10-0547 (MECH)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
10-00000547
Property Address:
49995 PARK AVE
APN:
649 -210 -021 -
Application description:
MECHANICAL
Property Zoning:
PARKS & RECREATION
Application valuation:
4500
Tuvl 4 4 "
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Applicant: Architect or Engineer:
M'-
------------------
LICENSED CONTRACTOR'S DECLARATION
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 Business and Professionals Code, and my License is in full force and effect.
License Class: C20 License No.: 374937
ontractor:'�5:�/F(/ ,
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.ISec. 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 ($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 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.).
(_ 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 Law3.
(_ 1 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
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 6/22/10
Owner:
BOYS/GIRLS CLUB CHEL VA
42600 COOK ST S 2
PALM DESERT, C 211
JUN 2 Z010
OF L
PALM DESERT AIR C0 �i Contractor: A p�rA
42081 BEACON HILL
PALM DESERT, CA 92211
(760)346-0677
Lic. No.: 374937
------------------
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 SOUTHERN INS Policy Number WSIO03802-01
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 become subject to the workers' compensation provisions of Section
3700 of the Labor Code, I shall forthwith cgmply with those provisions.
ate: �� cant:
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 ($100,0001• 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 building construction, and hereby authorize representatives
of/thh''s county to enter upon the above-mentioned property for inspeons as.
Date: G �`— �ature (Applicant or Agent): "' Jt—;
Application Number . . . . . 10-00000547
Permit . . MECHANICAL
Additional desc .
Permit Fee. 33.00 Plan Check Fee
8.25
Issue Date . . . . Valuation
0
Expiration Date 12/19/10
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
REPLACE ONE (1) 6.0 TON GAS/ELECTRIC-
AS/ELECTRICPACKAGE
PACKAGESYSTEM. 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
LQPERMIT
CERTIFICATE OF COMPLIANCE and
FIELD INSPECTION ENERGY CHECKLIST (Pagel of 5) MECH-IC
Project Name:�C FN✓ /n � ,n n � �
Date: �
Climate�Z
Project Add a s: � � �y�^ / /� 'n
rPi�� 7 TVA.. • L. 1q vG
Conditioned Floor
Area:
General Information -
Building Type: Nonresidential ❑ High -Rise Residential ❑ Hotel/Motel Guest Room
❑ Schools (Public School) ❑ Relocatable Public School Bldg. ❑ Conditioned Spaces ❑ Unconditioned Spaces
Phase of Construction: ❑ New Construction D Addition Alteration
Approach of Compliance: Component ❑ Overall Envelope TDV Energy ❑ Unconditioned (affidavit) affidavit
Front Orientation: N, E, S, W or in Degrees:
HVAC SYSTEM DETAILS
FIELD INSPECTION ENERGY CHECKLIST
Equipment2
Inspection Criteria
Meets Criteria or Requirements
Special Feature Pass
Fail - Describe Reason3
Item or System Tags
(i.e. AC -1, RTU -1, HP -1)
z 'x
Equipment T e°:GAS
PK%13+
°❑
`•0 , i
ix
No of Systems
t
�
❑ F D u.*
�+st� q
:. OF ❑ �
Max Allowed Heating Capacity
[3 g
Minimum Heating Efficient
P019
r, ❑ g
❑Owe
� rr ❑ P
Max Allowed Cooling Capacity1(
UUO
❑ ❑ . "a'
Y€� �D£:
Cooling Efficiency
•( rGrG
13'0
�n"'° `❑1�`1,
Duct Location/ R-Value1.
