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10-0453 (MECH)P.O. BOX 1504 78-495 CALLE TAMPICO LA\QUINTA, CALIFORNIA 92253 Architect or Engineer: ­ ---------------- LICENSED CONTRACTOR'S DECLARATION BUILDING & SAFETY DEPARTMENT BUILDING PERMIT 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 License No.: 374937 Dat//Cl/ _ e:, J x7 Con` t`a t r:`�� 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 fora permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).: (_) 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 proving that he or she did not build or improve for the purpose of sale.). ' (_) 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 Seca , 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: HAAS LISA 48755 AVENIDA EL NIDO LA QUINTA, CA 92253 ( _ Contractor: _ PALM DESERT AIR COND CO 42081 BEACON HILL PALM DESERT, CA 92211' (760)346-0677 Lic. No.: 374937 VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 5/27/10 ------------------ 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 SOUTHERN INS Policy Number WSIO03802-01 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 to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forth wi comply with those provisions. y„Date::/z'Z Applicant: 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 appjication 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. 1 agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this county to enter upon the above-mentioned property for inspection purposes �" ^�! � i--7 n Signature (Applicant or Agent)-�- ��/Li r .4 LQPERMIT Application Number . . . . . 10-00000453 Permit . . . MECHANICAL Additional desc . Permit Fee . . . . 31.50 Plan Check Fee 7.88 Issue Date . . . . Valuation . . . . 0 . Expiration Date 11/23/10 Qty Unit Charge Per Extension BASE FEE . 15.00 1.00 16.5000 EA MECH B/C >3-15HP/>100K-500KBTU 16.50 -------------------------- Special Notes and ------------------------------------------------- Comments REPLACE (1) S.O.TON A/C CONDENSER.13 - --- - - SEER.• --- ---------------------------------------------------------------------------- Other Fees . . . . . . . . . BLDG STDS ADMIN (SB1473) 1.00 Fee summary ----------------- Charged Paid Credited Due Permit Fee Total -------------------- 31.50 -------------------- .00 .00 31.50 Plan Check Total 7.88 .00 .00 7.88 Other Fee Total 1.00 .00 .00 1.0.0 Grand Total 40.38 .00 .00 40.38 Prescriptive Certificate of Compliance: Residential CF-1 R-ALT Residential Alterations Page 1 of 1 Project Name: HAAS, LISA Climate Zone 15 # of Stories 1 General Information: Site Address: 48-775 ADA. EL NIDO, LA QUINTA, CA 92253 Date Enforcement Agency: 5/27/10 Building Type: EI Single Family ❑ Multi Family Front Orientation: ❑ N ❑ E ❑ W ❑ S Project Type: ❑ Alteration M HVAC Replacement ❑ Duct Replacement ❑ Conditioned Floor Space (CFS): NOTE: This form is not to be used for new construction or additions. HVAC Systems — Heatin : Equipment Type Capacity AFUE HSPF Duct Insulation R-Value Thermostat Type Configuration (Split or Package) N/A N/A N/A N/A SET BACK SPLIT HVAC Systems — Coolin : Equipment Type Capacity SEER EER Pipe Insulation R-Value Thermostat Type Configuration (Split or Package) AC CONDENSER 60,000 13.00 0.00 N/A SET BACK SPLIT HERS Verification Summary: Duct Sealing & Testing — HERS verification is required for this measure. ❑ Yes 0 No In Climate Zones 2 and 9-16, if more than 40 linear feet of new or replacement ducts are installed in unconditioned space, the ducts are to be sealed per §152(b)1Dii and the newly installed ducts are to be insulated per §151(1)10. ❑ Exception: Existing duct systems that are extended, which are constructed, insulated or sealed with asbestos. ❑ Yes 0 No In Climate Zones 2 and 9-16, if the existing space-conditioning system (HVAC equipment and ducting) is replaced, the ducts are to be sealed per §152(b)1 Di. 0 Yes ❑ No In Climate Zones 2 and 9-16, if the existing HVAC equipment is replaced (including the replacement of the air handler, outdoor condensing unit of a split system, cooling or heating coil, or the furnace heat exchanger) the ducts are to be sealed per §152(b)1 E. O Exception: Duct systems that are documented to have been previously sealed confirmed through HERS verification in accordance with procedures in the Reference Residential Appendix RA3. ❑ Exception: Duct systems with less than 40 linear feet in unconditioned space. ❑ Exception: Existing duct systems are constructed, insulated or sealed with asbestos. Refrigerant Charge — Split System — HERS verification is required for this measure. Ll Yes ❑ No In Climate Zones 2 and 8-15, when the existing HVAC equipment is replaced (including the replacement of the air handler, outdoor condensing unit of a split system A/C or heat pump, cooling or heating coil, or the furnace heat exchanger) a refrigerant charge measurement shall be verified per §152 b 1 F. Central Fan Integrated (CFI) Ventilation System and Fan Watt Draw The ventilation requirements of §150(o) do not apply to existing residential homes. Ducted Split Systems — Air Conditioners and Heat Pumps: Airflow — HERS verification is required for this measure. ❑ Yes EI No In Climate Zones 10 through 15, when the existing space-conditioning system (HVAC equipment and ducting) is replaced, the airflow and fan watt draw shall be verified per 152 b 1 Ci to meet the requirements of §151(07B. Documentation Author's Declaration Statement I certify that this Certificate of Compliance documentation is accurate and corn I Name: KARL BROWN Signature: Company: PALM DESERT AIR CONDITIONING & HEATING COM ANY Date: 5/27/10 Address:42-081 BEACON HILL City, State, Zip Code: PALM DESERT, CA 92211 Phone: (760) 346-0677 Registration Number: Registration Date & Time: HERS Provider: 2008 Residential Compliance Forms PDAC January 2010 Bin # City of La Quinta Building Sr Safety Division P.O. Box 1504, 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 Permit Application and Tracking Sheet Permit # �C),jBuilding Project Address: 48-775 ADA. EL NIDO Owner's Name: HAAS, LISA A. P. Number: Address: 48-775 ADA. EL NIDO Legal Description: City, ST, Zip: LA QUINTA, CA 92253 Contractor: Palm Desert Air Conditioning & Heating Company Telephone: Address: 42081 Beacon Hill Project Description: City, ST, Zip: Palm Desert, CA 92211 REPLACE ONE 1 5.0 TON AC 760 346-0677 Telephone: ( ) R. CONDENSER. State Lic. # : 374937 City Lic. #. 100886 Arch., Engr., Designer: Address: City., ST, Zip: Telephone: State Lic. #: Name of Contact Person: KARL BROWN Construction Type: Occupancy: Project type (circle one): New Add'n Alter Repair Demo Sq. Ft.: # Stories: # Units: Telephone # of Contact Person: ( Estimated Value of Project: 3,525 APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Req'd Recd TRACKING PERMIT FEES Plan Sets Plan Check submitted Item Amount Structural Cales. Reviewed, ready for corrections Plan Check Deposit Truss Calcs. Called Contact Person Plan Check Balance Title 24 Calcs. Plans picked up Construction Flood plain plan Plans resubmitted Mechanical Grading plan tad Review, ready for correctionsAssue Electrical Subcontactor List Called Contact Person Plumbing Grant Deed Plans picked up S.M.I. H.O.A. Approval Plans resubmitted Grading IN HOUSE:- '"' Review, ready for corrections/issue Developer Impact Fee Planning Approval Called Contact Person A.I.P.P. Pub. Wks. Appr Date of permit issue School Fees Total Permit Fees