12-0425 (MECH)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 12-00000-425'
Property Address: 78522 POMPEII CT
APN: 609-551-023-10 -28458 -
Application description: MECHANICAL
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 4200
Applicant:
I hereby affirm under penalty of p.
Section 7000) of Division 3 9W
Y
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
DEVILLA JOSE H
78522 POMPEIL CT
UNKNOWN, CA 99999
Contractor:
Architect or Engineer: J ANTHONY PLUMBING HEAT/AIR
72216 NORTH SHORE STREET, #
THOUSAND PALMS, CA 92276
(760)328-8096
JA
.l Lic. No.: 777794
LICENSED CONTRACTOR'S DECLARATION
Vt 1 am licensed under provisions of Chapter'9 (commencing with
nd Professionals Code, and myUeemse.L%in full force and effect.
License N 77794 ",._
OWNER -BUILDER DECLARATION '
I hereby affirm under penalty of perj0Jhat 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'Protessions 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 contractor(s) licensed
pursuant to the Contractors' State License Law.).
I—) I am exempt under Sec. , BAP.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: ilk
LQPERMIT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 4/18/12
p Q 0
APR 13 2012
01 CITY OF LA QUINTA
FINANCE DEPT.
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
1 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
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:
Carrier GRANITE STATE f Policy Number WC065255599
1 certify that, in the perfor ance of the work for which this permit is issued, I shall not employ any
person in any manner o as to becomes act to the workers' compensation laws of California,
and agree that, if I s Id become subje t o the workers' compensation provi ' _*'9e�+an
/ 3700 of the La �foh mply with those provisi
Det€ fs W ;cant:
WARNING: FAIL RE TO SECURE WO KERS' 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 ermit.
2. Any permit issued as a result of this applicati n becomes null and void if work is not commenced
within 180 days from date of issuance of s ch permit, or cessation of work for 180 days will subject
permit to cancellation.
I certify that I have read this application and state t at t e above information. is correct. I agree to comply with all
city and county ordinances and state laws relating g constructio d hereby authorize representatives
of this co ty1,t enter up o the above-mentio op pr iq ecti pure ses.
Da a 17/ gnature (Applicant or Agent) V
Application Number . . . . . 12-00000425
Permit . . . MECHANICAL
Additional desc .
Permit Fee . . . . 31.50 Plan Check Fee
7.88
Issue Date Valuation . . . .
0
Expiration Date 10/15/12
Qty Unit Charge Per
Extension
BASE FEE
15.00
1.00 16.5000 EA MECH B/C >3-15HP/>100K-5OOKBTU
16.50
--------------------------------=-------------------------------------------
Special Notes and Comments
HVAC CHANGE -OUT CONDENSER & INDOOR COIL
ONLY. 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 .00 .00
40.38
LQPERMIT
in
Simplified Prescriptive Certificate of Compliance: 2008 Residential HVAC Alterations CF-lR-ALT-HVAC
Climate Zones 10 - 15
Site Address:
Enforcement Agency:
Date:
Permit #:
78522 POMPEII CT La Quinta, CA 92253
City of La Quinta
Apr 16, 2012
Duct insulation
Conditioned Floor
Equipment Typel
List Minimum Efficiency2
requirement
Area
Thermostat
❑ Package Unit
❑ Furnace
m Indoor Coil
❑ AFUE
p SEER 14.0
❑ COP
[3HSPF
❑ R 6 (CZ 10-13)
Served by system
®Setback
If not already present, must be
® Condensing Unit
❑ EER
❑ Resistance
❑ R 8 (CZ 14-15)
1800 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 -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 -611 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-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:
4❑'I'Duct system was documented to have been previously sealed and confirmed through HERS verification; or
❑ 2. Dud systems with less than. 40 linear feet in unconditioned space, or
❑ 3. Existing dud systems are constructed, insulated or sealed with asbestos
❑ 4. The
,,system,will not be Ducted 0e yDuctless Mini-Split_System)•(Also Exempt from ;Refrigerant Charge)
m, ,
❑ 2. New HVAC System
Required Forms_: " y " j / ") t ?" - .1 r` —TWA k
. Cut in 'or Changeout with,
new ducts: (all new
/ - �.
CF -6R forms: MECH-04, MECH-20-HERS, a4(for split systems) MECH, 22 -HERS and _.
-
ducting and all new
MECH=25;HERS ,•
CF -4R forms:, MECH-20, and (for split systems) MECH-22, and MECH-25)
equipment .,
yd"# {;r►: �, t_. fir. J t .rII J T.
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 outdoor condensing' unit
CF -611 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 orreplacing 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: Kevin Robinson Signature: Kevin Robinson
Company: I ANTHONY PLUMBING HEATING & AIR CONDITIONING Date: Apr 16, 2012
Address: 72216 NORTH SHORE ST #101 License: 777794
City/State/Zip: THOUSAND PALMS / CA / 92276 Phone: (760) 328-8096
Reg: 212-A0018812A-00000000-0000 Registration Date/Time: 2012/04/16 14:57:21 HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms July 2010
f
Bin #
C►ty f La Quinta '.
Building.& Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012 r
Building Permit Application and Tracking Sheet
Permit # ^^__
Project Address: 5��i 114p
Owner's Name: Jnr
A. P. Number:
Address:
Legal Description:
City, ST, Zip:
Contractor:
Address: 72216 NORTH SHORE ST. STE 101
1 PIOUSAND PALMS, GA- Q -2—:27 -6 -
City, ST, Zip:
:.y >:::�:c..ts;;; ,,.:.`::..
Telephone: %bb 3(00 3�4� �•�%�'X�;�<:cgixita<�.;
Project Description:
2 fc,, S 7D
Telephone:
~:i#:>::>:;>„ s'»;Lr>::
State Lic. # : %�7 �j City Lic. #: ps b 51�
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone:..
State Lic. #:
•,��:.;��;,�.. ,,,,s,„>},�� }�.
.... .�.. N�,M
}< s %x°?
Construction Type: Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
Sq. Ft.: # Stories: # Units:
Name of Contact Person:
Telephone # of Contact Person:
Estimated Value of Project: ozlZnn
APPLICANT: DO NOT WRITE BELOW THIS LINE
N
Submittal
Req'd
Recd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item Amount
Structural Cafes.
Reviewed, ready for corrections
Plan Cheek Deposit
Truss Cafes.
Called Contact Person
Plan Check Balance
Title 24 Cafes.
Pians picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2id Review, ready for correctionsfrssue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
'"' Review, ready for correctionslssue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees