10-0886 (MECH)P.O. BOX 1504 4
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Application Number:�-0
100000886• -^7 Owner:
. 1
Property Address: 48645 PASEO TARAZO CAMPBELL CAROLYN.
APN: 646-082-023= - - 48645 PASEO TARAZO
Application description: MECHANICAL LA QUINTA, CA 92253
Property Zoning: LOW DENSITY RESIDENTIAL (760) 771-3733
Application valuation: 5943
Contractor:
Applicant: A Architect or Engineer: AIR PRO SERVICES
P.O. BOX 1120
CATHEDRAL CITY, CA 92235
(760)343-5502
Lic. No.: 780198
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 9/09/10
--------------------------------------------------
LICENSED CONTRACTOR'S DECLARATION
----------------------------------------------—
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury that I am 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 and Professionals Code, and 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: C20 License No.: 780198
for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
issued.
Date / �S�d Contractor
_ 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
OWNER -BUILDER DECLARATION
insurance carrier and policy number are:
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the
Carrier NORGUARD INS Policy Number AIWC126845
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 as to 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 should become subject to the workers' 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 Code, I s rthwith comply with those provisions.
that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by
p
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).:
..Date: /-5-10 ,Applicant: '
(._ 1 I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and
- - r
the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The
WARNING: FAILURE TO SECU ORKERS' COMPENSATION 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 C IMINAL PENALTIES AND 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, 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 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
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 the above information is correct. I agree to comply with all
city and county ordinances and state laws relating to building cons uction, and hereby authorize representatives
of this county to enter upon the above-mentioned property r i tion purposes.
Date: S,—`7 '�v Signature (Applicant or Agent):
LQPERMIT
Application Number . . . . .. 10-00000886
Permit . . . MECHANICAL.
Additional desc .
Permit Fee . . . . 33.00
Plan Check Fee
•8.25
Issue Date . . . .
Valuation
0
Expiration Date .3/08/11
Qty Unit Charge Per
Extension
BASE
FEE
15.00
1:00 9.0000 EA MECH
APPT REP/AT,T/An-n
9.00
1.00 9.0000 EA MECH
B/C <=3HP/100K BTU
9.00
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Special Notes and Comments
HVAC CHANGE OUT AIR CONDITIONER
& COIL
ONLY. 2007 CODES. 14 SEER.
-------------------------------------------------------------------------.---
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
Sim lifted Prescriptive Certificate of Compliance: 2008 Residential HVAC Alterations CF -IR -ALT -HVAC
Climate Zones 10 to 15
Site Address:
V9 V 1'_4'r,1. ��
SPA Z d
Enforcement en
f n
Date:
Permit #:
Equipment T ' List Minimum Efficienc 2 Conditioned Floor
Duct insulation requirement Area Thermostat
O Packaged Unit
O Furnace ❑ AFUE ❑ COP Over 40 It of ducts added or O Setback
111 Indoor Coil XSEER_1/ ❑ HSPF replaced in unconditioned space Served by system (Ifnot already
09 Condensing Unit W EER /Z ❑ Resistance ❑ R 6 (CZ 10-13) sf present. mart be
O Other ❑ R 8 (CZ I4 -I5) installed)
-11
/.Equipment Type: Choose the equipment being installed: ijmore than one system, use another CF -I R-ALT-HYAC-jor each system.
2. Minimum Equipment Efficiencies: 13 SEER, 7891..IFUE, 7.7HSPFjortypical 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 HERS
the measures that must be conducted. A copy of the firms 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 CF4R forms (no hand filled CF41RN allowed) are filled out and
signed. Beginning October 1 2010 a regisitered copy of the CF -IR and CF -6R shall also be on site for tical Inspection.
