12-0906 (MECH)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number. ["12,-00'0'0!0.906
Property Address:
46415 ROUDEL LN
APN:
649-051-004-4 ' -2667 -
Application description:
MECHANICAL
Property Zoning:
MEDIUM DENSITY RES
Application valuation:
5626
4.4 Qu!c&
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
HART GUDRUN
46415 ROUDEL LAND
LA QUINTA, CA 92253
VOICE (760) 777-7012
FAX (760) 77777011
INSPECTIONS (760) 777-7153
Date: 8/13/,12
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 I, as owner of the property, arr 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 contractorls) licensed
pursuant to the Contractors' State License Law.).
(_ 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: Q
Lender's Address: .\
LQPERMIT
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 Ouinta, its officers, agents andemployees 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 ce tion of work for 1.80 days will subject
permit to cancellation.
1 certify that.I have read this application and state that the above infor t is correct. I agree to comply with all
city and county ordinances and state laws relating to building construc o and hereby authorize representatives
of/th/i S. county to enter upon the above-mentioned property for inspect urpo
Oate: �7 ignature (Applicant or Agent):
Contractor:
D� M Ll
Applicant: Architect or Engineer:
GENERAL AIR CONDITIONING
31170 RESERVE DRIVE
(� a
THOUSAND PALMS, CA 92276 i
ALIG �_0 2Q?2
AL
(760)343-7488.
Lic. No.: 686310CliY(JFLAQU.IN�
`pt.
f!Pgkt4uS DEP'
LICENSED CONTRACTOR'S DECLARATION
WORKER'S COMPENSATION DECLARATION
I herebyaffirm under penalty of perjury that I am liqVsed 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 Pr ssionals 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 icense No.: 686310 -
for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
p
/Date: �/1 3�l 2 ntractor:
issued.
�..I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor
T T— �
Code, for the performance of the work for which this permit is issued. My workers' compensation
NER-BUILDER DECLARATION
insurance carrier and policy number are:
I hereby affirm under penalty of perjury t I am exempt from the Contractor's State License Law for the
Carrier ZENITH INS CO Policy Num er 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 of the work f 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 su t 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 should become subjec 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 forthwit o 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).:
te: plicant:
(_ 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
WARNING: FAIL E TO SECURE WORK SATION 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'CIVILFINES 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.).
1 _ 1 I, as owner of the property, arr 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 contractorls) licensed
pursuant to the Contractors' State License Law.).
(_ 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: Q
Lender's Address: .\
LQPERMIT
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 Ouinta, its officers, agents andemployees 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 ce tion of work for 1.80 days will subject
permit to cancellation.
1 certify that.I have read this application and state that the above infor t is correct. I agree to comply with all
city and county ordinances and state laws relating to building construc o and hereby authorize representatives
of/th/i S. county to enter upon the above-mentioned property for inspect urpo
Oate: �7 ignature (Applicant or Agent):
Application Number 12-00000906
Permit . . MECHANICAL,
Additional desc .
Permit.Fee 31.50 Plan Check.Fee ..
7.88
Issue Date Valuation
.0
Expiration Date .. .2/09/13
Qty. Unit Charge Per
Extension
BASE FEE
15.00
1.00 16.5000 EA MECH B/C >3-15HP/>100K-500KBTU
16.50
-------------------------------------------------------
Special.Notes and Comments
HVAC CHANGE -OUT: 5 TON CONDENSER ONLY.
2010 CODES.
--------- .--------------------------------------
Other Fees `. . . . . . . BLDG STDS ADMIN (SB1473)
-
1.00
Fee summary Charged s 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
LQPERMIT
Simplified Prescriptive Certificate of Compliance: 2008 Residential HVAC Alterations CF-lR-ALT-HVAC
Climate Zones 10 - 15 ^
Site Address:
Enforcement Agency:
Date: •
Permit #:
46415 ROUDEL LANE La Quinta, CA 92253'.
City of La Quinta
Aug 12, 2012
Duct insulation
Conditioned Floor
Equipment Typel
List Minimum Efficiency2
requirement
Area
Thermostat
❑ Package Unit
❑ Furnace-
❑ AFUE
❑ COP
❑ R 6 (CZ 10-13)
Served by system
® Setback
❑ Indoor Coil
10 SEER 13.0
❑ HSPF
❑ R 8 (CZ 14-15)
2043 sf
If not already present, must be
® CondensingUnit
EER
Resistance
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 -5R 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 -6R 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-HEIRS
replaced
CF -4R forms: MECH-21 and, (for split systems) MECH-25 r
• 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 -
.
f ,_
For Split Systems: Duct leakage;<,,15 percent; RC, CCA <_ 300 CFM/ton (Minimum Air Flow Requirement), TMAH
Exempted from duct leakage testing if:
'�❑ 1.-SDuct system -Was documented to have been previously sealed and confirmed through,HERS verification, or
:❑ 2. Duct'systems with less th5n`40 linear feet in unconditioned space, or . . • •
El 3`Existing duct systems are constructed; insulated or sealed with asbestos '
❑'4. Thefsystemmill not be Ducted(ie.-Ductless.Mini,Sphta$ystem)T(AIso-Exempt frcm Refrige�a�nt4& rge)
❑ 2. NevitHVAC System
Required Forms :...�.(.. zIs
.Cut injor,Changeout with"
°0'" .` ,� i- ,
CF 6R forms ' MECH-04, MECH 20 HERS, andP(for split systems) MECH722 HERS, and._,,
new ductsa all new „s
(
ducting all new
MECH'25 HERS ,� ire :_ u" 1= _.
CF'4R forms °MECH 20 `and (for MECH 22;--a MECH-25
equipment);:, f
split systems) nd
fir is _. r< :3 ---••: x ..€s � t �ryrA 4., ^ 1,f N
For Split Systems:dDuct leakage:, 6'percent, RC;;CCA > 350 CFM/ton FWD, TMAH, SIMS, and either H -SPP or PSPP.'�'
r.
For Packaged Units:'Duct leakage <ry6 percent,
❑ 3;`New,Ducts with/or,without i :'
C.
Required Forms:
,. ;
Replacem'ent;„„� ,, sem, l
. 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 -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.21-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: bunielle Garcia
Company: HARRISON ENTERPRISES INC Date: Aug 12, 2012
Address: 31-170 RESERVE DRIVE STE A License: 686310
City/State/Zip: THOUSAND PALMS / CA / 92276 Phone: (760) 343-7488
Reg: 212-A0043668A700000000-0000 Registration Date/Time: 2012/08/12 12:29:24, HERS Provider: Ca10ERTS, Inc.,
Z 2008 Residential Compliance Forms - July 2010
Bill #
City of La Quanta
Building 8E Safety Msion
P.O. Box 1504,78-495 Carie Tampico
4.Quinta, CA 92253 -:(760) 777-7012
Building Permit Application and Tracking Sheet
Pem�lt #
a'
Project Address: �06 ROvG f'
77City,
Owner's Name:. G1UG� 1�U1n
A. P. Number. � .O b O y O Q
Address:..saw
Legal Description:
ST, Zip:
Contractor.,,....
�„�� `• ��
Telephone:
Address:
Proj Description: N� �,� CN D
City, ST, Z.
Telephone: 760 43 s1 49 9
State Lic. #: (� (9 y City Lic. #;
Arch, Engr., Designer
Address:
City, ST. Zip:
Telephone:
State Lic. #: '
Name of Contact Person:
Construction Type:. Occupancy:
Project type (circle one): New Add'n. Alter Repair Demo
Sq. Ft.: 2 U # Stories: # Units:
Telephone # of Contact Person:
Estimated Value of Project GJj 2
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item Amount
Structural CRIes.
Reviewed, ready for corrections
Plan Check Deposit. .
Toss Cates.
Called Contact Person
Plan Check Balance
Title 24 Cates.
Plans picked up
Constructio r
Flood plain plan
Plans resubmitted..
Mechanical
Grading plan
2id Review, ready for corrections/issue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
ML
H.O.A. Approval
Plans resubmitted
Grading
E4 HOUSE:-
''d 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