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