12-0802 (MECH)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
12-00000_8.0-2
Property Address:
52520 AVENIDA RAMIREZ
APN:
773-292-002-22 -000000--
Application description:
MECHANICAL
Property Zoning:
COVE RESIDENTIAL
Application valuation:
1500
Applicant: Architect or Engineer:
-4 Qw* A
BUILDING & SAFETY DEPARTMENT
BUILDING_ PERMIT
LICENSED CONTRACTOR'S DECLARATION
1 hereby affirm under penalty of perjury that'I 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.
Lirtse Class: • ' License No.:
�jDate: rdntraaor:
OWNER -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
a plicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars 1$5001.: -
(, ) 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. It, 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 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—) I am exempt under Sec. B.&P.C. for this reason
ate •' '1 1 Z�/Zner. Vi�
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:
PINSCORP
1 PARK PLACE#600
IRVINE, CA 92614
Contractor:
Owner
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 7/19/12
WORKER'S COMPENSATION DECLARATION
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 Policy Number .
�( I certify that, in the performance of the work for which this permit is issued, I shall not employ any
7� person in any manner sous 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 Labor Code, I shah forthw comply with those provisions.
ate•.`1 ` 9 :/tpplicanr. '
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 ($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 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 th' county to ter upon the above- eortioned property for inspec ion, purioses.
a0 te:�nature (Applicar Agent): 1
Application Number . . . . . 12-00000802
( Permit . . . MECHANICAL
Additional desc
Permit Fee 31.50 Plan Check.Fee
7.85
Issue Date Valuation
0.
Expiration Date 1/15/13
Qty Unit Charge Per
Extension .
BASE FEE
15.00
•1.00 16.5000 EA MECH B/C >3-15HP/>100K-500KBTU
16.50
--------------------
Special Notes and Comments
REPLACE A/C CONDENSER. 2010 CODES.
Other Fees . . . . . . . . . BLDG STDS ADMIN (SB1473)
1.00
Fee.summary Charged Paid Credited
Due
Permit Fee Total 31.50 .00 .00
31.50
Plan Check Total 7.88 .00 .00
7.88
Other Fee Total 1.00 .00 .00
1.00
Grand Total 40.38 .00 .00
40.38.
Simi ietTed, Piescii 'tive,Certifi'�afe:of'Coin' [in0:200
Climate Zones L0 to 15,'
RsidenttalflVAC:�lterizfio>ys'.`:• CF 1R=ALT HVAC
Site Address:
2- S '2 1`� t'►1 �r I Enloe
Equipment Tr
List Minimum Efficiency'
Duc
❑ Packaged Unit
Conditioned Floor "
insulation re uirement
❑ Fumace
O AFUE
❑ COP
Over 4
O Indoor Coil
EER..
❑ HSPF
replace
,WCondensing Unit
_jj�
❑ EER
❑Resistance
❑ R 6
O Other
installed)
OR 8
L Equipment T}Pe: Choose the equipment being installed • if h
ement itgency:
t
Date:
Permit #:
Conditioned Floor "
insulation re uirement
Area
Thermostat
0 R of ducts added or
O Setback
d in unconditioned space
SZ!,vFj by system
(lf not already
(CZ 10-13)
(CZ 14-15)
V�4Dsf
present. must be
installed)
more. an one system, use another CF- I R -ALT --Hi AC for each system.
7. Minimum EquipmentEJfteieneies: 13 SEER, 7801.AFUE. 7.7HSPFfortypicatresidentialsystems.
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 muse be conducted. A copy of the fortes 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 CF4R fortes (no hand filled CF4Rs allowed) are fill d
signed. Beginning October 1, 2010 a registered co of the CF -1R and CF -6R shalt also be on site for final Inspection. ed out an
1. H VAC Changeout Required Forms:
• All HVAC Equipment replaced CF-61kforms: MECH-04, MECH-21-HERS and (for split systems) MECH- 25 -HERS
CF -4R forms: MECH- 21 and for it sterns 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
lixern pied from duct leakage testing iE
O 1 Duct system %vas documented to have been previously sealed and confirmed through HERS verification, or
O 2. Duct systems with less than 40 linear feet in unconditioned space, or
O 3. Existing ducts stems are constructed, insulated or sealed with asbestos
El 2. New HVAC System Required Forms:
• Cut in or Changeout with new CF -6R forms: MECH-04, MECH-20-IERS,and for
ducts: (all new ducting and all ( split systems) MECH-22-IRS, and MECH-25-HERS
new equipment) CF -41K forms: MECH 20-, and (for split systerm)MECH-22, and MECH 25
For Split Systems: Duct leakage <6 percent; RC, CCA > 350 CFM1ton, FWD, TMAH, STMS, and either HSPP or PSPP.
For Packaged Units: Duct leakage <6 percent
113. New Ducts with Replacement Requtred`Forms:
• Includes replacing or installing all new ducting CF -6 ( forms: MECH-04, MECH-20-HERS,and (for split systems) MECH-25-HERS
and/or outdoor condensing unit and/or indoor CF -4R fortes: MECH-20 and (for split systems) MECH-25
coil and/or fumace. Not all equipment changed.
For Split Systems: Duct leakage < 6 percent, RC, CCA >_ 300 CFMhon, TMAH
For Packaged Units: Duct leakMe < 6 percent
O 4. New Ducting over 40 feet Required Forms:
• Include., addine or replacing more than 40
linear feet of duct in unconditioned s ace. CF -6R forms: MECH-04, MECH-2I-HERS CF4R 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)
• 16 certify that this Certificate of Compliance documentation is accurate and complete.
• 1 am eligible under Division 3 of the California Business and Professions Code to accept responsibility for the design identified on this Certificate of Compliance.
certifyand 6 of the California Code of Regulations. that the energy features and performance specifications for
farts I the design identified on this Certificate of Compliance conform to the requirements of Title 24,
'
-- '-- —•-7fic ..fe>t�n feawres idemif ed on this Certificate of Compliance are consistent with the information documented on other applicable compliance forms, worksheets
calculations, plans and $cific ons submitted to the enforcement a enc for a oval with the it application.
Name: t G
fr" t s o Signature:
Company:
Date: P 9 I L
Address: �•- `
L^ J -2-0�I i�L�1 License:
City/Statc2 ip:
ct. vl v �-�-- Phone: -7 &,o
2008 Residential Compliance Forms
March 2010
to P. -r-we m r# � -w, . r -i.
P.O. Box 1504
LA QUINTA, CALIFORNIA 92247-1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
r
BUILDING & SAFETY DEPARTMENT
PROPERTY OWNER'S PACKAGE
(760) 777-7012
FAX (760) 777-7011
Disclosures & Formsfor Owner -Builders Applying for Construction Permits.
MWORT NT. r NOTICE.IQ VROPER QW -NIM
It
Dear Property Owner.
An. application .for a building permit hasbeen sub 'teed in your name listing yourself as the builder of the .property
irnproe�ements specified at S' ), .
q ryl e r 1 7—
We are .providing you v Lith an Owner -Builder Acknowledgment and Information Verification Form to make you awamof your
responsibilities and possible risk you may incur by having this permit-issuedin your name as.the
Owner -Builder- We will not issue a buildingpermit until you.4ave read, initialed yourunderstanding of each'provision,
signed, and returned this form to us at our official address indicated. An agent of the owner cannot execute this:notice
unless you, the property owner, obtain the prior approval of the permitting authority.
Bead and initial -each: statement-hetowta signify you understand or verify this information.
1. I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner -Builder'
building pe't that erroneously implies that the property owner is providing his or her own labor and material personally. 1, as
an Owner -Builder, may be held liable and subject to serious financial risk for any injuries sustained by an unlicensed person
and his or her employees while working on my property. My homeowner's insurance may not provide coverage for those
injures. I am willfully acting as an Owner -Builder and am aware of the limits of my insurance coverage for injuries to workers
on MY property-
1 2. I understand building permits are not required to be signed by property owners unless they are responsible for the
construction and are not hiring a.licensed Contractor to assume this responsibility..
3. I understand as an "Owner -Builder" I am the re'' onsible.party of record on the permit. I understand that 1 may protect
myself from potential financial risk by hiring a licensed mi
Contractor and having the pert filed in his or her name instead of my
n
ow.
N
4. 1 understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on
permits and contracts.
5. I understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total value
Of my construction is at least five hundred dollars ($500), including labor and materials, I may be considered an "employee'
u(n�der state and federal law.
y
I understand if I am considered an "employer" under state and federal law, I must register with the state and federal
government, withhold payroll taxes, provide workers' compensation disability insurance, and' contribute to unemployment
compensation for each "employee." I also understand 'my failure to abide by these laws may subject me to serious financial
risk.
U�7. I understand under California Contractors' State License Law,. an Owner -Builder who builds single-family residential
structures cannot .legally build them with the .intent to offer them for sale unless all work iserformed b licensed
P Y
subcontractors and the number of structures does not exceed four within any calendar year, or all of the work is performed
under contract with a licensed general building Contractor.
� L8. I understand as an Owner -Builder if l sell the property for which this pertiut is issued, I may be held liable for any
financial or personal. injuries sustained by any subsequent owner(s) that result from any latent construction defects in the
w
o
rkmanship or materials.
I understand I may obtain more information regarding my obligations as an "employer" from the luternal Revenue
Service, the United States Small Business Administration, the California Department of Benefit Payments; and the California
Division of Industrial Accidents. I also understand I may contact the California Contractors' State License Board (CS LH) at 1-
i X800-321-CSLB (2752) or www.csib.ca.gov for more information about licensed contractors.
I0. 1 am aware of and consent to an Owner -Builder building permit applied for in my name, and understand that I am the
party legally and financially responsible for proposed construction activity at the following address:
U L 11.1 agree that, as the party legally and financially responsible for this proposed construction activity, .1 will abide by all
applicable laws and requirements that govern Owner- Builders as well at employers.
Vt 12.1 agree to notify the issuer of this, form immediately of any additions; deletions, or changes to any of the information l
have provided on this form. Licensed contractors are regulated by laws designed to protect the public. If you contract with
someone who does not have a license, the Contractors' State License Board may be unable to assist you with any finaneial loss
you may sustain as a result of a complaint. Your only remedy against unlicensed Contractors may be in'civil court. It is also
important for you to: understand that if an unlicensed Contractor or employee of that individual or firm is injured while working
on your property; you may be held fiat le for damages. If you obtain a permit as Owner -Builder and wish to hire Contractors,
You will be responsible for verifying whether or not those Contractors are properly licensed and 'the status of their woricers'
compensation insurance coverage.
Before a building permit can be issued, this form must be completed and signed by the property owner and returned to
the agency responsible for issuiug,tle.perndt. Note: A :copy of the property owner's Mver's lfcensef farm r otat;*att'0n; or
other verification acceptable to the agency is required to be presented when the permit is issued to verify the property
owner's signature.
Signature of property owner Vim' Date:
Note: The following Authorization Form is required to be completed by the property owner only when designating
an agent of the property owner to apply for a construction permit for the Owner -Builder.
AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF
Excluding. the Notice to Property Owner, the execution of which I understand is my personal responsibility, I hereby authorize
the following person(s) to act as my agents) to apply for, sign, and file the documents necessary to obtain an Owner -Builder
Permit for my project.
Scope of Construction Project (or Description of Work):
Project Location' or Address:
Name of Authorized Agent:
Address of Authorized Agent:
Tel No
I declare under penalty of perjury that I am the property owner for the address listed above and I personally filled out the above
information and certify its accuracy. Note: A copy of the owner's driver's license, form hotariaation, or other verification
acceptable to the agency is required to be presented when the permit is issued to verify the property owner's signature..
Property Owner's Signature: IDate:
Bin. # of La Quthta
RUM1ing a Safety Division
Permit # 0 P.O. Box 1504,"78-495 Calle Tamplw
tt// 1.a.Quinta, CA 92253- (760) 777-7012
Building Permit Application and Tracking Sheet
Project Address: ®�: t Z Owner's Name:. t h S l
A. P. Number.
Address: p
Legal Description:
Contractor.
City, ST, Zip. �V i/ l �+ .e C A- Ci -L 6 i
Telephone: —160 " S " 1-1!96 -.' x :xy
Address:
Project Description: g 4 C Vie_
City, ST, Zip:
A t✓ • C O
Telephone:-I
State Lie. # :
Arch, Engr., Designer
r. qui
City Lic. #;
Address:
City., ST, Zip:
Telephone:
State Lic. #:�'
� :w %.
Construction Type: Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
Name of Contact Person:
v l L-{--0 r
t rl 5,0 n
Sq. Ft.:
# Stories:
# Units:
Telephone # of Contact Person: 1 bQ" ' ~ ��
Estimated Value of Project: ®' Q
APPLICANT: DO NOT WRITE BELOW THIS LINE
N
Submittal
Req'd
'Rec'd
TRACMG
PERMfI 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.
-Tide 24 Calcs.
Pians picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2a° Review, ready for correcfionsauue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.L t'
H.O.A. Approval
Plans resubmitted
Grading
El HOUSE:-
''" Review,' ready for correctionsfissuc
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr "
Date of permit issue
School Fees
Total Permit Fees