10-0400 (MECH)P.O. BOX 1504
78-495 CALLE TAM PICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application description
Property Zoning:
Application valuation:
if 0 =-0�0 0
80552 PEBBLE
775 -131 -074 -
MECHANICAL
LOW DENSITY
1000
BEACH
RESIDENTIAL
Applicant: Architect or Engineer:
------------------
LICENSED CONTRACTOR'S DECLARATION
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with -
Section 7000) o{Division 3 of the Business and. Professionals Code, and my License is in full force and effect.
LicenseeClass: C20 -C10 License,N 286936
Dat e✓-5-10_.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 (Sec7031.5, 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 fora -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 town owner of property, who builds or improves thereon,
and who does the work'liimself or herself,through his or, her own employees, provided that'the
'improvements are not intended or'offered for sale. If, however,:the buildingor improvement is sold within
r oneryear.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-doesnot•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 _ 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:
LQPERMIT
Owner:
DIAMOND DOROTHY
80552 PEBBLE BEACH
LA QUINTA, CA 9225_
(
_—.- -.-.-.---..._..__..__Contractor:
CAVANAUGH ELECTRIC
83231 HIGHWAY 111
INDIO, CA 92201
(760)347-3608
Lic. No.: 286936
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 5/05/10
WORKER'S COMPENSATION DECLARATION
I hereby affirm.under'penalty of perjury one of:ttfe 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
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 SOUTHERN INS CO Policy Number -:WSI0038567-0i
_ 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 his
compensation laws "of California,
and agree that, if "I should become subject to the workers' compensation provisions of Section
3700 of the Labor Code, I shat forthwith comply with tho provisions. -
Z5 Go Applicant:
WARNING: ,FAILURE TO SECURE WORKERS' COMPENSATION COVE GE IS UNLAWFUL, AND SHALL
SUBJECT SAN 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
whosebenefit 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, or cessation of work for 180 days will subject
permit to cancellation.
I certify that I have read this application and state that the above information is correct. I agree to comply with all
city and county ordinances and state laws relating to building construction, and hereby uthorize representatives
of this county to enter upon the above-mentioned propenrty for inspection purposes.
Da e: JSignature-(Applicant or Agent):
L
Application Number . . . . . 10-00000400
Permit . . . . . MECHANICAL .
Additional desc .
-Permit Fee 24.00 Plan Check Fee
6.00
Issue.Date . . . . Valuation
0
Expiration Date 11/01/10
Qty Unit Charge Per
Extension
BASE FEE
15.00
1'.00 9:0000 .EA MECH B/C <=3HP/100K BTU
9.00
Special Notes and Comments
REPLACE A/C UNIT•CONDENSING "SECTION.
--:--SEER-----------.---_.-_------------:---------_.----........._. _ .. ._ ........-.,— ------------- - . _.......
....... .. ....... _... _ .......... .... _..... _.
--------------------------------------------------------
Other Fees . . . . . BLDG STDS ADMIN (SB1473)
.1.00..
Fee -summary Charged. Paid Credited
Due.
Permit Fee Total 24.00OQ .00
24.00
i, Phan'Check.Total" 6..00 .. 0:0 :00
6,00
Other Fee' Tota h 1,.00 _00 00
1.00
Grand .Total-: 31.00 00. :00
31.00
a,
LQPERMIT .
Sim lifted Prescriptive Certificate of Com (lance: 2008 Residential HVACAIteratiolts CF -IR -ALT -HVAC
Climate Zones 10 to 15
CWS
J7re AJQreE _ 552 Pebble &-7" �
Enforcement Agency:
Date:
Permit tF:
Equipment T n
List Minimum Efficiency'
Duct insulation requirement
Conditioned Floor
Area
Thermostat
O Packaged Unit
O Setback
O Furnace
O AFUE_ O COP
Over 40 ft of ducts added or
O Indoor Coil
OSEER/� O HSPF
replaced in unconditioned space
Served by system
lijnot already
OCondensing Unit
O EER O Resistance
OR 6 (CZ 10-13)
sf
present. must be
O Other
O R 8 (CZ 14-15)
installed)
1. Equipment Type: Choose the equipment being installed; ijmore Than one system, use another CF-/R-ALT-HVACjoreach system.
2. Minimum Equipment Effldendes: 13 SEER 78% AFUE, 7.7HSPF jor 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 forts shall be left on site for final
inspection and a copy given to the homeowner. At final, the,inspedor 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 -6I1 and registered CF4R forms (no hand filled CF-4Rs allowed) are filled out and
si ed. innio October l 2010 a r tered co of file CF -1R and CF -6R stall also be on'ste for final n.
