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13-0587 (MECH). 1 P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA,..CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT BUILDING PERMIT Application Number: Property Address: APN: Application description Property Zoning: Application valuation: Applicant: W� 13-00000587 79804 OLYMPIA FIELDS' 775-051-033- - - MECHANICAL LOW DENSITY RESIDENTIAL r;SSU Architect or Engineer: N '>� ----------------- 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 C36 License.No.: 906115 Date Cont" factor: 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 _) I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is riot 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 saW:). (_) 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 Law.). ' 1 I I am exempt under Sec. BAP.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: LQPERAIIT Owner: TAMARA HOFELICH 79804 OLYMPIA FIELDS LA QUINTA, CA 92253 (406)699-8505 Contractor: HYDES 42949 MADIO STREET INDIO, CA 92201 (760)360-2202 Lic. No.: 906115 •.,_, VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 lJ Date: 5/06/13 ° DMAY 07 2013 C1 ��g1C�DriyT TA WORKER'S COMPENSA ATION 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. 'wave 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 NORGUARD INS Policy Number CEWC356415 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 tot workers' compensation provisions of Section 37 0 of the Lab�or//Code, I shall forthwith c ply h those (OvisiOnS. Dat �O APPlicar 11 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 ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. APPLICANT ACKNOWLEDGEMENT IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on this application. 1 . Each person upon whose behalf this application is made, each person at whose request and Jor whose benefit work is performed under or pursuant to any permit issued as a result of this application, the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City of La Quinta, its officers, agents and employees for any act or omission related to the work being performed under or following issuance of this permit. 2. Any permit issued as a result of this application becomes null and void if work is not commenced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancellation. 'I certify that I have read this application and state that the above information is correct. I agree to co ¢ly with all city and county ordinances and state laws relating to building construction, and he y authorizer esentatives of th o o �t/o/fL7upon the above-mentioned pr�.tyifor inspe ion pur S. Date_ -s 7 / Brgnature (Applicant or Agent):/ - Application Number . . . . . 13-00000587 Permit . . . . MECHANICAL Additional desc . Permit Fee 42.50" 'Plan Check. Fee 10.63 Issue Date Valuation'.. Expiration Date .' 11/02/13 Qty Unit Charge Per Extension BASE 'FEE 15.00 1.00 11.0000 EA MECH FURNACE >100K 11.•00 1:00 16.5000 DA P•1DC'II• D/C 53j 151•IP/? 149Y.-5QQ$.DTT] i ti ;,n. " Special Notes and Comments HVAC CHANGEOUT 5 TON 13SEER/78AFUE SPLIT SYSTEM. 2010.CODES. Other Fees . . . . . . . . BLDG STDS ADMIN (SB1473)• 1.00- Fee summary Charged Paid Credited Due Permit Fee Total .42.50 .00 ..00 42•.50 Plan Check Total 10.63. .00 .00 10.63 Other Fee Total 1:00 -. .00 .00 1.00 Grand Total 54.13 .00 .0.0 54.13 Bin # City of La Quints Building o Safety Division P.O. Box 1504, 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Permit # Project Address: j Ci —30Y Owner's Name: A. P. Number. Address: Legal Description: Contractor. 2v�1 t I d l�Ga1 �o^T.5 / Telephone: Address:. PIC Project Description: G G City, ST, Zap: ef / ci ZZ d Telephone: 60_ZZe,Z State Lic. # qC76 J. "Cityc. #: �Z Arch-, Engr., Designer. Address: City, ST, Zip: Telephone: State I,io #: Construction Type: 0=paucy: Project type (circle one): New Add's Alter Repair' Demo Name of Contact Person: Sq. Ft : #Stories: #Units: Telephone # of Contact Person: Estimated Value of Project: �j l Ser APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Req'd-�. Recd TRACE3NG , PERMPI' FEES Plan Sets Plan Check submitted Item Amount Structural Cafes. Reviewed, ready for correddons Plan Check. Deposit Plan Check Balance Truss Calcs. Called Contact Person Energy Calcs. Plans picked up Construction Flood plain plan Plans resubmitted Mechanical. ceding plan Z'° Review, ready for corrections/issue Electrical Sabcontactor List Called Contact Person Plumbing Grant Deed Plans picked up SALL H.O.A. Approval Plans resubmitted Grading INHOUSE-_ '"' Review, ready for corrections/issue Developer Tmpact Fee Plannipg Approval Called Contact Person A.LP.P. Pub. Wks. Appr Date of permit issue School Fees Total Permit Fees Simplified Prescriptive Certificate of Compliance: 2008 Residential HVAC Alterations CF -IR -ALT -HVAC Climate Zones 10 - 1S Site Address: Enforcement Agency: Date: Permit #: 79-804'Olympia Field La Quinta, CA 92253 City of La Quinta May 6, 2013 Duct insulation Conditioned Floor Equipment Typel List Mirimum Efficiency2 requirement Area Thermostat ❑ Package Unit ® Furnace ® Indoor Coil ® AFUE 78% ® SEER 13.0 ❑ COP[3 [3HSPF R 6 (CZ 10-13) Served by system ® Setback If not already present, must be ® Condensing Unit ❑ EER ❑ Resistance ❑ R 8 (CZ 14-15) 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 comp+eted 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 -1R and CF -6111 shall also be on site for final inspection. ® 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 CF -6R 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 testing if: ,❑ 1. Duct system was documented to have been previously sealed and confirmed through HERS verification, 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 ❑ 4. The system will not be Ducted (ie. Ductless Mini -Split System) (Also Exempt from -Refrigerant Charge) ❑ 2. New HVAC System Required Forms: i 1 )1 i L . Cut in',or Changeout with"M * J - - _ -- CF -6R forms: MECH-04, EC-20=HERS, and (for split systems) MECH-22-HERS, and new ducts: (all new ducting and all new MECH-251HERS CF 4R forms: MECH-20, and,(for split systems) MECH-22, and MECH-25 equipment) � For Split Systems: Duct leakage <'6"percent; RC, CCA >_ 350 CFM/ton, FWD, TMAH, STMS, and either HSPP or PSPP. For Packaged Units: Duct leakage < 6 percent 113. New Ducts with/or without Required Forms: Replacement . Includes replacing or installing all new ducting and/or outdoor conctansing unit CF -6R forms: MECH-04, MECH-20-HERS, and (for split systems). MECH-25-HERS and/or indoor coil and/or furnace. No or some CF -411 forms: MECH-20 and (for split systems) MECH-25 equipment changed. I - 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 _ 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: May 6, 2013 Address: 42-949 MADIO STREET License: 906115 City/State/Zip: INDIO / CA / 92201 Phone: (760) 360-2202 y Reg: 213-A0026989A-OOOOOOaOO-0000 Registration Date/Time:,2013/05/06 12:23:53 HERS Provider: CalCERTS, Inc. ' 2008 Residential,,Compliance Forms - July 2010 {