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14-0301 (MECH)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application NumbeF__ 14-0000030.1) Property Address: _ 57695 BLACK APN: 762 -370 -004 - Application description: MECHANICAL Property Zoning: LOW DENSITY Application valuation: 15000 Applicant: 6N­wl,�=A� T4ht BUILDING & SAFETY DEPARTMENT BUILDING PERMIT l aw `SCONP] RESIDENTIAL Architect or Engineer: 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 ofe Business and Professionals Code, and my License is in full force and effect. License Class: C2.01 License No.: 619091 Date:_ � Contractor: v 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 _ 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 Owner: ZERBE DONALD G 57695 BLACK DIAMOND LA QUINTA, CA 92253 ( J $(; N VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Contractor: PALOMA AIR CONDITIONING P.O. BOX 3501 PALM DESERT, CA 92261 (760)347-1212 Lic. No.: 619091 Date: 3/24/14 D afy�� s M, � I CITy r1F LA QUPNIA FIPA� q;r: BpPi. 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 COMPANION PROPT Policy Number CPCA17452 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 t at, i Ald become subject to the workers' compensation provisions of Section 3300 •f he a or CpIJe, I sh II forthwith compI wrth th�s�e p�ro�ws%i ns. Date: !(JJ/nv�//A I lL w /%/� /�✓���` — J '� 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 appliQ�n and state that the above information is correct. I agree to comply with all city and county ordina _--tSt� laws relating to building construction, and hereby authorize representatives of this county to t pon t e'ab ve-mentioned property for inspection purposes. DatR'"Signator.-(Applicant-or-Agent): - Application Number . . . ... 14-00000301 Permit . . . MECHANICAL 2013 Additional desc . Permit Fee . . . . 250.26 Plan Check Fee .00 Issue Date . . . . Valuation . . . . 0 Expiration Date'. 9/20/14 Qty Unit Charge Per Extension 3.00 35.7500 EA MECH FURNACE 107.25 3.00 11.9200 EA MECH APPL REP/ALT 35.76 3.00 35.7500 EA MECH CONDENSER/COMP 107.25 ---------------------------------------------------------------------------- Special Notes and Comments (3)FURNACES,INDOOR COILS & CONDENSING UNITS 13 SEER PER 2013 MECHANICAL CODES.HVAC CHANGE OUT (2) 5 & (1) 3TON AFUE 13 SEER 2013 ENERGY] CARBON MONOXIDE ALARM(S) TO BE INSTALLED PRIOR TO FINAL INSPECTION. ---------------------------------------------------------------------------- Other Fees . . . . . . . . . BLDG STDS ADMIN (SB1473) -1.00 PERMIT ISSUANCE M/P/E 90.57 PLAN CHECK, MECHANICAL 157.29 Fee summary Charged Paid Credited -=--------------- Due ---------------------------------------- Permit Fee Total 250.26 .00 .00 250.26 Plan Check Total .00 .00 .00 .00 Other Fee Total 248.86 .00 .00 248.86 Grand Total 499.12 .00 .00 499.12 LQPERMIT Din #City of La Quinta Building 8L Safety Division P.O. Box 1504, 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tr g Sheet B Tracking Permit # Project Address: 5 -7 6 7'T- ! AAp wner's Name: —7(oo 2,Q y�,,y A. P. Number: Address:?_ dal Legal Description: City, ST, Zip: C . 0( Contractor: Address: Telephone: % ��€':><<%ii<>'��<" :..:•. Project Description: City, ST, Zip: — v p . Telephone: State Lic. # : City Lie. #c Arch., Engr., Designer: Address: City., ST, Zip: Telephone: Construction Type: Occupancy: State Lie. #: Project type (circle one): New Add'n Alter Repair Demo Name of Contact Person: Sq. Ft.: D # Stories: #Units: Telephone # of Contact Person: Estimated Value of Project: %s 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 Title 24 Calcs. Plans picked up Construction Flood plain plan Plans resubmitted Mechanical Grading plan god 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 correctionstiissue Developer Impact Fee Planning Approval Called Contact Person A.I.P.P. Pub. Wks. Appr Date of permit issue School Fees Total Permit Fees Ma- 1) n n Zr w, 1-n 6 r) -6M Simplified Prescriptive Certificate of Compliance: 2008 Residential HVAC Alterations CF -1R -ALT -HVAC Climate Zones 10 - 15 Site Address: Enforcement Agency: Date: Permit #: 57-695 Black Diamond La Quinta, CA 92253 City of La Quinta Mar 24, 2014 Duct insulation Conditioned Floor Equipment Typel List Minimum