14-0316 (MECH)44 P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
.Application Number: 14-00000316 Owner:
Property Address: 53590 AVENIDA RAMIREZ MICHEAL DEE
APN: 774-122-005-20 -000000- 53590 AVENIDA RAMIREZ
Application description: MECHANICAL LA QUINTA, CA 92253
Property Zoning: COVE RESIDENTIAL
Application valuation: 7000
Contractor:
App 'cant: Architect or Engineer: /cu/ �� HYDES
42949 MADIO STREET
1
✓�'' (°�.11�--- •U (-% IO, CA 92201
�►),� U
60)360-2202
Lio. No.: 906115
C!�°✓,� J } fIf
!''Jtlr.,Ji
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 Business and Professionals Code,- and my License is in full force and effect.
License Class: C20 C3 nse No.: 906115
--Dae:
Date: � Contractor: -
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 ($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 LicenseLawdoes 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.).
(_ 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 ISec. 3097, Civ. C.).
Lender's Name:
Lender's Address:
LQPERMIT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 3/25/14
WORKER'S COMPENSATION DECLARATION
I hereb r m 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 NORGUARD INS Policy Number CEWC468841
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 become subject to the workers' compensation provisions of Section
3700 of the Labor' Cod�forthwit mply itK those provisions.
Date: Ap`r 'p`ican�t:"
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 I '
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 this county toe to on the above-mentioned property for inspe n p rl%ses.
,
Da[e:1- zrea
t SignatuAppl�- ica� n� t or_AgenU:
LQPERMIT
Application Number . ... . . 14-00000316
e Permit . . . MECHANICAL 2013
Additional desc .
Permit Fee . . . . 83.42 Plan Check Fee
.00
Issue Date . . . . Valuation . . .
. 0
Expiration Date 9/21/14
Qty Unit Charge Per.
Extension
1.00 35.7500 EA MECH FURNACE
35.75
1.00 11.9200 EA MECH APPL REP/ALT
1.00 35.7500 EA. MECH CONDENSRR/COMP
35.75
----------------------------------------------------------------------------
Special Notes and Comments
AC,FURNACE, COIL PACKAGED UNIT CHANGE
OUT 13 SEER 4 TON 7.7 HSPF,2013
MECHANICAL CODES.
-------------------- ------------------------------------------------------
Other Fees' . . BLDG STDS ADMIN (SB1473)
1.00
PERMIT ISSUANCE M/P/E
`90.57
PLAN CHECK, MECHANICAL
52.43
Fee summary Charged Paid Credited
Due
Permit Fee Total 83.42 .00 .00
83.42
Plan Check Total .00 .00• .00
.00
Other Fee Total 144.00 .00 .00
144.00
Grand Total 227:42 .00 - .00
227.42
l
,
LQPERMIT
Bin#
- --
--- - - - _ .. -- __. — - ---- ---
City of La Quinta ^�
Buiidihg 8T Safety Division
P.O. Box 1504, 78-495 Case Tampico
La Quetta, CA 92253 - (760) 777-7012
Building Permit Application and Trackn g Sheet
—
Permit o
^
Project Addressf �'3 �j O. V e h j q PC, M 1re. Z
Owned's Name: !C /,, 9 t. g e
A. P. Number.
Address: -3 —'5�a/ G
Legal Description:
city, Sq', Zip:
Contractor. / el k 'f d COA, S g/'
Telephone:
Address: L[ Z L -i! N, ,
ProJectDescription:
City, ST, Zip: C A Z Z a
Telephone: Gb _ZZaZ
State Lic. # : q (% 1j. City Lic. #:
Arch., Engr., Designer-
esignerAddress:
Address:
City, ST, Zip:
—
Telephone.
State..Lic. #: Imig-Project
Construction Type: Occupancy-
type (circle one): New Add'u Alter_ Repair' Demo
Name of Contact Person
Sq. Ft:
# Stories
# Units:
Telephone ## of Contact Prion:.
Estimated Value of Project 4 � v
APPLICANT: DO NO.T WRITE BELOW THIS LINE
#
Submitfal
Req'd -
Reed
TRACMG .
PERMLT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Cales.
y
Reviewed, ready for corrections
Plan Cheek Deposit
Tress Calcs.
y,;ry
Called Contact Persou
Plan Check Ehlance
Energy Cales.
Pians picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical '
Grading Plaw
2' Review, ready for correctlonslissue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S,IVU
H.OA Approval
Pians resubmitted
Grading
IN HOUSE:-
s"' Review, ready for correetionslissue
Developer -Impact Fee
Flaming Approval
Called Contact Person
AJ-P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
----
TOW Permit Fees
0
Simplified Prescriptive Certificate of Compliance: 2008 Residential HVAC Alterations CF -IR -ALT -HVAC
Climate Zones 10 - 15
Site Address:
Enforcement Agency:
Date:
Permit #:
53-590 Avenida Ramirez La Quinta, CA 92253
City of La Quints I
Mar 25, 2014
Duct insulation
Conditioned Floor
Equipment Typei
List Minimum Efficiency2
requirement
Area
Thermostat
® Package Unit
❑ Furnace
❑ Indoor Coil
❑ AFUE
® SEER 13.0
❑ COP
® HSPF 7,7
❑ R 6 (CZ 10-13)
R $
Served by system
1600 sf
® Setback
If not already present, must be
[3 Condensing Unit
[3 EER
❑ Resistance
13 (CZ 14-15)
installed)
❑ Other
1. Equipment Type: Choose the equipment being installed; if more than one system, use another CF -1 R-ALT-WAC'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 decices 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 SCF -611 and registered CF -4R
forms (no hand filled CF-4Rs allowed) are filled out and signed.Beginning October 1, 2010, a registered copy of the CF -111 .
and CF -611 shall also be on site for final inspection.
® 1. HVAC Changeout
Required Forms:
. All HVAC Equipment..
CF -6R forms: MECH-04, MECH-2I-HERS
replaced
CF -4R forms: MECH-21
. Condenser Coil and /or
CF -6R forms: MECH-04, MECH-2I-HERS and (for split systems)
. Indoor Coil and /or
CF -411 forms: MECH-21
. Furnace
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 tfan;40 linear feet in unconditioned space, or
❑ 3. Existing duct systems are constructed, insulated or sealed with asbestos
[14. The system will not be Duete.d (ie. Ductless Mini -Split System) (Also Exempt from Refrigerart Charge)
❑ 2 -.New HVAC System
Required Forms:
• Cut in. or,0 ngeout with
�" :. e
CF -6R forms "MECH 04, MECH 2O -HERS; and (forsplrt systems) MECH ZZ HERS, and
new ducts (all new ni
ME 25 HERS
'
ductind." :,611 new -
r
CF 4R}forms MECH 20, and (for,�split systems) MECH 22,: and MECH 25 �xh
equipment)..
For Splii Systems Duct leakage < '6' t, RC, CCA > 350 CFM/ton, FWD, TMAH,'STMS„and either HSPPior PSPPf'
”Duct �g4'
leaks e< 6 eccenty
For Packaged Units sak _9 P . c , :•
_:..
:.
❑ 3. New Ducts with'/or without
s
Re quired Forms '
Replacement'
. Includes replacing or installing aW new
ducting and/or outdoor condensing`. unit
CF -6R forms: MECH-04, MECH-20-HERS, and (for split systems) MECH-25-HERS
and/or indoor coil and[or,furnaci ,.No or some
CF -4R forms: MECH-20 and (for split systems) MECH-25
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
I Required 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 Califomia 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 :he permit application.
Name: Mark Hyde Signature: Mark Hyde
Company: CERTIFIED COMFORT SYSTEMS INC. Date: Mar 25, 2014
Address: 42-949 MADIO STREET Limnse: 906115
City/State/Zip: INDIO / CA / 92201 Ph ane: (760) 360-2202
o'..... >il-ann,)n,?ana-nnnnnnnnn-nnnn RPai.stration Date/Time: 2014/03/25 13:43:35 HERS Provider: Ca10ERTS, Inca