10-0356 (MECH)1;�
P.O. BOX 1504
78-495 CALLE TAMPICO
-LA QUINTA, CALIFORNIA 92253
Application Number: 10� 00000356
Property Address: 78223 SAN TIMOTEO ST
APN: 646-160-014- -
Application description: MECHANICAL
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 1020
Applicant: Architect or En (neer:
-------------
LICENSED CONTRACTOR'S DECLARATION
4
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with
Section 7000) of Division 3 of the Busines and Professionals Code, and my License is in full force and effect.
License Class: C20 icense No.: 794315
Date: -Z9 0 -Contractor:
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 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 CodO 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 contractors) licensed
pursuant to the Contractors'. State License Law.).
1 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:
LQPERDIIT
Owner:
HALE MICHEAL
78223 SAN TIMOTEO
LA QUINTA, CA 92253
(
-- Contractor:.
DOVE AIR INC
69749 RISUENO ROAD
CATHEDRAL CITY, CA 92234
(760)327-1890 Lf
Lic. No.: 794315.
VOICE (760)-777-7012
FAX (760) 777-7011
INSPECTIONS (760) 7.77-7153
Date: 4/23/10
APR z2010�i
�Ir
-------------------------- - - -----= � --- -
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 EXEMPT Policy Number EXEMPT
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 become subject to the workers' compensation laws of California,
and agree that, if I should become subject to the workers' compensation provisions of Section
2 3700 of the Labor Code I all forthw' comply with those provisions.
,.Date: q - 23-i 1) Applicant: ;
i
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 1 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 t� enter upon the above-mentioned property f inspectiorlrpurp:s•
Date: . _ 0 Signature (Applicant or Agent):
Application Number . . . . . 10-00000356 -
Permit . ... MECHANICAL
Additional desc .
Permit Fee 33.00
Plan Check Fee
8.25
Issue Date
Valuation . . .
. 0
Expiration Date 10/20/10
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
REPLACE 4 -TON HVAC CHANGE OUT 13
SEER. - -" - - -
_. ..... _._ ......_.. .. _ ..... .. _.......... _. .
-----------------------------------------------
------------------
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
LQPERA11T
rvn O: LL ween a.a �uiuca,rauiiya.uyr.aa .y .,
r ..
City of %a Quinta
Buildln; at Safety Division
Permlt # / P.O. Box 1$04,.78-495 Calle Tampico
La Quinca, CA 92253 - (760).777-'10 12
Building Permit Application and Tracking. Sheet .
{j,jVva; vvi
Project Address: a�� SW,q "1 o e o
Qwne'r'sName: ;
A. P. Numbka:
Address:
Legal Description:
City, ST, Zip: a UL
Contractor: d J
Address;g . �. S
Project Description:
n
City, ST, Zip: C 6C( c,T
Telephone: 76 b 3 ,X- ( b
State Lic. # : 4 '315.7
1
City Lic. #: to 3 $ F q
fl t; 6 1.1 f
�.vC .-_Z.�+JL�
C ovJ f v r/ �
Axoh., Bngr., Designer:
Address:
City, SP, 'Lip:
eiepltunc
;tate Lic. #:
Name of Contact Person: G & t^
G K
Constriction Type: occupancy:
Project type (circle one): New AMP Alter Repair Demo
Sq. Ft.:
# Stories:
# Units:
Telephone # of Contact Person: 0
3gr) k"q 0 Estimated Value of Project: 0 0. u
APPLICANT: DO NOT W.FdTE SMOW THIS UNE
ii
Submittal
Plan Sets
Req1d
Recd
TRAMINt;
PVri CMetit submitted
PERAUT FEES
Iteul Amount
Structural Caics..
Revietieed, ready for corrections
Plan Check: Deposit
Truss Calea.
Called Contact Person
Plan Cheek Batafee
Energy C'ales.
Plass picked up
Construction
Flood plain plan
Plans resubmitted
Meehanieal
Grading.plan
V Review, ready t'or corrections/issue
Electrical
Subconticlar List
Called Contact Person
Plaalung
Grant Deed
Plans picked up
S.M.I:
R.O.A. Approval
Ptaas resubuiWed
Grading
IN HOUSE:
Review, ready for correctionslinue
Developer Impact Fee
Planning Approval
Called Contact Person
AUX.
Pub. Wks. Appr
Date of permit issue
School Fees
—
Total Permit Fees
,ted Prescriptive Certificate of Compliance: 2008 Residential HVAC Alterations CF 1R ALT HVAC
Zones 10 to 15
sue Aaaress:
oZoZ�j Sm T o eo l'
Enforcement J Agency:
Darq:
Permit #:
_ p
Equipment T List Minimum Efficienc Z
❑ Packaged Unit
Duct insulation requirement
Conditioned Floor
Area
Thermostat
N Setback
❑ Furnace ❑ AFUE ❑ COP
Over 40 ft of ducts added or
❑ Indoor Coil ❑SEER ❑ HSP _
01 Condensing
replaced in unconditioned space
❑ R
Served by system
(Ijnot already
Unit ❑ EER *Resistance
6 (CZ 10-13)
sf
present, must be
❑ Other
❑ R 8 (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.
1. Minimum Equipment Efficiencies: 13 SEER, 7896 AFUE, 7.7HSPF jor typical residential systems.
HERS VERIFICATION SUMMARY Listed below are four HVAC alteration Options. The installer decides what worst 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 be left for
shall on site 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 reghteredco of the CF -IR and CF -6R shall also be on site for final inspection.
1. HVAC Changeout Required Forms:
• All HVAC Equipment replaced CF-61(forms: MECH-04, MECH-2I-HERS and (for split systems) MECH- 25 -HERS
CF-411forms: MECH- 21 and fors lit stems MECH-25
• Condenser Coil and /or
• Indoor Coil and /or CF -6R forms: 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 > 300 CFM/ton(Minimum Air Flow Requirement), TMAH
For Packaged Units: Duct leakage < 15 percent
Exempted from duct leakage testing if:
❑ 1. 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 ducts stems are constructed,insulated or sealed with asbestos
❑ 2. New HVAC System Required Forms:
• Cut with new
Chang outducting
s: al 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 lits stems MECH-22, and MECH 25
new equipment) ( split y )
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
R - ulted-For ms:
• Includes replacing or installing all new ducting
CF -6R forms: MECH-04, MECH-20-HERS,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 2:300 CFM/ton, TMAH
For Packaged Units: Duct leakage < 6 percent
O 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 -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)
• 1 certifj, 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 Tide 24,
farts I and 6 of the California Code of Regulations.
• The deign features identified on this Certificate of Compliance are consistent with the informationocumented on other applicable compliance forms, worksheets.
calculations, plans an specifications submitted to the enforcement a enc fora roval with it lice � n.
Name:
CP iKr s ,r
signature:
Company:
4v -r 1,, s.
Date: 'f,a346
Address:
License:
City/Statc/7ip:
Z Z-'> Y
Phone: 6 a 3z— o
cvvv r.caguc.991448 1- vrnpuance worms March 2010