10-0466 (MECH)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
C&hf 4 4 Q"
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Application Number:
10-00000466"
Property Address:
57660 BLACK DIAMOND
APN:
762-380-026- - -
Application description: MECHANICAL
Property Zoning:
LOW DENSITY RESIDENTIAL
Application valuation:
1666
Applicant: )
- - Architect or Engineer:
pli%
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: B -C10 -C cense No.: 856936
ate: - ntramor:
OWNER -BUILDER DECLARATION
I hereby affirm under pena o 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 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 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.I.
Lender's Name:
Lender's Address:
LQPERMIT
Owner:
SARCILAZO DIANA
57660 BLACK DIAMOND
LA QUINTA, CA 92253
(
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 6/02/10
-- — Contractor:. o ...... �� .
TELFORDJONES, INC. t�
25920 IRIS AVE, STE 13A-4 !r
MORENO VALLEY, CA 92551JU Q N 2010
(951)486-0337 t
Lic. No.: 856936 (;TYOFRAene; —rA
(a .t '>>'%'E IEP
--------------------------------------------------
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 0059112009
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 becomesuN to the workers' compensation provisions of Section
3700,aPTML� or Cod�l sbA fortl}v t ii comply with those provisions.
WARNING: F ILURE TO SELURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN MPLOY O CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS ($1 1 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.
certify that I have read this appy i nd state that t e above rma ' n is correct. 1 agree to comply with all
city and county ordinances an , tate law elating t Iding str ion, and hereby authorize representatives
of thi aunty to enter upo a above -me ione r erty f i ection purposes.
ate g ture (Applicant A
Application Number . . . 10-00000466
Permit . . . MECHANICAL.
Additional desc .
Permit.Fee . . . 33.00
Plan Check Fee
8.25
Issue Date . . . .
Valuation . . .
. 0
Expiration Date 11/29/10
Qty Unit Charge Per
Extension
BASE FEE
15.00
2.00 9.0000 EA MECH APPL
REP/ALT/ADD
18.00
----------------------------------------------------------------------------
Special Notes and .Comments
AC-COND-COIL CHANGE OUT LIKE FOR LIKE
"----'—'SAME -LOCATION " 1'--3-TON UINT-13 SEER';
_....
(1)5 TON UNIT 13 SEER.
------------------------------------------------- --------------------------
Other Fees . . . . . . . BLDG STDS ADMIN (SB1473)
1.00
Fee summary Charged Paid
Credited
Due
Permit Fee Total 33.00
.00 .00
33.00
Plan Check Total 8.25
.00 .00
8.25
Other Fee Total 1.00
.00 .00
1.00
Grand Total 42.25
.00 .00
42.25
LQPERMIT
Simplified Prescriptive Certificate of Compliance: 2008 Residential HVAC Alterations CF -IR -ALT -HVAC
Climate Zones 10 to 15
Site Address:
Enforcement Agency:
Date:
Permit #:
6-,;? /o
Conditioned Floor
Equipment T t
List Minimum Efficiencyz
Duct insulation requirement
Area
Thermostat
❑ Packaged Unit
❑ Furnace
❑
OSEER
❑ COP.
Over 40 ft of ducts added or
etback
door Coil
-14,z
�
❑ HSPF
repla m unconditioned space
Served by system
(Ifnoactready
WCondensing Unit
❑ EER
_
❑ Resistance
^ ;� (� 10-13)
sf
present, must be
installed)
❑ Other
11W 8 (CZ 14-15)
1. Equipment Type: Choose the equipment being installed: if more than one system, use another CF -1 R -ALT -HVAC for each system.
2. Minimum Equipment Efficiencies: 13 SEER, 7890 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 forts 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 CF4Rs allowed) are filled out and
signed -Beginning October 1 2010 a registered copy of the CF -118 and CF -611 shall also be on site for final Ins tion.
GK HVAC Changeout
Required Forms:
• All HVAC Equipment replaced
CF -6R forms: MECH-04, MECH-2I-HERS and (for split systems) MECH- 25 -HERS
CF -4R forms: MECH- 21 and for split systems). MECH-25
• Condenser Coil and/or
• Condor Cor{ and/or
CF -6R forms: MECH-2I-HERS and (for split systems) MECH- 25 -HERS
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 Rom 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 duct systems are constructed, insulated or sealed with asbestos
❑ 2. New HVAC System Required Forms:
• Cut in or Changeout with new CF -6R forms: MECH-04, MECH-20-HERS,and for split systems) MECH-22-HERS, and MECH-25-HERS
ducts: (all new ductingrgrid all CF -4R forms: MECH 20-, and (for split systems)MECH-22, and MECH 25
new a ur ment
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 'RequIreC17orms:
• 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 CF4R 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
ff 4. New Ducting over 40 feet
Required Forms:
adding Include; add� or replacing more than 40
CF -6R forms: MECH-04, MECH-21-HERS CF4R forms: MECH-21
linear 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)
• 1 certifi, 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 ceniN, 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.
• i ale>ign features identified'on this Certificate of Compliance are consistent with the informs 'on ted o er pli mpliartce forms, worksheets,
calculations la andspecifications submitted to the enforcement a fora roval 11th a it i
Name:` �-�ZF
Signatu
Company: Zfd �it%G
Date:
6--2— —leAddress:
f�� J`�,;3
License: SCy
City/State/Zip:
Phone:
2008 Residential Compliance Forms March 2010
PLOT PLAN
Name:
Site Address: ci�74K&. PIVA
Phone:
Rear Property line /
X5,
Front Property line
o ,
c
Bin #
City Of La Quinta
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 #
"'
Project Address'
Owner's Name: . S�H"
A. P. Number:/
Address: Z40
Legal Description:.
City, ST, Zip:
Contractor: �C
Telephone:
Address: �O
Project Description:
City, ST, Zip:/f�('6�/ !� lf/ —
` L5?14�--00
Telephone:
State Lic. #: (j
City 4Lic.`#:.
Arch., Engr., Designer:
Address:
JF--/ VIV �3
City, ST, Zip:
Telephone:
aneY
Construction Type: Occupancy:
c. #:
State Li
ProJectty P (circle one): New Add'n Alter Repair it Demo
Name of Contact Person:
Sq. Ft.:
# Stories:
# Units:
Telephone # of Contact Person:
Estimated Value of Project: Awyl
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Rec'.d
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
Title 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
LI,4T 4 0A-
D -
ENERGY -- c A B E C.
Buvcx pIAMDw D S
P.D. Box 621 Ph/Fax f760) 564-2044
Rancho Mirage. CA 92270 CON. (760) 9=*M= 2SD- (852
Email: RKrom523740aol.com
CERTIFICATE OF FIELD VERIFICA'T'ION AND DIAGNOSTIC TESTING (Page I of 7) CF -411
Pas nd-F RA Ph--3-TE-S rte,_ 11-, e 2 1= 03
P�ect Title D e
/� ur'n! t4 - 6 L, a% ao�c libluN�l'!�
rojec Address Builder Na e
euc. N ue- � 760 Lo -3 Ll4 un ,
Bud er Contact Telephone Plan Number
#
4A �Li�
HS er Telephone Sample Group Number
1e -e 13ZG)f— LO -7-t- P
UenWying Signature Date -Sample House Number
Firm:®�5i&JAY 6Eqm C-IE.3 HERS Provider: �.1�•E.I�Q.S,
Street Address: P.0 - E6X %