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09-1100 (MECH)w. r� P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: 09-00001100 Property Address: 78220 CALLE CADIZ APN: 770-155-006-6 -000000- Application description: MECHANICAL Property Zoning: LOW DENSITY RESIDENTIAL Application valuation: 10000 Tiht 4 4 Q" Applicant: Architect or Engineer: )z ------------------ LICENSED CONTRACTOR'S DECLARATION BUILDING & SAFETY DEPARTMENT BUILDING PERMIT I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 30 1 the Bu ' s and Professionals C nd my License is in full force and effect. License Class: C20 -C36 827420 Date: 141 d� Cont ctor: 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).: 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.). (_ 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: LQPERMIT Owner: HOUDEK GEORGE 78220 CALLE CADIZ LA QUINTA, CA 92253 ( VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 10/15/09 Contractor: ;gyp tTY0FLAr1111.-,, ALL SEASONSA/C, PLMBG & HTN P.O. BOX 1112 PALM DESERT, CA 92261 20 9(760)568-2663JLic. No.: 827420 CI_, .� WORKER'S COMPENSATION DECLARATION 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. 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 SOUTHERN INS Policy Number WS1000131201 certify that, in the performance of the work for which this permit is issued, I shall not employ any person in any manner become subject to th rs' compensation laws of California, and agree that, if ould bec me subject to the o r ' compensation provisions of Section I0 of the L or Co eZIs ith c it a ions. Date: b (Applica 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 ab0- information is correct. gree to c ply with all city and county ordinances and state laws relating t wilding co struction, d hereby a resentatives of this cow ty enter upon the above-mentioned ropert foJin pection rposes Dater Signature (Applicant or Ag 1). Application Number . . . . . 09-00001100 Permit . . . MECHANICAL Additional desc . . Permit Fee . . . . 51.00 Plan Check Fee 12.75 Issue Date . . . . Valuation . . . . 0 Expiration Date 4/13/10 Qty Unit Charge Per Extension BASE FEE 15.00 2.00 9.0000 EA MECH FURNACE <=100K 18.00 2.00 9.0000 EA MECH B/C <=3HP/100K BTU 18.00 ---------------------------------------------------------------------------- Special Notes and Comments " REMOVING (2)OLD HVAC SYSTEMS & INSTALLING (2) NEW SYSTEMS 14 SEER. ---------------------------------------------------- ----------------------- Other Fees . . . . . . . . . BLDG STDS ADMIN.(SB1473) 1.00 Fee summary Charged ------------------------------------- Paid Credited -------------------- Due Permit Fee Total 51.00 .00 .00 51.00 Plan.Check Total 12.75 .00 .00 12.75 Other Fee Total 1.00 .00 .00 1.00 Grand Total ' 64.75 .00 .00 64.75 LQPERMIT Certificate of Compliance Prescriptive Method - HVAC -only Alteration CF -1_R -ALT Project Title: Date: © CaICERTS 2005 - = Enforcementen Use Only Project Address: �aao C.0\\e- Ccs&-- -L Climate Zone: Building Perms #:-t. F 3 Documentation Author: Telephone: Plan Check Date , Company Name: Field Check Date IMPORTANT: This CF -1R -ALT form is only for use when an HVAC -only alteration is made to an existing home Use one form for each system being altered. This is system # .a of systems altered in this house. Check all lines that aplilly. Check only lines that apply. Scope of Alterations: 1 A!f An Air Handler is to be installed or replaced. Duct sealing to be determined. Continue to next line. 2,e Furnace Heat exchanger is to be installed or replaced. Duct sealing to be determined. Continue to next line. 3 outdoor condensing unit is to be installed or replaced. Duct Sealing and/or TXV(RCA) to be determined. Continue to next line. 4 cooling or heating coil is to be installed or replaced. Duct Sealing and/or TXV(RCA) to be determined. Continue to next line. 5 O More than 40 feet of nes or replacement duct are to be installed in unconditioned space. Duct sealing to be determined. ❑ Check here if the entim duct system is also to be new or replaced. Continue to next line. 6 ❑ If none of lines 1-5 are checked, neither Duct Sealing nor TXV(RCA) are required. Go to Section 5. Section 1 - Duct Sealing (Only if any of Lines 1 2 3 4 or 5 are checked. Skip if Line 6 is checked. 7 ❑ Thiss stem is in Climate Zone 1, 3, 4, 5, 6, 7, or 8. No duct sealing is required. Go to Section 2. 