12-0668 (MECH)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
12-00000668
Property Address:
79235 CAMINO AMARILLO
APN:
604-192-031-56 -24517
Application description:
MECHANICAL
Property Zoning:
LOW DENSITY RESIDENTIAL
Application valuation:
7685.
Tu9v 4 XP Q"
Applicant: Architect or Engineer:
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that Ia icensed under provisions of Chapter 9 (commencing with
Section 7000) of Division 3 of the Business an • rofessionals Code, and my License is in full force and effect.
License Class: C20 License No.: 968141
Date: l4 Contractor:
OWNER -BUILDER DECLARATION
1 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 _ 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—) 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
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 6/14/12
Owner:
WAYBRANT,JOHN A & DOROTHY
79235 CAMINO AMARILLO t Q
LA QUINTA, CA 92253
+1iJU;y L 4n $
12
Contractor:
DCS AIR CONDITIONING f C1?y DF A QUiN iA
72078 CORPORATE WAY, #101 Ft+i'kiL;E CSi�;
THOUSAND PALMS, CA 92276
(760)343-5562
Lic. No.: 968141
------------------
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 Policy Number Z071741501
_ 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 sub to the workers' compensation laws of California,
and agree that, if I should become subject t t e workers' compensation provisions of Section
3700 of the Labor Code, I shall forthwith c ply with those provisions.
(Date: 6 12_ Applicant:
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, o essatian of work for 180 days will subject
permit to cancellation.
I certify that I have read this application and state that the above i rrration is correct. I agree to comply with all
city and county ordinances and state laws relating to building con ruction, and hereby authorize representatives
of this county
� to/enter upon the above-mentioned property for ins a on purposes.
Dale: -/ / 4 / 1 ?�6ignature (Applicant or Agent):
Application Number . . . . . 12-00000668
Permit . . . MECHANICAL
Additional desc .
Permit Fee 33.00 Plan Check Fee
8.25'
Issue Date Valuation . . .
. 0
Expiration Date 12/11/12
-
Qty Unit Charge Per
Extension
BASE FEE
15.00
1.00 9.0000 EA MECH FURNACE <=100K
9.00
1.00 9.0000 EA MECH B/C <=3HP/100K BTU
9.00
----------------------------------------------------------------------------
Special Notes and Comments
HVAC CHANGE OUT - 13SEER/80AFUE SPLIT
SYSTEM (2008 ENERGY] CARBON MONOXIDE
ALARM(S) TO BE INSTALLED PRIOR TO FINAL
INSPECTION. 2010 CALIFORNIA BUILDING
CODES.
'June 14, 2012 1:22:32 PM AORTEGA
----------7-----------------------------------------------------------------
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
Sim fi W Prescriptive Certificate of Com fiance: 2008 Restdentfal HVACA&era€ions . CF M -ALT HVAC
Climate Zones 10 to 15
SSreAddress. Ze3 S—
P
Date: Permit#:
Conditi ned Floor
Bjuipnxenti
List Minimum EftienCy2
Duct insulation requirement
Area Thermostat
P Unit
ki
�AFUE ��a
COP
C
�'�' 40 R of ducts added orki
re faced in unconditioned space
Setbarlc
Served by system not atrrady
r Coil
Condensing Unit
EER
(, EER ! I_
PF
PResistance
R 6 (CZ 14.13)
sf present m+�tr
R
Other
8 (1:714-15)
.
L Equipment Type Choose the equipment being installed,• if more than one system, use another CF -1R ALT-HVACfor each system.
2. Mbiinrrtm Pqulpment Efflekndes: 13 SEER Mo AME, 7 WSPFfor 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
WwVBeghmiing October 1, 2010 a reeistered copy of the CF -1R and CF -0R shall also be on site for final inspection.
1. HVAC Chan Bout
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 stems WCH-25
• Condenser Coil and/or
CF -6R forms: MECH 21 -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: Dud leakage < 15 percent; RC, CCA >_ 300 CFM/ton(Minimutn Air Flow Requirement), TMAH
For Packaged Units: Duct leakage < 15 percent
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. dud systems are constructed, insulated or sealed with asbestos
E32. New HVAC SyStem
Required Forms:
• Crit in or Changeout with new
CF -0R forms: MECH-04, Iv1ECH-20-HERS,and (for split systems) MECH-22-HERS, and MECH-25-HERS
ducts: (all new ducting jrA all
CF4R forms: MECH 20-, and (for split systems)h ECH-22, and MECH 25
new
For Split Systems: Dud 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 Duds with/or without Replacement
Required Forms:
• Includes replacing or installing all new ducting
CF -6R forms: MECH-04, MECH-20-EM,and (for split systems) MECH-25-HERS
and/or outdoor condensing unit and/or indoor. coil
CF -4R forms: MECH-20 and (for split systems) MECH 25
and/or f rmace. No or some equipment changed.
For Split Systems: Dud leakage < 6 percent, RC, CCA _> 300 CFM4on, TMAH
For Pa ed Units: Dud 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 CF -4R forms: MECH-21
linear feet of duct in unconditioned
For spliLsystem or packaged units: Dud leakage < 15 percent
El EXCEPTION: Existing duct systems 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.
• 1 am eligible under Division 3 of the California Business and Professions Code to accept responsibility for the design identified on this Certificate of Compliance.
• 1 cm-* 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 ted on other applicable compliance forms, worksheets,
cal and cations to the eriforcemerit for with the 'on
Name: Signataue:
Company: • �
J _ � ��
Address:
License:
Phone: -� laO 313- SSfi7 �"
City/Stattaip.. --rh r-Ga•d
Bin #
t
City of La Quints
Building 8i Safety Duron
P.O. Box 1504, 78-495 Calle Tampico
La Quanta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
�j
�1 • V""'
Project Address:
Owner's Name:
A. P. Number.
Address:
la
Legal Description:
City, ST, Zip:
Contractor- �j
Telephone:
Address: CJ
Project Description:
Tel o e:
State Lic.
Arch., Engr., Designs':
Address:
City, ST, Zip:
Telephone: Construction Type: Occupancy:
State Lie., #: Project type (circle one): New Add'n Alter Repair Demo
Name of Co Person: Sq. Ft.: # Stories: # Units:
Telep ne # of Coact Person:
p nor
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACMG
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Cala.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance
Tide 24 Caics.
Plans picked up
Construction
Flood plain pian
Plans resubmitted .
Mechanical
Grading plan
2w Review, ready for correctionsflssue
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