11-0477 (MECH)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application description
Property Zoning:
Application valuation:
Applicant:
11-00000477
55834 BRAE BURN
775 -280 -060 -
MECHANICAL
LOW DENSITY RESIDENTIAL
8400
Ti&t 4 4 Q"
Architect or Engineer:
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
RATHJEN KURT
55834 BRAE BURN
LA QUINTA, CA 92253
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Contractor: D
J ANTHONY PLUMBING HEAT/AIR
72216 N RTH SHORE STREET #
Date: 5/09/11
MAY 1 71111
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, 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. , BAP.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:
LQPEPMIT
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 NO:
abov information is correct. I agree to compI ith all
city and county ordinances and state laws reng onstr o nd her y authorize repres t ives
ofthis county
to
ent r upon the above-mentr ins c io u
44694�x
Sate: /6 ignature (Applicant or
O
THOUSAND PALMS, CA 92276'
(760)343-2121
CIN OF LA QUINTA
(�
Lic. No.: 777794 FINANCE DEPT.
-------------------------------------------------------------------------------------------------
LICENSED NTRACTOWS DECLARATION
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury that I am li nsed under provisions of Chapter 9 (commencing with
I hereby affirm under penalty of perjury one of the following declarations:
Section 7000) of Division 3 of t Business d P ofessi s o , an my License is in full f and effect.
I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided
License Class: C20 -C36 ens N 777794
_
for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
K9404/� /0'G......
( c or
issued.
1 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
OWNER -BUILDER DECLARATION
insurance carrier and policy number are:
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the
Carrier STATE FUND Policy Number 1932451-2011
following reason (Sec. 7031 .5, Business and Professions Code: Any city or county that requires a permit to
of _ I certify that, in the performance a work for which this permit is issued, I shall not employ any
construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the
person in any manner so as to come s ' ct to the orkers' compensation laws of California,
permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State
and agree th ' I shout ec me su ' ct t w ers' compensation pr ns of Section
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or
3700 of the abor d I s fo with mp those provisions.
that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by
IID' !
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).:
applican (/
[
(_ 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
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
Contractors' State License Law does not apply to an owner of property who builds or improves thereon,
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
and who does the work himself or herself through his or her own employees, provided that the
DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
improvements are not intended or offered for sale'. If, however, the building or improvement is sold within
SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
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, 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. , BAP.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:
LQPEPMIT
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 NO:
abov information is correct. I agree to compI ith all
city and county ordinances and state laws reng onstr o nd her y authorize repres t ives
ofthis county
to
ent r upon the above-mentr ins c io u
44694�x
Sate: /6 ignature (Applicant or
Application Number . . . . . 11-00000477
Permit . . . MECHANICAL
Additional desc .
Permit Fee . . . . 40.50 Plan Check Fee
10.13
Issue Date . . . . Valuation . . . .
0
Expiration Date 11/05/11
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 EXISTING CONDENSER WITH NEW 4
TON 14 SEER UNIT & NEW EVAP. COIL. 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
f
LQPERMIT
Simplified Prescriptive Certificate of Compliance: 2008 Residential HVAC CF -IR -ALT -HVAC
Alterations
Climate Zones 10 - 15
Site Address:
Enforcement Agency:
Date:
Permit #:
54834 BRAE BURN La Quinta, CA 92253
City of La Quinta
May 9, 2011
Duct insulation
Conditioned Floor
Equipment Typel
List Minimum Efficiency2
requirement
Area
Thermostat
❑ Package Unit
❑ Furnace
p Indoor Coil
❑ AFUE
M SEER 14.0
❑ COP
ElHSPF
❑ R 6 (CZ 10-13)
Served system
0 Setback
If not already present,
0 Condensing Unit
ElEER
❑ Resistance
❑ R 8 (CZ 14-15)�
sf sf
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 -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.
® 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
For Packaged Units: Duct leakage < 15 percent
Exempted from duct leagage 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 dgctsystems are constructed insulated or selale_d with asbestos
❑ 2. New` HVAC I
'
Required,Forms:
Syste m
.►r7 l' r� P �► �/ 1
. Cut in or Changducts: all
with new ducts: all
ducting
CF; 6R forms: MECH-04, MECH-20-HERS, and for split systems) MECH-22=HERS, and
)
MECH-25-HERS rj i Ar
► /d
new .all
�*-
:
CF -411 forms:•MECH-20,:and (forasplit 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
113. 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: 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 linear feet of duct in
CF -6R forms: MECH-04, MECH-2I-HERS
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: Kevin Robinson Signature: Kevin Robinson
Company: I ANTHONY PLUMBING HEATING & AIR CONDITIONING Date: May 9, 2011
Address: 72216 NORTH SHORE ST #101 License: 777794
City/State/Zip: THOUSAND PALMS / CA / 92276 Phone: (760) 328-8096
t 0
Reg: 211-A0022203A-00000000-0000 Registration Date/Time: 2011/05/09 11:56:23 HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms July 2010
Bin #
City of LQ Qutnta
Buliding 8r Safety Division
P.O. Box 1504, 78.495 Calle Tampico
La Qrdnta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
Project Address: ? C,�
Owner's Nagle L% 0
A. P. Number. td 3
Address: 07"o .
Legal Description:
City, ST, Zip -1,4 47 ;7 7 -
Contractor.
Contractor: J AWWOFIV SERVICES
Telephone:
Address: THOUSAND PALMS CA 92276
project Description:
City, ST, Zip:
(� .
Telephone: ,
py,
State Lic. # : Ciry Lic #; (�S
�!i�.J ��(�-G(' V ODIC
Arch., Engr., Designer.
Address:
City., ST, Zip:
Telephone: Construction Type: Occupancy: ,
State Lia #: Project type (circle one): New Add'n Alter Repair Demo
Name of Contact Person: Sq. FL:
# Stories: /
# Unit
Ts
Telephone # of Contact Person: Estimated Value of Project: 0 0
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req -d
Recd
TRACIMG PERMIT FEES
Plan Sets
Plan Check submitted
Item Amount
Structural Cafes.
Reviewed, ready for corrections
Plan Check Deposit
Truss Cales.
Called Contact Person
Plan Check Balance.
Title 24 Cates.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Gmdtng plan
2"' Review, ready for correctionvUsue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.L
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
311 Reytew, ready for correctionslissae
Developer Impact Fee
Planning Approval
Called Contact Person
A.LP.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees