11-1128 (MECH)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA. 92253
Application Number:
Property Address:
APN:
Application description:
Property Zoning:
Application Valuation:
Applicant:
_1.1-00a0112_8-
52970
1-000011 8
`52970 AVENIDA RAMIREZ
773-323-012-15 -000000-
MECHANICAL
COVE RESIDENTIAL
2800
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
PLONSKI THOMAS MATTISLAU
52970 AVENIDA REMIREZ
LA QUINTA, CA 92253
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Contractor: IIk26
U
Architect or Engineer- J ANTHONY PLUMBINGIR
72216 NORTH SHORE S� },0� ry 201
THOUSAND PALMS, . CA $ i
(760)328-8096 !f
1 LiC. No.: 777794 i CITY.OFLA QUINTA
N ` FllUnatne-..�_�
CENSED CONTRACTOR'S DECLARATION
I hereby affirm under!alty
of perjury t at I am licensed under provisions of Chapter 9 (commencing with
Section 7000) of Divf the Bu ss and Profess nils Code, and my License is in full force and'effect.
License lass: C20 Licens
te:I t 11 1 cto
1 OWNER -BUILDER DECLARATION
I hereby affirm underof perj ' 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 thanfivehundred dollars ($500).: -
(_) 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.).
K
(_) I'am exempt under Sec. , 8.8,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
Date: 10/27/11
----------------------------------------------—
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.
y'T 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 STATE FUND Policy Number 1932451-2011
_ I certify that, in the perfor ance of the work for which this permit is issued, I shali not employ any
person in any manner o as to become sub' ct to the workers' compensation lama�w's of California,
and agree that, if I sh Id become subjec t the workers' compensation roVfsions of Section
3700 of th Labo I shall forthw' c mply with those provi 'e
ate: G L'I pplicant..
WARNING: FAIL RE TO SECURE RKERS' 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 Quinti, its officers, agents and employeeL
ct or omission related to the work being
performed under or following issuance of this
2. Any permit issued as a result of this applicati null and void if work is not commenced
within 180 days from date of issuance of s cr cessation of work for 180 days will subject
permit to cancellation. ,
I certify that I have read this application and state the rmatio is correct. I agree to comply with all
t nd county ordinance and state laws relati b Idiction nd hereby author' re esentatives
y�athe above-mentio d p p rton p rposes.
Date:! Signature (Applicant or Agent
Application Number . . . 11-00001128
Permit MECHANICAL INV FEE
Additional desc .
Permit Fee . . . . 63 ..00 Plan"Check Fee
7.88
Issue Date Valuation . . . .
0
Expiration Date 4/24/12
Qty Unit Charge Per
Extension
BASE FEE
30.00
1.00 33.0000 EA* MECH B/C >3-15HP/>100K-50OKBTU
33:00.
Special Notes and Comments,
REPLACE 3.5 TON CONDENSING UNIT, 2010
CODES. INVESTIGATION FEE ASSESSED PER
1997 UNIFORM ADMINISTRATIVE CODE §304.5
FOR WORK BEGUN WITHOUT BUILDING PERMIT.
---------------------------------------------------------------
Other Fees . . . . . . . BLDG STDS ADMIN (SB1473)
-------------
1.00
Fee summary Charged Paid Credited
Due
Permit Fee Total 63.00 .00 00
63.00
Plan Check Total 7.88 .00 .00
7.88
Other Fee Total 1.00 .00 .00
1.00
Grand Total 71.88 .00 .00
71.88
o
.-j .
LQPERMIT
Simplified Prescriptive Certificate of Compliance: 2008 Residential HVAC Alterations CF-lR-ALT-HVAC
Climate Zones 30 - 15
Site Address:
Enforcement Agency:
Date:
Permit #:
52970 Avenida Ramirez La Quinta, CA 92253
City of La Quinta
Oct 13, 2011
Duct insulation
Conditioned Floor
Equipment Typel
List Minimum Efficiency2
requirement
Area
Thermostat
❑ Package Unit
❑ Furnace
❑ AFUE
❑ COP
❑ R 6 (CZ 10-13)
Served by system
Ej Setback
❑ Indoor Coil
0 SEER 13.0
[1HSPF
El 8 (CZ 14-15)
1550 sf
If not already present, must be
* Condensing Unit
❑ EER
El 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 -6R and registered CF -411
forms (no hand filled CF-4Rs allowed) are filled out and signed.Beginning October 1, 2010, a registered copy of the CF -IR
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 -411 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:
"•❑fl:" --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- System) (Also_ Exempt -from -Refrigerant. Charge)
❑ 2. New HVAC System
Required Forms:
. Cut in or Changeout with,
new ducts: (all new
CF -6R forms: MECH-04, MECH=20-HERS, and (for'split systems) MECH-22-HERS, and MECH 25 -HERS
ducting and all new
CF -4R forms: MECH 20, and,l(for split systems) MECH-22, and MECH 25 ;
m
equipent)y.Je1��1i
For Split Systems: Duct leakage < 6 percent; RC, CCA >-350 CFM%ton, FWD; TMAH, STMS, and either HSPP'orPSPP.
For Packaged Units: Duct leakage < 6 percent
❑ 3. New Ducts with/or without
Required Forms: "
Replacement
. Includes replacing or installing all new ducting
and/or outdoor condensing unit and/or indoor
CF -611 forms: MECH-04, MECH-20-HERS, and (for split systems) MECH-25-HERS
coil and/or furnace. No or some equipment
CF -411 forms: MECH-20 and (for split systems) MECH-25
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 lRequired 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: Kevin Robinson Signature: Kevin Robinson
Company: J ANTHONY PLUMBING HEATING & AIR CONDITIONING Date: Oct 13, 2011
Address: 72216 NORTH SHORE ST #101 License: 777794
City/State/Zip: THOUSAND PALMS / CA / 92276 Phone: (760) 328-8096
Reg: 211-A0053125A-00000000-0000 Registration Date/Time: 2011/10/13 12:52:58 HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms July 2010
4• '
'Sin #.: _ :....... ,
.. City Of La. Quin to
Building & Safety Division . �..
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking-Sheet
Permit #n
Project Address: S-?—'77,0 /71%/l)10 A- 2 iq* I LP
Owner's N81T1e:—roNM B�
A. P. Number:
Address:
Legal Description:
City, ST, Zip:
Contractor:
Telephone 6o — %O Z —
Address: . J ANTHONY SERVICES
Project Description:,
City, ST, Zip: THOUSAND PALMS, CA 92276
f ��Cp� A—
Telephone: / -X-3
State Lic. # 177 Z /.
City Lic. #: 07S-
'SArch.,
Arch.,Engr., Designer:
Address:
City, ST, Zip:
Telephone: ns 2
State Lic. #:
Name of Contact Person:
Construction Type: Occupancy:
Project type (circle one): New Adc'n Alto Repair Demo
Sq. Ft.:
# Stories: # Units:
Telephone # of Contact Person:
Estimated Value of Project: [z - d D
APPLICANT: DO NOT WRITE BELOW THIS UNE
N
Submittal
Req'd
Recd
TRACKING PERMIT FEES
Plan Sets
Plan Check submitted
!,� ll Item Amount
Structural Cates.
Reviewed, ready for corrections
Plan Che--k Deposit
Truss Cales.
Called Contact Person
Plan Chr..k Balance
Title 24 Caics.
Plans picked up
Construdion
Flood plain plan
Plans resubmitted
Mecham-tall
Grading plan
Review, ready for correctionstissue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
Review, ready for correctionsfissue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P_
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees
P
�a
NN AT E R ESTABLISHED IN 1918 AS A PUBLIC AGENCY p
1ISTRIC�
COACHELLA VALLEY WATER DISTRICT
POST OFFICE BOX 1058 • COACHELLA, CALIFORNIA 92236 • TELEPHONE (760) 398-2651 • FAX (760) 398-3711
DIRECTORS: OFFICERS:
JOHN W. McFADDEN, PRESIDENT STEVEN B. ROBBINS,
PETER NELSON, VICE PRESIDENT GENERAL MANAGER -CHIEF ENGINEER
TELLIS CODEKAS JULIA FERNANDEZ, SECRETARY
RUSSELL KITAHARA DAN PARKS, ASST. TO GENERAL MANAGER
PATRICIA A. LARSON REDWINE AND SHERRILL, ATTORNEYS
September 17, 2003
File: 1112.
Bill Davis '
_ _Davis and Associates,_
50-925 Paloma Court '
La Quinta, California 92253
Dear Mr. Davis:
Subject: 52-970 Avenida Ramirez
Account No. 606121,179.0.4
In researching our records, we found that the above -referenced property has
not met the sewer requirements of the district.
The district has no record of receiving a signed petition for annexation or
the payment of sewer fees, which would authorize connection to the sewer
system.
If'you have any questions please contact Rosie Anacleto, Customer Service "
Representative, extension 2420.
Yours very truly,
Steve 'Robbins
General Manager -Chief Engineer
RIA:ra
bc: City of La Quinta
Post Office Box 1504
La Quinta, California 92253
. .; 4�.. � ?�. '' � �• .. � ti .. : iii:.'•. ..'°t•.. .. .. «..r:f�••... ��.�,.
TRUE CONSERVATION
USE WATER WISELY