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11-0816 (MECH)P.O. BOX 1504 78-495 CALLE TAMPICO LA" QUINTA, CALIFORNIA 0253 Application Number: 11-00000816 Property Address: APN: 770-141-002-90- =000000 - Application description: MECHANICAL Property Zoning: LOW DENSITY RESIDENTIAL Application valuation: 5500 Appplifca'nt' el Architect or Engineer: L Pt BUILDING & SAFETY DEPARTMENT BUILDING PERMIT Owner: HUDSON ANYA B 51044 CALLE OBISPO LA QUINTA, CA 92253 (760)564-6576 . Contractor: J,ANTHONY PLUMBING,HEAT/AIR• 72216 NORTH SHORE STREET, #1 THOUSAND.PALMS, CA 92276 (760),343-2121 Lic. No.: 777794 VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 7/29/11 ' LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION I hereby affirm under'penalty of perjury that I am licensed under provisions of Chapter (commencing with I hereby affirm under penalty of perjury on6. of the following declarations:' Sectioi0600) of Division 3 of the Business and Professionals Code, and my License is in full force and effect. I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided License CI s: C20 -C36 License'No.: 777794 - _ ` for by Section 3700 of the Labor.Code, for the performance of the'work-for which this permit is \,Date ��_ issued. Contractor: - _ I have and will maintain workers'compensation •insurance, as required by Section3700 of the Labor - - - Code; for the performance of the work for which this permit is issued. My workers' compensation OWNER -BUILDER DECLARATIONinsurance carrier and policy number are: I hereby affirm under penalty of'perjury that) am exempt. from the Contractor's'State'License'Law for the Carrier CNCLD/ST 'F�JD. " Policy Number 1932.451-2011 ' following'reasori (Sec. 7031.5, Business and Professions Coder Anycity. or county that requires a permit to - I certifythat, in the, performance of the work for which "this. permit is issued, I.shall'not employ any construct, alter, improve, demolish, or repair any structure, :prior to: its issuance, also requires the applicant for the _ person in any-manner'so es to become subject to tne.workers' compensation laws of California, permit to file a signed statement that he or she is licensed pursuanvto the provisions of the Contractor's State - and agree that, if.l should become subjectto the. workers'/compensation pr •sions of Section � - License,Law (Chapter 9 (commencing with Section 7000) of Division 3 of theBusinessand Professions Code) or 37 0 of,the Labor Code, I shall forthwith compl; with those provisi . that•he of"she ds exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by 7 W • any applicant for a permit -subjects -the applicant to a civil penalty of not more thamfive hundred dollars ($500).: Date* ! '�) Applicant: 1, as owner of the property, or my employees with wages as their sole compensation, will do the work, and - - the structure isnot intended or offered.for sale (Sec. 7044, Business and Professions Code: The WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL Contractors' State License Law does not apply to an owner of `property who builds or improves thereon, , SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND _ and`who.does the work himself or herself through his ocher own'employees,provided that the DOLLARS:($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN. improvements are not intended or offered for sale. If, however, the building or improvement is sold within SECTION 3706 OF. THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. one year of completion, the owner -builder will have the burden of proving that he of she did not build or - Improve for the purpose of sale.).APPLICANT ACKNOWLEDGEMENT (_ 1 1, as owner of the"property, am exclusively contracting with licensed contractors to. construct the project (Sec. IMPORTANT' Application is hereby -made to the Director of Building and Safety for a permit subject to the ' 7044, Business. and Professions Code:. The Contractors' State License Law does not apply to an owner of conditions and restrictions. set forth on this application. . property who builds or, improves thereon,* and who contracts for the projects with a contractor(s) licensed 1 . Each person upon whose behalf this application is made, each person at whose request and for -pursuant to the'Contractors' State License Law.). whose benefit work is performed under or pursuant to any permit issued as a result of this application, (_ 1 I am exempt under Sec. B.&P.C. for this reason the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City of La Quints, its officers, agents and employees for any act or omission related to the work being performed under or following issuance of this permit. Date: Owner: 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 CONSTRUCTION LENDING AGENCY permit to cancellation. I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the I certify that I have read this application and state that the above information is correct. I agree to comply with all work for which this permit is issued (Sec. 3097, Civ. C.). city and county ordinances and state laws relating to building construction, and hereby authorize repres tives of this coun to a er upon the above-mentioned property for inspec ' urposes. Lender's Name � � % y�C► Datef V / e) Signature (Applicant or Agent): - Lender's Address: ' LQPERMIT LQPERMIT - - Application Number . . 