14-0530 (MECH)1. (4
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 14-00000530 '
Property Address: 53585 AVENIDA RAMIREZ
APN: 774-121-017-5 -000000-
Application description: MECHANICAL
Property Zoninq: COVE RESIDENTIAL
Application Valuation: 8595
Applicant:
Architect or Engineer:
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 (commencingwith-
Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect.
License Class: C20 I
`/ License o.: 489046
iDate0 6ntr.ct.r: � J
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
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars I$500).:
1 _ 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, 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 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: S(�.
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:
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.
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 /Q LE POINT NTL Policy Number WSI,THPE90140304
a,k!�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 worers' compensation laws of California,
and agree th t, if I should become subject to the workers' ompensation provisions of Se tion
3700 of tgelbor fide, I shill forthyllith gomply witt&ho a provisions. _
WARNING: FAILURE TO SECURE WORKER COMPENSATION COVERAGE IS UNLAWFUL, ANDALL
SUBJECT AN EMPLOYER TO CRIMINAL PE ALTIES AND CIVIL FINES UP TO ONE HUNDRED THgAiSAND
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 Ouinta, 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 thaothee ove information is correct. I agree to comply with all
city and county ordinances a d state laws relating to construction and hereby authorizesentatives
of this couteruP he above-mentioned pror 'nspe ion urposes.
Date vSighatu (Applicant or Agent): \
Date: 4/30/14
Owner:
JACQUELYN WARE
53585 AVENIDA RAMIREZ
LA QUINTA, CA 92253
(760)564-3184
Contractor:
HTG
ESSER AIR CONDITIONING
P.O. BOX 1636!
1
CATHEDRAL CITY, CA 9223:5
Clf°fta�y!>QUINTA
(760) 324-0550
j
LiC. No.: 489046
f�.�--.
-Fj`!Lt',..°:�
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.
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 /Q LE POINT NTL Policy Number WSI,THPE90140304
a,k!�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 worers' compensation laws of California,
and agree th t, if I should become subject to the workers' ompensation provisions of Se tion
3700 of tgelbor fide, I shill forthyllith gomply witt&ho a provisions. _
WARNING: FAILURE TO SECURE WORKER COMPENSATION COVERAGE IS UNLAWFUL, ANDALL
SUBJECT AN EMPLOYER TO CRIMINAL PE ALTIES AND CIVIL FINES UP TO ONE HUNDRED THgAiSAND
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 Ouinta, 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 thaothee ove information is correct. I agree to comply with all
city and county ordinances a d state laws relating to construction and hereby authorizesentatives
of this couteruP he above-mentioned pror 'nspe ion urposes.
Date vSighatu (Applicant or Agent): \
Application Number . . . 14-00000530
Permit . . . MECHANICAL 2013
Additional desc.
Permit Fee . . . . 71.50 Plan Check Fee
.00
Issue Date . . . . Valuation . . .
. 0
Expiration Date 10/27/14
Qty Unit Charge Per
Extension
1.00 35.7500 EA MECH'FURNACE
35.75
1.00 35.7500 EA MECH CONDENSER/COMP
35.75
----------------------------------------------------------------------------
Special Notes and Comments
HVAC CHANGE OUT - 13SEER/80AFUE SPLIT
SYSTEM [2008 ENERGY) CARBON MONOXIDE
ALARM(S) TO BE INSTALLED PRIOR TO FINAL
INSPECTION. 2013 CALIFORNIA BUILDING
CODES.
----------------------------------------------------------------------------
Other Fees . . . . . . . PERMIT ISSUANCE M/P/E
90.57
PLAN CHECK, MECHANICAL
47.66
Fee summary Charged Paid Credited
Due
Permit Fee Total 71.50 .00 .00
71.50
Plan Check Total .00 .00 .00
.00
Other Fee Total 138.23 .00 .00
138.23
Grand Total 209.73 .00 .00
209.73
r
LQPERAIIT
Qin #
City of La Quinta
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
Permit #
t 6� -
Project Address: 5 ms s epido
Owner's Name:
A. P. Number:
Address: 3 S
Legal Description:
City, ST, Zip: '
Contract r
o. S
-Tele hone:.
P o
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Address: U �d
Project Description:
City, ST, Zip: +_ CA 1225
Tele ne
P h o .
