14-0723 (MECH)P.O. BOX 1504 4
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253 i/ BUILDING & SAFETY DEPARTMENT
11 BUILDING PERMIT
' Application Number:
14-00000723
WORKER'S COMPENSATION DECLARATION '
Property Address:
79535 RANCHO
SANTA MARGARITA
APN:
649-610-005-5
-28964 -
Application description:
MECHANICAL
_
for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
Property Zoning:
LOW DENSITY RESIDENTIAL
issued.
_ I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor
Application valuation:
6613
Code, for the performance of the work for which this permit is issued. My workers' compensation
insurance
Applicant:
l
Architect r Engineer:
Owner:
ROBERT WEIR
79535 RANCHO
LA QUINTA,
(
SANTA MARGARITA
CA 92253
Contractor:
PREFERRED PLUMBING HTG
P.O. BOX 5120
PALM SPRINGS, CA 92263
(760)322-3173
Lic. No.: 457554
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date:' 5/30/14
D�
C MAY 3 0 20
1. JT
CITY AF LA QUINTA
FINMNCE DEPT.
--------------------------------------------------------------------------------------------------
LICENSED CONTRACTOR'S DECLARATION
WORKER'S COMPENSATION DECLARATION '
I hereby affirm under penalty of perjury that I licensed 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 the Business d Professionals Code, anq my License is in full force and effect.
I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided
License Class: C10 C16 C2 ice se 457554
-
_
for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
r//� �/ �-
Date+._! � � U/ / / ontractor: .�-Cy
issued.
_ I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor
/ - /
ILDER DECLARATION
Code, for the performance of the work for which this permit is issued. My workers' compensation
insurance
\6WNER-B
I hereby affirm under penalty of perjury that I am exam rom the Contractor's State License Law for the
carrier and policy number are:
Carrier EVEREST NATL .Policy Number 7600006445141
following reason (Sec. 7031.5, Business and Professions Code: Any city or county that requires a permit to
_ I certify that; in the performance of the 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 a become subject to the workers' 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 that, if I shout b come subject to thew er ' compensation provisions of Section
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or
3700 of the Labor C shall forthwit om ly it ose ovisions.
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 (5500).:Date:
A
Applicant:
(_ 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
WARNING: FAILURE TO SECURE WORKERS' gOMP NSATION 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 PENALT ES ND 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.).
(_ I 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—) 1 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 ISec. 3097, Civ. C.I.
Lender's Name:..
.Lender's Address:
LQPERMIT
APPLICANT ACKNOWLEDGEMENT
IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject fo 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 abov information is correct. I agree to comply with all
city and county ordinances and state laws relating to buildin co struction, eb oriz representatives
of this county to enter upon the -above-mentioned property or nspect on p rposes
Date5x?iOl 1441 Signature (Applicant or Agent): -
Application Number . . . . . 14-00000723
Permit . . . MECHANICAL 2013
Additional desc . .
Permit Fee . . . . 47.67 Plan Check Fee
.00
Issue Date . . . . Valuation . . .
. 0
Expiration Date . . 11/26/14
Qty Unit Charge Per
Extension
1.00 35.7500 EA MECH FURNACE
35.75
1.00 11.9200 EA MECH APPL REP/ALT
11.92
----------------------------------------------------------------------------
Special Notes and Comments
REPLACE FURNACE & INDOOR COIL 80o AFUE,
EER PER 2013 MECHANICAL CODES CODE2008
ENERGY) CARBON MONOXIDE ALARM S) TO BE
INSTALLED PRIOR TO FINAL INSPECTION.
----------------------------------------------------------------------------
Other Fees . . . . . . . . . BLDG STDS ADMIN (SB1473)
1.00
PERMIT ISSUANCE M/P/E
90.57
PLAN CHECK, MECHANICAL
28.60
Fee summary Charged Paid Credited
Due
------------=--------------------------------------------
Permit Fee Total 47.67 .00 .00
47.67
Plan Check Total .00 .00 .00
.00
Other Fee Total 120.17 .00 .00
120.17
Grand Total 167.84 .00 .00
167.84
LQPERMIT
Bin #
City of La `nta
Building i_ Safety Division
Permit
-P.O. Box 1 SO4, 78-49S Calle Tampico
•#
La Quints, CA 92253 - (760) 777-7012
Bupld! ' Permit Application and Tracking Sheet
Project Address:'' ` : ....
Owner`s Name: Q 6'>'.T w%► L�/e
A. P. Number: '
Address:
H S M -
Gi
.. .. Y:•;+: .::; :e�sa. .iii-.:.Y :<.'" _.'
Lega1 De City, ST Zip: 4A LI U i A1% 1'a aS3
Prei erd`r1,:'G:aiditoning
dba
Contractor �' Tele hone:
Pre:fEkrr:e:: Plumbiil Heatin &A' P
Address:-'PO :.:B.q 5'' ' .0.'.'..
ProjectDescrip6on:
City, S.`;
CA-..:9 2'2 6 3 I ve-
' Te]Vhci— D$-3 2
3:.
�D
State Lie.'
City I ic. #: 2 2 2 9
Arch,-':E0gr-.=Designi l
Address::. -
.City,.ST. Zip:...
Constr 6etion Type: Occupancy:
P cy:
:.
