11-0901 (MECH)41
P.O. BOX 1504
78-495 CALLE TAMPICO .
LA QUINTA, CALIFORNIA 92253
Application Number: _ Ci -f-- 6 o o oo 9 o i: _
Property Address: `--79828 OLYMPIA FIELDS
APN: 775-051-029- -
Application description: MECHANICAL
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation; i i Ann
Applicant: .7 Architect or Engineer: '
PlA
-------------
LICENSED CONTRACTOR'S DECLARATION
4 VOICE (760) 777-7012
FAX (760) 777-7011
BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date:. 8/22/11
Owner:
CHRISTINE DICKINSON ^�
79828 OLYMPIA FIELDS I
LA QUINTA, CA 9225320 1
I. hereby affirm under penalty of perjury that I am li sed under provisions of Chapter 9 (commencing with
Section 7000) of Division 3 of the Business and Pr ssionals Code, and my License is in full force and effect. -
License Class: C20 License No.: 686310
o
Date: _o/_�? / n Contractor:
NER-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 _) 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 theproperty, 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 ofthe
work for which this permit is issued (Sec. 3097, Civ. C.). -,
Lender's Name: - -
Lender's Address:
LQPERMIT
Contractor: I i
GENERAL AIR CONDITIO ING CGlTY0FtT1_- I A
31170 RESERVE DRIVE
THOUSAND PALMS, CA 92276
(760)343-7488
LiC. No.: 686310
WORKER'S COMPENSATION DECLARATION _
I her 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 EVEREST NATL Policy Number 7600006147101
_ 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 subj to the workers' compensation Iaws,of California,
and agree that, if I should become subject t he workers' compensation provisions of Section
3700 of the Labor Code, I shall forthwith ply with those provisions.
Date: !�L Applicant:. -
WARNING: FAILURE TO SECURE WORKERS' CeVPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS 1$100,0001. IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3706 OlITHELABOR 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 thekabovition is correct. 1 agree to comply with allcity and county ordinances and state laws relating to buildn, and hereby authorize representatives
of this county to enter upon the above-mentioned propertypurposes.
Date: Signature (Applicant or Agent):
Application Number 11-0000090.1-.
Permit. . . MECHANICAL
Additional desc .
' Permit Fee 40.50
P1an'Check Fee
10:13
Issue Date . . . .
Valuation . . .
0
Expiration Date 2/18/12 .
Qty Unit Charge Per
Extension
BASE
FEE
15.00
1.00 9.0000 EA MECH
FURNACE <=100K
9.00
1.00 16.5000 EA MECH
B/C '>3-15HP/>100K-500KBTU
-------------
16-50
Special. Notes and Comments
5 TON HVAC CHANGEOUT, CONDENSER,
FURNACE
& COIL AT GROUND LEVEL. 2010 CODES.
------------------ ---------------------
Other Fees . . . . . . . BLDG STDS ADMIN (SB1473)
1.00
Fee summary Charged
Paid Credited
Due
Permit Fee Total 40.50
.00 .00
40.50
'Plan Check Total 10.13
.00 .00
10.13
Other Fee Total 1.00
00, .00
1.00
Grand Total 51.63
.00 .00
51:63
_Simplified Prescriptive Certificate of Compliance:' 2008 Residential HVA C Alterations CF -IR -ALT -HVAC;
Climate Zones 10 to 15
Site Address:aa�-
13 01! 1� t O�
Enforcer ent Agency:
�$'l�—
Date:
Permit #:
Equipment T et
List Minimum Efficiency 2
Duct insolation requirement
Condi"ioned Floor
Area
Thermostat
❑ Packaged Unit
Furnace
❑ AF EL w ❑ COP
Over 40 ft of ducts added or
KSetback
Indoor Coil
❑SEER 13 ❑ HSPF
replaced in unconditioned space
Served by system
(If not already
ondensing Unit
❑ EER u
❑R 6 (CZ 10-13)
sf
present, must be
❑ Other I ❑ R 8 (CZ 14-15) installed)
I. Equipment Type: Choose the equipment being installed; if more than one system, use another CF-IR-ALT-HVACfor each'. Slem.
2. Minimum Equipment Efficiencies: 13 SEER, 78%AFUE, 7.7HSPFfor typical residential systems.
HERS VERIFICATION SUMMARY Listed below are fottr'HVAC alteration Options. The installer decide:; 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 wEs 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
si ed. Beginning October 1, 201.0, a registered copy of the CF -111 and CF -611 shall also be on site for final i-ts ection.
1. HVAC Changeout Required Forms:
O.All HVAC Equipment replaced CF -6R forms: MECH-04, MECH-2I-HERS and (for split systems) MEC.`4- 25 -HERS
CF -4R forms: MECH- 2d and fors lits stems MECH-25
• Condenser Coil and /or
• Indoor Coil and/or CF-611forms: 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
Exempted from duct leakage testing if.
