14-0380 (MECH)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFOR°NIA 92253
Application Number:
Property Address:
APN:
Application description:
Property Zoning:
Application valuation:
Applicant:
)0,a
6W
14-00000380
50057 CALLE OAXACA
773-340-029-29 -14496
MECHANICAL
LOW DENSITY RESIDENTIAL
8760
Architect or Engineer:
�\�p
------------------
LICENSED CONTRACTOR'S DECLARATION
BUILDING & SAFETY. DEPARTMENT
BUILDING PERMIT
Owner:
RICHARD GISS
50057 CALLE OAXACA
' LA QUINTA, CA 92253
(760)564-2975
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 906115
,e(! ` _
Date: Contractor:
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 ($500).:
1 _ 1 I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and
the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The
Contractors' State License Law does not apply to an owner of property who builds or improves thereon,
and who does the work himself or herself through his or her own employees, provided that the
improvements are not intended or offered for sale. If, however, the building or improvement is sold within
one year of completion, the owner -builder will have the burden of proving that he or she did not build or
improve for the purpose of sale.).
1 _) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.
7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of
property who builds or improves thereon, and who contracts for the projects with a contractoi(s) licensed
pursuant to the Contractors' State License Law.).
1 _ 1 I am exempt under Sec. , B.&P.C. for this reason
Date:
Owner:
CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the
work for which this permit is issued (Sec. 3097, . C.).
Lender's Name:
Lender's Address: \
LQPERMIT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 4/07/14
Contractor: D`
HYDE$
42949 MADIO STREET
,: ,
INDIO, CA 92201 ; I P,
(760)360-2202 E6 (f„v
Lic. No.: 906115 l
-----------------------------------------------
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
X � issued.
'p �ave and will maintain workers' compensation insurance, as required by Section 3700 of the Labor
rfy� Code, for the performance of the work for which this permit is issued. My workers' compensation
insurance carrier and policy number are:
Carrier NORGUARD INS Policy Number CEWC468841
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 subW' tt the workers' compensation provisions of Section
37,,0. f e Labor Code, I sh Y/ort 7 ompl ith those provisions.
Date: ` A�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 ($100,000). 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 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 ISO 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 orrect. I agree to comply with all
city and county ordinances and state laws relating to building construc ' n, a hereby a orize representatives
of this ounty to en pon the above-mentioned property for insp p oses.
Date ignature (Applicant or Age�1'
Application Number
Permit
Additional desc .
Permit Fee . . . .
Issue Date . . . .
Expiration Date . .
. . . . 14-00000380
MECHANICAL 2013
71.50
10/04/14
Plan Check Fee .
Valuation . . .
Qty Unit Charge Per
Extension
1.00
35.7500 EA
MECH FURNACE
35.75
1.00
35.7500 EA
MECH CONDENSER/COMP
35.75
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Special Notes
and Comments
HVAC CHANGE
OUT - 13SEER/78AFUE SPLIT
SYSTEM [2008
ENERGY] CARBON
MONOXIDE
ALARM(S) TO
BE INSTALLED PRIOR TO FINAL
INSPECTION.
2013 CALIFORNIA
BUILDING
CODES.
----------------------------------------------------------------------------
Other Fees
. . . . . . . .
