10-0804 (MECH)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
T-v4t 4 4 Q"
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Application Number: 10-0000.0804 Owner:
Property Address: 81974 COUPLES CT CORFMAN JIM
APN: 764-060-005- - 8197.4 COUPLES CT
Application description: MECHANICAL LA QUINTA, CA 92253
Property Zoning: LOW DENSITY RESIDENTIAL (
Application valuation: 4325
Applicant: Architect o En
61v
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 C �/ LicenseNo.: 374937 _
Date: Y!; i� Contractor:`^�f$l/�G,
OWNER -BUILDER DECLARATION
I hereby affirm under penaltyof perjurythat I am exempt from the Contractor's State License Law for the
following reason ISec. 70.31.5; 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 (6500)::
1, as owner of'the property, or my employees with wages as their solecompensation, 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 purposeSof sale.).
(_ 1 1, asrownerofthe 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,orimproves thereon, and who contracts for the projects with a contractors) licensed
pursuant to the Contractors' State License Law.).
(_ 1 I am•exempt under Sec. , BAP.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:
LQPERIIIIT
Contractor:
PALM DESERT AIR GOND
4.2081 BEACON HILL
PALM DESERT, CA 92211
(760,)346-0677
Lic. No..: 374937
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 8/26/10
AUG 2 6 2010
Ki
WORKER'S COMPENSATION DECLARATION
1 hereby affirm underpenalty 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;thispermit 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 SOUTHERN INS Policy Number WSIO03802-01
I certify that,. in the performance -of the work for which•this permit is issued, I shall not employ any
person in any manner sozasto 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 l ly with those provisions.
Date: - 6' �41M Applicants
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 (9100;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 fora 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 Le Quinta, its officers, agents and employees for any actor 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 readthisapplication: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 county to enter upon the above-mentioned property for inspection pur
Data: -'%nature (Applicant -or Agenfl"z:�W��
Application Number . . . . . 10-00000804
Permit. .
MECHANICAL
Additional desc .
Permit Fee
24.00
Plan Check Fee
6.00
Issue Date . .
.
Valuation
0
Expiration Date
2/22/11
Qty Unit Charge Per
Extension
BASE
FEE
15.00
1.00 9.0000 EA MECH
B/C <=3HP/10'0K BTU
9.00
------------------
Special Notes and
-- -------------------------------------------
Comments
REPLACE ONE (1) 5.0 TON A/C CONDENSER.
2007 CODES.
--
Other Fees . . .
------- - - -----------------
. . . . . . BLDG STDS ADMIN (SB1473)
1.00
Fee summary
Charged
Paid Credited
Due
Permit Fee Total
24.00
.00 .00
24.00
Plan Check Total
6.00
.00 .00
6.00
Other Fee Total
1.00
.00 .00
1.00
Grand Total
31:00
.00 .00
31.00
LQPERMT
Simplified Prescriptive Certificate of'Compliance: 2008 Residential HVACAlterations CF -YR -ALT -HVAC
Climate Zones 10 to IS
Site Address: 81-974 COUPLES CT., LA QUINTA 92253
EnforeementAgency:
Date: 08/26/2010
Permit,*
Conditioned Floor
Equipment T
List Minimum Efrciency2
Duct insulation requirement
Area
Thermostat
❑ Packaged Unit
C]
❑ AFUE
� COP
Over 40 ft of ducts added or
®Setback
:Furnace
❑.Indoor Coil
®SEER 13.00
[3 HSPF
reel m unconditioned space
Served by system
(If not already
III Condensing Unit
DEER
❑ Resistance
O R.6 (CZ 10-13)
sf
prese aR court be
❑ Other
❑ R.8 (CZ 14-15)
butaued)
1. Equipment Type: Choose the equipment being installed; if more than one system, use another CF -1 R:ALT-HVAC for each system.
2. Minimum Equipment.Ejf iciencies: 13 SEER, 78° o AFUE, 7.7HSPF for typical residential systems.
HERS VERIFICATION SUMMARY Listed below are four HVAC alteration Options. The installer decides whatwork 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 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
sijtned. Beginning October 1 2010 a redstered copy of the CF -1R and CF -6R shall.also be on site for final inspection.