Efficiency2 requirement Area Thermostat ❑ Package Unit ® Furnace ® AFUE 78% ❑ COP ❑ R 6 (CZ 10-13) Served by system ® Setback ® Indoor Coil ® SEER 13.0 ElHSPF 13 13 R 8 (CZ 14-15) 4200 sf If not already present, must be ® Condensing Unit (3EER Resistance Elta ❑ Other 1. Equipment Type: Choose the equipment being installed; if more than one system, use another CF -1R -ALT -HVAC 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 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 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 and (for split systems) MECH-25-HERS replaced CF -4R forms: MECH-21 and (for split systems) MECH-25 . Condenser Coil and /or . Indoor Coil and /or CF -6R forms: MECH-04, MECH-2I-HERS and (for split systems) MECH-25-HERS . Furnace CF -4R forms: MECH-21 and (for split systems) MECH-25 For Split Systems: Duct leakage < 15 percent; RC, CCA <_ 300 CFM/ton (Minimum Air Flow Requirement), TMAH ee.. Pars mitt, n....r lea 4 15 r aged age p Exempted from dud 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 [13. Existing dud systems are constructed, insulated or sealed with asbestos [14. The system will not be Ducted (ie. Ductless Mini -Split System) (Also Exempt from Refrigerant Charge) ❑ 2. New HVAC System Required Forms: . Cut in or Changeout with CF-6R'forms:°MECH-04,"MECH-20-HERS, and-(ior split systems) MECH-22-HERS, and new duds: (all new ducting -and all new MECH-25-HERS ` CF -4R forms: MECH-20, and (for.split systems)°MECH-22,iand MECH-25, equipment) , t �. For Split Systems_ Duct leakage,;_- 61percent; RC, CCA 2t 350 CFM/ton, FWD, TMAH; STMS, and either HSPP or,PSPP' E �' For Packaged Units Duct leakage'< 6 percent " AW/Ar ❑ 3. New Ducts with/or without Required Forms: Replacement . Includes replacing or installing all 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 furnace. 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 Required Forms: . Includes adding or replacing more than 40 7F -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 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 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 the permit application. Name: Herman Paredes Signature: Herman Paredes Company: PALOMA AIR CONDITIONING Date: Mar 24, 2014 Address: P 0 BOX 3501 License: 619091 City/State/Zip: PALM DESERT / CA / 92261 Phone: (760) 347-12121 Reg: 214-A0019929A-000000000-0000 Registration Date/Time: 2014/03/24 13:30:01 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms July 2010 Simplified Prescriptive Certificate of Compliance: 2008 Residential HVAC Alterations CF -IR -ALT -HVAC Climate Zones 10 - 15 Site Address: Enforcement Agency: Date: 7 Permit #: 57-695 Black Diamond La Quinta, CA 92253 City of La Quinta I Mar 24, 2014 Duct insulation Conditioned Floor Equipment Typel List Minimum Efficiency2 requirement Area Thermostat ❑ Package Unit ® Furnace ® AFUE 78% ❑ COP ❑ R 6 (CZ 10-13) Served system ® Setback ® Indoor Coil ® SEER 13.0 [3HSPF [3 R 8 (CZ 14-15) 4200 Sf If not already present, must be ® Condensing Unit [3 EER El Resistance installed) ❑ Other 1. Equipment Type: Choose the equipment being installed; if more than one system, use another CF -IR -ALT -HVAC 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 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 CF -4R forms (no hand filled CF-4Rs allowed) are filled out and signed.Beginning October 1, 2010, a registered copy of the CF -1111 and CF -611 shall also be on site for final inspection. 0.1. HVAC Changeout Required Forms: . All HVAC Equipment CF -6R forms: MECH-04, MECH-2I-HERS and (for split systems) MECH-25-HERS replaced CF -4R forms: MECH-21 and (for split systems) MECH-25 . Condenser Coil and /or . Indoor Coil and /or CF -6R forms: MECH-04, MECH-2I-HERS and (for split systems) MECH-25-HERS . Furnace CF -4R forms: MECH-21 and (for split systems) MECH-2S I For Split Systems: Duct leakage < 15 percent; RC, CCA <_ 300 CFM/ton (Minimum Air Flow Requirement), TMAH 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 [13. Existing duct systems are constructed, insulated or sealed with asbestos ❑ 4. The system will not be Ducted (ie. Ductless Mini -Split System) (Also Exempt from Refrigerant Charge) ❑ 2. New HVAC System Required Forms: . Cut in or Chan eout with g new ducts: (all new` ";i 1, __ Y ' " CF -6R +.MECH 04; MECH'20 HYERS and (for split systems) MECH=22-RS, and HE ducting' all new MECH,25 HERS CF 4R forms ;MECH-20, and (for split systems);MECH-22 (and.MECH 25 equipment) " >1 :x,1 r _e 0 350 CFM/ton; FWD TMAH 1STM5 and either HSPP�or.:PSPP '3* For Split Systems:, Duct leakage < 6jpercent; RC, CCA 2'3-50A .. o"N•fir -�n +�:.. _ _ For Packaged Units: Duct leakage: < 6 percent1� :.. tai;<t ...P _.. _ . ❑ 3. New Ducts witli/or without," Required'Forms: Replacement . Includes replacing or installing all 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 furnace. 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 114. New Ducting over 40 feet 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 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 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 the permit application. Name: Herman Paredes Signature: Herman Paredes Company: PALOMA AIR CONDITIONING Date: Mar 24, 2014 Address: P O BOX 3501 License: 619091 City/State/Zip: PALM DESERT / CA / 92261 Phone: (760) 347-1212 Reg: 214-A0019929A-000000000-0000 Registration Date/Time: 2014/03/24 13:30:01 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms July 2010 r)n n Ze t�)o, Gin--6nn -kn( n Simplified Prescriptive Certificate of Compliance: 2008 Residential HVAC Alterations CF -IR -ALT -HVAC Climate Zones 10 - 1S Site Address: Enforcement Agency: Date: Permit #: 57-695 Black Diamond La Quinta, CA 92253 City of La Quinta Mar 24, 2014 Duct insulation Conditioried Floor Equipment Typel List Minimum Efficiency2 requirement Area Thermostat ❑ Package Unit ® Furnace IM Indoor Coil ® AFUE 78% ® SEER 13.0 ❑ COP [3HSPF ❑ R 6 (CZ 10-13) Served system ®Setback - If not already present must be ® Condensing Unit [3 EER [3 Resistance [3 R 8 (CZ 14-1-5) 4200 sf installed) ❑ Other 1. Equipment Type: Choose the equipment being installed; if more than one system, use another CF -1R -ALT -HVAC 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 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 -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 -6R shall also be on site for final inspection. 181.1. HVAC Changeout Required Forms: . All HVAC Equipment CF -6R forms: MECH-04, MECH-2I-HERS and (for split systems) MECH-25-HERS replaced CF -4R forms: MECH-21 and (for split systems) MECH-25 . Condenser Coil and /or . Indoor Coil and /or CF -6R forms: MECH-04, MECH-2I-HERS and (for split systems) MECH-25-HERS . Furnace CF -411 forms: MECH-21 and (for split systems) MECH-25 For Split Systems: Duct leakage < 15 percent; RC, CCA <_ 300 CFM/ton (Minimum Air Flow Requirement), TMAH Fe- o....kaoed IInit.. Quet lea teage ; 19 .,r p 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 duct systems are constructed, insulated or sealed with asbestos ❑ 4. The system will not be Ducted (ie. Ductless Mini -Split System) (Also Exempt from Refrigerant Charge) ❑ 2. New HVAC System Required Forms: . Cut in or Chan eout.with w �,� 9 CF-6R"forms IMECH 04�MECH 20 HERS, and (for split systems) MECHY22-HERS, and new ducts: (all new MECH 25 HERS `' $ ! �> ducting and'all new CF 4R{forms MECH-20 and'(forsplit systeems)'MECH-22,ranVMECH 25 equipment) For Split Systems:. Duct leakage <.6 percent, RC, CCA > 350 CFM/,ton,-;FWD, TMAH ISTMS, and either,HSPP or PSPP For Packe ed UnitsADucf'leakage'< 6 percent + 9 k,S * ❑ 3. New Ducts with/or without ' Required Forms: " Replacement . Includes replacing or installing all new ducting and/or outdoor condensing unit CF -611 forms: MECH-04, MECH-20-HERS, and (for split systems) MECH-25-HERS and/or indoor coil and/or furnace: 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 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 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 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 the permit application. Name: Herman Paredes Signature: Herman Paredes Company: PALOMA AIR CONDITIONING Date: Mar 24, 2014 Address: P O BOX 3501 License: 619091 - City/State/Zip: PALM DESERT/ CA / 92261 Phone: (760) 347-1212 Reg: 214-A0019929A-000000000-0000 Registration Date/Time: 2014/03/24 13:30:01 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms July 2010