❑ I. Duct system was documented to have been previously sealed and confirmed through HERS verifica':ion, or
❑ 2. Duct systems with less than 40 linear feet in unconditioned space, or
❑ 3. Existing duct systems 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 eitter 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 -611 forms: MEC14-04, MECH-2I-HERS CF -411 fcrms: MECH-21
linear feet of duct in unconditioned s ace.
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)
• 1 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.
• 1 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 I and 6 of the Califomia Code of Regulations.
• The design features identified on this Certificate of Compliance are consistent with the ' ortm tion documented on other ppl c ompliance forms, worksheets,
calculations, plans and specifications submitted to the enforcement a enc fora ro al with t e e[Tit application.
[Name:(_�
I�,aeh �(%Q cS6il Si Lure:
Company:GDate enera-( 14'1r t�Dilde f,'onr`
Address:
3117D 124Serve t License:
�'t ✓� �86,3/b
City/State/Zip:-7—����� ' /
}�a.L�S'
rr, r;Ii ga-a-%Co Phone: %�.3
"43"%Teg
Ca10ERTS - CF -1R Registration
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CONGRATULATIONS
Your CF -IR -ALT -HVAC Registration is complete!
You may want to print this page for your records.
Site Address: 9828 OLIMPIA FIELDS
La Quinta, CA 92253
CEC Registration: 211-A004286IA-00000000-0000
CF -IR -ALT -HVAC: CLICK HERE TO DOWNLOAD
Assigned Company: I HARRISON ENTERPRISES INC
Do you know your HERS Rater?
- If you do, you may want to send this CF -IR to them.
Ca10ERTS Rater ID:
OR
My Rater Quick Select: The Energuy CA LLC
Every CalCERTS rater has a license number.
If you need to find the rater by name [Click HERE] to search our directory.
I
SEND :CF -1R TO.HERS RATER I
[CLICK HERE] to do another
Copyright 02010 CalCE:RTS. Inc. All rights reserved. Revised:.lanuary 11. 2)10
[Terms and Conditions] [Privacy Statement] [Class Cancellation Policy]
CaICERTS, Inc., 31 Natoma St Suite 120, Folsom, CA 95630
Office: 916-985-3400,Toll Free: 877-HERS-R8R, (877-437-7787)
Fax: 916-985-3402 Contact Us
'a.
T
BBB ffndueonFacebookQ
rmn Tmv
hftps://www.calcerts.com/public—cflR.cftn?project—id= 8/19/2011
Bin #. .
City of La Quin to
Building 8i' Safety Mvislon
P.O. Box 1504, 78-495 Calle Tampico �y
La Qulnta, CA 92253 - (760) 777-7012
Building Perm- it-Applicaiion and. Tracking Sheet
Permit #
Project Address: -71ga-$ D �i tri 10— File,Owner's
Name: Ckr15f1 Y1. -,e— Gc.i!l
A. P. Number:
Address:$ + r a
Legal Description:
City, ST, Zip: t_.O, Q ` q
Contractor:
Address:
City, ST, Zip: k.
Telephone: 90.3 SDN
Project Description: !E; Tori V
Telephone:
CityLie. C &61) 40
State Lic. # : 3
Arch., Engr., Designer:
Address:
City., ST, Zip:
Telephone:;
State Lic. #� �
Name of Contact- Person:
Construction Type`. Occupancy:
.rte„',>:••,�i' .� .
,,,�f�•.<:;:.,�/�;:• `f! Project type (circle one): New Md'n After Repair Demo
,
OYU Sq. Ft.: # Stories: # Units:
Telephone # of Contact Person: -7& D
3 Y3 Estimated Value of Project: I ( 'L)0 .
APPLICANT: DO. NOT WRITE. BELOW THIS LINE
#
Submittal
Req'd
RWd
TRACIMG
PERMIT FEES
Plan Sets;
Plan Check submitted
Item
Amount
Structural Cafes.
Reviewed, ready for corrections
Plan Ckeck Deposit
Truss Cafes.
Called Contact Person
Plan C Teck Balance.
Title 24 Cafes.
Plans picked no
Ciinstr°,ictiod
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2°" Review, ready for correctionslissue
Electrical
Subcontactor List
Called Contact Person
Plumbing .
Grant Deed
Plans picked up.
S.M.I.
H.O.A. Approval
Plans resubmitted
GradL g
1N HOUSE:-
7rd Review,.ready for correctionsfissue
Devel-sper Impact Fee
Planning Approval
Called Contact Person
A.I.P._ .
Pub. Wks. Appr.
Date of permit issue
School. Fees .
Total Permit Fees