12-0908 (MECH)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
-12:_ 000'OA908�
Property Address:
81.835 PRISM DR
APN:
764-270-999-67 -300232-
Application description:
MECHANICAL
Property Zoning:
MEDIUM HIGH DENSITY RES
Application valuation:
12725
Tdv14-4Q"
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
RICHARD MEAD
81835 PRISM DRIVE
LA QUINTA,, CA 92253
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 8/13/12
Contractor:�D�
'Applicant:. Architect or Engineer: GENERAL AIR CONDITIONI
31170 RESERVE DRIVE ; 1�
�0 j
�J) `� .
THOUSAND PALMS, CA 922AUS , 6
(760)343-7488 ! _
Lic. No.. 686310MCC
C17Yn(zP,�1�i!d7l�
-------—-----------------------------—-
LICENSED NTRACT0R'S DECLARATION WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury that I am lice 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 f ronals 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 LicenseNo.: 686310 for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
cs issued.
Date: a / 3 r� tractor: Prof- - plc.; I have and willmaintainworkers' compensation insurance, as required by Section 3700 of the Labor
T Code, for the performance of the work for which this permit is issued. My workers' compensation
OW ER -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 ZENITH INS CO Policy Number Z071741501
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't ork 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 appllcant.fur the person in any manner 30 es to b subjcct to the workers' compensation laws of California,
permit to Hale signed statement that he or she is licensed pursuant to the provisions of the Contractor's State and agree that, if I should beco s jest 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 . 3760 of the Labor Code, I shall rt with' omply with those provisions.
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):: ate: _§( IQ pplicant:
(_) 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 WARNING: FAILURE TO SECURE WO OMPENSATION 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 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.). APPLICANT ACKNOWLEDGEMENT
(_ 1 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. - IMPORTANT Application is hereby made to the Director of Building and Safety for a -permit subject to the
7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of conditions and restrictions set forth on this application.
property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed 1. Each person upon whose behalf this application is made, each person at whose request and .for
pursuant to'the Contractors' State License Law.). whose benefit work is performed under or pursuant to any permit issued as a result of this application,
(_ 1 1 am exempt under Sec. , B.&P.C. for this reason - 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
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: i
Lender's Address
LQPERMIT
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 per it, or cessation of work for 180 days will subject
permit to cancellation. .
I certify that I have read this application and state that the ab a information is correct. I agree to comply with all
city and county ordinances and state laws relating to building struction, and hereby authorize representatives
of this county to enter upon the above-mentioned property f ' spec ' n purposes.
Pate: 11/( 3 12 s, ature (Applicant or Agent):
Application Number . . . . . 12-00000908
Permit . . . MECHANICAL
Additional desc .
Permit Fee . . 40.50 Plan Check Fee
10.13
Issue Date Valuation . . . .
0
Expiration Date 2/09/13
Qty Unit Charge Per
-Extension
BASE FEE
15.00
1.00 9.0000 EA MECH FURNACE <=100K
9.00
1.00 16.5000 EA MECH B/C >3-15HP/>100K-500KBTU
16.50
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Special Notes and Comments
HVAC CHANGE -OUT: 5 TON SPLIT SYSTEM,
FURNACE,CONDENSER, INDOOR COIL. 2010
CODES.
----------------------------------------------------------------------------
Other Fees . . . . . . . . BLDG STDS ADMIN (SB1473)
1.00
Fee summary Charged Paid Credited
Due
•Permit Fee Total 40.50 .00 .00
40.50'
Plan Check Total 10.13 .00 .00
10.13
Other Fee Total 1.00 .00 .00
1.00
Grand Total 51.63 .00 .00
51.63
LQPERMIT
Simplified Prescriptive Certificate of Compliance: 2008 Residential HVAC Alterations CF -IR -ALT -HVAC
Climate Zones 10 - 15
Site Address:
Enforcement Agency:
Date:
Permit #:
81835 PRISM DRIVE La Quinta, CA 92253
City of La Quinta
Aug 12, 2012
Duct insulation
Conditioned Floor
Equipment Typel
List Minimum Efficiency2
requirement
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
® Condensing Unit
[I EER
❑ Resistance
❑ R 8 (CZ 14-15)�
sf
installed)
❑ Other
1. Equipment Type: Choose the equipment being installed; if more than one system, use another CF -IR -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 -6R 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 -IR
and CF -611 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
For Split Systems: Duct leakage < 15 percent; RC, CCA <_ 300 CFM/ton (Minimum Air Flow Requirement), TMAH
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
❑ 4. The�system�w.ill not be Ducted (ie Ductless vMinq-Split,Sym
stem}o(Also,Exept;fromjRefrigerant,Cha,rge)
❑ 2. New HVAC System
Required Fottns:
. Cut iWorChangeout with"
-
�` ` ' " 34"
CF -6R forms: MECH-04, MECH 20-HERS,and'(fo�'split systems) MECH 22 -HERS, and
new ducts: (all new,
ducting all new
MECH-25 HERS,
'
CF -4R forms: ,MECH-20, and (for split systems) MECH-22, and MECH-25 ,
e ui ment-
For Split System's: Duct leakage <,6 percent; RC, -CCA -,.2:.350 CFM/ton, FWD;'TMAH, SIMS, 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 >_ 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.
• The design features identified.on this Certificate of Compliance are consistent with the information documented on other applicable compliance
forms, worksheets, calculations, plans and specifications submitted to the enforcement agency for approval with the permit application.
Name: Danielle Garcia Signature: panielle Garcia
Company: HARRISON ENTERPRISES INC Date: Aug 12, 2012
Address: 31-170 RESERVE DRIVE STE A License: 686310
City/State/Zip: THOUSAND PALMS / CA / 92276 Phone: (760) 343-7488
Reg: 212-A0043666A-00000000-0000
2008 Residential Compliance Forms
Registration Date/Time: 2012/08/12 12:27:36 HERS Provider: CalCERTS, Inc.
July 2010
BIR #
Qty Of U. QuII1ta
Building & Safety Division
P.O. Box 1504,78-495 Calle Tampico
La.Quinta, CA 92253.:(760) 777-7012
Building Permit Application and Tracking Sheet
Perinit #
Project Address:�� r wn Dr •
Owner's Name://. 1 fib o ltd
A. P. Number. •�. W y 3 / o 0. W
Address: S vIY1(j `e
Legal Description:
Contractor. ���-
City, ST, Zip:
Telephone:
Project Description: v c C Vv l 73 WIC,
Address: 31— 170
City, ST, Zip:"r , 2 2 -7,9'.
I 5
Telephone• 760 �3
3 A� S
State Lic. # : 6.B6 3. I O City Lia #:
Arch., Engr., Designer
Address:
City, ST, Zip:
Telephone:
g Construction Type:. Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
State Lic. #:
Name of Contact Person: Sq. Ft.: 2 2 # Stories:
# Unit;:
Telephone # of Contact Person: Estimated Value of Project: I 2 5
APPLICANT: DO NOT WRITE BELOW THIS UNE
#
Submittal
Req'd
Recd
TRACKING
PERMfI' FEES
Plan Sets
Pian Cheek submitted
Item Amount
Structural Cales.
Reviewed, ready for corrections
Plan Check Deposit. .
Tross C21cs.
Called Contact Person
Plan Check Balance_
Title 24 Calci
Plans picked up
Construction
Flood plain plan
Plans resubmitted..
Mechanical
Grading plan
2" Review, ready for correctionsliissue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.L
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
'" Revtew; ready for corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees