10-0740 (MECH)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 10-00000740,
Property Address: 77205 AVENIDA FERNANDO
APN: 658-230-047- -
Application description: MECHANICAL
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 5961
Applicant:
T4tvl 4 4 a"
Architect or
Engineer:
ct
/ vh_
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
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 B siness Professionals Code, and my License is in full force and effect.
License Class: C10 C16 .C2 License,,19.: 4 7554
Date: Contractor. �'�
%Ia, 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 pioving that he or she did not build or
improve for the purpose of sale.).
1 _ 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.).
(_ 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
Owner:
VICK GARY
77205 AVENIDA FERNANDO
LA QUINTA,, CA 92253
(
PREFERRED PLUMBING H
P.O. BOX 5120
PALM SPRINGS, CA 922
(760)322-3173
Lic. No.: 457554
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date
8/09/10
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 OAK RIVER INS Policy Number 2200056449-101
_ 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 ecome subject to the workers' compensation laws of California,
and agree that, if I should omubjectto the wor rs co pensation provisions of Section
3700 of the Labor Code shall f We shwit rip
i os provisions. _
Date�tApplicant:
WARNING: FAILURE TO SEC RE WORKER COMP NSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENAL 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 this application and state that the abov ' ormation is correct. I ape to comply with all
city and county ordinances and state laws relating to building truction, and hereb th riz representatives
of this county ttoj enter upon the above-mentioned property f nspect' purpo e .
Dat +e� Signature (Applicant or Agent):
/y
LQPERMIT
Application Number . . . 10-00000740
Permit . . . MECHANICAL
Additional desc .
Permit Fee . . . .
42.00
Plan Check Fee
10.50.
Issue Date . . . .
Valuation . . .
. 0
Expiration Date
2/05/11
Qty Unit Charge
Per
Extension
BASE
FEE
15.00
1.00 9.0000
EA MECH
FURNACE <=100K
9.00
1.00 9.0000
EA MECH
APPL REP/ALT/ADD
9.00
1.00 9.0000
EA MECH
B/C <=3HP/100K BTU
9.00
----------------------------------------------------------------------------
Special--Notes arid—Comments
-- -- --"
-""_._.._ ...................._....__.._.
REPLACE 4 TON A/C UNIT.
13 SEER, LIKE FOR
LIKE & INDOOR COIL.
-------------------------------------------------------------------=---------
_ `:Other Fees . . . .
. . . . BLDG STDS ADMIN (SB1473)
1.00
_ 'F.ee:summary Charged
Paid Credited
Due
--- ------7-- ------- ----------
0_10. .Permit " Fee Total . 0::
----------
42.00
---------- ----------
- . 00 .00
42.00
Plan Check Total 5
10.50
.00 .00
10.50
Other Fee Total.- _
1.00
.00 .00
1.00.
Grand Total
53.50
.00 .00
53.50
i
Simplified Prescriptive Certificate of Compliance: 2008 Residential HVACAUerations CF -IR -ALT -HVAC
Climate Zones 10 to 15
Site Address:
Enforcement Agency:
Date:
Permit #:
Conditioned Floor
Equipment T er
List Minimum Efficienc 2
Duct insulation requirement
Area
Thermostat
❑ Packaged Unit
urnace
AFUE 8d
13 cop
copHSP
Over 40 Aof ducts added or
replaced in unconditioned space
Served by system
Setback
(If not already
Indoor Coil
SEER /-3
❑
❑ R 6 (CZ 10-13)
S0 sf
present, must be
ondensing Unit
EER JLdS
❑Resistance
❑ R 8 (CZ 14-15)
installed)
❑ Other
1. Equipment Type: Choose the equipment being installed; if more than one system, use another CF -1 R -ALT -HVAC for each system.
2. Minimum Equipment Efficiencies: 13 SEER, 78% AFUE, 7.7HSPF for typic',al 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 -61K and registeredlCF-4R forms (no hand filled CF-4Rs allowed) are filled out and
si ed. Beginning October 1 2010 a registered copy of the CF -1R and CF -6R shall also be on site for final inspection.
1. HVAC Changeout
Required Forms: j
• All HVAC Equipment replaced
CF -6R forms: MECH-04, MECH-2I-HERS and (for split systems) MECH- 25 -HERS
CF -4R forms: MECH- 21 and fors lits stems MECH-25
• Condenser Coil and /or
CF -6R forms: MECH-2I-HERS and (for split systems) MECH- 25 -HERS
• Indoor Coil and /or
CF -4R 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
For Packaged Units: Duct leakage < 15 percent ;
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 ducts stems 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-20-1 (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 either 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 -611 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
linear feet of duct in unconditioned space.
CF -611 forms: MECH-04, MECH-2I-HERS CFAR 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)
• 1 certify that this Certificate of Compliance documentation is accurate and complete. ,
• 1 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,
calculation glans and specifications submitted to the enforcement agency fora roV,al with the permit applicafion.
Q�
Naame:\\
Signature:
// / r(
/i�� 2rl¢b lv✓ It
Date:
Address: `
Licens :
7-,e
City/State/Zip1�% %, r✓� �/ ' -G'
Phone:
2008 Residential Compliance Forms March 2010
Bin # City of La QU'inta
Building U Safety Division
P O Box 1504 78-495 Calle Tam Irn
Permitfl
-Building P
Project Address:'
A. P. Number:
Legal Description:
Preferred Air Conditioning dba
Contractor: preferred Plumbing. Heating
Address: PO Box 5120
City, ST, Zip:paim Springs, CA ' 92263
R
Telephone: (7 6 0) 322-'3173
State Lie. #: 4 5 7 5 54 City Lie. #'-
Arch., Engr., esi er• JLaa ' v.,-
Address:
.Address:
City, ST, Zip: ' C� �•r�
Telephone: % a �3� 9. — 17
State Lie.
Name of Contact Person:
Telephone # of Contact Person:
Quinta, CA 92253 - (760) 777-7012
ermit Application and Tracking Sheet
Owner's Name: U
Address:
City, ST, Zip:
o r ;- Telephone: ?
Project Description:
APPLICANT: DO NOT W 06
7Q Al .
Construction Type: Occupancy:
Project'type (circle one): New Add'n�/ t Repair Demo
Sq. Ft.: oQ # Stories: # Units: I
Estimated Value of Project:
RITE BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Ite
Amount
Structural Calcs.
Reviewed, ready for corrections
P12Check Deposit
Truss Calcs.
Called Contact Person
Play Check Balance
Energy Calcs.
Plans picked up
Con itruction
Flood plain plan
Plans. resubmitted
Mec anicsl
Grading, pian'
2"" Review, ready tor'correctionsrssue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M I.
A.O.A. Approval
Plans resubmitted
Gra ing
IN HOUSE:-
''� Review, ready for correctionsdssue
Dev toper Impact Fee
Planning Approval
Called Contact Person
A.1.1 I.P.
Pub. Wks. Appr
Date of permit issue
school Fees ' 71
Fees