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11-1305 (MECH)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT BUILDING PERMIT Application Number: 11a�000'0136 Property Address: 564`3°8=PALMS DR APN: 764-020-012- - - Application description: MECHANICAL Property.Zoning: LOW DENSITY RESIDENTIAL Application valuation- 5165 Applicant: Architect or Engineer- -------------------------------- ,.LICENSED CONTRACTOR'S DECLARATION. 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 and rofessionals Code, and my License is in full force and effect. License Class: C))20 -C43 License No.: 276586 te: ��4I ontractor: . -- 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, Businessand 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 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 improvements arenotintended 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.).. l _ 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.). (_) 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: LQPERMIT Owner: BOB GORDON 56438 PALMS DRIVE LA QUINTA, CA 92253 Contractor: DESERT AIR CONDITIONING, 'I 590 WILLIAMS ROAD PALM SPRINGS.,, CA 92264 (760) 323,.-4383 Lia. No.: 276586 VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 12/07/11 Yap,; A +yi1,r4 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 . 7600007908111 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 b ome bject to the workers' compensation provisions of Section .3700 of-th Labor Code, I all f with comply with those provisions. . ate: 12,-7 pplicant: ' WARNING: FAIL RE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,0001. 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 onstruction, and hereby authorize representatives of t/1ys county to enter up the above-mentioned pro (rpeaion purposes. Date: /L - ]- /4 ignature (Applicant or Agent): ,a LQPERMIT Application Number . . . . . 11-00001305 Permit . . . MECHANICAL Additional desc . . Permit Fee . . . . 40.50 Plan Check Fee 10.13 Issue Date . . . . Valuation . . 0 Expiration Date 6/04/12 Qty Unit Charge Per Extension BASE FEE 15.00 1.00 9.0000 EA MECH FURNACE <=100K 9.00 1.00 16.5000 EA MECH B/C >3-15HP/>100K-500KBTU 16.50 7 ---------------------------------------------------------------------- Special Notes and Comments HVAC CHANGE -OUT: INSTALL 2 TON SPLIT SYSTEM AT GROUND LEVEL..2010 CODES. ------------- ---------------------------------------------------------------- Other Fees . . . . . . . . .. BLDG STDS ADMIN (SB1473) 1.00 Fee summary Charged Paid Credited Due Permit Fee Total 40.50 .00 .00 40.50 Plan Check Total 10.13 .00 .00 10.13 Other Fee Total 1.00 .00 .00 1.00. Grand Total 51.63 .00 .00 51.63 Simplified; Prescriptive'Certificate of Compliarace:.2008 Residential HVAC Alteration! CF-IR-ALT-HVAC Climate Zones 10 -'15 Site Address:. rEnfo7rcemnient Agency: Date: Permit*: . 56-438 PALMS DR. Le Quinta, CA 92253 City Quinta Dec 5, 2031 Duct insulation Conditioned Floor Equipment Type1 List Minimum Efficiency2 requirement Area Thermostat ❑ PackageUnit p Furnace ❑ Indoor Coil O AFUE 0 SEER 13.0 p COP . R HSPF. 7.7 ❑ R 6 (� 10-13) Served by system 0 Setback If not already present, must be P1 Condensing Unit L] EER ❑ Resistance R 8 CZ 14-15)EER -800 sf 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 Efftlendes: 13 SEER, 78°x6 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-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-6R shall also be on site for final inspection. ®.1. HVAC Changeout Required Forms: . All HVAC Equipment CF-611 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-6R 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 Exempted from dud leakage testing if: ❑ 1. Dud 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 ❑ 4. The system will not be Ducted (ie. Ductless ?MmlmSplit S,ystem).,..(Also..Exempt from.Refngerant Charge) ❑ 2. New HVAC System RequiCed Forms: „. . Cut in or Changeout with: new duets: (all news CF 611forms: MECH-04 MECH=2Q, � HERS hand (for split systems) MECH 22 HERS and r , ducting' n all new o MECH, 25 HERS CF-4R forms[ MECH 'th"d " r equipment) x .. 20, and (for split systems) MECH-2 MECfd-25 -:. c, �F" f: ? te._ rt iso, ri For Split Systems: Dud 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/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-4R 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: Dud leakage < 6 percent ❑ 4. New Ducting over 40 feet Required Forms: . Includes adding or replacing more than 40 CF-611 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. . 1 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 fortes, worksheets, calculations, plans and specifications submitted to the enforcement agency for approval with the permit application. Name: Jacqueline Zabik Signature: Jacqueline Zabik Company: DESERT AIR CONDITIONING INC Date: Dec 5, 2011 Address: 590 WILLIAMS ROAD License: 276586 City/State/Zip: PALM SPRINGS / CA / 92264 Phone:. (760) 323-3383 Reg: 211-AO062974A-00000000-0000 Registration Date/Time: 2011/12/05 19:33:09 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms July 2010 Bin #City pf La.Quin•fa BdOing 8t' Safety Dfvislon Permit # P.O. Box f 504;`78-.495. Caf a Tarnplco ` � B La Quinta, CA'92253 - (760)'777-7012 l ' Building Permit Apipjircation and ,Tracking sheet . J OName= Project Address:` 4 M.� � wners Cho .R A. P. Number: Address: 7 .3 0- /• c— Legal Description: Contractor. City, ST, Zip; � �` ' � 9P a 7.3 n, Telephone; Address.— City, ST, Zip. ' >� Telephone: State Lic. H : %6 J $6 Rltwyic. g:E Joy.C'. L. ,- GS Design= Address: City, ST, Zip: Telephone: State Lie 1f: Name of Contact Person a A 6- Construction Type-ex-/-,—Oowpancy: > Projea typc (circle one):' New Add'n Alter Repair Demo Sq. Ft.: lf,Stories N Units: Telephone # of Contact Person: Estimated Value of Project: l' S • O a APPLICANT: DO NOT WHITF�BELOW THIS LINE H Submittal Req'd Reed TRACKIP(G PERMIT FEffiS Plan Sets Plan Check submitted Item Amount Structural Calks Reviewed, ready for corrections Plan Check Deposit Truss Cates. Called Contact Person Plan Check Balance . Title 24 Calcs. Plans picked up Construction Flood plain plan Plans resubmitted lliecbaninf Grading plan 2`° Revitw, ready for correctionsAssae Electrical Subeontaetor List Called Contact Person Plumbing Grant Deed Pians picked up S.M.I. K.O.A. Approval Plans resubmitted Grading 'IN HOUSE:- '"' Review, ready for correctionslissue Developer impact Fee Planning Approval Called Contact Person A.LP.P. Pub. Wks. Appr Date of permit issue School Foes Total Permit Fees