10-0803 (MECH)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
10-00000803
Property Address:
45310 BIRCHCREST CIR
APN:
604-302-013-24 -23995
Application description:
MECHANICAL
Property Zoning:
LOW DENSITY RESIDENTIAL
Application valuation:
9505
Tjht 4 a vQ"
Applicant: Architect or Engineer:
n
------------------
LICENSED CONTRACTOR'S DECLARATION
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
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 Busine and P of ssi als Code, and my License is in full force and effect.
Lice lass: C20-rC43 enseNo.: 276586
Date C tc ctor.
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).:
(_ 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 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 _ 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 (Sec. 3097, Civ. C.). ,
Lender's Name: —
Lender's Address:
LQPERMIT
Owner:
KALMAN KEVIN C
45310 BIRCHCREST CI
LA QUINTA, CA 92253
(
Contractor:
DESERT AIR CONDITION N
590 WILLIAMS ROAD
PALM SPRINGS, CA 92264
(760)323-3383
Lic. No.: 276586
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 8/26/10
AUGLAI U
z e 2oto D
OF tAQWNTA
-----------------------------------------------
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 INS CO OF WEST Policy Number WSD216397402
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 becomeect to the workers' compensation laws of California,
and agree that, if I should b om ubj c o e workers' compensation provisions of Section
((//XXAA�� 3 00 of the La de, h orth c ply with t e provisions.
Date(J Applican
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 Ovinta, 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 ' co ect. I agr to comply with all
city and county ordinances and state laws relating to building con c ' , a h eb authoriz epresentatives
of thi unty to enter upon the above-mentioned pro for pec purp s
Date:a Signature (Applicant or Agen
Application Number . . . . . 10-00000803
Permit . . . MECHANICAL
Additional desc .
% Permit Fee . . 40.50
Plan Check Fee
10.13
Issue DateValuation
0
Expiration Date 2/22/11
Qty Unit Charge Per
Extension
BASE
FEE
15.00
1.00 9.0000 EA MECH
FURNACE <=100K
9.00
1.00 16.5000 EA MECH
B/C >3-15HP/>100K-500KBTU
16.50
----------------------------------------------------------------------------
Special Notes and Comments
REPLACE INDOOR COIL; 5 TON SPLIT
SYSTEM
ON GROUND LIKE FOR LIKE 16 SEER
2007
CODES.
------------------- --------------------------------------------------------
Other Fees . . . . . . . . . BLDG
STDS ADMIN (SB1473)
1.00
Fee summary Charged
Paid. Credited
Due
----------------- ---------- ----------
Permit Fee Total 40.50
------- - -- ----------
.00 .00
40.50
Plan Check Total 10.13
.00 .00
10.13
Other Fee Total 1.00
.00 .00
1.00
Grand Total 51.63
.00 .00
51.63
LQPERMIT
Simplified Prescriptive Certificate of Compliance: 2005 Residenlial HVACAIIerations CF -IR -ALT -HVAC
Climate Zones 10 to 15 -
Site Address: L
Enforcement Age cy:
Date-/
Permit H:
r �
4
Conditioned Floor
Equipment Ty e' List Minimum Efficiency2
Duct insulation requirement
Arca
Thermostat
❑ P�kaged Unit
L7Fywace ❑AFUE bry
C1 cop
Over 40 ft of ducts added or
❑Setback
Erin�tor Coit ❑SEER 76
❑ HSPF
replaced in unconditioned space
Served by system
(Ijnor already
ondensing Unit ❑EER 15
_
❑Resistance
❑ R 6 (C7. 10-13)
sr
present, mast be
installed)
❑ Other
❑ R 8 (CZ 14-15)
1 Equipment Type- Choose the equipment being installed: if more than one system, use another CF -1 R-ALT-HVACjor each system.
2. Minimum Equipment Efficiencies: 13 SEER. 78% AFUE, 7.7HSPF for typical residential systems.
HERS VERIFICATION SU1V MARV 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. AI final, the inspector verifies that the work listed on this form was in fact the work completed by the
installer. The igzr.Gtor also verifies that each appropriate CF -6R and registered CF -411 forms (no hand filled CF-4Rs allowed) are filled out and
signed._X.eg-1n_ning October 1, 2010, a registered copy of the CF -11R. and CF -6R shall also be on site for final inspection.
HVAC Changeout
Required Forms:
• All HVAC Equipment replaced
CF -6R forms: MECH-04, MECH-2I-HERS and (for split systems) MECH- 25-14ERS
CF -4R forms: MECH- 21 and (fors lit systems) MECH-25
• Condenser Coil and /or
an
• 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
Exempted from duct leakage testing if:
❑ I. 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
112. New HVAC System Required Forms:
• Cut in or Changeout with new CF -6R forms: MECI-1-04, MECI1-20-HERS,and (for split systems) MECtl-22-FIERS. and MECFI-25-HERS
ducts: (all new ducting and all
CF -4R forms: MECH 20-, and (for split systems)MECH-22, and MF,CII 25
new equipment)
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
❑ 3. New Ducts with Replacement
Required Forms:
• Includes replacing or installing all new ducting
CF -6R forms: MECH-04, MECH-20-HERS,and (for split systems) MECH-25-HERS
and/or outdoor condensing unit and/or indoor
CF -4R 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 Ductina over 40 feet Required Forms:
• Includes adding or replacing more than 40 CF -6R forms: MECH-04, MECH-21-HERS CFAR forms- MECH-21linear feet of duct in unconditioned space.
_
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 ofComphance documentation is accurate and complete
• t 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 Tule 24
Parts I 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 gency for approval with the permit a I ation
Name: de.,
Signature: -�
Company Date:
Address v I License:
City/State2ip: G� Phone: �.
U
2008 Residential Compliance Forms March 2010
Bin #
Qty of La Quinta
Building 8T Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
V
1�' b
Project Address: 5 �. �; ��
Owner's Name:jWA- 4,11 � ��
A. P. Number:
/�
Address: 5 31 a a i A (, C `J
Legal Description:
City, ST, Zip: �
Contractor: Desert Air Conditioninq Inc.
Telephone:
Address: 590 W i 11 i am S Rd
Project Description:
City, ST, Zip: pa 1•m S
c Ate— S
Telephone:1-1m
(7 6 0 323-3383
`<>'<;•v#n
sns �'>••::..r.:::...:::.
�w C
� �' �.• k'
State Lic. #: 276586'
City Lic. #: 3 6 3
Arch., Engr., Designer.
Address:
City, ST, Zip:
Telephone:
State Lic. #: '
Construction Type: Occupancy:
Repair Demo
Project a circle one): New Add'n Alter
Name of Contact PCTSWO a C a 49-P ore P. Z4 • k
Sq. Ft.:
# Stories:
# Units:
Telephone # of Contact Person:( 7 6 0) 3 2 3— 3 3 8 3
Estimated Value of Project: —! 6
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Cates.
Reviewed, ready for corrections
Plan Check Deposit
Truss Cates.
Called Contact Person
Plan Check Balance •
Tide 24 Cates.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2"d Review, ready for corrections/issue
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 Fees