Projecttype (circle one): 14ew Add'n Alter Repair
p Demo
Name of:CQn�acC:Pe on.::E 9T I3ARAJAS Sq. Ft: #Stories: # Units:
Telepfiome-# �b;!EoiictF?eron'' 7 6 0
7-77
mG
Estimated f t
863-083.2 Value o Project.
7
APPLICANT: DO NOT WRITE BELOW THIS LIME
# . Snbiiiittal Reed TRACKING PERI r FEES
Plan,SEts:.
Plan Cheek fitted
Ite
Amount
St?vctpral:l;al�s....
Reviewed, ready for corrections
Pla Check Deposit
Trdss Calcs...:.::.
Called Contact Person
Pla Check Balance
JB4e�gy CaLcs,:' :
]Plans �iicked up Con truct[on
Flood plain plaq :.
Plans-resubmitted Cal'
Gradingplsn •= • .
2 Review, ready Yor'correctionsrssue Me icat
': -:Subeodtactor.List
Called Contact Peron Pin b[n g
GrantDeed
Plans picked up S
HOA, Approval
Plans resubmitted Gra ing
INHOUSE:-.
'"' Review, ready for corrections/is:sueDe4 toper Impact Fee
Pianni#g Apprbyal .
Caned Contact Person
-Pub. Wks. Appr '
Date of permit issue
Sehool Fccs
- '
Tot PermltFees
HVAC Permit Checklist
Comfort Consultant (RSP):
Service Order ##: I� z 2 ` � — �
Owner's Name: f
Jobsite Address: -7eq
Permit Application Declaration Page:
❑ Commercial esidential
�ingle family residence ❑ Multi -family residence
❑ Condominium ❑ Other:
Ac,
Name of Community:
Location of new unit on/in structure: O V3
Plot plan required?:
Line of sight - screened / parapet / distance from lot line:
Components to be: ❑ installed /eplaced: Mil e for like"or upgrade? (circle one)
❑ Condenser ❑ Furnace BTU:
YFAU / Air Handler ❑ Size (tonnage):
XEvaporative Coil ❑ SEER:
❑ Package unit - PGE or HP ❑ EER:
s CO Detector:
�❑ Other:
CF -IR -A Form:
Project valuation:1 j
Date Permit Needed at Jobsite:
Other Information:
Simplified Prescriptive Certificate of Compliance: 2008 Residential RVACAIterations CF -IR -ALT -HVAC
Climate Zones 10 to 15
Site Address:�
51N-64
E fo ceMe t Agen `Dat
Permit #:
S31s,
Equipment T el
List Minimum Efficient z
Condition46d Mor
Duct insulation requirement Area
Thermostat
❑ Packaged Unit
urate
FUE�
❑ COp
Over 40 ft of ducts added or
Setback
3replaced
door Coil
❑SEER
❑ HSPF
in unconditioned space Served by system
(If not already
❑ Condensing Unit
❑ EER
❑ Resistance
❑ R 6 (CZ 10-13) Zaz sf
❑ R 8 (CZ -1445)
present, must be
installed)
❑ Other
1. Equipment Type: Choose the equipment being bastalled,• if more than one system, use another CF -1R ALT -HVAC for each system.
2. Minimum Equipment Efficiencies: 13 SEER, 78% AME, 7.7HSPFfor 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 sball 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. BeginiVmg October 1, 2010, a registered co y of the CF -1R and CF -6R shall also be on site for final inspection.
. HVAC Changeout
Required Forms:
• All HVAC Equipment replaced
CF -6R forms: MECH-04, MECH-2I-HERS and (for split systems) MECH- 25 -HERS
CF4R forms: MECH- 21 and (fors lit stems) MECH-25
• Condenser Coil and/or
• Indoor Coil and /or
CF -6R forms: 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 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. Existing duct systems are constructed, insulated or sealed with asbestos
❑ 2. New HVAC System Required Forms:
• Cutin or Changeout with new CF -6R forms: MECH-04, MECH-20-HERS,and (for split systems) MECH-22-HERS, and MECH-25-HERS
ducts: (a11 new ducting and all
new equipment) CF -4R forms: MECH 20-, and (for split systems)MECH-22, and MECH 25
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
❑ 3. New Ducts with Replacement Required Forms:
• Includes replacing or installing all new ducting CF -6R forms: MECH-04, MECH-20-HERS,and (for split systems) MECH-25-HERS
and/or outdoor condensing unit and/or indoor CF -4R forms: MECH-20 and (for split systems) MECH-25
coil and/or furnace. Not all equipment changed.
For Split Systems: Duct leakage < 6 percent, RC, CCA > 300 CFM/ton, TMAH
For Packaged Units: Duct le e < 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 space.
For split system or packaged units: Duct leakage .< 15 percent
❑ EXCEPTION: Existing ducts stems 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 Califomia Code of Regulations.
• The design features identified on this Certificate of Compliance are consistent with the information documented on er applicable compliance forms, worksheets,
calculations, plans and specifications submitted to the enforcement agency for approval with the do
Name: -PAT 71 6 - ® Signature:
Company V 1 r 1 M tjl:. , q T r ate: f
tom: /�
lqd
Addressyo� �12b
License: �O 5 755-4
City/State/Zip: __ _L1 � �?V( rA6 S . /T R ?— (j � Phone: �?iat'�
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