U
U
State Lie. # : ' City Lie. #c
l
,
Arch., Engr., Designer: v �l cx-
Address:
City., ST, Zip:
Telephone:
on tructi n TY
�C
P e: Occupancy:
State Lie. #:
ProJect tYPa circle one): New Add'n 41ter Repair Demo
Name of Contact Person:
Sq. Ft.:
# Stories:
# Units:
Telephone # of Contact Person:
Estimated Value of Project: S
APPLICANT: DO NOT WRITE BELOW THIS LINE
It
Submittal
Req'd
Recd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Cales.
Called Contact Person
Plan Check Balance
Title 24 Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2" Review, ready for correctionslissue
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 corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees,
Total Permit V-cs
Simplified Prescriptive Certificate of Compliance: 2008 Residential HVA C Alterations CF -IR -ALT -HVAC
Climate Zones 10 to 15
Site Address: �G 1
J
A-��n&Nnjlnl�-X�Z_
Enforcement Agency:
Date:
_ /� — ermit #:
Conditioned Floor
Equipment T
List Minimum Efficient Z
Duct insulation requirement
Area Thermostat
aged Unit
/
}�FUE
❑COP
Over 40 ft of ducts added or
ck
❑ Indoor Coil
ER1
❑ HSPF
replaced in unconditioned space
p p
S ed s si✓m to
��j jnor
❑ Condensing Unit
❑ EER
_
❑Resistance
❑ R 6 (CZ 10-13)
w`ST 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 -1 R -ALT -HVAC for each system.
1. Minimum Equipment Efficiencies: 13 SEER, 78%AFUE, 7.7HSPFfortypical 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 CF4R forms (no hand filled CF-4Rs allbwed) are filled out and
si ed. Beginning October 1, 2010, a registered co of the CF -IR and CF -6R shall also be on site for final inspection.
_ 1. HVAC Changeout
Required Forms:
• All HVAC Equipment replaced
CF-611forms: MECH-04, MECH-2I-HERS and (for split systems) MECH- 25 -HERS
CF -4R forms: MECH- 21 -and (fors lits stems) MECH-25 -
an
• Condenser Coil and/or
• Indoor Coil and
CF -6R forms: MECH-2I-HERS and (for split systems) MECH- 25 -HERS
CF -4R forms: MECH- 21 and (for split systems) MECH-25
• Furnace
For Split Systems: Duct leakage < 15 percent; RC, CCA > 300 CFM/ton(Minimum Air Flow Requirement;, TMAH
For Packaged Units: Duct leakage < 15 percent
Exemptedm duct leakage testing if:
04.
Duct system %vas 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
ducts: (all new ducting and all
CF -6R forms: MECH-04, MECH-20-HERS,and (for split systems) MECH-22-HERS, and MECH-25-HERS
new equipment)
CF -4R forms: MECH 20-, and (for split systems)MECH-22, and MECH 25
For Split Systems: Duct leakage < 6 percent; RC, CCA > 350 CFM/ton, FWD, TMAH, STMS, and either HSPP or PSPP.
For Packaged units: Duct leakage <6 percent
113. New Ducts with Replacement Required Forms:
• Includes replacing or installing all new ducting CF -6R forms: MECH-04, MECH-20-HERS,and (for split system.:) MECH-25-HERS
and/or outdoor condensing unit and/or indoor CF -411 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 Required Forms:
• Includes adding. ur replacin.- more than 40 CF -6R forms: MECH-04, MECH-2I-HERS CF -4R forms: MECH-21
Linear feet of duct in unconditioned s ace.
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)
• 1 certify that this Certificate of Compl iance documentation is accurate and complete.
• [am eligible under Division 3 of the Cali fomia Business and Professions Code to accept responsibility for the design identified on this Certificate of Compliance.
• I cenify that the energy features and performance specifications for the design identified on this Certificate of Compliance confom: to the requirements of Title 24,
Parts I and 6 of the Califomia Code of Regulations.
• The design features identified on this Certificate of Compliance are consistent with the information documented on other applicabl: c mpliance forms, worksheets,
calculations, plans and specifications submitted to the enforcement agency for approval with a rmit application.
Name:
1�
Signature:
Company:
Date:
Address: � 1 � � �
License:
)City/State/tip:
rA 2 S
Phone: 4 r) (y?
V'
2UU6 Hesidentia! Compliance Forms March 2010