12-0773 (MECH)• "
P.O. BOX 1504 VOICE (760) 777-7012
T 4' 78-495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT -
Application Number:
Property Address:
` APN:
Application description:
Property Zoning:
Application valuation:
Applicant:
12-=00 0 -773
+48653 Pit TARAZO
646 -082 -053 -
MECHANICAL
LOW DENSITY RESIDENTIAL
3400
Architect or Engineer:
UC ED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I m lice under provisions of Chapter 9 (commencing with
Section 7000) of Division 3 of the Bu si ss rofes Code, de, and my License is in full force and effect.
Lice CI ss: 20-C36 License No.: 77
Date: Xontr.clo,: '
OWNER -BUILDER DECLARATION
I 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)•:
(_ 1 1, 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, 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 contractors) licensed
pursuant to the Contractors' State License Law.).
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: l '
Lender's Address:
LQPERMIT
Owner:
PEARSON JUNELLE
48653 PASEO TARAZO
LA QUINTA, CA 92253
Contractor:
J ANTHONY PLUMBING HEAT/
72216 NORTH SHORE STREET
THOUSAND PALMS, CA 92276
(760)328-8096
Lic. No.: 777794
Date: 7/12/12
WORK ER'S.COMPENSATION DECLARATION
I 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
Yissued.
l 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 GRANITE STATE Policy Number WC065255599
_ I certify that, in the per6,x,
e work for which this permit is issued, I shall not employ any
person in any mannsubject to the workers' compensation laws of California,
and agree that, if I se o the workers' compensationprovisions of Section
337700of the Labor Cith omply wit
Date: /_4 1 vA can,. -
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 (5100,000). 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 such6perit, or cessation of work for 180 days will subject
permit to cancellation.
I certify that I have read this application and state that theormation is correct. 1 agree to comply with all
cityand ut ordinances and state laws relating bu' inruction, and hereby authorize representatives
of thisccnty o enter upon the above-mentioned r ny fction purposes.
pig ! w cure (Applicant or Agent):
LQPERMIT
Application Number . . . . . 12-00000773
Permit .". MECHANICAL
Additional desc .
Permit Fee . . . . 31.50
Plan Check Fee
7.88
Issue Date
Valuation
0
Expiration Date 1/08/13
Qty Unit Charge' Per.
Extension
BASE
FEE
15.00
1.00. 16.5000 EA MECH
B/C >3-15HP/>1,OOK-500KBTU
16.50
--
Special Notes and Comments
REPLACE5 TON CONDENSER. 2010 CODES.
---------------------------=------------------------------------------------
Other Fees BLDG STDS ADMIN (SB1473)
1.00
Fee summary Charged
Paid Credited
Due
Permit Fee Total 31.50
00 .00
31.50
Plan Check Total. 7.88
.00 .00
7.88
Other Fee Total 1.00
.00 _00
1.00
Grand Total 40.38
r
.00 .00
40.38
Simplified Prescriptive Certificate of Compliance: 2008 Residential HVAC Alterations CF-111-ALT-HVAC
Climate Zones 10 - 15
Site Address:
Enforcement Agency:
Date:
Permit #:
48653 PASEO TARAZO La Quinta, CA 92253
City of La Quinta
Jul 12, 2012
Duct insulation
Conditioned Floor
Equipment Typel
List Minimum Efficiency2
requirement
Area
Thermostat
❑ Package Unit
❑ Furnace
❑ AFUE
❑ COP
❑ R 6 (CZ 10-13)
Served by system
la Set:)ack
❑ Indoor Coil
0 SEER 13.0
❑ HSPF
❑ R $ (CZ 14-15)'
1800 sf
If not already present, must be
0 Condensing'Unit
[I EER
❑ Resistance
installed)
❑ Other
1. Equipment Type: Choose the equipment being installed; if more than one system, use another CF-ZR-ALT-HVAC for each system.
2. Minimum Equipment Efficiencies: 13 SEER, 78% 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-5R and registered CF-4R
forms (no hand filled CF-4Rs allowed) are filled out and signed.Beg inning October 1, 2010, a registered copy of the CF-1R
and CF-6111 shall also be on site for final inspection.
