11-0376 (MECH)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 11-00000376
Property Address: 78488 CALLE SEAMA
APN: 646 -182 -018 -
Application description: MECHANICAL
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 2600
TWyl 4 4 a"
Applicant: Architect or Engineer:
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
------------------------- -----------------------
LICENSED CO Pj TOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licen d under provisions of Chapter 9 (commencing with
Section 7000) of Division 3 of the Busi(+ess and Prof sio Is Cade, and my License is in full force and effect.
License Class: C20 f License No.: 725283
fDate:.LAI\`k I 1 "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 tie 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.). '
(_ I I, as owner of the property, am exclusively contracting with licensed contractors to construct theproject (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 1 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:
DUNHAM JUDY
78488 CALLE SEA MA
LA QUINTA, CA 92253
(
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 4/14/11
Contractor:
AIR EXPERTS AIR CONDITIOrIAPR
PO BOX 94
LA QUINTA, CA 92247
(760) 777-1724 14 2011
Lic. No.: 725283
CITY OF LA QUINTA
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 ermit is issued. My workers' compensation
insurance carrier and policy number are:
Carrier NORGUARD INS Policy Number P WC120854
_'I certify that, in the performance of the work for 'ch this permit is issued, I shall not employ any
person in any manner so as to become subje t the workers' compensation laws of California,
and agree that, if I should become subjec the workers' compensation provisions of Section
ii'' ' I 3700 of the Labor Code, I hall f hw comply with those provisions.
Date: Lq \�I I \ I 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 orlC for 180 days will subject
permit to cancellation. /
certify that I have read this application and state that the above 'nformation i correct. I agree to comply with all
city and county ordinances and state laws relating to building c struction, nd f}ereby authorize representatives
of this county to enter upon the above-mentioned property for ' spa ses.
Date:' I q ( 1 ( Signature (Applicant or Agent):
J1
Application Number
. . . 11-00000376
Permit . .
MECHANICAL
Additional desc .
Permit Fee
24.00
Plan Check Fee
6.00
Issue Date ..
Valuation
0
Expiration Date
10/11/11
Qty Unit Charge
Per
Extension
BASE
FEE
15.00 .
1.00 9.0000
EA MECH
B/C <=3HP/100K.BTU
9.00
- -----------------------------------------------------------
Special Notes and Comments
A/C CHANGE OUT 4 TON
13 SEER CONDENSER.
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-IR-ALT-HVAC
Climate Zones 10 - 15
Site Address:
Enforcement Agency:
Date:
Permit #:
78-488 Calle Seame La Quinta, CA 92253
City of La Quinta
Apr 13, 2011
Equipment Typel
. List Minimum Efficiency2
Duct insulation
requirement
Conditioned Floor
Area
Thermostat
❑ Package Unit
❑ Furnace
C3 Indoor Coil
❑ AFUE
0 SEER 13.0
❑ COP
❑ HSPF
0 R 6 (cz 10-13)
Served by system
9 Setback
If not already present,
El Condensing Unit
❑ EER
El Resistance
❑ R 8 (CZ 14-15)
1600 sf
must be installed)
El Other
1. Equipment Type: Choose the equipment being installed; if more than one system, use another CF-IR-ALT-HVAC for each system.
1. Minimum Equipment Ef ciendes: 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 fad 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 signedAeginning
October 1, 2010, a registered copy of the CF-IR and CF-611 shall also be on site for final inspection.
D 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-411 forms: MECH-21 and (for split systems) MECH-25
. Condenser Coil and /or
. Indoor Coil and /or
CF-611 forms: MECH-04, MECH-2I-HERS and (for split systems) MECH-25-HERS
• Furnace
CF-411 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: Dud leakage < 15 percent
Exempted from dud leagage testing if:
❑ 1. Duct system was documented to have been previously sealed and confirmed through HERS verification, or
❑ 2. Dud systems with less than 40 linear feet in unconditioned space, or
❑ 3. Existing dud systems are constructed; insulated or sealed with asbestos
❑ 2. New HVAC
F17
Required Forms:
System
r
i
• Cut in or Changeout
with new ducts: (all
k x ,.
CF-6R forms 'MECH-04, MECH=20-HERS, and (for,split systems) MECH-22 HERS, and
new ducting Xd all
MECH-25-HERS .. , 11rI., � 7
CF=411 forms MECH 20, and (for split systems) MECH722, end_MECH 25
new equipment)
'>_
For Split Systems: Dud leakage < 6 percent; RC, CCA350 CFM/ton, FWD, TMAH, STMS, and either HSPP or PSPP.
For Packaged Units: Duct leakage < 6 percent
❑ 3. New Ducts with/or without
Required Forms:
Replacement
. Includes replacing or installing all
new ducting and/or outdoor
condensing unit and/or indoor coil
CF-611 forms: MECH-04, MECH-20-HERS, and (for split systems) MECH-25-HERS
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 >_ 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 linear feet of duct in
CF-611 forms: MECH-04, MECH-2I-HERS
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: Paul Van Vlymen Signature: Pw Van Vlymen
Company: AIR EXRERTS AIR CONDITIONING-HEATING Date: Apr 13, 2011
Address: PO BOX 94'' License: 725283
City/State/Zip: LA QUINTA / CA / 92247-0094 Phone: (760) 777-1724
Reg: 211-A0018457A-00000000-0000
2008 Residential Compliance Forms
Registration Date/Time: 2011/04/13 20:10:36 HERS Provider: CalCERTS, Inc.
July 2010
Bin #
City of La Quinia
Building &r Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
It, 1 �/`�
t
Project Address: '7 _ i� 1 X1S eQM�
Owner's Name:
A. P. Number:
Address: --)g c (� Ca—t 1 S eQm
Legal Description:
Contractor: LA e(LkS Lt.ik AecaA
City, ST, Zip: L (A Q11,�C,41-4 q 2.2,-3
Telephone: ?• �>:�s»»:<:>::»::>:>••:::;:»»»:;•;:>.•<:>:::>:;:.:
Address: P. b -boy ciA
Project Description:
City, ST, Zip: C, Qum• -1 pct C°-(� "12-2c5"3
Telephone: -1 l oo `1'7
<:><:::::
State Lie. # : '"1 ZS Z F
City Lie. #..
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone:
State Lie. #: >:_.:`•%>jsa>.»<::::::>::'.::>.;;:;;.;;;:;.;;..;,.
::s:::.{.f:•.;::<;>.::;•,:;:•.::•::•:;:;.::.;.;::«:.:;::::.:;>::.<::r;:.::;:r.>:;:;:::;;::<.::'.
Name of Contact Person:
Construction Type:
n Alter Repair Demo:::;..:..;::P
roJect hPa circle one): New Add'
Sq. Ft.: k V C -XL::) # Stories: # Units: 1
Telephone # of Contact Person:
Estimated Value of Project: Zte c::�o , �-
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Rec'd
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
Title 24 Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2e° 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 corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person
A,I,P,P,
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees