13-0302 (MECH)P.O. AOX 1504
78-495 CALLE TAMPICO
LA-QUINTA, CALIFORNIA 92253
Application Number: 13-00000302
Property Address: .56078 PALMS DR
APN: 7647030-004- -
Application description: MECHANICAL
Property Zoning: LOW DENSITY -RESIDENTIAL
Application valuation: .6471
T-it!t 4 4v 0",
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:. .
SURBER
56078: PALMS DR.
LA QUINTA, CA 92253
(760)564=6436
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777=7153
Date: 3/19/13
actor omission
Contractor:
Applicant: Architect or Engineer.
GENERAL AIR .CONDITIONING
31170 -RESERVE DRIVE
All
THOUSAND PALMS, CA 92276. HA 1 p A
- (760)'343 7488 1 n{L i t7 2013
/l
Lic. No.. 686310
crYy OF �3UINra
FIMARiC� DEPT
.
———--———--—--—--------7--—---—--—--——---
LICENSED CONTRACTOR'S DECLARATION
- •WORKER'S COMPENSATION DECLARATION '
I hereby affirm under penalty of perjury, that I am licensed under provisions of Chapter 9 (commencing with.
I hereby affirm under penalty of'.perjury pne of the following declarations:
. Section 7000) of Division 3 of the Business and Professionals Code, and *my License is in full force and effect.
C1_� I have and will maintain,a-certificate of consent to self -insure for workers' compensation, as provided
License Class: C2D- A - License No.: 686310 -
r I ' for by Section 3700 of the Labor Code, for the, performance of the work for which this permit is .
01'�"''—_
• �� C�a
issued. -
I have and will maintain workers' compensation insurance, as required by -Section 3700 of the Labor
Date tor: C:�t t 1,62— - -
_
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:
I/hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the
Carrier ZENITH INS CO- Policy Number Z071741502
following reason (Sec. 7031 .5, Business and Professions Code:' Any city or county that requires a permit to
M 1 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 asigned statement that he or she is licensed pursuant to the provisions of the Contractor's State
andagree that, if I 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
3700 of the Labor 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
any applicant for a permit subjects the applicant to a civil penaltyofnot more than five hundred dollarsIS5001.:
�^��l^ ,
Dater • Cl I Applicartt:�',r�
(_) 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 sate.)..
APPLICANT ACKNOWLEDGEMENT
(_) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.
IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the
7044, Business and Professions Code:. The Contractors' State License Law does not apply to an owner of
conditions and restrictions set forth on this application. -
property who builds or improves thereon, and who contracts for the •projects with a contractor(s) licensed
1 . Each person upon whose behalf this application is made, each person at whose request and for
pursuant to the Contractors' State License Law.)..
whose benefit work is performed under or pursuant to any permit issued as a result -of this application,
(_) I am exempt under Sec. , BAP.C. for this reason r
the owner, and the applicant, each agrees to, and shall defend; indemnify and hold harmless the City
f 0' ff' d 1 f related to the work bein
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
o La umta, its o iters, agents an emp lo or any ac o o issio e g
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 building construction, and hereby authorize representatives
of this county to enter upon the above-mentioned property for inspection purposes.t
Date: Signature,1451 cant or Agent): -
Application Number . . . . 13-00000302
Permit . . . MECHANICAL
Additional desc .
Permit Fee . . . . 26.00 Plan Check Fee
10.13
Issue Date . . . . Valuation
0
Expiration Date 9/15/13
.Qty Unit Charge Per
Extension
BASE FEE
15.00
.00 9.0000 EA MECH FURNACE <=100K
.00
1.00 11.0000 EA MECH-FURNACE >100K
11.00
.00 16.5000 EA MECH B/C >3-15HP/>100K-500KBTU
.00
--------'---------------------------------------------------------
Special Notes and -Comments
-----------
INSTALL (1) 2 TON DUCTLESS MINI SPLIT
SYSTEM AIR CONDITIONES WITH CONDENSOR..
NO FURNACE. 2010 CALIFORNIA BUILDING "
CODES.
------------------------------------------------------ -----------------------
Other Fees . . . . . . . BLDG STDs ADMIN (SB1473)
1.00
Fee summary Charged Paid Credited
Due
Permit Fee Total 26.00 .00 .00
26.00 .
Plan Check Total 10.13 00 .00
10.•13
Other Fee Total 1.00 .00 .00
1;D0
Grand Total 37.13 .00 .00
37.13
LQPERMIT
,a
Simplified Prescriptive Certificate of Compliance: 2008 Residential HVACAIterations CF-IR-ALT-HVAC1[,
Climate Zones 10 to 15 ;,
Site Address:"�
S co s w �c
Enforcement Agen
D e:
Permit #:
1 M S
C� O� LC_&thk�
3 I q t3
Conditioned Floor
Equipment T ]
List Minimum Efiicienc Z
Duct insulation requirement
Area
Thermostat
Packaged Unit
Furnace
Q AFUE
0 COP
Over 40 ft of ducts added or
® Setback
Indoor Coil
SEER J-2,
BEER-
HSPF
®
laced in unconditioned space
R 6. (CZ 10-13)
Served by system
sf
(7j not already
present, must be
Condensing Unit
Other
R 8 (CZ 14-15)
installed)
1. Equipment Type: Choose the equipment being installed, iifmore than one system, use another CF -IR -ALT -HVAC jor each system.
