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10-1016 (MECH)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: -1.0 00001016 Property Address: 487,50_ SAN ISIDRO ST APN: 646-130-019- - Application description: MECHANICAL Property Zoning: LOW DENSITY RESIDENTIAL Application valuation: 4000 Applicant: Architect or Eng �1P c&t!t 4 4 gumm, BUILDING & SAFETY DEPARTMENT BUILDING PERMIT Owner: PISTILLI BEVERLY S 48-750 SAN ISIDRO LA QUINT A, CA 92253 Contractor: D (fes U PALOMA AIR CONDITIONING P.O. BOX 3501 Ctl n r �alo PALM DESERT, CA 92261 f' (760)347-1212 Lic. No.: 619091 CITY 0�. LA Q)JINTA VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 9/29/10 ------------------------------------------------- ' LICENSED CONTRACTOR'S DECLARATION - ----------------------------------------------— WORKER'S COMPENSATION DECLARATION ' 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 declaratioris: Section 7000) of Division 3 of the Business and 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 License No.: 619091 for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. I have insurance, as required by Section 3700 of the Labor tractor: -- and will maintain workers' compensation 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: 1 hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the Carrier SOUTHERN INS CO Policy Number WSIO02303402 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 t t, 1 should become 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 t L r Code, I shall forthwith 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 �70(?f any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).: e: plicant: (_) 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.).. (_ 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.). ( 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: 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 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 applicationand 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 c to enter uyy/P�on the above-mentioned property for inspection purposes. 01 rte: S119 IA cant or Agent): • Application Number ... . . . 10-00001016 Permit . . . MECHANICAL Additional desc . Permit'Fee . . . . 33.00 Plan Check Fee 8.25 Issue Date . . . . Valuation 0 Expiration Date 3/28/11 Qty Unit .Charge Per Extension BASE FEE 15.00 1.00 9.0000 EA MECH FURNACE <=100K 9.00 1.00 9.0000 EA MECH B/C <=3HP/100K BTU 9.00 ---------------------------------------------------------------------------- Special Notes and Comments INSTALL NEW HVAC SPLIT SYSTEM, 14 SEER. 2007 CODES. -------------------------------------------------------------- Other Fees . . . . . . . . . BLDG STDS ADMIN (SB1473) -------------- 1.00 Fee summary Charged Paid Credited Due Permit Fee Total 33.00 .00 .00 33.00 Plan Check Total 8.25 .00 .00 8.25 Other Fee Total 1.00 .00 .00 1.00 Grand Total 42.25 .00 .00 42.25 LQPERM IT Bin # City of La Quinta Building & Safety Division P.O. Box 1504, 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Permit # O I Project Address: S d w �j / (/Q Owner's Name: �. S A. P. Number: Address: �U Sow IS / u Legal Description: City, ST, Zip: ( (' o- Contractor: f) a 1 0 v"I K1/�` �%t� Telephone: � � ��� :>::;;::.. NEE= Address: C 961—e V 4' Project Description: City, ST, Zip: .. Z� ( U.Ka Telephone:3 State Lic. # : d C% City Lic. #c Arch., Engr., Designer: Address: City., ST, Zip: Telephone: ..... ..... ;..;;.;;.; State Lic. #: Name of Contact Person: ' Construction Type: Occupancy: Project hPa circle one): New Add'nAlter Repair Demo Sq. Ft.: # Stories: #Units: Telephone # of Contact Person: Estimated Value of Project: APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Req'd Reed TRACKING PERMIT FEES Plan Sets Plan Check submitted Item Amount Structural Calcs. Reviewed, ready for corrections Plan Check Deposit Truss Calcs. Called Contact Person Plan Check Balance Tide 24 Cates. Plans picked up Construction Flood plain plan Plans resubmitted Mechanical Grading plan 2ad 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:- '"' Review, ready for correctionslissue Developer Impact Fee Planning Approval ' Called Contact Person A.I.P.P. Pub. Wks. Appr Date of permit issue School Fees Total Permit Fees Simplified Prescriptive Certificate of Compliance: 2008 Residential HVA C Alterations CF 1R ALT HVAC Climate Zones 10 to 15 Jtte Address: /Q / S r —7 b 1 L(, En orcement Agency: Date. Permit #: Equipment T t Conditioned Floor List Minimum Efficienc Z Duct insulation requirement Area Thermostat O Packaged Unit M -F Tmace ❑ AFUE d O COP Over 40 ft of ducts added or I>�ack laced in unconditioned space mfndoor Coil OSEER 13 HSPF _ � p ce Served by system (Ijnot already atondensing Unit ❑ EER O R 6 (CZ 10-13) O Resistance sf O Other OR 8 (CZ 14-1 S) Present, must be installed) 1. Equipment Type: Choose the equipment being installed: ii(more than one system, use another CF -1 R -ALT -HVAC jor each system. 2. Minimum Equipment Efficiencies: 13 SEER, 78•10 AFUE. 7.7HSPF jor typical residential systems. HERS VERIFICATION SUMMARY Listed below are foto 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 CF4Rs 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. HVAC Changeout Required Forms: • All HVAC Equipment replaced CF -6R forms: MECH-04, MECH-2I-HERS and (for split systems) MECH- 25 -HERS CF -4R forms: MECH- 21 and for litsystems).MECH-25 • Condenser Coil and/or s • 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: O I. Duct system was documented to have been previously sealed and confirmed through HERS verification, or O 2. Duct systems with less than 40 linear feet in unconditioned space, or ❑ 3. Existing ducts stems are constructed, insulated or sealed with asbestos ❑ 2. New HVAC System Required Forms: • Cut in or Changeout with new CF -6R forms: MECH-04, MECH-20-HERS,and for lit ducts: (all new ducting and all -HERS, and MECH-25-HERS -, an CF -4R forms: MECH 20d (for split systems)MECH new equipment) -22, and MECH 2522 For Split Systems: Duct leakage < 6 percent; 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 - ­ ' -RegtfiPed-FiSrms: • Includes replacing or installing all new ducting and/or outdoor condensing unit and/or indoor CF -6R forms: MECH-04, MECH-20-HERS,and (for split systems) MECH-25-HERS 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 CF ton, TMAH For Packa ed Units: Duct leakage < 6 percent ❑ 4. New Ducting over 40 feet Required Forms: • Include; adding or replacing more than 40 linear feet of duct in unconditioned space. CF -6R forms: MECH-04, MECH-2I-HERS CF4R forms: MECH-21 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. • 1 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 cenifv 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 sub 'red to the enforcement aRency for approval the with permit application. Name: V2 ('f A A a � Signature: ��/ ""nI Company: 1, 2 U W/ Date: L Address: ^ O l O 8 c n (�1 I v"'C U License: D / City/State/zip: QA I Phone: 2008 Residential Compliance Forms March 2010