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11-1285 (MECH)
P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: Property Address: APN: Application description: Property Zoning: Application valuation: 11``-00001285e... 78860 RIO SECO 646 -330 -014 - MECHANICAL LOW DENSITY RESIDENTIAL 7200 Architect or Engineer: PIA ------------------ 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) of Division 3 of the Business and Professionals Code, and my License is in full force and effect. License Cl s: C2�ontrac�tor:� cense No.: 906115 �_. 0 if 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).: ( _) 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 1, 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 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: 1wX Lender's Address: T - LQPERMIT VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 11/29/11 Owner: COWAN CORINNE 78860 RIO SECO. LA QUINTA, CA 92253 ------------------------------------------------ WORKER'S COMPENSATION 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 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 NORGUARD INS Policy Number CEWC243358 '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 should become subject to the workers' compensation provisions of Section 3700�o the Labor Code,- ll forthwi � co y with se provisions. - pplicam: 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. 1. 2. Any permit issued as a result of this application becomes null and void if work is not mmenced within 180. days from date of issuance of such permit, or cessation of work for 0 days will subject permit to cancellation. I certify that I have read this application and state that the above information is corre . I agree to comply with all city and county ordinances and state laws relating to building construction, a d y authorize representatives ofyhis c to enter upo the above-mentioned property for inspectio u as. /Date: gnature (Applicant or Agent): Contractor: HYDES NOV 2,9 2011 42949 MADIO STREET INDIO, CA 92201. CITY OF LA QUINTA (760) 360-2202 Lic. No.: 906115 FINANCE DC -?T ------------------------------------------------ WORKER'S COMPENSATION 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 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 NORGUARD INS Policy Number CEWC243358 '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 should become subject to the workers' compensation provisions of Section 3700�o the Labor Code,- ll forthwi � co y with se provisions. - pplicam: 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. 1. 2. Any permit issued as a result of this application becomes null and void if work is not mmenced within 180. days from date of issuance of such permit, or cessation of work for 0 days will subject permit to cancellation. I certify that I have read this application and state that the above information is corre . I agree to comply with all city and county ordinances and state laws relating to building construction, a d y authorize representatives ofyhis c to enter upo the above-mentioned property for inspectio u as. /Date: gnature (Applicant or Agent): Application Number . . . . . 11-00001285 Permit . . . MECHANICAL Additional desc . Permit Fee . . 40.50 PlanCheck Fee 10.13 Issue Date. Valuation 0 Expiration Date 5/27/12 - Qty Unit Charge Per Extension BASE FEE 15.00 1.00 9.0000 EA MECH FURNACE <=100K 9.00 1.00 16.500.0 EA MECH B/C >3-15HP/>100K-500KBTU 16.50 . - Special Notes and Comments -- - - -- --- ------ - - ---- CHANGE-OUT,.CONDENSER, COIL, FURNACE. 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 Tbtal 1.00 .00 .00 1.00 Grand Total 51.63 _00 .00 51.63 G LQPERMIT Simplified Prescriptive Certificate of Compliance: 2008 Residential HVAC Alterations CF -IR -ALT -HVAC Climate Zones 10 - 15 • Site Address: Enforcement Agency: .- Date: Permit #: 78-860 Rio Seco La Quinta, CA 92253 City of La Quinta , Nov 23, 2011 1 Duct insulation i, Conditioned Floor Equipment Typel List Minimum Efficiency2 requirement Area y Thermostat ❑ Package Unit '71 Furnace R Indoor Coil ❑ AFUE 2 SEER 13.0 ❑ COP p HSPF ❑ R 6 (CZ 10-13) -• Served by system FJ Setback If not already present, must be Z Condensing Unit ❑ EER C3 Resistance n R 8 (CZ 14-15) 1600 sf Installed) ❑Other 1. Equipment Type: Choose the equipment being installed; if more than one system, use another CF -ZR -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 -111 and CF -6111 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 -411 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 I< 15 percent; RC, CCA <_ 300 CFM/ton (Minimum Air Flow Requirement), TMAH , Exempted from duct leakage testing if: Y ❑ 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 will not be Ducted (ieDuctless�Mini-Split System)r(AIso,Exempt from�Refrige�ant Charge) ylf El 2. New HVAC System Required Forms::- r tF� (e:; if r >r: -' . Cut in.jor,Changeout with; new ducts: all new f ( ' CF -6R forms: MECH-04, MECH 2O=HERS;�andr(foY split systems) MECH;22-HERS, and � -�• t �' ducting � all new MECH-25=HERS { -- 5 r `' f CF -4R forms: MECH 20 and (for split systems) MECH-22, and MECH-25 'f j' equipment) , Al rrr \ '� �...�.�r^ .� f �r_L.• �'.�• p• For Split Systems:;Duct leakage, <j6, percent; RC;;CCA.>_ 350 CFM/ton; FWD;, TMAH; STMS, and either HSPP"or PSPP. For Packaged Units: Duct leakagell< 6 percent - ❑ 3. New Ducts with/or without Required Forms: Replacement V J , . 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 -411 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: Mark Hyde Signature: Mark Hyde Company: CERTIFIED COMFORT SYSTEMS INC Date: Nov 23, 2011 Address: 42-949 MADIO STREET , License: 906115 City/State/Zip: INDIO / CA / 92201 Phone: (760) 360-2202 Reg: 211-AO061033A-00000000-000O.-.Registration Date/Time: 2011/11/23 11:25:46 , HERS -Provider: CalCERTS, Inc. 2008 Residential Compliance Forms �,' July 2010 Bin # Permit#� tk' , t Address:61umber:F�Descriptio Construction Type: Occupancy: P cy: :ctor: k New Add'n Alter Repair. Demo Sq. Ft.: Address: / / ( Z—q `T/`tel City, ST, Zip: Estimated Value of Project: Z CXo Telephone: Rec'd CKIlYG State Lie. # . ITOG L Arch., Engr., Designer: Address: City, ST, Zip: Amount Telephone: sit State Lic_ #: Name of Contact Person: Telephone # of Contact Person: # Submittal Plan Sets Structural Calcs. Truss Calcs. Energy Calcs. Flood plain plan Grading. plan Subcontactor List Grant Deed ILO -A. Approval IN HOUSE: - Planning Approval Pub. Wks. Appr School Fees C City of La Quinta Building & Safety Division P.O. Box 1504, 78-49S Calle Tampito La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Owner's Name: G© Address: City, ST, Zip: Telephone:' Project Description: Lic. #: Total Permit Fees Construction Type: Occupancy: P cy: Project type (circle one): New Add'n Alter Repair. Demo Sq. Ft.: # Stories: # Units: Estimated Value of Project: Z CXo APPLICANT: DO NOT WRITE BELOW THIS LINE Rec'd CKIlYG Rv RMIT FEES Plan Che Reviewedections ITPlanChe;iCkBalance Amount sit Called Contact Person Plans picked up Construction Plans resubmitted Mechanical god Review, ready for corrections/issue Electrical Called Contact Person Plumbing Plans picked up S.M.I. Plans resubmitted Grading ''d Review, ready for corrections/issue Developer Impact Fee Called Contact Person A-LP.P. Date of permit issue Total Permit Fees