13-0480 (MECH)C, .. ;_ ". '
P.O. BOX 1504
78-495 CALLE TAMPICO 44
LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Application Number:
13-00000480
Property Address:
58569 QUARRY RANCH RD
APN: .
766-060-026- -
Application description:
MECHANICAL
Property Zoning:
LOW DENSITY RESIDENTIAL
Application valuation:
4800
Applicant:. Architect or Engineer:
--------------------------------------------------
NSED CON ACTOR'S DECLARATION
I hereby affirm under penalty of perj that I am license rider provisions of Chapter 9 (commencing with
Section 7 00'of Division 3 of the usiness and Prof ionals Code, and my License is in full force and effect.
License as C20 License No.: 725283
�yDaty.� Contractor"��,
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 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.).
(_ 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 pr9j9gt5 With a fnntrarindO lironrnrl
fu r^!nnl la th;, Ov i.uvia' State utrense LaW.).
(_) 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 ISec. 3097, Civ. C.I.
Lender's Name:
Lender's Address:_
LQPE-RA1IT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
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WORKER'SCOMPENSATION 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
W
ySection 3700 of the Labor Code, for the performance of the work for which this permit is
d.nd will maintain workers' compensation insurance, as required by Section 3700 of the Labor
e, for the performance of the work for which this permit is issued. My workers' compensation
insurance carrier and policy number are:
Carrier NORGUARD INS Policy Number PAWC334856
I certify that, in the performance of the work for which this permit is issued, I shall not employ any
person in any manner so as to become subject to the workers' compensation laws of California,
and agree that, if I sho com ject to the workers' compensation provisions of Section
3700 of the Labor Co e, I shall fort) ith comply with those provisions.
(Date: Applicant: %
WAR
If
FAILURE TO SECURE WORK S' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS 1$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 . Eat,lt uei sun upon Wn6t6 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 ouinta, 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.
1 certify that I have read this application and state that the above information is correct. I agree to comply with all
city and cou qty o dinances and state laws relating to b ' ing cons tion, and hereby authorize representatives
of this cou y t enter upon the above-mentioned pro rty for ins ion purposes.
Date:Signature (Applicant or Agent): 4!114
Date:'
4/18/13
Owner:
GEORGIANA CRONIN
58569 QUARRY RANCH ROAD
LA QUINTA, CA 92253
a
(415)860-5079
APR 1 cu
P
2u13
Contractor-
AIR EXPERTS AIR CONDITIONG-H
PO BOX 94
CITY OF LA
QUINTA
LA QUINTA, CA 92247
FINANCEDEPT.
(760)777-1724
LiC. No.: 725283
-----------------------------------------------
WORKER'SCOMPENSATION 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
W
ySection 3700 of the Labor Code, for the performance of the work for which this permit is
d.nd will maintain workers' compensation insurance, as required by Section 3700 of the Labor
e, for the performance of the work for which this permit is issued. My workers' compensation
insurance carrier and policy number are:
Carrier NORGUARD INS Policy Number PAWC334856
I certify that, in the performance of the work for which this permit is issued, I shall not employ any
person in any manner so as to become subject to the workers' compensation laws of California,
and agree that, if I sho com ject to the workers' compensation provisions of Section
3700 of the Labor Co e, I shall fort) ith comply with those provisions.
(Date: Applicant: %
WAR
If
FAILURE TO SECURE WORK S' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS 1$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 . Eat,lt uei sun upon Wn6t6 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 ouinta, 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.
1 certify that I have read this application and state that the above information is correct. I agree to comply with all
city and cou qty o dinances and state laws relating to b ' ing cons tion, and hereby authorize representatives
of this cou y t enter upon the above-mentioned pro rty for ins ion purposes.
Date:Signature (Applicant or Agent): 4!114
Application Number . . . . 13-00000480
Permit . . . . . MECHANICAL
Additional desc .
Permit Fee 31.50 Plan Check Fee
7.88
Issue Date .`. . . Valuation . . . .
0
Expiration Date 10/15/13
Qty Unit Charge Per
Extension
BASE FEE
15.00
1-001 16.5000 EA MECH B/C >3-15HP/>100K-500KBTU
16.50
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Special Notes and Comments
HVAC CHANGE OUT REPLACE (1) UNIT
13SEER CONDENSING UNIT AND (1)
EVAPORATOR COIL [2008 ENERGY] CARBON
MONOXIDE ALARM(S) TO BE INSTALLED PRIOR
TO FINAL INSPECTION.• 2010 CALIFORNIA
BUILDING 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
Blrr.#
City of La Quanta
Building 8T SafetyDivision
P.O. Box 1504,78-495 Calle Tampico
La.Quinta, CA 92253 -:(760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
ff ``
Project Address: � � QU4A2, . AA -Q
Owner's Name:. �1
A. P. Number.
Address: Q� ric—A A A )
Legal Description:
Contractor. 11� QED t
City, ST, Zip: 2ZS 3
Telephone: �?
k
Project Description:
p: �ti rte} '322Y _%
0/11
%��
: Z Z� City Lie. #;
VAddress:
E✓/90g�e
, Designer.
