13-0334 (MECH)<Fl P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
13-00000334
Property Address_:
48721 'SANTA
APN:
646 -130 -013 -
Application description:
MECHANICAL
Property Zoning:
LOW DENSITY
Application valuation:
1960
Applicant:
URSULA ST
RESIDENTIAL
Architect or Engineer:
------------------
LICENSED CONTRACTOR'S DECLARATION
41,14 a",.
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 a ProfessionaCode, and my License is in full force and effect.
Licensee�Class: C20 cense No.: 794315
Date: 1 rl�'� 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 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.). -
( 1'I am exempt under Sec. , BAP.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
- 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
ssued.
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 shout a me subject o the workers' compensation provisions of Section
3700 of the Labor Code II forthwi comp) ith those provisions.
Date: d 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 buildin construction, a d hereby authorize representatives
of this county to enter upon the above-mentioned property /fin/s�pection p pos .
Date: 3 G Signature (Applicant or Agent): `� r
Date: 3/20/13
Owner:
ROBERT& KATHY HATFIELD
48721 SANTA URSUIJ
922!D Q
(
MAR 2 12013
Contractor:
DOVE AIR INC CI'PY
(' F LA QUINTA
69749 RISUENO ROAFINANCE
DEPT.
CATHEDRAL CITY, CA 2234
(760)327-1890
Lic. No.: 794315
- 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
ssued.
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 shout a me subject o the workers' compensation provisions of Section
3700 of the Labor Code II forthwi comp) ith those provisions.
Date: d 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 buildin construction, a d hereby authorize representatives
of this county to enter upon the above-mentioned property /fin/s�pection p pos .
Date: 3 G Signature (Applicant or Agent): `� r
LQPERMIT
Application Number . . . . . 13-00000334
Permit MECHANICAL
Additional desc
Permit Fee . . . . 24.00 Plan Check
Fee
6".00
Issue Date Valuation
. ..
. 0
Expiration Date 9/16/13
Qty Unit Charge Per
Extension
BASE FEE
15.00
1.00 9.0000 EA MECH FURNACE <=100K
9.00
-------------
--------
Special Notes and Comments
REPLACE GAS FURNACE AND A/C EVAPORATIVE
COIL IN CLOSET. 2010 CALIFORNIA BUILDING
CODES.
--------------------------------------------------
Other Fees . . BLDG.STDS ADMIN (SB1473)
1.00
Fee summary Charged Paid Credited
----------
Due
-----------------
Permit Fee Total 24.00 .00
.00
24.00
Plan. Check Total 6.00 .00
00
6:00
Other Fee Total 1.00. 00
.00
1.00
Grand Total 31.00 .00
.00
31.00.
LQPERMIT
Simplified Prescriptive Certificate of Compliance: 2008 Residential HVAC Alterations CF -1R -ALT -HVAC
Climate Zones 10 - 15
Site Address:Enforcement
Agency:
Date:
Permit #:
48721 Santa Ursula St. La Quinta, CA 92253
City of La.Quinta
Mar 20, 2013
-
Duct insulation
Conditioned Floor
Equipment Typel
List Minimum Efficiency2
requirement
Area
Thermostat =
❑ Package Unit
® Furnace
® Indoor Coil
® AFUE 78%
❑'SEER
❑ COP
[3HSPF
❑ R 6 (CZ 10-13)
R 8
Served by system
1700 sf
® Setback
If not already present, must be
[3 Condensing Unit
[3 EER
❑ Resistance
❑ (CZ 14-15) .
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 -611 and registered CF -411
forms (no hand filled CF-4Rs 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.
® 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 '
CF -6R forms: MECH-04, MECH-2I-HERS and (for split systems) MECH-25-HERS
. Indoor Coil and /or
CF -4R forms: MECH-21 and (for split systems) MECH-25
. Furnace
For Split Systems: Duct leakage < 15 percent; RC, CCA 5 300 CFM/ton (Minimum Air Flow Requirement), TMAH
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 duct systems are constructed, insulated or sealed with asbestos "
❑ 4. The system,w,ill not be Ducted (ie. Ductless Mini,, plit;System),(Also Exempt from Refrigerant Charge)
❑ 2. New.;HVAC System
Required Forms: s-, -
. Cut in or Changeout witht
»x
CF 6R forms .MECH-04 MECH=20=HERS and.:(for split systems) MECH 22 HERS and
new ducts: all new ��
( tf
ducting all new
y
MECH `254 ERSreA •..
),
s
CF 4R forms MECH-20 and'(for split systems) MECH-22; an•d MECH=25
equipment)'
For Split Systems: Duct leakage °<-6 percent, RC 'CCA_rz= 350 CFM/ton', FWD, TMAH, SIMS, and_ either HSPP or PSPP.
For Packaged Units: Duct leakage < 6 percent
113. New Ducts with/or without '
Required Forms:
Replacement
`
. Includes replacing or installing all new
'•
ducting and/or outdoor condensing unit
CF -6R forms: MECH-04, MECH-20-HERS, and (for split systems) MECH-25-HERS
and/or indoor coil and/or furnace. No or some
CF -411 forms: MECH-20 and (for split systems) MECH-25
equipment changed.
For Split Systems: Duct leakage < 6 percent; RC, CCA 2 300 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: Gary Laster Signature: Gary Laster
Company: DOVE AIR INC Date: Mar 20, 2013
Address: 68-749 RISUENO ROAD License: 794315
City/State/Zip: CATHEDRAL CITY / CA / 92234 Phone: (760) 327-1890
Reg: 213-A0016939A-000000000-0000 Registration Date/Time: 2013/03/20 16:19:18 HERS Provider: Ca10ERTS,- Inc.
2008 Residential Compliance Forms r July 2010
8
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Bin !f
a
City of L,a Quinta
WON a Safety Division
P.O. Box 104,18-495 Calle Tampico
La Qulnia, CA 92253 - (760).777-7012
Building Permit Application and Tracking. Sheet .
Permit #
l L
Project Address: – %pl S
A. P. Nunibea:
r S u CA
owner's Name..0-1 Fa I (i o f
Address: -7at angor ,�Xj a Sf
Legal Vescription:
Contractor: 0y.Q
Air mn _
City, ST, Zip: aJ, s3
Telophoue:
Address:
City, ST, Zip:
; 1
a.1 C l
JI-) H
Project Description: C� .-Pur s1G
_T
VL
Telephone:
State t.ic. # :
— ��t10
City Lica#
L%0
Arch., Bngr., Designer:
Address:
City; 91', 'Lip:
.ielepltone:
;tate Lie. #:
Name. of Contact Person:
Ka
Constr etionType: Occupancy:
Projecttyj)e'(Cirele one): New, Add'n Xter ,Repair Demo
Sq. Ft.:
# Stories:
lr Uuits:
Telephone # of Contact Person:
eP
–
0 0
Esti nated Value of Project: • b. 0
APPUdANT: D0. N9T WRITE•BELOW THIS UNE
N
Submittal
Reqld '
Rec'd
TRAC3CfIYG
PERKIT FEES
Plan Sets
Plan Check submitt it
item Amoaat
Structural. Cates..
Reaicxed, ready for corrections
Plan Check Deposit
Tress Calar.
Called Contact Person
Pian Check Bala.nce
Energy Cnlcs-
plus bieked up
Construction
Flood plain plan
Plana resubmitted
Mechanical
Grading.plan
V Review, ready for correctiow/Issxe
Electrical
Sabcoutaclor List
Cilled Contact Person
PSwntWng
Grant Deed
Plans picked up
H.O.A. Approval
{'laep resuhiuilted
Gradidg
IN HOUSE:-
44'9tvlew, ready for correctionstissue
Developer Impact Fee
Planning Approval
Called Contact Person
Pub. Wks. Appr
Date of permit Issue.
School Fees
_.....
Total Permit Fees
I