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10-0304 (MECH)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT BUILDING PERMIT Application Number: 10-00000304 Property Address: 78715 SAGEBRUSH AVE APN: 646-311-021-21 -000000- Application description: MECHANICAL Property Zoning: MEDIUM DENSITY RES Application valuation: 5000 Applicant: Architect or. Engineer: 44 LICENSED CONTRACTOR'S DECLARATION 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 Class: C20 License No.: 619091 pate: y 9 ,Contractor: I ja:g!f�/ OWNER -BUILDER DECLARATION 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 I, as owner of the property, amexclusively 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: LQPERMIT Owner: MARSHALL SALLY K 78715 SAGEBRUSH AVE LA QUINTA, CA 92253 VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 4/28/10 --- - -- _.. _—Contractor: U...... --APR- 29- PALOMA AIR CONDITIO IN P.O. BOX 3501 �FJNA (.�IiUVTA PALM DESERT, CA 922 1 (760)347=1212 l3EPT. Lic- No.: 6190.91 WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: I have and will maintain a certificate ofconsent 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 SOUTHERN INS CO Policy Number WSI002303401 I certify that, in the performance of the work for which this permit is issued, 1 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 37000 of the Labor Code, I shall forth th comply with those provisions. %Dat X r � Applicant: �� 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. 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 information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this county to enter upon the above-mentioned prop for inspection pur oses. '`` p' ��. 1yy3[e: / . Signature (Applicant or Agent): �7� Application Number . . . . . 10-00000304 Permit . . . BUILDING PERMIT Additional desc . Permit Fee . . . . 72.00 Plan Check Fee 46.80 Issue Date . . Valuation . . . . 5000 Expiration Date . . 10/25/10 Qty Unit Charge Per Extension BASE FEE 45.00 3.00 9.0000 THOU BLDG 2,001-25,000 ---------------------------------------------------------------------------- 27.00 Permit . . . MECHANICAL Additional-desc .-- _-----------------_.---------------- Permit Fee . . 28.50 Plan Check Fee 7.13 .Issue Date . . . . Valuation . . . . 0 Expiration Date .. 10/25/10 Qty init Charge .Per Extension BASE..FEE 15.00 1.0.0 4:5000 EA MECH VENT INST/ DUCT ALT 4.50 1.0.0 9.0000 -EA MECH APPL REP/ALT/ADD 9.00 --------------------- -- ---------------------------------------- Special Notes and Comments ROOF •MOUNTED.;HVAC CHANGEOUT [�l5 SEER] WITH SCREENED ENCLOSURE PER LQMC 9. 60 : 140B (1)'' - THIS. PERMIT IS TO ADD ADDITIONAL SCOPE,OF WORK TO PREVIOUSLY PERMITTED [RER],PERMITS 09-0922/10-0091. 2007CALIFORNIA BUILDING AND MECHANICAL CODES. April 28, 2010 8:00:20 AM AORTEGA ---------------------------------------------------------------------------- Other Fees . . . . . . . BLDG STDS ADMIN (SB1473) 1.00 ENERGY REVIEW FEE 4.68 Fee.summary ChargedPaid Credited Due Permit Fee Total 100.50 .00 .00 100.50 Plan Check Total 53.93 .00 .00 53.93 Other Fee Total 5.68 .00 .00 5.68 Grand Total 160.11 .00 .00 160.11 LQPERA1IT Bin # City of La Qu►nta Building 8t Safety Division P.O. Box 1504, 78-495 Calle Tampico La Quinta, CA 92253.- (760) 777-7012 Building Permit Application and Tracking Sheet Permit # 1 0 3 Project Address: d6 Owner's Name: A. P. Number: Address: X 7f I Legal Description: . City, ST, Zip: C, 61 Contractor: I l Telephone:3sv Address:_ �U� Project Description:421t jL re u— City, ST, Zip: Vk V Q C J E! o u I Telephone: % 6 0 iz r�u s State Lic. #: % Q ('./ City Lic. ftU"-T% AQ r Arch., Engr., Designer: Address: 'A an City, ST, Zip: Telephone: F%}%:iv�i.: \,`v4.i:i"•'v�' ":i\Li'a�.�Y 2{;vif w>:w: :;� " :zt>.: •:.t;> .,: ;, :::<:>t.>::<s::?s o, :E#:<n Construction Type: Occupancy. State Lic. #:a:.::s: Project type (circle one): New Add'n Alter Repair Demo r Name of Contact Person:. '� �,� .' Sq. Ft.: # Stories: # Units: Telephone # of Contact Person: o;C6 r Estimated. Value of Project: (/ APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Req'd ` IkWd TRACKING PERMIT FEES Plan Sets Plan Check submitted' ,Q Item Amount Structural Calcs. Reviewed, ready for corrections Plan Check Deposit Truss Cales. Called Contact Person Plan Check Balance Title 24 Cales. Plans picked up Construction Flood plain plan Plans resubmitted Mechanical Grading plan 2.1 Review, ready for.correctionsAssue Electrical Subcontactor List Called ContactPerson Plumbing Grant Deed Plans picked up S.M.I. H.O.A. Approval Plans resubmitted Grading IN HOUSE:- ' Review, ready for correctlonsfissue Developer Impact Fee Planning ApprovalCalled Contact Person A.I.P.P. Pub. Wks. Appr Date of permit issue School Fees i Total Permit Fees Simplified Prescriptive Certificate of Compliance: 2008 Residential HVAC Alterations CF -IR -ALT -HVAC Climate Zones 10 to 15 J!!e Address:E orcemen! S cy: Da : nA Permit #: LID pq E ui ment T List Minimum Efficiency Duct insulation requirement C ndi oned Floor Area Thermostat Packaged Unit ZKeffback ❑ Furnace M -KF_ UE 90 O COP Over 40 ft of ducts added or ❑ Indoor Coil WEER- % S�- ❑ HSPF �laced in unconditioned space Servedy system afaotalready O Condensing Unit O EER �� 13 Resistance O R 6 (CZ /0-/3) 9VO sf present. must be O Other ISKI (CZ 14-15) installed) 1. Equipment Type: Choose the equipment being installed; if more than one system, use another CF -1 R -ALT -HVAC jor each system. 2. Minimum Equipment Efflelendes: 13 SEER, 78%AFUE, 7.WSPFjortypical 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 CF4R forms (no hand filled CF-4Rs allowed) are filled out and BeginningOctober l 2010 ,sigqO. a registered COPY of the CF -111 and CF -6R shall ahto be on site for final inspection. I. HVAC Changeout -Required Forms: • All H VAC Equipment replaced CF -6R forms: MECH-04, MECH-2I-HERS and (for split systems) MECH- 25 -HERS CF -4R forms: MECH- 21 and for lit systems) MECH-25 • Condenser Coil and /or • Indoor Coil and /or CF-611forts: MECH-2I-HERS and (for split systems) MECH- 25 -HERS • Furnace CF4R forms: MECH- 21 and (for split systems) MECH-25 For Split Systems: Duct leakage < 15 percent; RC, CCA 2:300 CFM/ton(Minimum Air Flow Requirement), TMAH ..,.. . For Packaged Units: Duct leakage < 15 percent A Exempted from duct leakage testing if: TA O 1. Duct system was documented to have been previously sealed and confirmed Qifi�at�a,br`_�,� P O 2. Duct systems with less than 40 linear feet in unconditioned space, or O 3. Existing ducts stems are constructed, insulated or sealed with asbestos New HVAC System Required Forms:' • Cut in or Changeout with new CF -6R forms: MECH-04, MECH-20-HERS,and or split ) r. ducts: (all new ducting and all CH -25 RS. new equipment) CF -4R forts: MECH 20-, and (for split systems) CH- , For Split Systems: Duct leakage < 6 percent; RC, CCA > 350 CFM/ton, FWD, H, STMS an either HSI For Packaged Units: Duct leakage <6 percent 3. New Ducts with Replacement Req~ Formg: QA • Includes replacing or installing all new ducting CF -611 forms: MECH-04, MECH-20- RS,and (for split systems) MECH-25-HERS and/or outdoor condensing unit and/or indoor CF4R 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 CFMhon, TMAH For Packaged Units: Duct leakage <6 percent 4. New Ducting over 40 feet Required Forms: • Includes adding or replacing more than 40 linear feet of duct in unconditioned space. CF -6R forms: MECH 04, MECH-2I-HERS CF -411 forms: MECH-21 For split system or packaged units: Duct leakage < 15 percent O EXCEPTION: Existing duct systems construct4 insulated or sealed with asbestos. Contractor (Documentation Author's /Responsible Designer's Declaration Statement) • 1 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. • 1 certify- that the energy features and performance specifications for the design identified on this Certificate of Compliance conform to the requirements of Title 24, Paris I and 6 of the California Code of Regulations. • i'he ale>ign features identified on this Certificate of Compliance are consistent with the information documented on other applicable compliance forms. worksheets. calculations, and plans specifications submitted to the enforcement agency for approval with the permit application. Name: l CPc UA fA 0(� 04 Piz i ► L Signature: Company Date: Address: © / License: (01 City/State tp: ra Phone: .— ZUUts nestaential ( ompliance Forms March 2010 P.O. Box 1504 75-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 To: Greg Butler, Building & Safety Manager From: Les Johnson, Director -Planning Permit #: BUILDING & SAFETY DEPARTMENT (760) 777-7012 FAX (760) 777-7011 To CDD: Due Date: 41- 22-10 Status: Building Plans Approval (This is an approval to issue a Building Permit) The Planning Department has reviewed the Building Plans for the following project: Description:G�-�- Address or General Location: 78- 7/5 �. Applicant Contact: 0 The Planning Department finds that: ❑ ...these Building Plans do not require Planning Department approval. ...these Building Plans are approved by the Planning Department. ❑ ...these Building Plans require corrections. Please forward a copy of the attached corrections to the applicant. When the corrections are made lease return them to the Planning Department for review. IN WP , i ' Date ■mm v Ift � r RRRR�t• s w. ..; � N I&A LA