City., ST, Zip:
Telephone:
State Lie. #:
Name of Coataq Person:
Construction Type:. Occu Fancy:
Prqjecttype (circle one): New Add'n Alter Repair Demo
Sq. Ft : # Stories: # Univ:
Telephone # of Contact Person:
Estimated Value of Project: 00
APPLICANT: DO NOT WRITE BELOW THIS LINE
N
Submittal
Req'd
'Reed
TRACKENG
ItERhIIT FEES
Plan Sets
Plan Check submitted
Item Amount
S"ctural Gales.
Reviewed, ready for corrections
Plan Check Deposit. .
Truss Coles.
CaUed Contact Person
Plan Check Balance
Tide 24 Calci.
Plans picked up
Construction
Flood plain plan
Plans resubmitted..
Mechanical
Grading plan
2' Review, ready for correctionmiissue
Electrical
Subeoatactor List
Called Contact Person
Plumbing
Grout Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
3'd Review; ready for eorrectionsilssoe
Developer Impact Fee
Planning Approval
Called Contact Person
A.LP.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees
Simplifiedi Prescriptive Certificate of Compliance: 2008 Residential HVAC Alterations CF-IR-ALT-HVAC
Climate Zones 10 - 15
Site Address:
Enforcement Agency:
Dater
Permit #:
58569 Quarry Ranch Road La Quinta, CA 92253
City of La Quinta
Apr 17, 2013
Duct insulation
Conditioned Floor
Equipment Typei
List Minimum Efficiency2
requirement
Area.
Thermostat
0 Package Unit
p Furnace
O AFUE
0 COP
0• R 6 (CZ 10-13)
Served by system
® Setback
0 Indoor Coil
® SEER 13.0
- 0' HSPF
R 8 (CZ 14-15)
2000 sf
If not already present, must be
® Condensing Unit
p EER
0 Resistance
Installed)
0 Other
1. Equipment Type: Choose the equipment being installed; if more than one system, use another CF-1R-ALT-HVAC for each system.
2. Minimum Equipment Effrdendes. 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
sand' 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-611 forms; MECH-04, MECH-2I-HERS and (for split systems) MECH-25-HERS
replaced
CF-411 forms: MECH-21 and (for split systems) MECH-25
. Condenser Coil and /or
.. Indoor Coil and /or
CF-611, forms•: MECH-04,. MECH-2.I-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
Exempted from duct leakage testing if:
® 1. Duct system was documented to have been previously sealed and confirmed through HERS verification, or
0 2. Duct systems with less than 40 linear feet in unconditioned, space, or
0 3. Existing duct systems are constructed, insulated or sealed with asbestos
E3 4. The systeeQo veill not be Dui (ie�,quctless Iini-Sp6it-Sy; t") (AksO ExeiZn-€mm Re€hcieta Cpnarge)
0' 2. stew NVAC System
Requiked Fanrnins:
. Cut in or Changeout with'
C ECH-04, MrECtii-20-HERS, and (fdr sprit systems) HECK-22-fiERS and
new, ducts (all new
d'udirig and an new
r
MECHI-��
CF-4R forms: MECH-20, a d for split (for systems) MECH-22 acrd' MECH-25 J Vie"
equipiq�t)
11 i:. F ''a " _, ;q_ ...,,• rV r.- w _ f J
;For Spirt Systentis: Duct leakage < 6'percent; RC, CCA >_ 350 CFM/ton, FWD, TiMAH, SIMS, and either HSPP orPSPP.
!For Packaged knits` Duct leakage*< 6 percent
0 3. mew Ducts vAth/or without
Required' Forms:
RepFacemecrt )
.• Includes replacing or installing ale 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-411 forms:. MECH-20 and (for split systems), MECH-25
equipment changed.
For Split Systems: Duct leakage < 6 percent; RC, CCA >_ 300 CFM/ton, TM'AH
For Packaged Units: Duct leakage < 6 percent
0' 4. New Ducting over 40 feet
Required' Forms:
Includes adding or replacing more: than 40
CF-611 forms: MECH-04, MECH-2I-HERS
linear feet of dud in unconditioned space.
CF-4R forms: MECH-21
For split system or packaged units: Dud leakage < 15 percent
13—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: Paul Van Vlymen Signature: Paul Van Vlytnen
Company: AIR EXPERTS AIR CONDITIONING-HEATING Date: Apr 17, 2013
Address: PO BOX 94 License: 725283
+City/State/Zip: LA QUINTA / CA [92247-0094 Phone: (760) 777-1724
Reg: 213-A0022941A-000000000-0000 Registration Date/Time: 2013/04/17 21:24:38 HERS Provider: Ca10ERTS,-Inc.
2008 Residential Compliance Forms July 2010