11-0673 (MECH)P.O. BOX 1504 .
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 11-0000067_3_^_)
Property Address: 44525 SAFFRON CT
APN: 604-252-025-45 -.24208.-
Application description: MECHANICAL
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 7585
Applicant: Architect or Engineer:
1_ I
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LICENSED CONTRACTOR'S DECLARATION
4
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 nd Professionals Code, and my License is in full force and effect.
Licens Class: C20 License No.: 686310
ate: 6/_-/11 ontractor.
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).:
(_ 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
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 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 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:
Lender's Address:
I
LQPERMIT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 6/20/11
Owner:
RAY KUJAWA
44525 SAFFRON COURT
LA QUINTA, CA 92253. Q
�D �'`�
Contractor. 1 ��;� 2 0- �� 11 )
GENERAL AIR CONDITIONING;.
31170 RESERVE DRIVE CITY OF l A;,Oj�7�
THOUSAND PALMS, CA 92276 TY
(760) 343'-7488
Lic. No.: 686310
-------------------------------------
WORKER'S COMPENSATION DECLARATION
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 EVEREST NATL Policy Number 7600006147101
_ 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 beco subject to the workers' compensation laws of California,
and -agree that, if I should become s . act to the workers' compensation provisions of Section
3700 of the Labor Code, 1 shall fo ith comply with those provisions.
�te: 6 pplicant:
WARNING: FAILURE TO SECURE WORKERS' CO PENSATION 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, indemnity 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 i fo at' on is correct. I agree to comply with all
city and county ordinances and state laws relating to building co tru tion, and hereby authorize representatives
of this county to enter upon t e above-mentioned property for in a ion pu poses. -
nature (Applicant or Agent): '
r
•
Application Number . . . ... 11-00000673
Permit . . . MECHANICAL
Additional desc .
Permit Fee . . .t 40.50 Plan Check Fee
10.13
. Issue Date Valuation
0
Expiration Date 12/17/11
Qty Unit Charge Per
Extension
BASE.FEE
15.00
1.00 9.0000 EA MECH FURNACE <=100K
9.00
1.100 1G:5000 MN MECII D/C >3 15IIP/>1OOK 500KDTU
1G.50 „
------------------------------------------
Special Notes and Comments
INSTALL'NEW 5 TON HVAC SYSTEM, FURNACE,
INDOOR COIL & CONDENSING UNIT. 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
Dlq ff
City of La Quinta
"Building &r Safety Division .
Permit #
P.O. Box 15.04, 78.495 Calle Tampico ;
La Quinta, CA 92253 - (760) 777-7012
'
Building Permit Application and: Tracking Sheet
Project Address:Sa–,Owner's Name:
A. P.' Number: Address:
Legal Description: City, ST, Zip:
Contractor:
Telephone:r? /n
riSi%},?JiY.tii++CS'iJ:•:�i?iL YJ��+�`;:;j}•G
Address: 3Project Description:"
City, ST, Zip: 7k—
Tele hone:
:?
` r
State Lic. # : 3 L CityLic. #,-.
Arch., Engr., Designer:
Address:
City., ST, Zip:
Telephone:'•>er,<:% Construction Type: Occupancy:
State Lic. # :»
`'`•`>:z�<;%��>'s��'
Project Pro
<:`::�a><-?�•type (circle one): New Ad'n Alter Repair Demo
Name of Contact•Person: Sq. Ft.: #Stories: #Units:
Telephone # of Contact Person: Estimated Value of Project:
APPLICANT: DO. NOT WRITE. BELOW THIS LINE
# Submittal Req'd Recd TRACKIIVG PERMIT FEES
Plan Sets Plan Check submitted Item Amount
Structural Cafes.
Reviewed, ready for corrections
Plan Check Deposit
Truss Cafes.
Called Contact Person
Plan Check Balance
Tithe 24 Cafes.
Plans picked no
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2"d Review, ready for corrections/issue
Electrical
Subcontactor List
Called Contact Person
Plumbing .
Grant Deed
Plans picked up.
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
Jrd Review, ready for corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr.
Date of permit issue
School Fees
'ILITotal
Bermit Fees
_Simplified Prescriptive Certificate of Compliance: 2008 Residential HVACAIterations CF -IR -ALT -HVAC,
Climate Zones 10 to 15
Site Address:
E fiorcemant Agency:
Date:
Permit N:
S,
'
z
Conditianed Floor.