8 O Thiss stem has less than 40 feet of ducts in unconditioned space. No duct sealing is required. Go to Section 2. 9 ❑ This system was previously sealed and tested, and was certified by a HERS rater. No duct sealing is required. Attach previous CF -4R form. Go to Section 2. 10 ❑ his ducts stem is sealed or insulated with asbestos. No duct sealing is required. Go to Section 2. Note: If the entire ducts stem is to be new or replaced, Lines 11-14 do not apply. 11 ❑ In Climate Zones 2 12 and 16: An 0.92 AFUE furnace will be installed in lieu of duct sealing and TXV if applicable). 12 ❑ In Climate Zones 10, 13 and 15: An SEER 14 AND EER 12 condenser will be installed with TXV(RCA) AND added duct insulation R-4 wrap on e)dsting ducts, R-8 new ducts in lieu of duct sealing. Go to Section 2. 13X In Climate Zones 9, 10, 11, 13, 14, or 15: An SEER 14 AMQ EER 12 condenser will be installed with TXV(RCA) AND a 0.92 AFUE furnace will be installed in lieu of duct sealing. Go to Section 2. 14 O In Climate Zones 2, 9, 11, 12, 14 or 16: An SEER 14 AMQ EER 12 condenser will be installed with TXV(RCA) ND an 0.82 AFUE furnace will be installed with increased duct insulation in lieu of duct sealing. Go to Section 2. 15 ❑ INone of lines 7-14 above are checked. Duct Sealing is Required. Continue. Section 2 - TXV(RCA) (Only if Lines 3 or 4 are checked, otherwise got to Section 3 16 ❑ Thes stem being altered is a package unit. No TXV(RCA) is required. Go to Section 3. 17 ❑ This system is in Climate Zone 8 and a 14 SEER air conditioner or 0.82 AFUE furnace is being installed. No TXV(RCA) is required. Go to Section 3. 18 O his system is in Climate Zone 1 3 4 5 6 or 7. No TXV(RCA) is required. Go to Section 3. 19 O Thiss stem is in Climate Zone 16 and line 14 is not checked. No TXV(RCA) is required. Go to Section 3. 20 O ITtfiss stem is in Climate Zone 16 and line 14 is checked and not line 16. TXV(RCA) is required. Go to Section 3. 21,6 his system is in Climate Zone 2 or 8-15 and line 11, 16 or 17 is not checked. TXV(RCA) is required. Go to Section 3. Section 3 - HERS Rater verification 22 O If line 15 is checked, HERS verification is required for Duct Sealing. 23 ❑ If line 12, 13, 14, 20 or 21 are checked and not line 16 or 17, HERS verification is required for TXV(RCA). 24 ❑ lif line 12, 13 or 14 are checked, HERS verification is required for 12 EER. Section 4 - Equipment Efficiencies 25 ❑ fiflines 11, 12, 13, 14 or 17 are checked, upgraded equipment efficiencies are required. List in Section 6. Section 5- Duct R -Values 26 ❑ If more than 40 feet of duct is being installed or replaced, duct R -value must meet or exceed Package D requirements. 27 O Ilf less than 40 feet of duct is being installed or replaced, duct R -value must meet or exceed R-4.2 Section 6 - see next page Version 03-10-06 Page 1 of 2 This form can only be used on projects being verified by CaICERTS certified raters. www.calcerts.com Certificate of Compliance Prescriptive Method - HVAC -only Alteration CF -1 R -ALT Project Title: Date: © CaICERTS 2005 IMPORTANT: This CF -1 R -ALT form is only for use when an HVAC -only alteration is made to an existing home Use one form for each system being altered. This is system # of systems altered in this house. Section 6 - Minimum Requirements for Equipment to be Installed/Altered. Installed equipment must match type/location and meet or exceed efrxiencies/R-values. 28 Configuration: O Split system O Package Unit 29 ❑ Air Handler ❑Gas fumace, AFUE: OHeatpump FAU. OHydronic FAU ❑Other 30 ❑ Heat Exchanger 31 ❑ Outdoor Condensing Unit ❑A/C OFteatpump Vfficiencv SEER/HSPF: 1EER d read): 32 ❑ Cooling or heating coil OA/C 0Heatpump 13HydronIc 33 ❑ Duds Location: Le th ft):IR-value: All mandatory measures apply to any altered component. See MF -1 R - ALT form. Compliance Statement: This certificate of compliance lists the building features and specifications needed to comply with Title 24, Parts 1 and 6 of the California Code of Regulations, and the administrative regulations to implement them. This certificate has been signed by the individual with overall project responsibility. The undersigned recognizes that compliance using duct sealing, verification of refrigerant charge, and TXV require installer testing and certification and verification by an approved HERS rater. Home