2. Minimum Equipment Efficiencus: 13 SEER, 78.16 AFJE, 7.7HSPFjor 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 CF4R forms (no hand filled CF4Rs allowed) are filled out and
signed. Beginning October 1 .2010 a rejostered copy of the CF -IR and CF -6R shall also be on site for final ins on.
1. HVAC Changeout
Required Forms:
• All HVAC Equipment laced
CF-6R"forms: MECH-04,.MECH-2I-HERS and (for split systems) MECH-25-HERS
CF4R forms: MECH-21 and for split stems MECH-25
• Condenser Coil and/or
• Indoor Coil and/or
CF -6R forms: MECH-2I-HERS and (for split systems) MECH-25-HERS
CF -4R forms: MECH-21 and (for split systems) MECH-25
• Furnace
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 previouslysealed 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
2. New HVAC System
Required Forms:
• Cutin or Changcout with new
ducts: (all new ducting and all
CF -6R forms: MECH-04, MECH-20-HERS,and (for.sp lit systems) MECH-22-HERS, and MECH-25-HERS
CF -4R forms: MECH-20, and (for split systems) MECH-22, and MEC14-25
new equipment)
For Split Systems: Duct, leakage < 6 percent; RC, CCA >_ 350 CFM/ton, FWD, TMAH, SIMS, and either. HSPP or PSPP.
For Packaged Units: Duct leakage < 6 percent .
3. New Ducts with Re hioement
Required Forms:
• Includes replacing or installing all'new ducting
CF -6R foims: MECW04, 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 f imace. Not all equipment changed.
For Split Systems: Duct leakage < 6 percent, RC, CCA > 300 CFM/ton, TMAH
For Packaged Units: Duct leakage < 6 ivreent
4. New Ducting over 40 feet
Required Forms:
• Includes adding or replacing more than 40
linear feet duct in
CF -0R forms: MECH-04, MECH-2I-HERS CF4R forms: MECH-21
of unconditioned space.
For splits stem or packaged units: Duct leakage < 15 percent
EXCEPTION:,bdstinj 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 s ' ifrcations submitted to the enforcement enc for approval with the "t a licaiion.
Name:
Signature: C
,
Company:
Date:
Address:
31 � 7 O 1��sexv e_
License.
/ SIo31C
t0
City/State/Zip: 1hOv5aane� �t;:,rr�5 C�. ClZZ-7G
Phone:-A:,0-3y3_-7Li.8Z
2008 Residential Compliance Forms July 2010
Bin #
,
Cray of La Qurnta
Bullding:Br:Safety A v Oh
'78-495 Calle Tampico
P.O. BOX: it'92'
1a.QulntaC4 92253 (760) 777-7012-
Building Permit-A'plica ion,and.tr.kk ng Sheet
Permit #
®
Project:Address: tJloO! ��YYS
Owner'§Name:. ,3c:c. St�ac b�Y
A. P. Number.
Address:
Legal Description:
City; ST, Zip: -(� (,�v� CA !R2 -2-S3
Contractor f r �O
Telephone: %(oC}.`Ji�}-(o
Address: 3 1\ —1® -
Project Description:.'
City, ST, Zip:�CvSa4.c��c.�v�n5 �ZZ%la .r5kct.�r,
1 zov1.c�lay
Telephone: ?Go -3L)3 -7ti Y -
state Lic. # : (ogb310 CityLic. #;
Arch., Engr., Designer.
Address:
City., ST, Zip:
Telephone:
State Lic. #:Project
Name of Contact Person:
{`Construction Type: ' Occupancy:,.
type (cncle-64). New,, 'Add'n Alter 'Repair Demo
Sq. Ft :
#Stories:
# Units:
Telephone # of Contact Person:
Estimated Value of Project: , (p 4% 1•. 00
APPLICANT: D'O NOT WRrrE:BELO.W;THIS UNE
#
Submittal
Rcq'd
Reed
w TRACMG
PERMIT FEES
Plan Sets
PlanCheck submitted
Item Amount
Structural Cates.
Reviewed, ready for corrections
Plan Check Deposit: .
Truss Calcs.
Called Contact Person
•;
Plan Check,Balance
Title 24 Coles.
Plans picked up
Cuiistruedon
Flood plain 6100
.;
-Pians resubmitted. ,
MechaWcal
Grading plan
2'! Rcvlew, ready for correctionsfissue
Electrical .
Subcontactor List
CAM Contact Perso.
Plumbing
Grant Deed
Plans picked up
SMI ;
H.O.A. Approval
.Plans resubmitted
Gadiug
IN HOUSE:-,
>.a Review; ready for correedonOssue
Developer Impact Fee
Planning Approval
Called Contact Person
Pub. Wks. Appr
Date of permit issue
School Fees
Total:Permit Fees