Equipment T et
List Minimum Efficient
Duct insulation requirement
F.rea
Thermostat
❑ Packaged Unit
❑ AFUE 80%
❑ COP
Over 40 ft of ducts added or
`Xsetback
door Coil
❑SEER t 3
❑ HSPF
replaced in unconditioned space
Served b} system
(1/'not alreatly
kFurnac.e
ondesing Unit
❑ EER / /
❑ Resistance❑R
❑ R 6 (CZ 10-13) '
sf
present, must be
'ther
8 (CZ 14-l5)
installed)
1. Equipment Type: Choose the equipment being installed; ifmore than one system, use another CF-IR-ALT-HVACfor each system.
2. Minimum Equipment Efficiencies: 13 SEER, 73% AFUE, 7.7HSPFJor 0pical 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 mast be conducted. A copy of the brms 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
sign .
ed. Beginning October 1, 2010, a registered co of the CF -IR and CF -6R shall also be on site for final in: ection.
1. HVAC Changeout
Required Forms:
• All HVAC Equipment replaced CF -6R forms: MECH-04, MECH-2l-HERS and (for split systems) MECf4- 25 -HERS
CF -4R forms: MECH- 2l and (for split systems) MECH-25
• Condenser Coil and/or
• Indoor Coil and /or . CF -6R forms: 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 < 15 percent; RC, CCA > 300 CFM/ton(Minimum Air Flow Requirement), TMAH
For Packaged Units: Duct leakage < 15 percent
Exempted from duct 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
112. New HVAC System Required Forms..-
Cut
orms;Cut in or Changeout with new CF -6R forms: MECH-04, MECH-20-HERS,and (for split systems) MECH-22-HERS, and MECH-25-HERS
ducts: (all new ducting and all CF -4R forms: MECH 20-, and (for split systems)MECH-22, and MECH 2`
new equipment)
For Split Systems: Duct leakage < 6 percerit; RC, CCA > 350 CFM/ton, FWD, TMAH, STMS, and either HSPP or PSPP.
For Packaged Units: Duct leakage < 6 percent
❑ 3. New Ducts with Replacement Required Forms:
• Includes replacing or installing all new ducting CF -6R forms: MECH-04, MECH-20- HERS, and (for split sys-ems) MECH-25-HERS
and/or outdoor condensing unit and/or indoor CF -4R 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 > 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 CF -4R forms: MECH-21
linear feet of duct in unconditioned space.
For split system or packaged units: Duct leakage < 15 percent
❑ EXCEPTION: Existing ducts stems 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 identifiec on this Certificate of Compliance.
• I certify that the energy features and performance specifications for the design identified on this Certificate of Compliance conbrm to the requirements of Title 24,
Parts I and 6 of the California Code of Regulations.
• 'rhe design feantres identified on this Certificate of Compliance are consistent with the ' orm, tion documented on other a0pli ompliance forms, worksheets,
calculations, plans ands specifications submitted to the enforcement agency fora ro al with t e ennit application.
Na,be: Co I(eef't � ��I Sig titre: A, j
Company:
67
� n Date:
p C��n-er�a. Ar Co11d[ f i`0n > ��/
Address: C
.311 �D eserve fir` ✓� License:
city/state/zip:-r—�ou�s �e s, Grp Phone:
- 76G .-3 413 - 74
2008 Residential Compliance Forms ,t.[.,, -,•ti 7o to
CaICERTS - CF -IR Registration
Pagel •of'1.
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Secure 14.1- CONGRATULATIONS
About Us . ' Your CF -1 R -ALT -HVAC Registration is complete! t
Trtining r You may, want to print this page for your records.
Rater Directory y Site Address: 44525 SAFFRON COURT
r La Quinia, CA 92253
Forms CEC Registration: 211-A0029490A-00000000-0000
1NtmbersAtp73cnefirs ` CF -IR -ALT -HVAC: CLICK HERE TO DOWNLOAD
Assigned Company: HARRISON ENTERPRISES INC
.. _Evens _ •. .
nd,kwry Partneit Do you know your HERS Rater?
If you do, you may want to send this CF -1 R to them.
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newsletter, please My Rater Quick Select:: Energy Driven Solutions, Inc.
click here. Every CaICERTS rater has a license number.
Ifyou need to find the rater by name [Click HERE_] to search our directory.
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Office: 916-985-3400,Toll Free: 877-HERS-R8R, (877-437-7787)
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https'://www.c'alcerts.com/public_cfl Rxin?project_id=119541 6/17/2011