10-0522 (MECH)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 10-00000522
Property Address: 79165 BIG HORN TR
APN: 772-030-013-20 -25429 -
Application description: MECHANICAL
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 1500
r+NNnt:drit:
T4ht 4 XP Q"
Architect or Engineer
------------------
LICENSED CONTRACTOR'S DECLARATION
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
I hereby affirm under penalty of perjury that I a ' nsed under provisions of Chapter 9 (commencing with
Section 7000) of Division 3 of the Business d Prof ionals Code, and my License is in full force and effect.
License /Class: C20 -C,138 LicenseNo.: 826714
r
Date: `— " 2!/- !/-Vtractor:
.
�G ER= 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 1, 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 _ 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 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:
LQPERMIT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 6/16/10
Owner:
BAINBRIDGE BEN
79165 BIG HORN TR
LA QUINTA, CA 92253
(
Contractor.
BEST IN THE WEST Dtcayor
255 N. EL CIELO, 140-125
PALM SPRINGS, CA 92262
(760)343-1002 2010
Lic. No.: 826714
wnoA
-----------------------------------------------
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 STATE FUND Policy Number 1932774-09
I certify that, in the performance of ork,for which this permit is issued, 1 shat) not employ any
person in any manner so as ec a subject to the workers' compensation laws of California,
and agree that, if I shoul co su ' ct to the workers' compensation provisions of Section
377 0 of the Labor Co s w th comply with those provisions.
Date: 7�+ ! u icant:
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 abov in on is correct. I agree to comply with all
city and county ordinances and state laws relating to building ru ' a hereby authorize representatives
of this county to enter upon the above-mentioned propert o p as.
Date: ature (Applicant or Agent):
1 4
Application Number . . . . . 10-00000522
Permit . .
. MECHANICAL
Additional desc .
Permit Fee . .
. 24.00
Plan Check
Fee
6.00
Issue Date . . .
.
Valuation
. . .
. 0
Expiration Date
12/13/10
Qty Unit Charge
Per
Extension
BASE
FEE
15.00
1.00 9.0000
EA MECH
APPL REP/ALT/ADD
9.00
---------------------------------------------------------------------7------
Special Notes and
Comments
EVAP COIL CHANGE
OUT SAME FOR SAME 3 TON
---_. —__UNIT.---------- - --
L
--- •------- --
-- - ---- ------ - .
.... ..
_. ... ......_ ... ...._...._._......_..-. ...__....
---------------------------------------------------------------------------
Other Fees . . .
. . . . . . BLDG STDS ADMIN (SB1473)
1.00
Fee summary
Charged
Paid Credited
---------- ----=-----
Due
-----------------
Permit Fee Total
------ - --- ----------
24.00
.00
.00
24.00
Plan Check Total
6.00
.00
.00
6.00
Other Fee Total:
1.00
.00
.00
1.00
Grand Total
31.00
.00
.00
31.00
LQPERMIT
Simplified Prescriptive Certificate of Compliance: 2008 Residential HVACAlferations CF -IR -ALT -HVAC
Climate Zones 10 to 15
SiteAddress:
/'//
Enforcement Agency:
Date:
Permit #:
Conditioned Floor
Equipment Type t
List Minimum Efficiency,
Duct insulation requirement
Area
Thermostat
❑ Packaged Unit
❑ Furnace
❑AFUE_
p COp
Over 40 ft of ducts added or
❑Setback
Indoor Coil
❑SEER
❑ HSPF
replaced in unconditioned space
Served by system
(!east alreaah
❑ CondensingUnit
❑ EER
_
❑ Resistance
O R 6 (CZ 14-/3J
❑ R s (CZ ►a -15J
sf
preterit, mrcrr he
inttauecn
❑ Other
1. Equipment T1 pe: Choose the equipment being instilled: if ntore than one ststent, use another CF -1 R -:I LT -11 PAC. fire each spstern.
2. Minimum Equipment Efcieacies: 13 SEER. 78%.4 FUE. 7.711SPF ftrr tt pica/ residential sustents.
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 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 -611 and registered CF4R forms (no hand filled CF4Rs allowed) are filled out and
Wed. Beginning October 1, 2010, a registered copy of the CF -IR and CF -61R shall also be on site for Gnat inspection.
HVAC Changeout
Required Forms:
• All HVAC Equipment replaced
CF -611 forms: MECH-04, MECH-2l-HERS and (for split systems) MECH- 25 -HERS
CF -4R forms: MECH- 21 and fors lits stems) MECH-25
• Condenser Coil and /or
CF -6R forms: MECH-21-HERS and (for split systems) MECH- 25 -HERS
• Indoor Coil and/or
—.
CF4R 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
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
0 2. New HVAC System Required Forms:
with new CF -6R forms: MECH-04, MECH-20-HERS,and (for split systems) MECH-22-HERS, and MECH-25-HERS
• Cut s: al Chang outducting
ducts: (ail new ducting and all
CF -41K forms: MECH 20-, and (for split systems)MECH-22, and MECH 25
new equipment)
For Split Systems: Duct leakage < 6 percerit; RC, CCA ? 350 CFM/ton, FWD, TMAH, STMS, and either HSPP or PSPP.
For Packaged Units: Duct leakage < 6 percent
❑ 3. New Ducts with Replacement Required Forms:
• Includes replacing or installing all new ducting CF -6I1 forms: MECH-04, MECH-20-HERS and (for split systems) 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 Ductins over 40 feet
Required Forms:
• Includes adding or replacing more than 40
CF -6R forms: MECH-04, MECH-2I-HERS CF -411 forms: MECH-21
linear feet of duct in unconditioned space.
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)
• I certify that this Certificate of Compliance documentation is accurate and complete.
• I ate eligible under Division 3 ofthe California Business and Professions Code to accept responsibility for the design identified on this Certificate ofCompliancc.
• I certify that the energy features and performance specifications for the design identified on this Certificate of Compliance conform to the requirements of-ritle 24,
Parts I and 6 of the California Code of Regulations.
• 'Me design features identified on this Certificate of Compliance are consistent with the information t on other applicable compliance funns. workshects.
calcul5t- n, Ia s and specific tions submitted to the enforcement agency for approval with the rmi plication.
Name: r , n
Signature:
Compa
& V & d,
Date
� -- / _ —/c
AJdres • 12CL /LIh
License: 77-67(q 7`7
City/State/Zip: _S I ! � Z_
Phone: 7 0 312f 00Z—
lA
2008 Residential Compliance Forms March 2010
B`" #
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
Permit #/
/"j 1✓
J v
Project Address.` %�� /'�a `�Z
Owner's Name: _&A f 141;f 2 i
A. P. Number:
Address: 7 4 C �j lle/1`✓ -,-
Legal Description:
City, ST, Zip: 1,4 v i fyy-?J_ i 9 Z Z , :3
Contractor: LS 7— / %� E_ �
Tele hone:
''
Address:•25Y,4./t� 9[-j�/,7 /�� /tf(y-�Z�
Project Description: 641A ed 1-6 Cj-,.A-v L k-7—
City,ST, Zip: r¢ -!i`/ !sem i?-�ZZ6
Telephone:
State Lic. # : L %
City Lic. #:
Arch., Engr., Designer:
Address:
City, ST, Zip:
Tele hone: n�
p
State Lic. #: ;_3:i _
Construction Type: Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
Name of Contact Person: / G`j ¢—/Z v
Sq. Ft.:
# Stories:
J# Units:
Telephone # of Contact Person: -7 a -o - -
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACKING
PERMIT 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
Energy Calcs.
Plans picked up
Construction
Flood plain plan.
Plans resubmitted
Mechanical
Grading.plau
2°" Review, ready for correctionsrssue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
7nd 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