. PERMIT ISSUANCE M/P/E
90.57
PLAN CHECK, MECHANICAL
47.66
Fee summary Charged
Permit Fee Total 71.50
Plan Check Total .00
Other Fee Total 138.23
Grand Total 209.73
LQPERMIT
Paid Credited Due
.00 .00 71.50
.00 .00 .00
.00 .00 138.23
.00 .00 209.73
Simplified Prescriptive Certificate of Compliance: 2008 Residential HVAC Alterations CF-lR-ALT-HVAC
Climate Zones 10 - 15
Site Address:
Enforcement Agency:
Date:
Permit #:
50-057 Calle Oaxaca La Quinta, CA 92253
City of La Qilinta
Apr 7, 2014
Duct insulation
Conditioned Floor
Equipment Type1
List Minimum Efficiency2
requirement
Area
Thermostat
❑ Package Unit
® Furnace
® Indoor Coil
® AFUE 78%
® SEER 13.0
13 COP
13HSPF
13R 6 (CZ 10-13)
Served by system
®Setback
If not already present, must be
® Condensing Unit
[3 EER
E30
R gCZ 14-15)Resistance (
2000 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 Efficiencies: 13 SEER, 78% 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-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-111
and CF-6111 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
CF-611 forms: MECH-04, MECH-2I-HERS and (for split systems) MECH-25-HERS
. Indoor Coil and /or
CF-411 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
Exempted from duct leakage testin,g;if:
[31. Duct system was documented to have been previously sealed and confirmed through HERS verification, or
❑ 2. Duct systems with less th;an.40 linear feet in unconditioned space, or
❑ 3: Existing duct systems are:constructed, insulated or sealed with asbestos
❑ 4. The system will not be Ducted (ie. Ductless Mini-Split System) (Also Exempt from Refrigerant Charge)
❑ 2: New HVAC System
Required Forms _
. Cut in9 r Ch( rignew! ith a A
a �... CF-6R forms-4MECH 04�MECH�20 ERS for split s�yste MECH 22 HERS, and
new�ductS all new
MECH. �2,,5 RS
du Ri+to�ms MECH 20, and (for split Systeme), MECH 22, andrMECH�f
ctin f"EM, all new . CF7.-
eq uiment
CA
For SpIft Systems, Duct leakage <R61 rcent; RC, CCA 550 CFM/ton,'IFWDT MAH�,STMS,,a either�HSPPaor+PSPP;
�,�
For Packaged Units kage < 6perce"
_ , �x Required Forms
❑ 3. New D i s with ,or wfiN 7 ,>
Replacement :.-.
. Includes,,.replacin:g'or installing all neuv
duetirg a[d%or outdoor condensing :iihit CF-6R forms: MECH-04, MECH-20-HERS, and (for split systems) MECH-25-HERS
and/&.indoor coil and/or furnace N6 or some CF-411 forms: MECH-20 and (for split systems) MECH-25
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
linear feet of duct in unconditioned space.
CF-411 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.
• 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 specifications submitted to the enforcement agency for approval with the permit application.
Name: Mark Hyde Signature: Mark Hyde
Company: CERTIFIED COMFORT SYSTEMS INC Date: Apr 7, 2014
Address: 42-949 MADIO STREET License: 906115
City/State/Zip: INDIO / CA / 92201 Phone: (760) 360-2202
Reg: 214-A0023527A-000000000-0000 Registration Date/Time: 2014/04/07 14:15:52 HERS Provicler: c:a.Lut;K-rb, inc.
Bin #
-
City of La Quints
Building 8[ Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quints, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
-__.
Permit ;4E
PmjectAddress:j C7 —05_7 (?- O�)C,(C
A P. Number
Owner's Name: /C
Address: 057 C- //0- V 5 XGGc-,
Legal Description:
City, ST, Zip. `- G
Telephone: S '
Contractor. 5 A / C
(
Address: `-[ 2_1 q q Nl -
Project Description: �/G �-
City, ST, Zip: O C A ZZ d
Telephone: 6o _ ZZdZ
State Lie. # : q 0c, %• City Lic. #: ZZ
Arch., Engr., Designer. '
Address:
City, ST, Zip:
- -
Telephone:
State.Lic. #
gction Type: Occupancy:
type (circle one): New Add'n Alter Repair' Demo
tS
Name of Contact Person:
#Stories
#�:
Telephone# of Contact Pawn:.
ted Value of Project: 7 4!� o.
APPLICANT: DO NOT WRITE BELOW THIS UNE
#
Submittal
Req'd
Recd
TRACIMG .
PERbffr FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Chale Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance
Energy Calcs.
Plans picked up
Construction
Flood plain Plan
Plans resubmitted
Mechanical'
Grading PIw
2' Review, ready for corrections/issue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S-M.L
IiO.A. Approval,
Pians resubmitted
Grading
INHOUSE:-
r"' Review, ready for eorrections/issue
Developer -Impact Fee
Planning Approval
Called Contact Person
A.LP.P.
I.Pub.
Wks. Appr
Date of permit issue
School Fees
Total Permit Fees
-