13-1205 (MECH)a
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application description
Property Zoning:
Application valuation:.
Applicant:
13-00001205
79465 BROOKVILLE
772 -040 -009 -
MECHANICAL
LOW DENSITY RESIDENTIAL
13250
c&'ht 4 �W
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Architect or Engineer:
��v
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: C20 License No.: 686310
�-
Date: Z Contractor:
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, 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 contractorls) licensed
pursuant to the Contractors' State License Law.).
I _ 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: tlE
14
LQPERMIT
Owner:
BOB & STELLA NYLUND
79465 BROOKVILLE
LA QUINTA
LA QUINTA, CA 92253
Contractor:
GENERAL AIR CONDITIONING
31170 RESERVE DRIVE
THOUSAND PALMS, CA 92276
(760)343-7488
Lic. No.: 686310
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 9/24/13
tSEP
Q 2 4 2013I I
CITY OF LA QUINTA
FINANCE DEPT.
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 ZENITH INS CO Policy Number Z071741502
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 become subject to the workers' compensation provisions of Section
3700 of the Labor Code, I shall forthwith comply with those provisions.
Date: Applicant: _ "s
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 application and state that the above information is correct. I agree to comply with all
city and county ordinances and state laws relating to building construction, and hereby authorize representatives
of this co nq ty to enter upon the above-mentioned property for inspection purposes.
Date: Cl//II47CTI )aSignature (Applicant or Agent):
Application Number . . . . . 13-00001205
Permit . . . MECHANICAL 2013
Additional desc .
Permit Fee . . . . 71.50 Plan Check Fee
.00
Issue Date . . . . Valuation . . .
. 0
Expiration Date . . 3/23/14
Qty Unit Charge Per
Extension
1.00 35.7500 EA MECH FURNACE
35.75
1..00 35.7500 EA MECH CONDENSER/COMP
35.75
----------------------------------------------------------------------------
Special Notes and Comments
HVAC CHANGE OUT - (1) 5TON CONDENSOR AND
90K BTU FURNACE 16SEER/78AFUE [2008
ENERGY] CARBON MONOXIDE ALARM(S) TO BE
INSTALLED PRIOR TO FINAL INSPECTION.
2010 CALIFORNIA BUILDING CODES.
----------------------------------------------------------------------------
Other Fees . . . . . . . . . PERMIT ISSUANCE M/P/E
90.57
PLAN CHECK, MECHANICAL
47.66
Fee summary Charged Paid Credited
----------------------------------------
Due
-----------------
Permit Fee Total 71.50 .00 .00
71.50
Plan Check Total .00 .00 .00
.00
Other Fee Total 138.23 .00 .00
138.23
Grand Total 209.73 .00 .00
209.73
LQPERMIT
t�
Bin#
Qty Of La Qufnta
Building &r 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: q y los -Br 0p V ; 1C-
Owner's Name: 130 -ai
A. P. Number:
Address: 7 941(mS ):�r
Legal Description:
City, ST, Zip: L Qui C/a ct Z Z53
Contractor e \
Telephone:
Address:
Address: 3 �� Z O
Project Description:
City, ST, Zip: ovscrlallMS gZZ7(-
A C- £ 901 �Tv
Telephone: 7 b0-
P 3x-13- 74 8 9-
r
v c.c
Y'\ �-
State Lic. # :
City Lic. #:
Arch., Engr., Designer.
Address:
City., ST, Zip:
Telephone:
:::<:>:<;<.<::gly:;::.>::
4n'r,'y�Lr: ,:!n:'::• +-::i:•ry:i:'ii�::vii:Ji:•:vti<:'
Construction Type: Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
State Lic. #
{:fir'
«J,�:yi�:ti4iiiii::i'::.i `:•.;: �;: :ti9u:::;:
:;::;;";•: .
""` "
Name of Contact Person:
Sq. Ft.:
# Stories:
# Units:
Telephone # of Contact Person:
Estimated Value of Project: 13 ZSO. OV
APPLICANT: DO NOT WRITE BELOW THIS LINE
N
Submittal
Req'd
Recd
TRACMG
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Cala.
Reviewed, ready for corrections
Plan Check Deposit
Truss Cala.
Called Contact Person
Plan Check Balance.
Title 24 Cala.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
tad Review, ready for corrections/issue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Decd
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
'`" Review, ready for correctionsfissue
Developer Impact Fee
—Planning App
9
P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees
Simplified Prescriptive Certificate of Compliance: 2008 Residential HVACAlterations CF-lR-ALT-HVAC
Climate Zones 10 - 15
Site Address:
Enforcement Agency:
Date:
Permit #t:
79465 BROOKVILLE La Quinta, CA 92253
City of La Quinta
Sep 22, 2013
Duct insulation
Conditioned Floor
Equipment Typel
List Minimum Efficiency2
requirement
Area
Thermostat
p Package Unit
® Furnace
® AFUE 78%
0 COP
13 R 6 (CZ 10-13)
Served by system
® Setback
be
® Indoor Coil
® SEER 16.0
❑ HSPF
0 R 8 (CZ 14-15)
4783 sf
If not already present, must
® Condensing Unit
0 EER
p Resistance
installed)
Q 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 Efflciencies: 13 SEER, 78°x6 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 signed.Beginning October 1, 2010, a registered copy of the CF -1R
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 -411 forms: MECH-21 and (for split systems) MECH-25
. Condenser Coil and /or
CF -6R forms: MECH-04, MECH-2I-HERS and (for split systems) MECH-25-HERS
. Indoor Coil and /or
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
Exempted from duct leakage testis.... "
Q 1:'Duct system was documei ted to have been previously sealed and confirmed through HERS verification, or
❑ 2. Duct systems with less thais:j40 linear feet in unconditioned space, or
❑ 3. Existing duct systems are `cgristructed, insulated or sealed with asbestos
Q`4: Th ill not be Ducied (ie:, D;uctiess>:Mini.-Splt._S..ystem„(Also;_Exempt frQ(rr.,:Re(xlger..antliarge)
0 2. New�HVAG stem
_ _ F
Re ut a
q -- ' -
. Cut irrror=Gfiangeout with,_:
forms MECH-04., MEfi#i-HERS,2and (for spirt sySiettts) MECH 2Z HERS;:and ..:.::.:...:..::::::
new ducts:: ail new .:...,"6R
ct..g> tall e
-- :
GH Sdun
.:::•:::�z.....
e
C 2
,C�-�:-.4R. :.fflrm .. _ME. ...-
For Split Systems•; butt ieaka
ge <'6 percent RC, GCA 350 2MJton<fWD=. fMAHiN15 and:either EISPP or`PSPP. `` :,
For Packaged Units. Duct
leae <kag6_pertent :
-
0-3: New .;Ducts°:°:viirth/or wtthot�t:<:*..
Required Forms:
Replacement
. Includes replacing or iristalfing all::new
ducting and/or outdoor'cdAdensi*Ag:-unit
CF -6R forms: MECH-04, MECH-20-HERS, and (for split systems) MECH-25-HERS
and/or indoor coil and/or fiir'naces:No or some
CF -411 forms: MECH-20 and (for split systems) MECH-25
equipment changed.
For Split Systems: Duct leakage < 6 percent; RC, CCA z 300 CFM/ton, TMAH
For Packaged Units: Duct leakage < 6 percent
13 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
E3 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 eonforrn 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: Danielle Garcia Signature: bonielle Garcia
Company: HARRISON ENTERPRISES INC Date: Sep 22, 2013
Address: 31-170 RESERVE DRIVE STE A License: 686310
City/State/Zip: THOUSAND PALMS / CA / 92276 Phone: (760) 343-7488
Reg: 213-A0072547A-000000000-0000 Registration Date/Time: 2013/09/22 23:47:40 HERS Provider: Ca10ERTS, Inc.
2008 Residential Compliance Forms July 2010