13❑ x
' Y' �:13
Duct Leakage TestingIf Yes, a
MECH-4A must be submitted
" 3' ""
D
;` s„t
`�T E,
Economizer
❑
i9k N�❑�«f
Thermostat
mT
❑
❑ ` ; 0 4
Fan Control
AAA
❑ ❑ °
I?>'❑�5;
Equipment Z
Inspection Criteria
FIELD INSPECTION ENERGY CHECKLIST
Special Feature'
Pass
Fail - Describe Reason
Item or System Tags
(i.e. AC -1, RTU -1, UP-1).�
❑
❑
Qt� `
Equipment T e°:
❑D
3 0�
��� •>
No of System
13❑2
=rp�
Max Allowed Heatin Ca aci
13❑'
,b
;;
` ib1° " �yf
L ,.� . .t�i'' .F au4.
Minimum Heating Efficiency
❑
Max Allowed Cooling Capacity
❑
1-.T❑
t;r''C'O t'c'
Cooling Efficiency
❑�❑
�l
Duct Location/ R -Value
❑
D'3❑
a ;�
Duct Leakage Testing - If Yes, a
MECH-4-A must be submitted
❑s
, _
y �p
_„
Economizer
13,•,
❑
t
Thermostat
❑
❑
,ten "` ❑� *- .�L .. �`
Fan Control
❑
tD l
13
1. Indicate special feature DETAILS on Page 2 of the Inspection Checklist Form.
2. If the Actual installed equipment performance efficiency and capacity is less than the Proposed (from the energy compliance submittal or from
the building plans) the responsible party shall resubmit energy compliance to include the new changes.
3. For additional detailed discrepancy use Page 2 of the Inspection Checklist Form.
4. Indicate Equipment Type: Gas(Pkg or, Split), VAV, HP (Pkg or split), Hydronic, PTAC, or other
2008 Nonresidential Compliance Forms August 2009
CERTIFICATE OF COMPLIANCE and
FIELD INSPECTION ENERGY CHECKLIST (Page T of 5) MECH-1C
Project Name: Date:
SPECIAL FEATURES INSPECTION CHECKLIST
The local enforcement agency should pay special attention to the items specified in this checklist. These items require special written
justification and documentation, and special verification. The local enforcement agency determines the adequacy of the justification,
and may reject a building or design that otherwise complies based on the adequacy of the special justification and documentation
Discrepancies:
2008 Nonresidential Compliance Forms
August 2009
CERTIFICATE OF COMPLIANCE and FIELD INSPECTION ENERGY CHECKLIST (Part 3 of 5) MECH-1C
Project Name
Date
Required Acceptance Tests
Designer:
This form is to be used by the designer and attached to the plans. Listed below are all the acceptance tests for mechanical systems. The designer is required to check the
applicable boxes by all acceptance tests that apply and list all equipment that requires an acceptance test. If all equipment of a certain type requires a test, list the
equipment description and the number of systems. The NA number designates the Section in the Appendix of the Nonresidential Reference Appendices Manual that
describes the test. Since this form will be part of the plans, completion of this section will allow the responsible party to budget for the scope of work appropriately.
Enforcement Agency:
Systems Acceptance. Before occupancy permit is granted for a newly constructed building or space, or a new space -conditioning system serving a building or space is
operated for normal use, all control devices serving the building or space shall be certified as meeting the Acceptance Requirements for Code Compliance.
Systems Acceptance. Before occupancy permit is granted. All newly installed HVAC equipment must be tested using the Acceptance Requirements.
