12-1346 (MECH)P.O. BOX 1504 .
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: L2-0000134 6
Property Address:79785 OLYMPIA FIELDS
APN: 775-152-045- - -
Application description: MECHANICAL
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 11180
T,"it 4 4,Q"
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
HOVEN JOHN P/CHERYL TRUST
79785 OLYMPIA'FIELDS
LA QUINTA, CA 92253
Contractor:
Applicant: Architect or Engineer: HYDES
42949 MADIO STREET
INDIO, CA 92201
(760)360-2202
Lic. No.: 906115
_w l
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 Prof ssionaI Code, and my License is in full force and effect.
Lice a Class�:]C20 C36 License No.: 906115
(n1ractor:
( 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 morethan five hundred dollars ($500).:
(_ 1 1, 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 contractor(s) licensed
" pursuant to the Contractors' State License Law.l.
(_ 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, Civ. C.).
Lender's Name:
Lender's Address: _
LQPERMIT
VOICE (760) 777-7012
�^ FAX (760) 777-7011
I ECTIONS (760) 777-7153
Date:. . 11/13/12
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.
ALI 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 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 s bject to the wo ers' compensation provisions of Section
"3700 of thp Labor Code, I sha fo with co Code, l with comp�h tho rovisiotho rovisions.
gate: pplicant:
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 1$100,0001. 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.
I.. 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 co my ordinances and state laws relating to building construction, and hereby authorize representatives
of hi c ty to ante ;upon above-mentioned property for inspec ' p oses.
ate: r" Applicant or Agent):
QS
Application Number 12-00001346
Permit MECHANICAL
Additional desc .
Permit Fee ." .40.50 Plan Check Fee..
10.13
Issue Date . . . : Valuation
0
Expiration Date 5/12/13
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
HVAC CHANGE -OUT: 5 TON COMPLETE" SYSTEM, -
FURNACE, CONDENSER, COIL. 2010 CODES.
Other Fees. . . . . . . . BLDG SIDS 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
LQPERMIT -.
"
Simplified Prescriptive Certificate of Compliance: 2008 Residential HVAC Alterations- CF-lR-ALT-HVAC
Climate Zones 10 - 15
Site Address:
Enforcement Agency:
Date:
Permit 7
79-785 Olympia Field La Quinta, CA 92253
City of La Quinta
Nov 8, 2012
Duct insulation
Conditioned Floor
,.•
Equipment Typel
List Minimum Efficiency2
requirement
Area
Thermostat
p Package Unit
® Furnace
® AFUE 78%
❑ COPp
R 6 (CZ 10-13)
Served by system
® Setback
® Indoor Coil
® SEER 13.0
[3HSPF
[3R 8 (CZ 14-15)
2000 sf
if not 2Iready present, must be
® Condensing Unit
p EER
[3Resistance
installed)
❑ Other
—
I -
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 copyof the CF -111
and CF -611 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 -411 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
CF4Rforms: MECH-21 and (for split systems) MECH-25
.
For Split Systems: Duct Ieakage3 T15:percent; RC, CCA _< 300 CFM/ton (Minimum Air Flow Requirement), TMAH
eRt
Exempted from duct leakege.testingvjif -
jp 1`'D'u`ct system was.documented-to have been previously sealed and confirmed through HERS verFication, 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:aThesysternvvill not beDucted (ieDuctlesMmi4SglitSystem) (Also Exempt fromRefrager�ant Ca;rge)
❑ 2: Nev6HVAC Systerin Regwr`edlForms��«>_c�
. Cut mfor Changeout with , ...
`CF 6R forms ,MECH 04 MECH=20 HERS, and�(for split systems) MECH=22 HERS; nand x .
ducts
new (allnew c ;MECHi25°HERS . v d .fir tic s IL
ducting and all new CF 4R forms 20 Addi(for tems)"MECH ,H'25
MECH splits 22, and`MOR
E
equipment)
For Split Systems `Duct leakage ..< 6 percent, RC SCCA > 350 CFM/ton; F1ND TMAH STMS, and either HSPP 6VPSPP "Y ,
` '
For. Packaged Unit's Ductleakage;<'6 percents + w `" �''" • `' -
❑ 3. NewDucts with/or,,without:k
Required Forms:
Re facement N'
.Includes replacing; or ms011ingtall:new,.
ducting and/or outdoor condensing unit
CF -6R forms: MECH-04, MECH-20-HERS, and (for -split systems) MECH-25-HERS
and/or indoor coil and/or furnacet.No.or some
CF -4R 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
CF -6R forms: MECH-04, MECH-2I-HERS
linear feet of duct in 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 design identified on this Certificate of
Compliance.
• I certify that the energy features and performance specifications for the design identified on this Certificate of Compli ince 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: Nov 8, 2012
Address: 42-949 MADIO STREET : Licensee: 906115
City/State/Zip: INDIO / CA / 92201 - Phone: (760) 360-2202
' Reg: 212-A0062961A-000000000-0000, Registration Date/Time: 2012/11/08.16:51:05 HERS Prc-vider: CalCERTS, Inc.
2008 Residential Compliance Forms' July 2010
I
Bin #
Permit #
Project Address: ?CT -7
A. P. Number:
City of La Ouinta
Building 8L Safety Division
P.O. Boz 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and TracMng Sheet
(/a Owner's Name:
Address:
City' ST' Zip; ^ 10
>M
Contractor: �r / I
Address:
City, ST, Zip.
!�
77
Telephone: 6
State Lic. # : ('t Ocl tCity
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone:
N
Lic. #:
Project Description:
1-1
26,
�-T
Total Permit Fees
Construction Type:
-3ccupancy:
State Lic. #:
Name of Contact Person:
Project type (circle one):
New Aden Alter air
Repair Demo
Telephone # of Contact Person:
Sq. Ft.: # Stori s: # Units:
Estimated value of Project.
APPLICANT: DO NOT WRITE BELOW THIS LINE
_TRACKING
# Submittal Req'dTReviewed,
Plan Sets
PEItMIT FEES
mitted
Structural Calcs.
y for corrections
Item Amount
Truss Calcs.
Plan Checb Deposit
Person
Energy Calcs.
Plan Check Balance
Flood plain plan
Constructim
Plans
Plans resubmitted
plan'
Mechanical!Grading,
Review, ready for correctioosrssue
Subcontactor List
Electrical
Called Contact Person
Grant Deed
Plumbing
Plans picked up
H.O.A. Approval
Plans resubmitted
S.M.I.
INHOUSE:-
Grading
3b Review, ready for corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person
Pub. Wks. Appr
A I.P.P.
Date of permit issue
School Fees
Total Permit Fees