11-00000816 Permit . . . MECHANICAL Additional desc . Permit Fee . . . . 33.00 Plan Check Fee 8.25 Issue Date . . . . Valuation . . . .. 0 Expiration Date 1/25/12 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<,-Not.es . and- Comments-.:., HVAC, CHANGE'>O.UT PACKAGED UNIT 13 SEER 3:5 TON. 2010 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 Other Fee Total 1.00 00 00 1.00 Grand Total' 42.25 .0'0 .00 42.25 LQPERMIT - - Simplified Prescriptive Certificate of Compliance: 2008 Residential HVAC Alterations CF-lR-ALT-HVAC Climate Zones 10 - 15 Site Address: Enforcement Agency: Date: Permit #: 51044 CALLE OBISPO La Quinta, CA 92253 City of La Quinta Jul 29, 2011 Duct insulation Conditioned Floor Equipment Type1 List Minimum Efficiency2 requirement Area Thermostat p Package Unit ❑ Furnace ❑ Indoor Coil ❑ AFUE p SEER 0 ❑ COP p HSPF 7,7 ❑ R 6 (CZ 10-13) Served by system © Setback If not alreadyresent must be p ❑ Condensing Unit El EER El Resistance El 8 (CZ 14-IS) 1400sf 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 EfAciencies: 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-411 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-611 shall also be on site for final inspection. D 1. HVAC Changeout Required Forms: . All HVAC Equipment CF-611 forms: MECH-04, MECH-2I-HERS and (fer s..ck ,-.,,.«,.ms) Mci-4_2r44&ec replaced CF-411 forms: MECH-21 --a (f__ split systems) MEG14 2 • Condenser Coil and /or CF-6R forms: MECH-04, MECH-21-HERS and (09F split systems) MEGH 29 HERS . Indoor Coil and /or ,. CF-4R forms: MECH-21 and (fee: ,...°,k systems) MC!`LI_2 . Furnace f t. 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 0 2. Duct systems with less than 40 linear feet in unconditioned space, or ❑.3. Existing duct systems are`constructed, insulated or sealed with asbestos ❑ 4. Thesystemwill not be Dulled (ie.D.uctless)Mim-SptitSystem) (Also Exempt=fromRef.�igerant=Charge) ❑ 2. New HVAC System Required, forms.` .Cut inlor4Changeout with,' %t fa- r;._ new duc&.s'(all new ducting and all new CF 6R forms ,.MECH-04, MECH 20 HERS, and�(for split systems) MECH=22 HERS; and'MECH-25-HERS CF 4R forms' *MECH 20, an&(for split system's) MECH-22, and='MECjH 25 s . 71; qC equiprg6t)_ `fit . .• 1. M For Split Systems: Duct leakage <6 percent' RC;'CCA� 350`CFM/t6n; FWD'TMAH, SIMS, and either HSPP or PSPP. For Packaged Units: Duct leakage:<.6 percent ❑ 3.-New'bucts with/or without Required Forms: Replacement N I: . Includes replacing or installing all new ducting and/or outdoor condensing unit and/or indoor CF-611 forms: MECH-04, MECH-20-HERS, and (for split systems) MECH-25-HERS coil and/or furnace. No or some equipment 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-611 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 Re u ions. • The design features identified on this Cert' ce are consistent with the information documented on other applicable compliance forms, worksheets, ans and s ec" is qs �VPVTITkfto the enforcement agency for approval with the permit application. Name: Kevin Robins n `-"' ° " ' ' Signature: Kevin Robinson Company: I ANTHO YI ME_A N O & FAIR ONDirIONING Date: Jul 29, 2011 Address: 72216 NO H SHOR STTr101 i� License: 777794 City/State/Zip: THO SAND PA'L`M / CA I �9�2 76 Phone: (760) 328-8096 t-urt vNl•� "M.1r, 11���j-- Reg: 211-A0038486A-00000000-b000 Regis 2008 Residential Compliance Forms Date/Time: 2011/07/29 15:38:05 HERS Provider: CalCERTS, Inc. July 2010 ,7.'. __w R 2560 • \ O W. m m10 — STREET—IWO— W o. C. T. 5 156.05 28.9 30 T � W J � \ yej 3 / W I ey -I c..AA N Z'N OO� r O SAA r'n 0 8@- r � a Ln _. r' z r v; SZr r+) N Z•.. � NNS —N� N'Z v.N r z�w • r -c Bin # :City of 'La- Quinta` . Btri1ding,8t Safety Division P:O..•Box 1504;;78 495 Calle'Tampico. Permit # La Quetta, CA 92253 (760) 777T7012 Bu►lding'Pe kt Application and:Tracking','Sheet _. b,p ii Project Addres . 1V� S« c c _� F0 Owner's Name. ` P; ; D 1 A. P. Number:r Addiess: Legal Description: City, ST; Zipy . R Contractor. ii'L:\ S•'.n::?;4{jai i£M:S Telephone:? 6 zA NfSL< /, 65'7 -` Address: 72216 NORTH SHORE 8T STE 101• _ •Project Description: K City, ST, Zip: ItV Telephone: a. <t <ss 'State Lic. # :�� City tic.#. U " Arch., Engr., Designer: Address: «. City., ST, Zip: i Telephone:. r $, ,» ri f >a z r Constructton Type: Occupancy: :••:.;. � , Pa c� ircl:e , one): New Add'n Alter „ , Rep air Demo State Lic. #: <}r,.,.... F. ,,��Project Name of Contact Person: Sq. Ft.: #'Stories: #Units: Telephone # of Contact Person: Estimated Value of Pmiect: vAPPLICANT:.DO-NOT:WRITE%ELOW THIS LINE" # Submittal-' Req Id Recd 'x TRACKING.'' _ PERMIT FEES Plan Sets Plan Check subinttted .T Item Amount StructuraLCalcs. Reviewed, ready for corrections PIaa.Check Deposit Truss Calcs. Called Contact Person Plan"Check Balance. Title 24 Calcs. Plans picked up Construction Flood plain pian Plans resubmitted , Mechanical Grading plan 2" Review,,ready,for, corrections/issue Electrical Subcontactor List Called Contact Person Plumbing Grant Deed Plans'oicked up S.M.I. H.O.A. Approval Plans resubmitted Grading IN HOUSE:- - 4..'Reyiew ready Cor correctionsrssue " eeveloper Impact Fee Planning Approval 'Called Contact Person' A.I.P.P. Pub. Wks. Appr Date of permit issue School Fees Total Permit Fees o0t