11-0577 (MECH)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:1100000577--
Property Address: 78582 POMPEII CT
APN: 609-544-003-16 -28458
Application description: MECHANICAL
Property Zoning- LOW DENSITY RESIDENTIAL
Application valuation: - 5900
Tit!t-44Q"
Applicant: Architect or Engineer:
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT ;
"
--------------- - - - WOWNER-BUILDERDECLARATI
------------------------
LIOR'S DECLARATION
hereby affirm under penalty of perjury that.provisions of Chapter 9 (commencing with ,
Section 7000) of Divisio the B si ssde, and my License is in full force and effect.
Licens Class: C 0- 6se No.: 777794
_�
e C ra
R DECLARATI N
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 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 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: Qy
LQPERMIT
Owner: dl it►,� 2011
LONGO RICHARD Fi s'
78582 POMPEII C�OURI —_ -
LA QUINTA, CA 922533 UTYOF�AffUIN7A
Contractor:
J ANTHONY PLUMBING HEAT/AIR
72216 NORTH SHORE STREET, #101
THOUSAND PALMS, CA 92276
(760)343-2121
LiC. No.: 777794
VOICE (760) 777-7012
FAX (760) 777-7011
'T QNS (760) 777-7153
6/02/11
WORKER'S COMPENSATION DECLARATION _
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
Jissued.
1 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 e:
Carrier STATE FUND Po' y Number 1932451-2011
I certify that, in the performance of a work for which this permit is issued, I shall not employ any
person in manner so to com bject to the workers' compensation laws of California,
and agree hat, ' I shou be m bje the rkers' compensation ov' ions of Section
of th Labo a I orthw' c mply 'th those provisio
D'�—/ Ap ca
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 ($100,000). 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 such permit, o cessation of work for 180 days will subject
permit to cancellation.
I certify that I have read this application and s a that the above ' fo i is torr . I agree to comply with a -
city and county ordinances and state.laws rel ing buil g n uction and h authorize representative
of this county too erlter up o the above -mention pr y 'ns ectio p
ignature (Applicant or Age
Application -Number . . . . . 11-00000577
Permit . . . MECHANICAL
Additional desc .
Permit Fee . . . . 40.50
Plan Check Fee ..
10.13
Issue Date
Valuation . . . .
0
Expiration Date 11/29/11
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
-----------------------------------------------------------------------------
Special Notes and Comments
INSTALL AMANA 5 TON 14 SEER SPLIT
SYSTEM
WITH PROGRAMMABLE THERMOSTAT. 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
CF -11R -ALT -HVAC
Alterations
Climate Zones 10 - 15
Site Address:..
Enforcement Agency:
Date:
Permit #:
78582 Pompeii ct La Quinta, CA 92253
City of La Quinta
May 17, 2011
Duct insulation
Conditioned Floor
Equipment Typel
List Minimum Efficiency2
requirement
Area
Thermostat
❑ Package Unit
p Furnace .
p Indoor Coil
p AFUE 80%
® SEER 14.0
❑ COP
El HSPF
R 6 (CZ 10-13)
Served system
M Setback
If not already present,
* Condensing Unit
E]EER
❑ Resistance
❑ R 8 (CZ 14=15)
? sf
must be 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 signeclAeginning
October 1, 2010, a registered copy of the CF -111 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 -411 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 leagage testing if:
❑ 1. Duct system was documented to have been previously sealed and confirmed through HERS verification, or
Q 2. Duct systems with less than 40 linear feet in unconditioned space, or'
❑ 3. Existingrductsystems are constructed ,insulated-orsealed with -asbestos •f'�ow.f
❑ 2. New HVAC l
Required,Forms: 0
System..
. Cut in or Changeout
Witt new ducts: (all
ducting(all
" t " i• + e `
CF,6R forms: MECH-04, MECH-20-HERS, and (for.split systems) MECH-22-HERS, and
MECH-25-HERS? I (a a--- '.n /�`
f[
new
ui '
ME-11,—,
CF 4R forms - EC H,20, -.and systems) MECH,22, and;MECH 25 `
new a ment
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/or without
Required•Forms:
Replacement `
. Includes replacing or installing all
new ducting and/or outdoorCF-6R
condensing unit and indoor coil
forms: MECH-04, MECH-20-HERS, and (for split systems) MECH-25-HERS
and/or furnace. No orr 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: Dud leakage < 6 percent
❑ 4. New Ducting over 40 feet
Required Forms:
. Includes adding or replacing more
than linear feet dud in
CF -6R forms: MECH-04, MECH-2I-HERS
unconditioned spacee..
CF -4R forms: MECH-21
For split system or packaged units: Dud leakage < 15 percent
El 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: Kevin Robinson Signature: Kevin Robinson
Company: ] ANTHONY PLUMBING HEATING & AIR CONDITIONING Date: May 17, 2011
Address: 72216 NORTH SHORE ST #101 License: 777794
City/State/Zip: THOUSAND PALMS / CA / 92276 Phone: (760) 328-8096
0
N
Reg: 211-A0023799A-00000000-0000 Registration Date/Time; 2011/05/17 15:18:09 _ HERS Provider: Ca10ERTS, Inc.
2008 Residential Compliance Forms - July 2010
IT
Bin # .
City of La Qtuina
Building & Safety Divtrion
Permit # �� P.O. Box 1504, 78-495 Calle Tampko
\\ La Quints, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Project Address: Owner's Name:
� EGD
A P. Number Address: p
�Q z 4
o �7
Legal Description: City. ST, Zip:
Contraetor:v.V/ j W felephone:7 /
Address: �.
City. ST, Zi
Telephone.76Q 4/3-
State Lic. # : '7
Arch., Eng.. Designs.
Address:
City, ST, Zip:
Telephone:
State Lic. #:
N Contact Person:
Telephone # of Contact Person:
# Submittal Ra
Plan Sets
Structural Cale&
Truss Calcs.
Tide 24 Calcs.
Flood plain plan
Grading plan
Subcontactor List
Grant Deed
H.O.A. Approval
AY HOUSE:-
Planning Approval
Puh Wks. Appr
School Fees
sect Descnpuon:
R�
Construction Type:
Occupancy:
Project type (circle one):
New Add'n Alter . Repair Demo
Sq. Ft':
#Stories:
#Units
Estimated Value of Project:
APPLICANT:
DO NOT WRITE BELOW THIS LINE -
Rcc'd
TRACKING
PERNIIT FEES
Plan Check submitted
Item
Amount
Reviewed, ready for corrections
Plan Check Deposit
Called Contact Person
Plan Check Balance
Plans picked up
Construction
Plans resubmitted
Mechanical
2" Review, ready for corrections/issue
Electrical
Called Contact Person
Plumbing
Plans picked up
S L
Plans resubmitted .
Grading
Review, ready for correctionalissue
Developer Impact Fee
Called Contact Person
AXP.P.
Date of permit issue
Total Permit Fees