CF-4Rs allowed) are filled out and si . 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 replaced CF -6R forms: MECH-04, MECH-2I-HERS and (for split systems) MECH- 25 -HERS CF -4R forms: MECH- 21 and(for split sstems MECH-25 • Condenser Coil and/or • Indoor Coil and/or CF -6R forms: 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 For Packaged Units: Duct leakage < 15 percent 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 ducts stems are constructed, insulated or sealed with asbestos ❑ 2. New HVAC System Required Forms: • Cut in 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 (for split systems)MECH-22, and MECH 25 new equipment) For Split Systems: Duct leakage < 6 percent; RC, CCA > 350 GFM/ton, FWD, TMAH, STMS, and either HSPP or PSPP. For Packaged Units: Duct leakage < 6 percent ❑ 3. New Ducts with Replacement Required Forms: im 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 .CF -4R 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 ❑ 4. New Ducting over 40 feet Re uired Forms: • Includes adding or replacing more than 40 linear feet of duct in unconditioned s ace. 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 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 Califomia Business and Professions Code to accept responsibility for the design identified on this Certificate of Compliance. • 1 certify that the energy features and performance specifications for the design identified on this Certificate of Complian/conrm to the requirements ofTitle 24, Parts 1 and 6 ofthe California Code ofRegulations. The design features identified on this Certificate of Compliance are consistent with the inform on documented on othle compliance forms, s eels, calculations plans andspecifications submitted to the enfor cement a en fora royal with ermi ti Name: Te FrL ��N 5 " SiQg'nature: r�- Company; PZ � �/+ � 0 PLO ��ll�►l= k��NG Address:�D S � Z o License: j 1 7 5-5L+ 5 L+ -T' City/State/Zip:'-P NG CV21 _ 3 F► tC?�� Phone: ZZ 3 17 HVAC Permit Checklist Comfort Consultant (RSP): �J err- Service rr Service Order #:( q -f) Owner's Name: Jobsite Address: �' ��'1P3 L3 E 10 LAS Mio-tA, CA 9ZZ6_3 Permit Application Declaration Page: El Commercial. : residential N5ingle family residence ❑ Multi -family residence /❑ _Condominium ❑ Other: Name of Community: . Location of new unit on/in structure: Plot plan required?: k116 Line of sight - screened / parapet / distance from lot line: Components.to be: ❑ installed /placed: ike for like' or upgrade? (circle one) Condenser PSize (tonnage): XFAU / r HandleISEER: ❑ Evaporative Coil ❑ EER: ❑ Package unit PGE or HP ❑ Other: CF -IR -A Form: Project valuation:'o�} OC7 Date Permit Needed at Jobsite: Other Information: d Y� ,i