Owner or Authorized Agent Documentation Author Name: Name: Address: Com/ppany Name: �l i City/StatelZip: Address: Phone:. City/State/`Zip: C �-� "a` C 1 (1 /� l� / i 1a3 y Phone: --I Cea(-P3 Signature: Signature: Enforcement Agency (Building Department) Notes/Comments: Name: Title: Department: Phone #: Fax #: Signature or Stamp: Required forms: CF -1 R -ALT: by anyone. Required at time of permit application. Copies to home owner, enforcement agency, HERS rater. CF -6R -ALT: by installing contractor: Required to close permit. Copies to home owner, enforcement agency, HERS rater. CF -4R -ALT: by HERS rater. Required to Gose permit. Copies to home owner, enforcement agency, installer. The CF -4R forms for a sample group shall not be released until all testing and verification is completed and passed for the entire group. Version 03-10-06 Page 2 of 2 This form can only be used on projects being verified by CaICERTS certified raters. www.calcerts.com Certificate of Compliance Prescriptive Method - HVAC -only Alteration CF -1 R -ALT Project Title: \� Date: © CaICERTS 2005 , Enbcement Agency Use Project Address: Climate Zone: Building Permit # Documentation Author: Telephone: Plan check Date ; Companyame: Field Check Date IMPORTANT: This CF -1 R -ALT form is only for use when an HVAC -only alteration is made to an existing home Use one form for each system being altered. This is s stem # of vL systems altered in this house. Check all lines that anoly; Check only lines that aooly. Scope of Alterations: 1 - Air Handler is to be installed or replaced. Duct sealing to be determined. Continue to neA line. 2 ARr A Fumace Heat exchanger is to be installed or replaced. Duct sealing to be determined. Continue to next line. 3 outdoor condensing unit is to be installed or replaced. Duct Sealing and/or TXV(RCA) to be determined. Continue to nand line. 4.0' A cooling or heating coil is to be installed or replaced. Duct Sealing and/or TXV(RCA) to be determined. Continue to next line. 5 ❑ More than 40 feet of new or replacement duct are to be installed in unconditioned space. Duct sealing to be determined. ❑ Check here if the WtiCS duct system is also to be new or replaced. Continue to next line. 6 ❑ If none of lines 1-5 are checked neither Duct Sealing nor TXV(RCA) are required. Go to Section 5. Section 1 - Duct Sealing onl if any of Lines 1 2 3 4 or 5 are checked. Skip if Line 6 is checked. 7 ❑ This system is in Climate Zone 1 3 4 5 6, 7 or 8. No duct sealing is required. Go to Section 2. 8 ❑ This system has less than 40 feet of ducts in unconditioned space. No duct sealing is required. Go to Section 2. 9 ❑ 110 This system was previously sealed and tested, and was certified by a HERS rater. No duct sealing is required. Attach previous CF -4R form. Go to Section 2. ❑ rrhis duct system is sealed or insulated with asbestos. No duct sealing is required. Go to Section 2. Note: If the entire ducts stem is to be new or replaced, Lines 11-14 do not apply. 11 ❑ In Climate Zones 2 12 and 16: An 0.92 AFUE furnace will be installed in lieu of duct seali and TXV if iaable . 12 ❑ In Climate Zones 10, 13 and 15: An SEER 14 AND EER 12 condenser will be installed with TXV(RCA) D added duct insulation R-4 wrap on e)dsting ducts, R-8 new ducts in lieu of duct sealing. Go to Section 2. 13 Z In Climate Zones 9, 10, 11, 13, 14, or 15: An SEER 14 AdQ EER 12 condenser will be installed with TXV(RCA) D a 0.92 AFUE furnace -will be installed in lieu of duct sealing.'Go to Section 2. 14 ❑ In Climate Zones 2, 9, 11, 12, 14 or 16: An SEER 14 AbM EER 12 condenser will be installed with TXV(RCA) D an 0.82 AFUE furnace will be installed with increased duct insulation in lieu of duct sealing. Go to Section 2. 15 13 INone of lines 7-14 above are checked. Duct Sealing is Required. Continue. Section 2 - TXV(RCA) (Only if Lines 3 or 4 are checked, otherwise got to Section 3 16 ❑ The system being altered is a package unit. No TXV(RCA) is required. Go to Section 3. 17 ❑ This system is in Climate Zone 8 and a 14 SEER air conditioner or 0.82 AFUE furnace is being installed. No TXV(RCA) is required. Go to Section 3. 18 ❑ is system is in Climate Zone 1 3 4 5 6 or 7. No TXV(RCA) is required. Go to Section 3. 19 ❑ This system is in Climate Zone 16 and line 14 is not checked. No TXV(RCA) is required. Go to Section 3. 