M 1. HVAC Changeout
Required1orms:
• All HVAC Equipment replaced
CF -6R forms: MECH-04, MECH-21-HERS and (for split systems) MECH- 25 -HERS
CF -4R fors: MECH- 21 and for lit, stems MECH-25
• Condenser Coil and/or
CF-611forms: 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
For Packaged Units: Duct leakage < 15 percent
Exempted fiom duct leakage testing if:
❑ 1. Duct system was documented to.have been previously sealed and confirmed through HERS verification, or
E3 2. Duct systems with less -than 40 linear feet in unconditioned space, or
❑ 3. Existing -duct systenistare constructed,insulated or.sealed with asbestos
❑ 2. New HVAC System
Required Forms:
• Cut in out with new
ducts: (elll new ucting > all
(a new ducting
CF -6R forms: MECH-04, : MECH-20-HERS,and (for split systems) MECH-22-HERS, and MECH-25-HERS
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, SIMS, and either HSPP or PSPP.
For Packaged Units: Duct leakage < 6 percent
❑ 3. New Ducts with/or without Replacement
Required Forms:
a Includes replacing or installing all new ducting
CF -611 forms: MECH-04, MECH-20-HERS,and (for split systems).MECH-25-HERS
and/or outdoor condensing unit and/or indoor coil
CF -4R forts: MECH-20 and (for split systems) MECH-25
and/or f tmace. No or some 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
R uired-Forms:
• Includes adding or replacing more than 40
CF -611 forms: MECH-04, MECH-21-HERS CF -4R forms: MECH 21
linear feet of duct in 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 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 requiremonts of Title 24,
Parts t and 6 of the California Code of Regulations.
• The design features identified on this. Certificate of Compliance are consistent with the iriforrnation documented r licable compliance forms, worksheets,
calculations plans and specifications submitted, to the enforcement agency for approval with the permit appli
Name: KARL BROWN
Signature:
Company' PALM DESERT AIR CONDITIONING 8 HEATING COMPANY
Dom' 08/26/2010
Address: 42-081 BEACON HILL
License: 374937
City/Stu WZip: PALM DESERT, CA 92211
Phone: 17601 346.0677
2008 Residential Compliance Forms March 2010
Bin #City
Of L QUlflt
Building 8T Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La. Quinta, CA,92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
FA
Project Address: 81-974 COUPLES CT.
Ownees,Name: CORFMAN, JIM
A. P. Number.
Address: 81-974=COUPLES CT.
Legal Description:
City, ST, Zip: LA QUINTA, CA 92253
Contractor. Palm DesertAir & Heating Company
Telephone: 760-771-6355
Address: 42081 Beacon Hill
Project Description:
City, ST, Zip: Palm Desert, CA 92211
REPLACE ONE.(1 5.0 TON AC
Telephone; (Iso) 346-0677
CONDENSER. .
State Lie. # 374937 City Lie. #; 100886
Arch., Engr., Designer.
Address:
City, ST, Zip:
Telephone:
State Lie. #: 7M=Project
Construction Type: Occupancy:
type (circle one): New Add'n ter 'Repair Demo
Name of Contact Person. KARL BROWN
Sq. Ft :
# Stories: # Units:
'Telephone # of Contact person: (760) 346-0677
Estimated Value of project: $4,325
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Reg'd
Reed
TRACKING
PERMIT FEES
Plan Sets
Plan Check'submitted
Item
Amount
Structural Cale#.
Reviewed, ready for corrections
Plan Check Deposit
Truss Cates:
Caped Contact Person
Plan Cheek Balance.
Title U Calks.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
20° Review, ready for cortections/iune
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.L
H.O.A. Approval
Pians resubmitted
Grading
IN ROUSE:-
7° Review, ready for eorrectiomlipae
Developer Lnpact Fee
Planning Approval
Called Contact Person
A.LP:P.
Pub. Wks. Appr
Date ofpermltissue
School Fees
Total Permiffees