, HVAC Changeout
Required Forms:
• All HVAC Equipment replaced
CF -6R forms: MECH=04, MECH-21-HERS and (for split systems) MECH- 25 -HERS
CF -4R forms: MECH- 21 and for split stems MECH-25
• Condenser Coil and/or
• Indoor Coil and/or
CF-61tforms: MECH-2I-HERS and (for split systems) MECH- 25 -HERS
• Furnace
CF4R forms: MECH- 21 and (for split systems) MECH-25
For Split Systems: Duct leakage < 15 percent; RC, CCA > 300 CFMhon(Minimum Air Flow Requirement), TMAH
For Packaged Units: Duct leakage < 15 percent
Fxempled from duct leakage testing if:
❑ 1 Duct system was documented to have been previously sealed and confirmed through HERS verification, or
O 2. Duct systems with less than 40 linear feet in unconditioned space, or
O 3. Existing ducts stems are constructed,insulated or sealed with asbestos
O 2. New HVAC System
Required Forms:
with new
• Cut in orducting
ducts: (alll new
new elduding all
CF -6R forms: MECH-04, MECH-20-HERS,and (for split systems) MECH-22-HERS, and MECH-25-HERS
new equipment)
CF -4R forms: MECH 20-, and (for split systems)MECH-22, and MECH 25
For Split Systems: Duct, leakage < 6 percent; RC, CCA 2:350 CFM/ton, FWD, TMAH, STMS, and either HSPP or PSPP.
For Packaged Units: Duct leakage <6 percent
O 3. New Ducts with Replacement
R -Forms:
• Includes replacing or installing all new ducting
CF -6R fortes: MECH-04, MECH-20-HERS,and (for split systems) MECH-25-HERS
and/or outdoor condensing unit and/or indoor
CF411 forms: MECH-20 and (for split systems) MECH-25
coil and/or furnace. Not all equipment changed.
For Split Systems: Duct leakage < 6 percent, RC, CCA 2:100 CFM/ton, TMAH
For Packaged Units: Duct leakage < 6 percent
O 4. New Ducting over 40 feet
Required Forms:
• Include; adding or replacing more than 40
linear feet of duct in unconditioned space.
CF -611 fortes: MECH-04, MECH-21-HERS CF4R fortes: MECH-21
For split system or packaged units: Duct leakage < 15 percent
O EXCEPTION: Existing ducts sterns 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.
• 1 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 b of the California Code of Regulations.
• 'i h,: deogn features identified on this Certificate of Compliance arc consistent with the information documented on other applicable compliance fours, worksheets.
calculations, plarLs and specifications s brined to the enforcement agency for approval with the permit application.
Name: Rod CaVQn,)u
Signature:
Company: } J J �
Date-
ate:
Address-
AddressS3 -23/ /may ///
83-231
License:86 �3�0
City/State/7ip: Zn ) O CSI-. 9 —Z -2v`
Phone:
zuva ttestaenrtat t-.ompuance Corms March 2010
-Bin #
City of La - Qujnta
Building.& Safety<Division
P.O. Box'1504, 78=495 ,Calle Tampico
La Qtiinta, CA 92253 - (760),777-7012
B ` lding'Permit- Appllcatl6n<,and Tracking Sheet
Permit #
Project Address: 5 � gbh. eac
Owner's Name:. Dorofh `. oj'/aMo
.A. P. Number: •
Address:
Legal Description:
Contractor: o�T%C
''City, ST; Zip: '
�a.
�r
Address:. g�—" 3� ���
Project Description:
City, ST, Zip:
1 G'
Telephone:760
State Lic. # :
City Lic #'
Y`
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone: ���;,Construction
State Lic. #:
Name of Contact Person: /Pam/ COVa12a11h
Type: :~ Occupancy:
Prblect type'(circle one): New Add'n Alter - Repair . Demo
Sq. Ft, : # Stories:' # Units:
.
Telephone # of Contact Person:6-5 • gig- X14 --% j
Estimated Value of Proje /
-APPLICANT: DO:NOT.WRITE;BELOW�THIS LI'
#
Submittal
Req'd, :.
Rec.'.d
TRACKING ,
r PERMIT FEES
Plan Sets
Plan Check submitted
Item r
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance
Energy Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
.Mechanical
Grading plan
2"". Review, ready for corrections/issue
•Electrical
a
Subcontactor List
Called Contact Person
Plumbing .
Grant Deed
Plans picked up
S.M.L.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
''" Review, ready for corrections/issue:Developer
Impact Fee
Planning Approval
Called Contact Person
A.LP.P.
Pub. Wks. Appr
Date of,permit issue
School Fees
Total Permit Fees-