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12-0974 (MECH)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: 12-00000974 Property Address: 48800 SAN DIMAS ST APN: 646-140-026- - Application description: MECHANICAL Property Zoning: LOW DENSITY RESIDENTIAL Application valuation: 5400 T,&t " BUILDING & SAFETY DEPARTMENT BUILDING PERMIT Applicant: Architect or Engineer: -------------------------------------------------- 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. ' Li nse Ca C20 C3 License No.: 906115/ Date: Z3� ontractor: Z - >___ 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 _ 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.). (_) 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: LQPERMIT VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 8/23/12 Owner: HODGKISS THOMAS P 48800 SAN DIMAS STREET LA QUINTA, CA 92253 D n Contractor: AUG 23 2012 HYDES ClTy pF 42949 MADIO STREET F�fiIANCE�UONTA INDIO, CA 92201 EPT, (760)360-2202 LiC. No.: 906115 -------------------------------- ----------- WORKER'S COMPENSATION DECLARATION I 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 NORGUARD INS Policy Number CEWC356415 I certify that, in the performance of the work for which this perm; is issued, I shall not employ any person in any manner so as to become subject to the % s' compensation laws of California, and agree that, if I should become subject to rs' compensation provisions of Section 3700 of the Labor Code, I shall f with m with those provisions. 1-6 ateg=--_2_ pplicant: WARNING: FA UR�ECURE 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. 1 agree to comply with all city and county ordinances and state laws relating to building construction, and hereb authorize representatives of th' ty�t%o enter upo the above-mentioned property for inspectio urpos�. D/ate: I �'I nature (Applicant or Agent): Application Number . . . . . 12-00000974 Permit MECHANICAL Additional desc . Permit Fee . . . . 40.50 Plan Check Fee 10.13 Issue Date . . . . Valuation . . 0 Expiration Date 2/19/13 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 3 TON 13 SEER SYSTEM, FURNACE, CONDENSER, INDOOR COIL. 2010 CODES. ---------------------------------------------------------------------------- Other Fees . . . . . . . . . BLDG STDS ADMIN (SB147.3) 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 Bin # City of La Quints Building .& Safety Division Permit.# �� P.O. BOX 1504, 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Project Address: 5;--. �fDO Owner's A. P P. Number: Name: ytl� S a S :. •�,. Address: G d I h! be`scription: ea 40it7aCtd1 2v 11 Y E City, ST, Zip- Sk g A /c Telephone: Ct City, SI; Zip: Project Description: iv `Ielephoiie: G ZZ� C� — Ste Lic. # : ' � a(7 %• City I. #: Arch., Engr., Designer: Address: City, ST, Zip: Telephone: State Lic. #: Construction Type: Occupancy: an . Name of Contact Person: Project type (circle one): New Add'n Alter Repair Demo Telephone # of Contact Person: Sq.iFt.: # Stories: # Units: Estimated Value of Project: v� APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Req'd Ree'd TRACKING Plan Sets PERMIT FEES tted Plpresubmit-te-d-M] Structural Calcs. Item Amount Reor corrections Tress Calcs. Plan Check Deposit Carson Energy Cales. Plan Check Balance Pla Flood plain plan Construction ------------ Plaumtted Grading.plan' Mechanical 2od Review, ready for correctio�ssue Electrical Subcontactor List Called Contact Person Grant Deed Plumbing Plans picked up S.M.I. ILO.A.. Approval Plans resubmitted IN HOUSE: - Grading 3W Review, ready for correc6ons/�ssue Developer Impact Fee Planning Approval Called Contact Persou Pub. Wks. Appr A-LP.P. Date of permit issue LS&choolFees Total Permit Fees Simplified Prescriptive Certificate of Compliance: 2008 Residential HVAC` Alterations CF-IR-ALT-HVAC Climate Zones 10 - 15 Site Address: Enforcement Agency: Date: Permit #: 48-800 San Dimas La Quinta, CA 92253 City of La Quinta Aug 20, 2012 Equipment Typel List Minimum Efficiency2 Duct insulation requirement Conditioned Floor Area Thermostat ' ❑ Package Unit [0 Furnace p Indoor Coil @ AFUE 78% p SEER 13.0 ❑ COP ❑ HSPF - ❑ R 6 (CZ 1013) Served by system © Setback' If not already present, must be [0 Condensing Unit ❑ EER ❑ Resistance ❑ R 8 (CZ 14-15) 1200 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-6R and registered CF-4R forms (no hand filled CF-411s allowed) are filled out and signed.Beginning October 1,2010, a registered copy of the CF-111 and CF-6111 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) MECH725-HERS . Furnace,.•..;, CF-411 forms: MECH-21 and (for split systems) MECH-25 •. For Split Systems: Duct lea kage#<A5 percent; RC, CCA <_ 300 CFM/ton,(Minimum Air Flow Requirement), TMAH 4L3,g Exempted from duct leakage testing if. - - ' ° ❑ 1. "Duct system was documr nted.to have been previously sealed and confirmed through HERS verification, or t• ❑ 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;(i�-uctless Min Split System),(AlsoTEzempt fro_m_ERefrigerant=Cha.rge) �. ❑ 2. New'HVAC System Required Formsyr'�*mr`'� . Cut infor'Changeout with," new ducts:'(all new CF 6R`forms:iMECH 04, MECH'=20 HERS,^ anflfor split systems) MECH-22 HERS, and, --. �' MECH'25 HERS r _ � ?� r aw »-- ducting a'nd all new CF 4114orms: MECH-20 and for s it systems) MECH-22 and'MECH-25 �+ equipment)=.�Yzy� For Split Systems:,,, leakage.<i6 percent, RC;',CCA > 350 CFM/ton, FWD, TMAH, SIMS, and either, HSPP or PSPP 'T'*r —:1. t ... r . ,�: :i "t..y..4.„ 1a, , Y'- � 3a z>..kiF:� For Packaged,Units: Duct leakagei- 6 percent ; s ` ❑ 3 :New-Ducts with/or without Required Forms: Replacement 6y Includes replacing or installing,aWnew ducting and/or outdoor condensing unit CF-611 forms: MECH-04, MECH-20-HERS, and (for split systems) MECH-25-HERS and/or indoor coil and/or fuer ace 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: Mark Hyde Signature: Mark Hyde Company: CERTIFIED COMFORT SYSTEMS INC Date: Aug 20, 2012 Address: 42-949 MADIO STREET License: 906115 City/State/Zip: INDIO / CA / 92201 ' Phone: (760) 360-2202 Reg: 212-A0045508A-00000000-0000 Registration Date/Time: 2012/08/20 14:37:22 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms July 2010