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12-0510 (MECH)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: 12-00000510 Property Address: 77040 AVENIDA FERNANDO APN: 658-240-009- - Application description: MECHANICAL Property Zoning: LOW DENSITY RESIDENTIAL Application valuation: 6000 Applicant: Architect or Engineer: pt 1C BUILDING & SAFETY DEPARTMENT BUILDING PERMIT LICENSED CONTRACTOR'S DECLARATION It affirm under pen ty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Divisiop o Business and Professionals Code, and rcense is in full force and effect. License Class: 1 0.: 619091 ate:�ontractor: 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, 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 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.). (_) 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 Owner: KAVIER 77040 AVENIDA FERNANDO LA QUINTA, CA 92253 Contractor: PALOMA AIR CONDITIONING P.O. BOX 3501 PALM DESERT, CA 92261 (760)34771212 Lic. No.: 619091 VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 5/08/12 tA Y 08 2012 CITY OF LA QUINTA FINANCE DEPT. 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 EVEREST NATL Policy Number 7600007550111 _ 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 aQQQQree hat,�shouId become subject to the workers' compensation provisions of Section 370fd,e:- a Labor Code; I shall forthwith comply with provisions. ate: �bj cant: -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 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 IN liiea ind s hat the above information is correct. I agree to comply with all city and county ordinances Kd state laws relating to building construction, and hereby authorize representatives of this c my o�pter upo�e above-mentioned property for inspection purposes. ;P re (Applicant or Agent): Application Number .. . . . 12-00000510 Permit . . . MECHANICAL Additional desc . Permit Fee . . . . 40.50 Plan -Check Fee .. 10.13 Issue Date Valuation . . . . 0 Expiration Date 11/04/12 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 HVAC CHANGE -OUT, INSTALL NEW PACKAGE UNIT, 13 SEER. 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' LQPERMIT Simplified Prescriptive Certificate of Compliance: 2008' Residential HVAC Alterations CF-IR-ALT-HVAC Climate Zones 10 - 15 Site Address: Enforcement Agency: Date: Permit #: 77-040 AVENIDA FERNANDO La Quinta, CA 92253 City of La Quinta May 2, 2012 Duct insulation Conditioned Floor Equipment Type1 List Minimum Efficiency2 requirement Area Thermostat 0 Package Unit ❑ Furnace [I Indoor Coil 0 AFUE 78% 0 SEER 13.0 ❑ COP ❑ HSPF ❑ R 6 (CZ 10-13) Served by system 0 Setback If not already present, must be ❑ Condensing Unit ❑ EER ❑ Resistance ❑ R 8 (CZ 14-15) 1500 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, Z7HSPF 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-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-6R shall also be on site for final inspection. 0 1. HVAC Changeout Required Forms: . All HVAC Equipment CF-611 forms: MECH-04, MECH-2I-HERS replaced CF-4R forms: MECH-21 -Ra (f ff Split Systems) MEG14-2 . Condenser Coil and /or . Indoor Coil and /or CF-611 forms: MECH-04, MECH-2I-HERS _.,a (o„r split ,.,,..t.,ms) WGI4 25-14SoS . Furnace CF-40-16rms: MECH-21 For Packaged Units: Duct"leakage < 145 percent Exempted from duct leakage testirig�if ❑ 1 Quctsystem was documented fo have been previously sealed and confirmed through' HERS verification, or p.2,;QLctsystems.with.less,than40,'linear feet in unconditioned space, or ❑ 3 Existing duct systems are`.;constrti,cted, insulated or sealed. with asbestos . ❑ 4 The s steIll not be Ducted (ie�D ctless Mini=Split{Systemj(Also ECerptfrpmRefgeant Charge) r ❑ 2 New�HYAC§ystem Requi ed Forms r• W ; :.. ,: .Cut mM rhangeout wi .;t new dii'ctsF (all new sa- 6R o MACH 04, MCH20HERS" nd :forsplitaystems) MEC, Z2 NERS, and ductlni3IIs� all n NIEC(i`i 5'HELtS 4 CF-4i2fo s;' MECH 20, nd{for spits stems MECH,-22, nd;:MECH,25�» equipment) x. e ..• r. For Split Systems xDucC leakages< 6; percent,-SRC TGA,�,350'CFM/atom; FWD„�TMAH; STMS, and either HSPP'or PSPP. For Packaged Units :Duct s leakageNc- 6,percent �:3 New`Dutts wrth/or: without Required Forms: Replacements”, . Includes. replacing or installing all "new ducting and/or outdoor condensing unit CF-611 forms: MECH-04, MECH-20-HERS, and (for split systems) MECH-25-HERS and/or indoor coil and/or'furnace N6: or some , CF-4R forms: MECH-20 and (for split systems) MECH-25 equipment changed. kx For Split Systems: Duct leakage <­6 percent; RC, CCA z 300 CFM/ton, TMAH For Packaged Units: Dud 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 dud in unconditioned space. CF-4R forms: MECH-21 For split system or packaged units: Dud leakage < 15 percent ❑ EXCEPTION: Existing dud 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 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: Herman Paredes Signature: Hemran Paredes Company: PALOMA AIR CONDITIONING Date: May 2, 2012 Address: P 0 BOX 3501 License: 619091 City/State/Zip: PALM DESERT / CA / 92261 Phone: (760) 347-1212 Reg: 212-A0021951A-00000000-0000 Registration Date/Time: 2012/05/02 14:50:10 HERS Provider: Ca10ERTS, Inc. 2008 Residential Compliance Forms July 2010 Bfn.# Q 0f LC( Qulnta Bulung & Safety Division P.O. Box 1504,'78-495 Calle Tampico La,Quinta, CA 92253 -:(760) 777-7012 Building Permit Application and Tracking Sheet Permit # ` J. Project Address: 7 f�pG uv' er's Name:. A. P. Number. Address: v tti S U�1% ' Legal Description: City, ST, Zip: Contractor. m (OUA Telephone: Address: 0 (-Q Project Description: City, ST, Zip: mV C /► �/2 Z 8 i . / r� Q l ILL 4� / Telephone: 7 3/ L, <. %\. State Lie. #: [P i D ell City Lia M. Arcfr., Engr., Designer. Address: City., ST, Zip: Telephone: State Lie. Name of Contact Person: v ' ; ^ Construction Type:. Occupancy: Project type (circle one): New Add'n Alter Repair Demo Sq. Ft.: # Stories: # Unitp: Telephone # of Contact Person: ep Estimated Value of Project V APPLICANT: DO NOT WRITE BELOW THIS UNE # Submittal Rcq'd Reed TRACKING PERMrr FEES- Pip Sets Plan Check submitted Item Amount Structural Cales Reviewed, ready for corrections Plan Check Deposit. 'Russ Cates. Called Contact Person Plan Check Balance" Title 24 Cates. Plans picked up Construction " Flood plain plan Plans resubmitted Mechanical Grading plan 2`r Review, ready for correctionsliissue Electrical Sobcoatactor List Called Contact Person Plumbing Grant Deed Uplans picked up S.M.I. H.O.A. Approval Plans resubmitted Grading IN HOUSE:- 1n° Re"view; ready for corrections/issue Developer Impact Fee Planning Approval Called Contact Person AXP -P. Pub. Wks. Appr ' Date of permit Issue School Fees Total Permit Fees