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11-0375 (MECH)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: , Property Address: APN: Application description: Property Zoning: Application valuation: 11-00000375 55802 BRAE BURN 775 -280 -058 - MECHANICAL LOW DENSITY RESIDENTIAL 8960 Architect or Engineer: air BUILDING & SAFETY DEPARTMENT BUILDING PERMIT LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury Ia tf licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Bus, ess and rofess,onals Code, and my License-is"in'full force and effect. L�i cLicensess: C20 License No.: 046 /ate:*J���nctor: ' 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 _ 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.). (_) I am exempt.under Sec. B.&P.C. for this reason Date: Owner: CONSTRUCTION LENDING AGENCY 1 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: JIM SORENSON 55802 BRAE BURN LA QUINTA, CA 92253 Contractor: ESSER AIR CONDITIONING & P.O. BOX 1636 CATHEDRAL CITY, CA 92235 (760)324-0550 Lic. No.: 489046 VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 4/13/11 APR 14 2011 D OF LA QUI -NTA ANC€ DEP1; 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 MAINTSTAY BUSNS Policy Number MBS-SIP0051611 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 1 should become subject to the workers' compensation provisions of Section �} 700 of the Lab Code, I tall fo wit c m I rose provisions. te: l icant:� WARNING: Fill. 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 ab a nformation,s Corr I agree to comply with all city and co ty ordinances and sta laws relating to bu,ldI c struct,on�.ption an reby authorize representatives of thi cou /y to enter upon t bove•mentioned groses. of Le 6 nature (Applicant or Agent . /1 Application Number 11-00000375 Permit . . . MECHANICAL Additional desc . Permit Fee. 40.50 Plan Check Fee 10.13 Issue Date Valuation . . . . 0 Expiration Date.. 10/10/11 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-50OKBTU 16.50 Special Notes. and Comments INSTALL AC/HEATING SYSTEM WITH 1 4 TON 16SEER SYSTEM. 2010 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: 2008 Residential HVAC CF -1R -ALT -HVAC Alterations - Climate Zones 10 - 15 Site Address: Enforcement Agency: Date: Permit #: 55802 BRAE BURN La Quinta, CA 92253 City of La Quinta Apr 12, 2011 Duct insulation Conditioned Floor Equipment Type1 List Minimum Efficiency2 requirement Area Thermostat ❑ Package Unit 0 Furnace 0 AFUE 78% ❑ COP ❑ R 6 (CZ 10-13) Served by system ® Setback 0 Indoor Coil 0 SEER 16.0 ❑ HSPF R 8 (CZ 14 15) 1500 sf If not already present, 0 Condensing Unit [:1 EER F1 Resistance must be 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 -411 forms (no hand filled CF-4Rs allowed) are filled out and sig ned.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 -411 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 5 300 CFM/ton (Minimum Air Flow Requirement), TMAH For Packaged Units: Duct leakage < 15 percent Exempted from duct leagage testing if: 1. Duct system was documented to have been previously sealed aro,l confirmed through HERS verification, or ❑ 2. Dud systems with less than 40 linear feet in unconditioned space, or ❑ 3. Existing dud systems are -constructed, � insulated or.sealed with asbestos ❑ 2. New HVAC i Required Forms: System. . Cut in or Changeout,/$ with new ducts: (all CF -6R forms: MECH-04, MECH-20-HERS, and (for split systems) MECH-22-HERS, and. _ ; new ducting �q�'all MECH=25-HERS f! i ,+ t CF -4R forms: MECH 20, and (for split systems) MECH-22;and MECH 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/or without Required Forms: Replacement . Includes replacing or installing all new ducting and/or outdoor condensing unit and/or indoor coil CF -6R forms: MECH-04, MECH-20-HERS, and (for split systems) MECH-25-HERS and/or furnace. No or some CF -4R forms: MECH-20 and (for split systems) MECH-25 equipment changed. For Split Systems: Dud 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 CF -6R forms: MECH-04, MECH-2I-HERS than 40 linear feet of duct in CF -4R forms: MECH-21 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 of Compliance documentation is accurate and comple^.a. . 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: Kevin Hampton Signature: Kevin Hampton Company: ESSER SERVICES INC Date: Apr 12, 2011 Address: P O BOX 1636 License: 489046 City/State/Zip: CATHEDRAL CITY / CA / 92235 Phone: (760) 324-0550 Reg: 211-A0018134A-00000000-0000 Registration Date/Time: 2011/04/12 17:31:32 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms July 2010 J Bin > Qty Of La Quinta Building 8t Safety Duron P.O. Box 1504, 78-495 Calle Tampko La QuInta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Permit # ^ ProjectAddress: j 'i ` ^ 2 B k4 i,- , `B o A d Owner's Name: j i w( 50 Q C �45,>r A. P. Number. Address: 5'liv'1- ��i10� 13J 1° Legal Description: Contractor: C,5 =� e-9- 5 = OW i C C s IN C . City, ST, Zip: 44. 0, 01 N ?A CA, . Cl )-1 3 Telephone• ' Address: $oX 1436 Project Descr iption: JIrpuvw'rlw9Tfti,; City, ST, Zip: Ch'fiYr D Rg c e l�/T Telephone: 76o.32rt.0h50 ��STI�tiG G�C4-6D:>J State Lic. # : City Lie. #; Arch., Emgr., 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: DA V i D W f L c..1,q M S Sq. FL: # Stories- # Units: Telephone # of Contact Person: Estimated Value of Project C16,) APPLICANT: DO NOT WRITE BELOW THIS UNE # Submittal Req'd Rec'd TRACICIIVG PERMIT FEES Plan Sets Pian Check submitted Item Amount Structural Coles. Reviewed, ready for corrections Plan Cheek Deposit Truss Calcs. Called Contact Person Plan Check Balance [gee U Calts. Plana puked np Construction Flood plain plan Plans resubmitted Mechanical Grading plan 2" Review, ready for corrections/issue Electrical Subcostaetor List Called Contact Person Plumbing Grant Deed Plans picked up S.M.L H.O.A. Approval Plans resubmitted Grading IN HOUSE-- Review, ready for correctiossl'rssue Developer Impact Fee Planning Approval Called Contact Person A.LP.P. Pub. Wks. Appr Date of permit issue School Fees Total Permit Fees