20 ❑ Fbis system is in Climate Zone 16 and line 14 is checked and not line 16. TXV(RCA) is required. Go to Section 3. 21 Cis system is in Climate Zone 2 or 8-15 and line 11, 16 or 17 is not checked. TXV(RCA) is required. Go to Section 3. Section 3 - HERS Rater verification 22 ❑ If line 15 is checked, HERS verification is required for Duct Sealing. 23 ❑ If line 12, 13, 14, 20 or 21 are checked and not line 16 or 17, HERS verification is required for TXV(RCA). 24 ❑ If line 12, 13 or 14 are checked, HERS verification is required for 12 EER. Section 4 - Equipment Efficiencies 25 ❑ If lines 11, 12, 13, 14 or 17 are checked, upgraded equipment efficiencies are required. List in Section 6. Section 5- Duct R -Values 26 ❑ Ilf more than 40 feet of duct is being installed or replaced, duct R -value must meet or exceed Package D requirements. 27 ❑ lif less than 40 feet of duct is being installed or replaced, duct R -value must meet or exceed R-4.2 Section 6 - see next paAe Version 03-10-06 Page 1 of 2 This form can only be used on projects being verified by CaICERTS certified raters. www.calcerts.com Certificate of Compliance Prescriptive Method - HVAC -only Alteration CF -11R -ALT Project Title: [f C Date: ©CaICERTS 2005 IMPORTANT: This CF -1R -ALT form is only for use when an HVAC only alteration is made to an existing home Use one form for each system being altered. This is system # of oZ systems altered in this house. Section 6 - Minimum Requirements for Equipment to be Installed/Altered. Installed equipment must match typellocation and meet or exceed efrociertdes/R43bss. 28 Configuration: O Split system O Package Una 29 ❑ Air Handler OGas hmace, AFUE: OHeatpump FAU OHydrordc FAU ❑Other 30 ❑ Heat E=hanner 31 ❑ Outdoor Conder . Unit OA/C OHeatpumP lEffidem SEERMSPF: IEER A d : 32 ❑ cooling or heating coo OA/C OHeatpump O rork 33 ❑ DuctsVocation: I Length (it): R -rate: All mandatory measures apply to any altered component. See MFA R -ALT form. Compliance Statement: This certificate of compliance lists the building features and specifications needed to comply with Title 24, Parts 1 and 6 of the California Code of Regulations, and the administrative regulations to implement them. This certificate has been signed by the individual with overall project responsibility. The undersigned recognizes that compliance using duct sealing, verification of refrigerant charge,. and TXV require installer testing and certification and verification by an approved HERS rater. Horne Owner or Authorized Agent Documentation Author Name: Name: C'�' Address: Company Name: City/State0p: Address: - - .--. --- - Phone: City/Stat Phone: Signature: Signer V� , Enforcement Agency (Building Department) Notes/Comments: Name: Title: Department: Phone #: Fax #: Signature or Stamp: Required forms: CF -1 R -ALT: by anyone. Required at time of permit application. Copies to home owner, enforcement agency, HERS rater. CF -6R -ALT: by installing contractor. Required to dose permit. Copies to home owner, enforcement agency, HERS rater. CF -4R -ALT: by HERS rater. Required to Gose permit. Copies to home owner, enforcement agency, installer. The CF -4R forms for a sample group shall not be released until all testing and verification is completed and passed for the entire group. Version 03-10-06 Page 2 of 2 This form can only be used on projects being verified by CaICERTS certified raters. www.calcerts.com Bin # City of La Quinta Building & 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:? Daao CO3&_ Owner's Name: A. P. Number: Address: $aaD cc�e— C G1.k;Z Legal Description: City, ST, Zip: �� (� V r.�r� C Baa t, Contractor: �� Qom, i ilia �\ ,:i>?'>> <ri:<:r:•i:`+v:> (� Address: SQ %9 C� r �`l2rA Project Description: City, ST, Zip: 'A Telephone: p , 40 State Lic. # City Lie. #z U 63 Arch., Engr., Designer: Address: City., ST, Zip: Telephone: �:...,. Construction Type: Occupancy: type (circle one): New Add> n Alter Demo Sq. Ft.: # Stories: # Units: State Lic. #: ..Project Name of Contact Person: Telephone # of Contact Person: p s - 2LU (10 Estimated Value of Project: 0 bOb' APPLICANT: DO NOT WHITE 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 21" Review, ready for corrections/issue Electrical Subcontactor List Called Contact Person Plumbing Grant Deed Plans picked up S.M.I. H.O.A. Approval Pians 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