12-0550 (MECH)Tiht 4 4 Q"
P.O. BOX 1504 VOICE (760) 777-7012
78-495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT INSPECTIONS '(760) 777-7153
BUILDING PERMIT
Date: 5/17/12
Application Number: x._„_12-00000550 Owner:
Property Address: 78895 RIO SECO BRAUN MAX
APN: 646-330-039- - - 78895 RIO SECO
Application description: MECHANICAL LA QUINTA, CA 92253
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 9981
Contractor:
Applicant: Architect or Engineer: GENERAL AIR CONDITIONING.
31170 RESERVE DRIVE
�� THOUSAND PALMS, CA 92276
r (760)343-7488
Lic. No.: 686310
---------------------------------------------------------------------------------------------------
LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury that I am lice sed under provisions of Chapter 9 (commencing with I.hereby affirm under penalty of perjury one of the following declarations:
Section 7000) of Division 3 of the Business and Prof sionals Code, and my License is in full force and effect. _ I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided
Licen a Class: C20 License No.: 686310 for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
issued.
Date: S/T tractor:. ,J1 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
ER -BUILDER DECLARATION insurance carrier and policy number are:
I hereby affirm under penalty of perjury th I am exempt from the Contractor's State License Law for the Carrier ZENITH INS CO Policy Number Z071741501
following reason (Sec. 7031.5, Business and Professions Code: Any city or county that requires a permit to _ I certify that, in the performance ofthe ork for which this permit is issued, I shall not employ any
construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the person in any manner so as to beco subject to the workers' compensation laws of California,
permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State and'agree that, if 1 should becomes ea to the workers' compensation provisions of Section
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or 3700 of the Labor Code, I shall fort ith co ply with those provisions.
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).:ate: s Applicant:
(_) 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 WARNING: FAILURE TO SECURE WOR PENSATION COVERAGE IS UNLAWFUL, AND SHALL
Contractors' State License Law does not apply to an owner of property who builds or improves thereon, SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
and who does the work himself or herself through his or her own employees, provided that the DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
improvements are not intended or offered for sale. If, however, the building or improvement is sold within SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
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.). APPUCAN C EDGEMENT
(_) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. IMPORTANT Application is hereby made to the Directo ilding and miLsulij_e o the
7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of conditions and restrictions set forth on this application. A
property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed 1. Each person upon whose behalf this applic i me , r-%) ose rues or
pursuant to the Contractors' State License Law.). whose benefit work is performed under or t to any permit issued as a resu t o i pplication,
(_ 1 I am exempt under Sec. ' , B.&P.C. for this reason the owner, and the applicant, each agrees , an shall dftcLinde ify and hold he , I r the City
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
of La Quinta, its officers, agents and am i
performed under or following issuance of is
2. Any permit issued as a result of this applic do
within 180 days from date of issuance o suc
permit to cancellation.
1 certify that I have read this application and state that rir
city and county ordinances and state laws relating to buildi
of this unty to enter upo the above-mentioned property
0 e: S 1� Z ' nature (Applicant or Agent):
ir.any om s50n geld°} f� o th
nit. LlJ
comes null and void if work is not
purposes.
fet 80 day ill subject
rA
agree to corr)ply with all
17 . Q,
Application Number . . . . . 12-00000550.
Permit MECHANICAL
Additional desc .
Permit Fee . . . . 40.50 Plan Check Fee ..
10.13
Issue Date. Valuation
0
Expiration Date 11/13/12
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
HVAC.'CHANGE-OUT: INSTALL NEW 5 TON
"
UPFLOW SPLIT SYSTEM, FURNACE, CONDENSER,
'•
INDOOR COIL..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 Y
LQPERMIT
Simplified Prescriptive Certificate of Compliance: 2008 Residential HVAC Alterations CF-iR-ALT-HVAC
r
V
Enforcement Agency:
Simplified Prescriptive Certificate of Compliance: 2008 Residential HVAC Alterations CF-iR-ALT-HVAC
Climate Zones 10 - 15 1 • • ,
Site Address:
Enforcement Agency:
Date:
Permit #:
78895 RIO SECO La Quinta,,CA 92253
City of La Quinta
May 16, 2012
Equipment Typel
List Minimum Efficiency2
Dud insulation
requirement
Conditioned Floor
Area
Thermostat,
❑ Package Unit
® Furnace
® Indoor Coil
® AFUE 78%
® SEER l 3.0
❑ COP
HSP
❑[3CZ
❑ R 6 (CZ 10-13)
Served by system
®Setback
If not already present must be `
® Condensing Unit
[3 EER
(j Resistance
14-15 R 8
( )
038 sf
-�—installed)
❑ 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 Efficiencies: 13 SEER, 78016 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 -411
forms (no hand filled CF-4Rs allowed) are filled out and signed.Beg inning October 1, 2010, a registered copy of the CF -111
and CF -611 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 -4R forms: MECH-21•and (for split systems) MECH-25
, •
For Split Systems: Duct leakages' <n;15 percent; RC, CCA <_ 300 CFM/ton (Minimum Air Flow Requirement), TMAH
Exempted from dud leakage testing`if:
❑ I. -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 (ie. Ductless Mini:-SpNtSystem} AIso,Exempt fr-om Ref ige¢ant;Charge)
❑ 2. New HVAC System
RequiFed °Forms k I{'fi'X0 f,, �`+ ' V W,
. Cut inror Changeout with
�- ^
new ducts:'(all new`
ductrngkallnew
equipment)
—01 s
CF 61t formsaMECH-04, M C�H 20 HERS ands(for split systems) MECH 22 HERS, and
MECH; 25°HERS' -
CF 4K10 nns.[MECH20, nmf& split S S, ms) MECH 22, and MECH=:25�
For Split Systems: Duet leakage' percent„RC; CCA!><350 CFM/ton; fWD, TMAH,:STMS, and`either,HSPP or• PSPP:
k . - F..: _. ,
For Packaged Units: D'ud leakagei< 6'.percent`
❑ 3 New•Ducts with/or without �`
Required Forms:
Replacement''`'
. Includes replacing or installing all''.new
ducting and/or outdoorcondensing 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 -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 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: Danielle Garcia Signature: Danielle Garcia
Company: HARRISON ENTERPRISES INC Date: May 16, 2012
Address: 31-170 RESERVE DRIVE STE A . License: 686310
City/State/Zip: THOUSAND PALMS / CA / 92276 Phone: (760) 343-7488
e r , ° .
Reg: 212-A0024915A-00000000-0000 .Registration Date/Time: 2012/05/16 15:07:03 HERS Provider: Ca10ERTS, Inc.
2008 Residential Compliance Forms Y' •� r •ay,++ July 2010
Bin. #
City of La Quihta
Btdiding at Safety Division
Box 1504,78-495 Calle Tampico
La.Quinta, CA 92253 -:(760) 777-7012
Building Permit Application• and Tracking Sheet
Permit #P.O.
.6 J"
Project Address: , �� I u S� (p
Owner's Name:. my
A. P. Number.
Address: , q S -Rio S e C D
Legal Description:
Contractor.3QN)VOI Air Cbodtmn
City, ST, Zip: CA ,9 2 3
Telephone.
Address: � � Qi(v � �(_ .
Project Description: �VftC ` O VT n
City, ST, Zip.-Ma d 6 1 L rte, l..i 1 q/22--lo.,
-'122-lo.
U2110w s .
Telephone: %-7A�?2�
State Lia #: "atyLic,#;
Arch , Engr., Designer
Address:
City, ST, Zip:
Telephone:
Construction Type:. Occupancy:
State Lic. #:
Project type (circle one): New Add'n Alter Repair Demo
Name of Contact Person: � �.� Rumv.
Sq. Ft,: 2 3
# Stories:
# units:
Telephone* of Contact Person t 00 3-7 4 (
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS UNE
#
Submittal
'd
Recd
TRACKING
PERMCT FEES
Pian Sets
Plan Check submitted.
Item
Amount
Structural Calm
Reviewed, ready for corrections
Plan Check Deposit. .
Truss Calcs.
Called Contact Person
Plan Check Balance
Title 24 Cates.
Pians picked up
Congtmcdou
Flood plain plan
Plans resubmitted •
Mechanical
Grading plan
rl Review, ready for correctionstiissue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
Shu
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
'"` Review, ready for correetlonvIssue
Developer Impact Fee
Planning Approval
Called Contact Person
A.LP.P'.
Pub. yVks. Appr '
Date of permit Issue
School Fees
Total Permit Fees