0 1. HVAC Changeout
Required Forms:
• All HVAC Equipment
CF-6R forms: MECH-04, MECH-2I-HERS and (for split systems) MECH-25-HEIS
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
For Split Systems: Duct leakage,:< 15 percent; RC, CCA <_ 300 CFM/ton (Minimum Air Flow Requirement), TMAH
Exempted from duct leakage testing if:
'N❑ 1 `Duct system was documented to have been previously sealed and confirmed through HERS verif[cation, 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
❑ 4. Thedsystem,will not be Ducted ''-(ie.•Ductless Mini-Split ;System).(AIso-Exempt. from Refrigerant Charge)
❑ 2. New HVAC System
Required Forms... " f f' '' ;� f;' ) !�•-. t[•
. Cut inior,Changeout with;
new ducts: all new `
+ r +� ,i { `• °
CF-6R forms: MECH-04, MECH-20=HERS, and (for split systems) MECH 22-HERS, and �4 ��r�+..-•
ductin andallnew
g —
MECH=25�HERS 1 r V
CF-4R formsr MECH-20 and forsplit s stems MECH-22 and MECH-25
(,_Y )
' ) _ :
equipment). -,.f
s, s '� r 1...
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
0.3.. 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 >_ 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 ide-itified on this Certificate of
Compliance.
• I certify that the energy features and performance specifications for the design identified on this Certificate of Compliaace conform to the
requirements of Title 24, Parts 1 and 6 of the California Code of Regulations.
• The design features identified on this Certificate of Compliance are consistent with the information documented on other applicable compliance
fortes, worksheets, calculations, plans and specifications submitted to the enforcement agency for approval with the permit application.
Name: Kevin Robinson Signature: Kevin Robinson
Company: 3 ANTHONY PLUMBING HEATING & AIR CONDITIONING Date: ILI 12, 2012
Address: 72216 NORTH SHORE ST #101 License: 777794
City/State/Zip: THOUSAND PALMS / CA / 92276 Phone: i760) 343-2121
i
Reg: 212-A0036914A-00000000-0000 Registration Date/Time: 2012/07/12 11:31:24 HERS Provider: Ca10ERTS, Inc.
2008 Residential Compliance Forms July 2010
Bin #
[PenWt
Cray of: La Quth- . Q
Bulfd n 8t Safety Division :. P
P.O. Boz. 1504,78.495 Calle Tampico
La :Quints, CA 92253 -(760) 1777012
BUilding Permit Application and Tracking- Sheet
#
1/y ,
p
Project Add=: 4ee4 7 3
Owna's Name:. /vltQS ,PeoV--s
A P. Number.
Address: Sif
Legal Description:
City, ST, Zip.
Contractor.Telephone:?
-7 Ff
Adm: J ANTHONY SERVICES
Project Description:
City, $T, Zip: THOUSAND PALMS, CA 92276
Telephone: ?too
"4Cityc
State Lia # :-77774
Arch., Bag., Designer.
Address.
City ST, Zip.
Telephone:
Construction Type:. Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
Sq �: # Stories: #Univ
e Lia
rameof Contact Person: ro 2 G(/� ��� ,.¢yK,S
phonc # of Comet Person: % (`p. 3 Y3 IZI Estimated Value of Project
APPLICANT: DO NOT WFM BELOW THIS UNE
0 Submittal Req'd Reed TRACXMgG PERMIT FEES -
Plan Sets Pian Check submitted item Amount
Strgdntni Caics
Reviewed, ready for correcauns Plan Check Deposit. .
Truss Cala.
Called Contact Person Plan Check Balance.
Title Tq Cates.
Plans picked up Construe -don
Flood plain plan
Plans resubmitted .. Mechanical
Girding plan
2'! Review, ready for correctiourasue Electrical
Subcoatactor List
Called Contact Person Plumbing
Grant Deed .
Plans picked up S b t
H.O.A. Approval
Plans resubmitted Grading
IN HOUSE:-
''' Review; ready for eorrectionsiissue Developer Impact Fee
Planning Approval
Called Contact Person A.%P.P.
Pub. Wks. APpr
Date of permit issue
School Fees
Total Fermit Fees