The MECH-1 C form is not considered a completed form and is not to be accepted by the building department unless the correct boxes are checked. The equipment
requiring testing, person performing the test (Example: HVAC installer, TAB contractor, controls contractor, PE in charge of project) and what Acceptance test must be
conducted. The following checked -off forms are required for ALL newly installed equipment. In addition a Certificate of Acceptance forms shall be submitted to the
building department that certifies plans, specifications, installation certificates, and operating and maintenance information meet the requirements of §10-103(b) and Title
24 Part 6. The building inspector must receive the properlyfilled out and signed forms before the building can receive final occupancy,
Test Description
MECH-2A
MECH-3A
MECH-4A
MECH-5A
MECH-6A
MECH-7A
MECH-8A
MECH-9A
MECH-10A
MECH-11A
Outdoor
Ventilation
Constant
Demand
Hydronic
for
Volume &
Air
Control
Supply
Valve
System
Automatic
Equipment Requiring Testing or
Verification
# of
units
VAV &
CAV
Single -Zone
Unitary
Distribution
Ducts
Economizer
Controls
Ventilation
DCV
Fan
VAV
Leakage
Test
Supply Water
Temp. Reset
Variable Flow
Control
Demand Shed
Control
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
2008 Nonresidential Compliance Forms August 2009
CERTIFICATE OF COMPLIANCE and FIELD INSPECTION ENERGY CHECKLIST (Part 4 of 5) MECH-1C
Project Name
Date
Test Description MECH-12A
MECH-13A
MECH-14A
MECH-15A
Fault
Detection &
Diagnostics
Equipment Re uirin Testing # of for DX Units
Automatic Fault
Detection &
Diagnostics for
Air & Zone
Distributed
Energy Storage
DX AC
Systems
Thermal Energy
Storage (TES)
Systems Test Performed By:
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
2008 Nonresidential Compliance Forms August 2009
CERTIFICATE OF COMPLIANCE and
FIELD INSPECTION ENERGY CHECKLIST (Part s of 5) MECH-1C
Project Name:
Date:
Documentation Author's Declaration Statement
• I certify that this Certificate of Compliance documentation is accurate and complete.
Name: �t t
tet/
Signature:
Company:
Lm / A OO t7- L
ovr
e S-1 D
Address:
''120 1 gC.��1W
If Applicable
CEA#
CEPE #
City/State/Z�Lm ^ ^ /
Phone; _ ^ �„ l (e _&G -7
Principal Mechanical Designer's Declaration Statement
• I am eligible under Division 3 of the California Business and Professions Code to accept respons _bility for the mechanical
design.
• This Certificate of Compliance identifies the mechanical features and performance specifications required for compliance with
Title 24, Parts 1 and 6 of the California Code of Regulations.
• The design features represented on this Certificate of Compliance are consistent with the information provided to document
this design on the other applicable compliance forms, worksheets, calculations, plans and specifuations submitted to the
enforcement agency for approval with this building permit application.
Name:
Signature:
Company Name:
Date:
Address:
License #
City/State/Zip
Phone: .
Mandatory Measures
Indicate location on building plans of Note Block for Mandatory Measures
MECHANICAL COMPLIANCE FORMS & WORKSHEETS check box if worksheet is included
For detailed instructions on the use of this and all Energy Efficiency Standards compliance forms, re,;rer to the 2008 Nonresidential
Manual Note: The En rcement Agency may require all.forms to be incorporated onto the building.ans.
MECH-1C Certificate of Compliance. Required on plans for all submittals.
MECH-2C Mechanical Equipment Summa is required for all submittals.
❑ MECH-3C Mechanical Ventilation and Reheat is required for all submittals with mechan_cal ventilation.
❑ MECH-4C I Fan Power Consumption is required when for all prescriptive submittals.
2008 Nonresidential Compliance Forms August 2009
AIR SYSTEM REQUIREMENTS
(Part 1 of 3) MECH-2C
PROJECT NAME:
DATE:
Item or System Tags
(i.e. AC-1, RTU-1, HP-1)
Indicate Air Systems Type (Central, Single Zone, Package, VA or etc...)