L. HVAC Changeout Required Forms:
• All HVAC Equipment replaced CF -6R fors: MECH-04, MECH-2I-HERS and (for split systems) MECH- 25 -HERS
CF -4R 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
CF4R fors: MECH- 21 and (for split systems) MECH-25
For Split Systems: Duct leakage < 15 percent; RC, CCA 2:300 CFM/ton(Minimum Air Flow Requirement), TMAH
.For Packaged Units: Duct leakage < 15 percent
I Tempted from duct leakage testing if:
❑ 1 Duct system was documented to have been previously sealed and confirmed through HERS verificati3n, or
❑ 2. Duct systems with less than 40 linear feet in
unconditioned space, or
❑ 3. Existing ducts stems are constructed, insulated
or sealed with asbestos
O 2. New HVAC System Required Forms:'
• Cut in or Changeout with new
ducts: (all new ducting and all CF -6R fors: MECH-04, MECH-20-HERS,and for split stems MECM22-HERS, and MECH-25-HERS
CF -4R fors: MECH 20-, and fors lits stems ME H-22, and MECH 25
new equipment) ( p • y )
For Split Systems: Duct leakage < 6 percent; RC, CCA > 350 CFM/ton, FWD, TMAH, STMS, and eidicr HSPP or PSPP.
For Packaged Units: Duct leakage <6 percent
O 3. New Ducts with Replacement Requtred"Forms: - —
• Includes replacing or installing all new ducting CF -611 fors: MECH-04, MECH-20-HERS,and (for split systems) MECH-25-HERS
and/or outdoor condensing unit and/or indoor CF -4R fors: MECH-20 and (for split systems) MECH-25
coil and/or fumace. Not all equipment changed.
For Split Systems: Duct leakage < 6 percent, RC, CCA >_ 300 CFMhon, TMAH
For Packaged Units: Duct leakage < 6 percent
O 4. New Ducting over 40 feet
Required Forms:
• Includes adding or replacing more than 40
linear feet of duct in unconditioned s ace.
CF -611 fors: MECH-04, MECH-2I-HERS CF -0R forms: MECH-21
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)
• 1 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 cotf'orm to the requirements of Title 24.
Parts I and 6 of the California Code of Regulations.
• 'i'h,: de.i;n features identified on this Certificate of Compliance are consistent with the information documented on other appl:eable compliance forms, worksheets:
calculations,tans nd s cifications submitted to the enforcement for
a enc approval with the permit ication.
Name:
o e. R i est Signature:
Company:
1;e
Date:
/
Address:
9-�o
2 6 S SLicense:
F
—r
City/State/Zip:
JA
Phone:
76 C. - J— SSO�
2008 Residential Compliance Forms March 2010
Bin #
Qty of La Quinta
Building 8r Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Reet
Permit #
Project Address: c� 8 (� yS 6 _
Owner's Name: CR
A. P. Number:
Address: qy,6
Legal Description:
City, ST, Zip: 1 • ,, spas
Contractor:
Address: 7oZ N �- E
Telephone 76 - 7 ! - 7<:»::•
Project Description:
City, ST, Zip: j;. It vL� let -Alas 64
r/A rlqtvc6c./_
Telephone: ssai
7Go-3N3.
k:>?{'•: v>; < #:..:>:::>:""
r�:iii:•'' :2i> :r. :;.t; :.
/
/
State Lic. # : D./ City Lic. #.:
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone:
P<:>.;:>:<;;>:;;?;;:.;;::z:;:;::s:>::;;:;:•:;:,•:.;:•::;
xxx
State Lic. #:
Name of Contact Person: ,oQ es-t�-
Construction Type: Occupancy:
,
Project type (circle one): New Add'n _Ater Repair Demo
Sq. Ft.: # Stories: # Units:
Telephone # of Contact Person: 766 _ 3 V? - 575o'X—
Estimated Value of Project:
APPLICANT: DO NOT WRITE 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 Cales.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2". Review, ready for corrections/issue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
'rd Review, ready for corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date or permit issue
School Fees
Total Permit Fees