13-1490 (MECH)a
4 P.O. BOX 1504 VOICE (760) 777-7012
78-495 CALLE TAMPICO / FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 11/22/13
Application Number: 13-00001490 Owner:
Property Address: 48609 PASEO TARAZO FRANK PETRICKA
a
APN: 646-082-005- - - 48609 PASEO TARAZO
Application description: MECHANICAL LA QUINTA, CA 92253
Property Zoning: LOW DENSITY RESIDENTIAL (507) 271-1218
Application valuation: 8831
Contractor:
Applicant: Architect or Engineer: PALM DESERT AIR COND CO I
42081 BEACON HILL
PALM DESERT, CA 92211
(760) 346-0677 FNNtV 22201Lic. No.: 374937 L
CITY OF l A QUINTA
FINANCE DEPT
-7------------------------------------------------7----------------------------------------------
LICENSED CONT TOR'S DECLARATION
I hereby affirm under penalty of perjury that I am ' s d r isions of Chapter 9 (commencing with
Section 7000) of Division 3 of the Business Prof n C e, and my License is in full force and effect.
License Class: C20Li nse No.: 374937
Date: ll -Z JIJ22 Contractor:
I hereby affirm under penalty of perjur at I am eiMeRp from th Contractor's State License Law for the
following reason (Sec. 7031 .5, Busipffss and Profession Cod 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.).
(_) 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 contractorls) licensed
pursuant to the Contractors' State License Law.).
( ) 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
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
I veand 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:
Ca6ier MID CENTURY Policy Number 09454905-12
I certify that, in the performance of the work for 'cl is permit is issued, I shat) not employ any
person in any manner so as to b e subl o orkers' compensation laws f California,
and agree that, if I should be me subject workers pens Bions of Section
��//$$7Q@yf the Labor Code, hall forthwit m ly with those p ovi ' s.
Date: '� PPlicant:
WARNING: FAILURE TO SECURE WORK/ESTESAND
E ION AGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINALAND Cl ES UP TO ONE HUNDRED THOUSAND
DOLLARS Is 100,000). IN ADDITION TOOF C ENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3706 OF THE LABOR CODE, I 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 wor of commenced
within 180 days from date of issuance of such permit, or cessai n o rk for 80 days will subject
permit to cancellation.
I certify that I have read this application and state that the above inf is correc I agree to comply with all
city and county ordinances and state laws relating to buildin stru and her y authorize representatives
of this un ejt iupon the above-mentioned proper or ins pe urpo
Date: `I 6ignature (Applicant or Agent):
LQPERMIT
Application Number . . . . 13-00001490
Permit . . . MECHANICAL 2013
Additional desc .
Fee . . . 83.42 Plan Check Fee
.00
_Permit
Issue Date . . . . Valuation
0
Expiration Date _ 5/21/14
Qty Unit Charge Per
Extension
1.00 35.7500 EA MECH FURNACE
35.75
. t 1.00 11 q?nn FA ' MECH APPT. RFP/ALT
-11.92
1.00 35.7500 EA MECH CONDENSER/COMP
35.75
--------=------
-------------------------------------------------------------
Special Notes and Comments
HVAC CHANGE OUT - 13SEER/78AFUE SPLIT
SYSTEM [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
52.43
Fee summary Charged Paid Credited
Due
Permit Fee.Total 83.42 .00 .00
83.42
Plan Check Total .00 .00 .00-
.00
Other Fee Total 143.00 .00 .00
143.00
Grand Total 226.42 .00 .00
226.42
LQPERMIT
�u
P.O. Box 150.4.78-495 Calle Tampico, • La Quinta, California 92211
QTel: (760) 777-7012 • Fax: (760) 777-7112 ,....
--GG141%.DE=T Website: www.La-Quinta.Org • Email: Building@La-Quinta.Org `'"•tio,�,{�•'�
Bin #: Permit #: (410Building Permit Application&Tracking Sheet
Project Address: 48-609 PASEO TARAZO
Owner's Name: PETRICKA, FRANK
A.P. Number:
Address: 48-609 PASEO TAP.AZO '
Legal Description:
City, State, Zip: LA QUINTA, CA 92253
Contractor. Palm Desert Air Conditioning & Heating Company
Telephone: (507) 271-1218
,Address: 42-081 Beacon Hill
Project Description:
City, State, Zip: Palm Desert, CA
92211
REPLACE (1) AIR CONDITIONING SPLIT SYSTEM.
Telephone No.: (760) 346-0677 �•
jam° �{Y ;�F �M1'TT-y✓ '�.&'a`-'J ,y`.,;
r. ^�, ' ,
State: Lic. #: 374937
City Lic. #: 100886
Arch./Eng r./Designer:
Address:
City, State, Zip:
Telephone No.:
� ' F a -
Construction Type:
Occupancy:
State: Lic. #:
"• `� r t
Project Type: ❑ New • ® Add'n • ❑ Alter • O Repair • O Demo
Name of,Contact Person: KARL BROWN
Sq. Ft.:
# Stories:
# Units:'
Contact Telephone No.: (760) 346-0677
Estimated Value of Project: $8,831.00
APPLICANT:
DO NOT WRITE
BELOW THIS. LINE
#
Submittal
Req'd
Recd
Tracking
Permit Fee's
Plan Sets
Plan Check Submitted
Item
Amount
Structural Cales.
Reviewed, Ready for Corrections
Plan Check Deposit
Thus Calcs.
Called Contact Person
Plan Check Balance
rite 24 Cales.
Plans Picked Up
Construction
Flood Plain. Plan
Plans Resubmitted
Mechanical
Grading Plan
2 ° Review, Ready for Corrections
Electrical
Subcontractor List
Called Contact Person
Plumbing
Grant Deed
Plans Picked Up
S.M.I.
H.O.A. Approval
Plans Resubmitted
Grading
IN HOUSE
3n0 Review, Ready for Corrections '
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Works Appel
Date of Permit Issue,
School Fees
Total Permit Fee's
Simplified Prescriptive Certificate of Compliance: 2008 Residential HVAC Alterations CF-IR-ALT-HVAC
Climate Zones 10 - 15
Site Address:
Enforcement. Agency:
Date:
Permit:
48-609 PASEO TARAZO La Quinta, CA 92253
City of La Quinta .
Nov 5, 2013
Equipment Typel
List Minimum'Efficiency2
Duct insulation
requirement
Conditioned Floor
Area
Thermostat
❑ Package Unit
® Furnace
® Indoor Coil
® AFUE 78%
® SEER 13.0
❑ COP
❑ HSPF
❑ R 6 (CZ 10-13)
Served by system
® Setback
If not already present, must be
IM Condensing Unit
[3 EER
[3 Resistance
[3R 8 (CZ 14-15)
2000 sf
installed)
"
❑ Other
1. Equipment Type: Choose the equipment being installed; if more than one system, use another CF•lR-ALT-HVAC for each system.
2. Minimum Equipment Efficiencies: 13 SEER, 76°o 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-611 and registered CF-4R
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-4R forms: MECH-21 and (for split systems) MECH-25
• Condenser Coil and /or
• Indoor Coil and /or
CF-6R forms: MECH-04 MECH-2I-HERS and (for split systems) MECH-25-HERS
• Furnace
CF-4R forms: MECH-21 and (for split systems) MECH-25
Duct leakage,< .15<- percent; RC, CCA 300 CFM/ton (Minimum Air Flow Requirement), TMAH
For Split Systems:r�
or- Packayed 5
peFce44
Exempted from duct leakage testing if:
❑ 1. Duct system was documented to have been previously sealed and confirmed through HERS verification, of-
0 2. Duct systems with less than 40 linear feet in unconditioned space, or
❑ 3. Existing duct systems are constructed, insulated or sealed with asbestos
❑ 4. The,_ not be Ducted (ie�Ouctless Mrni Split System),(Also Exempt from-.RefrigerantCh.arge)
,.,.w
13 2. New' HVAC System
Required Forms:' F �,z- sr,
��
.Cut morChangeout with
new ducts: (all new
ducting'and all new
H ,
CF 6R forms MECH-04 MECH-2M HERS, and.(for split systems) MECH-22 HERS and
MECH 225 HERS. S �
equipment) .; .
CF 4R forms:'MECH-20 and (for split systems) MECH-22 and MECH-25
�t /x N �: # � " .:`fl , - 3 K «_* t SEE; e e r r
#
,
For Split Systems: Duct leakage < 6:percent; RC; CCA, >_3 50 CFM/ton; FV,ID; TMAH,-STMS, and either HSPP or'PSPP. ='
For Packaged Units: Duct leakage < 6-percent
•❑ 3. New Ducts 'with/or without
Required Forms:
Replacement.
. Includes replacing or installing all new
ducting and/or outdoor condensing unit
CF-6R:forms: MECH-04, MECH-20-HERS, and (for split systems) MECH-25-HERS
and/or indoor coil and/or furnace. No or some
CF-4R forms: MECH-20 and (for split systems) MECH-25
equipment changed.
For Split Systems: Duct leakage < 6 percent; RC, CCA 2 300 CFM/ton, TMAH
For Packaged Units: Duct 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
_
linear feet of duct in unconditioned space. CF-4R forms: MECH-21
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
requirements of Title 24, Parts 1 and 6 of the California Code of Regulations. I
• The design features identified on this Certificate of Compliance are consistent with the information documented on other applicable compliance
forms, worksheets, calculations, and
plans specifications submitted to the enforcement agency for approval with the permit application.
Name: Karl Brown Signature: Knrl Brown
Company: PALM DESERT AIR CONDITIONING CO INC Date: Nov 5, 2013 -
Address: 42-081 BEACON HILL License: 374937
City/State/Zip: PALM DESERT/ CA/ 92211 Phone: (760) 346-0677
'-UReg: 213-A008369OA-0_00000000-0000
2008 -Residential Compliance Forms
Registration Date/Time: 2013/11/05 12:58:07 HERS Provider: yCa10ERTS,'Inc .f3
July 2010