10-1304 (MECH)..6 f_ `"t
P.O. BOX 1504
78-495. CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
f170=0-0-0-0-130`4
Property Address:
5613.8 PALMS DR
APN:
764-030-002- -
Application description:
MECHANICAL
Property Zoning:
LOW DENSITY RESIDENTIAL
Application valuation:
49,00 .
App' t Architect or Engineer:
- - - ——LICENSED CONTRACTOR'S DECLARATION
p,
-4"`D VOICE (760).777-7012
FAX (760) 777-7011
BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 11/30/10
'Owner:
CULLINANE KEVIN
56138 PALM DRIVE
LA QUINTA, CA 922,53
.(760)564-4-775.-
Owner:
760)564-4'775'
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 " ess and Professionals Code, and my License is in full force and effect.
License Cl ssi C20 ^ e No.: 686310
Daate�_ -- Conti ract'or.
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 (5500).:
(_ 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
improvementsare 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 heor she did not build or
improve for the purpose of sale.).
(_) 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.). '
(. ) 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:
LQPERAI IT
Contractor: . - U I
GENERAL AIR CONDITIONI q
31170 RESERVE DRIVE Nov 3 0 2 10
THOUSAND PALMS, CA 9.227
.(760:)'343-7488 Cffy OF,IA QU�INTTA
Lic. 'No.:' 686310. FKANiCEDE'r�,_
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 EVEREST NATL Policy,Number 7600006147101
_ 1 certify that, in the performance of the.work.for which this permit is issued, Ishall 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
9YER
of the La r C de, I all forthwith c ly with' those provisions.
D ApplicaaTOSECU WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
TO CRIMINAL: PENALTIES AND,CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS J$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 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 coo;y to enter upon the above-mentioned gWpgrty for iryspection purp9sye3
Application Number . . . . . 10-00001304
Permit . . . MECHANICAL
Additional desc . .
Permit Fee . . . . 33.00
Plan Check Fee
8.25
Issue Date . . . .
Valuation . . .
. 0
Expiration Date 5/29/11
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
HVAC CHANGE OUT FURNACE & CONDENSING
UNIT. 13 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
LQPERTIIT
Jlm lified Prescriptive Certificate of Compliance: 2008 Residential HVACAIterations CF -IR -ALT -HVAC
Climate Zones 10 to 15 -
Site Address:tG r3
6
Fnforcement �4gencv:
Date.
Permit #:.
=Mown=
Conditioned Floor
E ui ment T et List Minimum Efficienc 2
Duct insulation requirement
Area
Thermostat
Fl Packaged Unit
IgFumace
o
❑ AFUEgd�
❑ COP
Over 40 ft of ducts added or
p� Setback
,indoor Coil
❑SEER❑
�
HSPF _
replaced in unconditioned space
❑ R 6 (CZ 10-13)
Served by system
(I not already
must be
W119ondensing Unit
❑ EER
❑ Resistance
sf
present,
❑ Other
❑ R 8 (CZ 14-15)
installed)
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, 7:7HSPFfor typical residential systems.
HERS VERIFICATION SUNUgARY 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 formwas in fact the work completed by the
installer. The inspector also verifies that each appropriate CF -6R and registered CF -4R forms (no hand filled CF-4Rs •allowed) are filled out and
signed. Beginning October 1 2010, a registered copy of the CF -1R and CF -611 shall also be on for final inspection.
1. 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 split sstems 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(Miriimum 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 in or Changeout with new 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
new equipment) CF -4R forms: MECH 20-, and (for split systems)MECH-22, and MECH 25
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 Required Forms:
• 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 CF -4R forms: MECH-20 and (for split system's) MECH-25,
coil and/or furnace. Not all 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
Re • uired 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 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.
• 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 l and 6 of the California Code of Regulations.
• The design features identified on this Certificate of Compliance are consistent with theinformation documented on other applicable compliance forms, worksheets,
calculatio lans ands ecifi ons submitted to the enforcement agency for approval with the i a li i .
Name:Signature:
Company: Date: / / ��- l'l
KO
Address: r License:
(Oat 0
City/State/Zip:U'VIYA Phone:' O , 3 ( 3-7
CaICERTS - U- I R- Registration'
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Do`you know-yourHERS Rater'
If you do, you may want to send this CF -IR to,them.
CaICERTS Rate[' lD: I..
My Rater Quick Select:,:-',Energj.Doven Solutions, Inc.
Every C610ERTS rater hds a'ttcense' number.
If you need to find the rater by name [Click,HERE]to sear,.ch our directory.
SEND CF,IR.TO HERS RATER. ,,,,.i„
[CLICK HEREI to do another
Copvriehi3O 2010 CaICERTS, Inc. All rights reserved. Revised: January 11, 2010
[Terns and Conditions] [Privacy Statement]
CaICERTS, Inc., 314w0md9t Suite":120,, Folsom, CA 95630
Office: 916-985 '3400, -Toll Free:: 877-FIERS-11811, (877-437-7787)
Fax: 916-985-3402, E=Mail: info a calcerts.com
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Your CF -IR -ALT -HVAC Registration`is comie!
ple
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Site Addressa56138'PALMS DRIVE
T:a nrtiritn CA 99951 !
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bin #
City of La Quinta
• Building 8r Safety Mslon
P.O. Box 1504, 78-495 Calle Tamplco
La Qulnta, CA 92253 ' (760).777-7012 }
Building Permit Application and. Trading, Sheet
Permit # �`
�uU
Project Address: S(p 3 GGiCp'1,�5
Owner's Name:
A. P. Number:
Address: 5&o ?
Legal Description:
City, ST, Zip:
Telephone: 1&0 SG
Project Description:
Contractor:
Address: ✓
City, ST, Zip:
Telephone: 3 s>y/
State Lie. # : 3 City Lie. #;
d"a
Arch., Engr., Designer:
Address:
City,, ST, Zip:
' Y ''•�' tii>?4:.4�S:N4i}Y::JC�:�•�: 4"�t$r
Telephone: _,:v:': a. ,:{:;.; Y..
�{a
State Lie. #:
..
Construction Type:
Project type (circle one): New Add'n Alter Repair Demo
Name of Contact -Person:
Sq: Ft.:
#Stories:
#Units:
Telephone # of Contact Person: Estimated Value of Project: q
APPLICANT: DO. NOT WRITE. BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACIUNG
PERMIT FEES
Plan Sets
. Plan Check submitted
Item Amount
Structural Cafes.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance
Title 24 Calcs.
Plans picked no
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2"" Review, ready for corrections/issue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
'°' Review,.ready for correctionshisue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees