12-0524 (MECH)P.O. BOX 1504 Tld!t 4
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT r
Application Number:
Property Address:
APN: '
Application description:
Property Zoning:
Application valuation:
Applicant:
12-00000524
78730 ROCKBERRY CT
604-431-021-29 -23995 -
MECHANICAL
LOW DENSITY RESIDENTIAL
6842
Architect or Engineer:
Owner:
KONTRA'ALAN
78730 ROCKBERRY CT
LA QUINTA, CA 9225
Contractor:
DESERT AIR CONDITI
590 WILLIAMS ROAD
PALM SPRINGS, CA 9
(7601323-3383
L' N 276586
r _41 .
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 5/ 10 / 12 .'
--------------
' LICENSED CONTRACTOR'S DECLARATION,
C. o..
WORKER'S COMPENSATION DECLARATION
- I hereby affirm under penalty of perjury that I am licensed 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 an Professionals 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
License Class: C20 -C43 icense No.: '276586 •
for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
• _
bate:,5 0 � ( 1 -Contractor:
— issued.
I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor
-1, ,
Code, for the performance of the work for which this permit is issued. My workers' compensation
OWNER -BUILDER DECLARATION
insurance carrier and policy number are:
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the
Carrier EVEREST NATL Policy Number 7600007908111 _
_
following reason (Sec. 7031.5, Business and Professions Code: Any city or county that requires a permit to
_ I certify that, in the performance of the work 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 become 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 I shout beco a subject 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 Cod h ort ith comply with those provisions.
that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by
i ) ,� "
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500)•:
Date• 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 WORKERS' COMPENSATION 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.).
APPLICANT ACKNOWLEDGEMENT
(_ 1 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.
IMPORTANT Application is hereby -made to the Director of Building and Safety for a permit subject to the
_
7044, Business and Professions Code: The Contractors'. State License Law does not apply toan owner of
conditions and restrictions set forth on this application.
. - property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed
1. Each person upon whose behalf this application is made, each person at whose request and for
pursuant to the Contractors' State License Law.).
Q whose benefit work is performed under or pursuant to any permit issued as a result of this application,
I am exempt under Sec. , B.&P.C. for this reason
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. "
Date: Owner:
2. Any permit issued as result of this application becomes null and void if work is not commenced
within 160 days from date of issuance of such permit, or cessation of work for 180 days will subject
" CONSTRUCTION LENDING AGENCY
permit to cancellation.
I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the "
I certify that I have read this application and state that t#0Jon is correct. I agree to comply with all
work for which this permit is issued (Sec. 3097, Civ. C.).
city and county ordinances and state laws relating to buand hereby authorize representatives
f this county to enter upon the above-mentioned propeurposes.
orate:jS
Lender's Name:
!�
til' 1Z4ignature
(Applicant or Agent): . •,
Lender's Address:
LQPERMIT
Application Number . . . . . 12-00000524
Permit MECHANICAL
Additional desc .
Permit Fee . . . . 40.50 Plan Check Fee
10.13
Issue Date . . Valuation
0
Expiration Date 11/06/12
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 - 14.5SEER/80AFUE SPLIT
SYSTEM (2008 ENERGY] CARBON MONOXIDE
ALARM(S). TO BE INSTALLED PRIOR TO FINAL
.•
INSPECTION. 2010 CALIFORNIA BUILDING
CODES.
May 10, 2012 2:37:48 PM AORTEGA
-
-------------------_---------------------------
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
LQPERMIT
Simplified Prescriptive Certificate of Compliance: 2008 Residential HVAC Alterations ' CF -1R -ALT -HVAC
Climate Zones 10 - 15
Site Address: ,
Enforcement Agency:
Date:
Permit #:
78-730 ROCKBERRY CT La Quinta, CA 92253
City of La Quinta
Apr 27, 2012
w
Equipment Type1
-
List Minimum Efficiency
Duct insulation
requirement '
Conditioned Floor
Area
Thermostat
❑ PackageUnit
® Furnace
® Indoor Coil
® AFUE 80%
0 SEER 14.
❑ COP
❑ HSPF
❑ R 6 (CZ 10-13)
Served by system
® Se -back
If not already present, must be
,® Condensing Unit
❑ EER
❑ Resistance
❑ R 8 (CZ 14-15)
2000 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 -111
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-NIERS
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-2I-HERS and (forsplit 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:
❑ 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 (ie. Ductles_s:Mini-Split-System)(Also Exempt-fromtRefrigerantCharge)
Y`
❑ 2. New HVAC System
Required Forms: Y j t v y
. Cut in?or Changeout with'
new ducts: (all new
' �} ' , fi I/�
CF 611 forms: MECH-041 MECH-20y;HERS, and�(for split systems) MECH 22 -TIERS, and
ducting an all new z
MECH=25=HERS I
+ � s `• - --' !�
CF -4R forms: MECH-20, and (for split systems) MECH-22, and MECH-25) , J j�
equipment)
;?I I,- \ '. _ 1 .. •_.� - ter- . k ,1 .. 7 N, 4.
For. Split Systems: Duct leakage <'6 percent; RC, CCA .2: 350 CFM/ton, FWD; TMAH, STMS, and either:HSPP'or PSPP. "'-` 'ter
For Packaged Units: Duct leakage < 6 percent. '
❑ 3. New Ducts with/or without
Required Forms:
Replacement
. Includes replacing or installing all new t
,
ducting and/or outdoor condensing unit
CF -611 forms: MECH-04, MECH-20-HERS, and (for spli- systems) MECH-25-HERS
and/or indoor coil and/or furnace. No 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 dud in unconditioned space.
CF -4R forms: MECH-21
For split system or packaged units: Dud leakage < 15 percent
❑ EXCEPTION: Existing dud 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 ComFiiance 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 cher applicable compliance
forms, worksheets, calculations, plans and specifications submitted to the'enforcement agency for approval with the permit application.
Name: Jacqueline Zabik Signature: Jacqueline Zabik
Company: DESERT AIR CONDITIONING INC Date: Apr 27, 2012
Address: 590 WILLIAMS ROAD License: 276586
]Phone:
City/State/Zip: PALM SPRINGS / CA / 92264 , (760) 323-3383
Reg: 212-A0021070A-00000000-0000 Registration Date/Time: 2012/04/27 15:19:53 HERS Provider: CalCERTS, Inc.
2008 Residential. -Compliance Forms _ July 2010
F
Bir; #
..,City of La Quinta
Building et Safety Duron
P.O. Box 1504; 78-495 Calle Tampico
U Quints, CA 92253- (760) 777-7012
Building Permit Application and Tracking Sleet
Permit #
' I
11ioject Address: 78-730 ROCKBERRY CT
Owner's Name: ELAINE KONTRA
A. P. Number:
Address: 78-730 ROCKBERRY CT
Legal Description:
CiV, ST, Zip: LA QUINTA CA 92253
Contractor.V&��a % ,�'�
Telephone: w <
Address --.
-Prglject.Description:-------.--
City, ST Zip: '/�'S e� 4a� 6 `1
REPLACE 5 TON SPLIT SYSTEM ON GROUND LIKE
Telephone:
State Lia City Lia #:
Designer.
Address:
City, ST, Zip.
Telephone: Construction Type: e-c4-,-0ccapaney: '
State Lia #: Project type (circle one): New Add'n Alter Repair Demo
Name of Concoct Person: � (� n Sq. Ft.: # Stories: V# Units:
Telephone # of Contact Person: 3 Estimated Value of Project: $6,842.00
APPLICANT: DO NOT WPJTE BELOW THIS LINE
#
Submittal
Req'd
Reed
TRACXMG
PERMIT FEES
Plan Sets
Pian Cheat submitted
Hcm Amount
Structural Cares.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calm.
. Called Contact Person
Pian Check Balance.
Title 24 Calcs.
Plans picked up
Construction
Flood plain plan
Pians resubmitted
Mechanical
Grading plan .
2'' Review, ready for correetionslissue
Electrical
Subeontaetor List
Called. Contact Person
Plumbing
Grant Deed
Plans picked up
S -hu-
H.OA. Approval
Plans resubmitted
Grading
IN HOUSE:-
'"' Review, ready for cormcdons/Issue
Developer Ikopaet Fee
Planning Approval
Called Contact Person
A.LP.P.
Pub. Wks. Appr
Date of permit issue
Scbkiol Fees
Total Perml Fees