10-1066 (MECH)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
o.
Application Number: 10-00001066
Property Address: 79075 OCOTILLO DR
APN: 604-264-004-66 -23,913 -
Application description: MECHANICAL
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 9000
Applicant:
T`h '4 Q94&
, f4
Architect or Engineer:
X4d`
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LICENSED CONTRACTOR'S DECLARATION
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
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 Bu iness and rofessionals Code'
and my license is in full force and effect
.
_License Cas C2 ens
De No.: 686310
ate/ % ontr.ctor: j
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 (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 ($5001.:
(_) I, as owner of the property, or my employees with wages as their solecompensation, 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 1, 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.). .
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 fending 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:
SHIGEMASA FRED T
79075 OCOTILLO DRIVE
LA QUINTA, CA 92253
'(760)772-9447
Contractor:
GENERAL AIR CONDITIONING
31170 RESERVE DRIVE
THOUSAND PALMS, .CA 92276
(760)343-7488
Lic. No.: 686310
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 10/14'/10
f "F
ocT 1 * 2010
CITY OF LA 4WNTA
-----------------------------------------------
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 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,Al should become subject to the workers' compensation provisions of Section
700 of the Loil,ode, I shH I forthw
i
th compl with those provisions.
Da[ Applicant V\
WAR NG: tAILURE TO SECURE W RKERS' 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 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 this cou ' y to ter upon the above-mentioned propear i coo/n p/uurrposes.
Date' ignature (Applicant or Agent): ['
Application Number. 10-00001066
Permit . . MECHANICAL
Additional desc
- =
' Permit Fee 33.00 Plan Check,Fee
8.25.
Issue Date Valuation
0
Expiration Date 4/12/11
Qty Unit Charge -Per
Extension
BASE FEE
15.6.0-
1.0'0 '9.0000 EA MECH FURNACE <=100K
9.00
1.00 p,QQnn Fa mFru R/r, i-iy4p'/lnnK RTTT'
9 nn
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Special Notes and Comments
HVAC CHANGE OUT 13 SEER 2.007 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 1.00
.8.25
Other Fee Total 1.00• .00 .00
-1.00`
Grand Total 42.25 .00 .00
r ,
42.25
Simplified Prescriptive Certificate of Compliance: 2008 Residential HVAC
Alterations CF-ALT-HVAC
Climate Zones 10 - 15
Site Address:
Enforcement Agency:
Date:
Permit #:
79075 OCOTILLO DR La Quinta, CA 92253
City of La Quinta
Oct 14, 2010
Equipment Typel
List Minimum Efficiency2
Duct insulation
requirement
Conditioned Floor
Area
Thermostat
❑ Package Unit
0 Furnace
0 Indoor Coil
® AFUE 00
® SEER 13.0
❑ COP
❑ HSPF
❑ R 6 (CZ 10-13)
Served by system
® Setbeck
If not already present,
0 Condensing Unit
❑ EER
❑ Resistance
❑ R 8 (CZ 14715)
1900 sf
must be installed)
❑ Other
1. Equipment Type: Choose the equipment being Installed; if more than one system, use another CF-IR-ALT-HVAC fnr 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-611 and registered CF-4R forms (no hand filled CF-4Rs allowed) are filled out and sgned.Beginning
October 1, 2010, a registered copy of the CF-111 and CF-611 shall also be on site for final inspection.
0 1. HVAC Changeout
Required Forms:
• All HVAC Equipment
CF-6R forms: MECH-04, MECH-2I-HERS and (for split systems) MECH-25-HERS
replaced
CF-4R 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-4R 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
For Packaged Units: Duct leakage < 15 percent
Exempii d'from duct leagage testing if:
C31. Dud system was documented to have been previously sealed and confirmed through HERS verification, or
[12. Dud systems with less than 40 linear feet in unconditioned space, or
❑ 3. Existing ductsystems are,construded;`insulatedTorsealed^with-asbestos
.m..
El 2. New HVAC' ..
system
Required Forms ""`, �� "
".
.Cut in on Changeout
with new duds: (all
new ductin 9>allf
' * )
CFF6Rsforms MECH 04, MECH 20 HERS, nd (for split systems) MECH 22 HERS, and",
a
;MECH-25HERS'�i 1� ,� ..�
new equ`ipmenC) '
CF 4R forms�MECHr-20 4 (for split systems) MECH 22, and MECH,251°
x r z ,':. .
For Split Systems: Dud leakage < 6, percent;'RC`CCA'z 350 CFM/ton, FWD, TMAH, SIMS, and either HSPP or PSPP.
For Packaged.Units: Dud leakage <;6 percent
❑ 3. New Uucts'with%or Without
Required Forms:
Replacement
. Includes replacing or installing all
new ducting and/or outdoor
condensing unit and/or indoor coil
CF-6R forms: MECH-04, MECH-20-HERS, and (for split systems) MECH-25-HERS
and/or furnace. No or some
CF-411 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: Duct leakage < 6 percent
❑ 4. New Ducting over 40 feet
Required Forms:
. Includes adding or replacing more
than 40 linear feet of duct in
CF-6R forms: MECH-04, MECH-2I-HERS
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 desigr 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 ether applicable
compliance forms, worksheets, calculations, plans and specifications submitted to the enforcement agency for approval with the permit
application.
Name: Danielle Garcia Signature: Danielle Garcia
Company: HARRISON ENTERPRISES INC Date: Oct 14, 2010
Address: 31-170 RESERVE DRIVE STE A License: 685310
City/State/Zip: THOUSAND PALMS / CA / 92276 Phone: (760) 343-7488
0
Reg: 210-A0019907A-00000000-0000 Registration Date/Time: 2010/10/14 13:57:34 HERS,Provider: CalCERTS, Inc.
2008 Residential Compliance Forms March 2010
W.
Ein #
06i Of La Q[ Int-a
Building 81 Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-70124
Building Permit-Application and. Tracking Sheet
Permit # \\_
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Project Address: V ! S �Lj-�I (p �'
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ame: �.� � 1 Y:L�SG\ •
A. P. Number:
7Addres
`1i(?'�� 6GOti-� 110Legal
Description:
Contractor.sz°4
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Telephone 7(oC) �>
Address:
Project Description: �-VAil
City, ST, Zip: O U Sq 1'L & It l 0TW—ko(j
[�
Tele hone� v/,
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State Lic. # : (Of6� •3� 0
City Lic. #; '
Arch., Engr., Designer:
Address:
City., ST, Zip:
y'.:'i}:,
Telephone:'. ,.�; ��'�:s-��,••�'t�,•.''�,,t:
State Lic. #..t;.r;: >..,..,<•,:;:,t#:.Hsti..
• • r-'�%"'•;:��•."`>�,,,�::.,%•�^'!'••c•
-
Construction Type: Occupancy:
"Project circle one): Ne Add'n Alter Repair Demo.
Name of Contact. Person:
Sq. FL:
# Stories:,
# Units:
Telephone # of Contact Person:
Estimated Value of Project:
APPLICANT: DO. NOT WRITE. BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACKING PERMIT FEES
Plan Sets
Plan Check submitted
Item Amount
Structural Cafes.
Reviewed, ready, for corrections
Plaa Check Deposit
Truss Cale S..,
Called Contact Person
Plan. Check Balance
Title 24 Calcs.
Plans picked no
- Construction
Flood plain plan
Plans resubmitted
MecBanical
Grading plan
2°" Review, ready for correctionslissue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up.
SMA.
HAA. Approval
Plans resubmitted
Gra -ling
IN
'"' Reyiew,.ready for corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees