10-0866 (MECH)P.O. BOX 1504
78-495 CALLE TAMPICO
LA-QUINTA, CALIFORNIA 92253
Application Number: 10,;0:0'00'0866
Property Address:�0625 CALLE PALOMA
APN: .770-096-001-74 -000000-
Application description: MECHANICAL
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 19065
Applicant:}- --
AJ
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
- - = --- -- - -- ----Architect-or-Engineer: - - - -
aI
LICENSED CONTRACTOR'S DECLARATION.
I hereby affirm under penalty ot'perjury that I am licensed under provisions of Chapter (commencing with
Section 7000) -of Division 3 of the BusinesslandProfessionals'Code; and my Licerise'is'in full force and effect.
Lice se CI s . FC20,` ,g1p-Lic se No.: 686310
Date. Contractor . �` `
. �.
OWNER -BUILDER DECLARATION
I,hereby at under penalty of perjury that I am exempt ,froa the Contractor's State License Law for the
following reason (Sec.. 7631..5, Business and Professions Code:: Any city or county that requires a permit to
construct; alter, it iprove,'demolish,ror 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'doesthe 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 wili 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 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:
JERRY WHITTINGTON.
50625 CALLEL PALOMA
LA QUINTA, CA 9.2253
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 9/07/10
. Contractor-
— - GENERAL AIR CONDITIONING}
31170:RESERVE DRIVE
THOUSAND..PALMS, CA 92276,-
(760.)343-7488
2276,'(760.)343 7488
Lic. No :' 686310
WORKER'S COMPENSATION DECLARATION .,
I hereby affirm under penalty of perjury oneof the: following declarations: :�
_ I"have have 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. forwhich this permit is
issued.
' I have and will. maintainworkers' 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 PREFERRED EMPL Policy Number WKN1295355
_ 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 nould become subject to the workers' compensation provisions of Section
,x700 of.. he b(r�th comply with those provisions.
ate-Applican10.f�G�f
00
WARNG: 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 herebymade 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, indemnity 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 building construction, and hereby authorize representatives
of ' c unty o enter upon th ove-mentioned proper[ for inspection"purposes.
Date-. —1 9�,Ig4ture (Applicant or Agent): (–� vA keg
LQPERMIT
Application Number . . . . 10-00000866
Permit . . . MECHANICAL
INV FEE
Additional desc .
Permit Fee . . . 102.00
Plan Check Fee
12.75
Issue Date
Valuation
0
Expiration Date 3/06/11
Qty Unit Charge Per
Extension
BASE
FEE
30.00
2.00 18.0000 EA MECH
FURNACE <=100K
36.00
2..00 18.:0000 EA MECH
B/C <=31iP/100K BTU
36.00
' Special Notes and Comments
INSTALL (2) 5 •. TON• HORIZONTAL 13
SEER
SYSTEMS IN-AT.TIC.. 2007-
007-CODES.INVESTIGATION..FEE,.ASSESSED
-CODES. INVESTIGATION. ..FEE,. ASSESSED
PER
>. 49,9.7,,-UNIFORM ADMINISTRATIVE,CODE
§304.5
FOR WORK BEGUN WITHOUT BUILDING
PERMIT.
Fee summary Charged_
Paid Credited
Due
_------ - - - - -- -- -- - -- ------
Permit Fee Total 102.Ob
.0.0. .00
102.00
Plan Check Total 12.7-5
.°0.0 .00
12.7-5
r'and'Total 1'14'.75
.00 .00
114.75
LQPERMIT
Simplified Prescriptive Certificate of Compliance: 2008 Residential RVACAlterations CF -IR -ALT -HVAC
Climate Zones 10 to 15
Site Address:
E forc nt Agengy:
Doe:
Permit #:.
ft&.
Co diti ned Floor
Eq ui ment Type'
List Minimum Efficienc Z
Duct insulation requirement
Area
Thermostat
❑ P ckaged Unit
ace
❑ AFUE
❑ COP
Over 40 ft of ducts added or
replaced in unconditioned s ace
Served b system
Sem tback
door Coil
❑SEER
❑ HSPF
p p
Y Y
(If not already
Condensing Unit
0. EER
❑Resistance
❑ R 6 (CZ 10-13)
❑ R 8 (CZ 14-15)
sf
present, must be
installed)
❑ Other
I. Equipment Type: Choose the equipment being installed; if more than one system, use another CF -1 R -ALT -HVAC for each system.
2. Minimum Equipment Efficiencies: 13 SEER, 78%AFUE, 7.7HSPFfor 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 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. a inspector also verifies that each appropriate CF -6R and registered CF -4R forms (no hand filled CF-4Rs allowed) are filled out and
si ne . Beginning October 1 2010, a registered copy of the CF -1R and CF -6R shall also be on site for final inspection.
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 fors lits stems MECH-25
• Condenser Coil and/or
CF -6R forms: 'MECH-21-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 > 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 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
CF -4R forms: MECH 20-, and (for split systems)MECH-22, and MECH 25
new equipment)
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 systems) 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
Required Forms:
• Includes adding or replacing more than 40
CF -6R forms: MECH-04, MECH-2I-HERS CF -4R forms: MECH-21
linear feet of duct in^unconditioned space.
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 1 and 6 of the California Code of Regulations.
• . The design features identified on this Certificate of Compliance are consistent with the information docume d on other applicable compliance forms, worksheets,
calculations, plans and specifications submitted to the enforcement agency for approval with the permit apflicItion.
Name:
Signature:
Company:. C/
Date: 0 7
Address: �` O U nt/ b
I
License: („
1�(f
City/State/Zip:
Phone:
urn rt
'.0ty. of .La {Qu• nt'a
Building. &' Safety :D►vislon '•
P.O. Box 15.04, 78=495 Calle Tampico
La Wnta; CA�92253 -'(760). 777-7012; .
Building Permit App[1cat►on and Tracking Sheet
Permit #
�p
l�
Project Address:
Owner's Name:. r_ y.. lr
A. P. Number:
�
Address: 11
Legal Description:
City; ST, Zip:.-' I S
Contractor:
Address:
Telephon . D " a
Project Descriptio :r AR
Cit Y, 5T, Zip: I/ `►rJV �,7
s
�r : Sv:��flti i:;?,\{ i.;`.JY:L{3: • ••N•ti:r :v T�
Telephone.f':;;,. ;<::,: ,>:<::•^?'::zN:.,:>,
State Lic. #: City Lia,#;
Arch., Engr., Designer:
Address:
City., ST,* Zip:
7j� ,�.::�: ��<".:�;•. rhe"z;• �.
Telephone: _ r``;:.?:;f� .:x:::,.? :
', -;r< .,;�.-��?,-
.%x�tis%i'�+r"rjyri•?3t:,v�x:•,i::t:;•{�fJ�::
?,•ti,/State Lic. #
" .Construction -Type: Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
Name. of Contact•Person:
_7
Sq: Ft.:
#Stories:
#Units:
Telephone # of Contact Person:
Estimated Value of Project:
APPLICANT: DO. NOT WRITE;BELOW,THIS LINE
#
Submittal
Plan Sets:
Req'd
Recd
F TRACIGNG
Plan Check submitted
PERMIT FEES
Item Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person:
:PIan,Check Balance.
Title 24 Calcs.
Plans picked no
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plaa
2°" Review, ready for correctionstissue
Electrical
Subcontactor List
Called Contact Person
Plumbing .
Grant Deed
Plans picked up.
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
''d Reyiew, 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
4
Total Permit Fees