,v
_
No. of Systems
'
MANDATORY MEASURES
Heating Equipment Efficiency
Cooling Equipment Efficiency
HVAC or Heat Pump Thermostats
Furnace Controls/Thermostat
Natural Ventilation
Mechanical Ventilation
VAV Minimum Position Control
Demand Control Ventilation
Time Control
Setback and Setup Control
Outdoor Damper Control
Isolation Zones
Pipe Insulation
Duct Insulation
PRESCRIPTIVE MEASURES
Calculated Design Heating Load
Calculated Design Cooling Load
Fan Control
DP Sensor Location
Supply Pressure Reset (DDC only)
Simultaneous Heat/Cool
Economizer
Heat and Cool Air Supply Reset
Electric Resistance Heating'
Heat Rejection System
Air Cooled Chiller Limitation
Duct Leakage Sealing. If Yes, a
MECH-4-A must be submitted
Indicate Page Reference on the Plans or Schedule list or list
information below
T-24 Sections
112(a)
(J
112(a)
112(b), 112(c)
14 Ll A-e
112(c), 115(a)
121(b)
121(b)
121(c)
121(c)
122(e)
122(e)
SET
122(f)
122(g)
123
&-X ls77
124
144(a & b)
144(a & b)
144(c)
144(c)
144(c)
144(d)
144(e)
144(f)
144(8)
§ 144 (h)
§ 144 (i)
144(k)
1. Total installed capacity (MBtu/hr) of all electric heat on this project exclusive of electric auxiliary heat for heat pumps. If electric heat is used
explain which exception(s) to 144 apply.
2008 Nonresidential Compliance Forms August 2009
SERVICE HOT WATER'& POOL/SPA' REQUIREMENTS ' . - +r .. r ;'(Part '3 of 3) MECH-2C
PROJECT NAME: -
-
DATE: ,
Service Hot Water, Pool Heating -
`� .. Item or System 'fags
r}•
(i.e. WH -1, WHP, DHW, etc..
, R
No. of Systems
131
Eft� '
'Indicate Page Reference on Plans or Schedule'
MANDATORY MEASURES
T-24 Section
SERVICE HOT WATER.,'
.Certified Water Heater-'-
§111, §113 (a) '
Water Heater Efficiency �.
6
§113 O '
Service Water Heating Installation
§113 (c)
Pipe Insulation
§123 '
POOL AND SPA '.
Pool and Spa Efficiency and Control •
•§114 (a)'
§114 (b) +
Pool and Spa Electric Resisting Heating
Exception `
Pool and Spa Installation
§114 (b)
Pool Heater — No Pilot Light
§115 (c)
Spa Heater —No Pilot Light
§115 (d)
Pipe Insulation
§123
1: The Proposed equipment need to match the building plans schedule or specificatio s. If a requirement is not applicable, put WIA" in the column next to the measure.
2: For each water heater, pool heat and domestic water. loop (or groups of similar equipment) fill in the reference to sheet number and/or specification section and paragraph number where the
required features are documented. If a requirement is not applicable, put "N/A" in the column.
Bin #
City of La Quinta
Building 8r Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
rl ,
V
Project Address: 49-995 PARK AVE.
Owner's Name: BOYS & GIRLS CLUB OF C.V
A. P. Number:
Address: 49-995 PARK AVE.
Legal Description:
City, ST, Zip: LA QUINTA, CA 92253
Contractor: Palm Desert Air Conditioning & Heating Com anY
Telephone: 760-564-5555
";:'':•.;:;?`::>.:' ;`•':.:s' >?;s:n>"•>>„<s„<::f;."<i`?<">: >>
Address: 42081 Beacon Hill
Project Description:
City, ST, Zip: Palm" Desert, CA 92211
REPLACE ONE (1 6.0 TON
Telephone: (760) 34 -06 77
01,GAS/ELECTRIC
PACKAGE.
State Lic. # : 374937
City Lic. #; 100886
SYSTEM.
Arch., Engr., Designer:
Address:
City., ST, Zip:
Telephone:
State Lic.
Construction Type: Occup ancY:
a circle one): New Add'n Alter Repair DemoJect tYP
Name of Contact Person: KARL BROWN
Sq. Ft.:
# Stories:
# Units:
Telephone # of Contact Person: (760) 346-0677
Estimated Value of Project: $4,500
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACKING
?ERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Cates.
Reviewed, ready for corrections
Plan Check Deposit
Truss Cates.
Called Contact Person
Plan Check Balance
Title 24 Cates.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
r' 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