13-0746 (MECH)— P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
13-00000746
Property Address:
52570 AVENIDA JUAREZ
APN:
773-281-004-20 -000000-
Application description:
MECHANICAL
Property Zoning:
COVE RESIDENTIAL
Application valuation:
8221
Tl&f 4
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Applicant: Architect or Engineer:
�o•t'[��-fit. �!�
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 Professionals Code, and my License is in full force and effect.
License Class: C20 License No.: 968141
T Date: (7 �3 Contractor:
OWNER -BUILDER DECLARATION
1 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 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.).
(_ 1 1 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
INSPECTIONS (760) 777-7153
Date: 6/17/13
Owner:
ANDREW MOGENSEN
52570 AVENIDA JUAREZ
LA QUINTA, CA 92253
Contractor: �L
DCS AIR CONDITIONING
72078 CORPORATE WAY, #101 of �pQU1NTA
THOUSAND PALMS, CA 92276 CIF' gNCEpEp7
(760)343-5562
Lic. No.: 968141
-----------------------------------------------
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 ZENITH INS Policy Number Z071741502
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 forthwith comply with those provisions.
CDate: 1 >3 Applicani:
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 J$1 00,000). 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 above information is correct. I 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.
Date: (7 (3 Signature (Applicant or Agent):
Application Number . . . . . 13-00000746
Permit . . . MECHANICAL 2013
Additional desc . .
Permit Fee . . . . 35.75 Plan Check Fee
.00
Issue Date Valuation . . .
. 0
Expiration Date 12/14/13
Qty Unit Charge Per
Extension
1.00 35.7500 EA MECH CONDENSER/COMP
35.75
----------------------------------------------------------------------------
Special Notes and Comments
HVAC CHANGE OUT - 13SEER/78AFUE PACKAGED
SYSTEM [2008 ENERGY) CARBON MONOXIDE
.ALARM(S) TO BE INSTALLED PRIOR TO FINAL
INSPECTION. 2010 CALIFORNIA BUILDING
CODES.
June 17, 2013 12:18:47 PM AORTEGA
----------------------------------------------------------------------------
Other Fees . . . . . . . BLDG STDS ADMIN (SB1473)
1.00
PERMIT ISSUANCE M/P/E
90.57
PLAN CHECK, MECHANICAL
23.83
Fee summary Charged Paid Credited
---------------------------
Due
------------------------------
Permit Fee Total 35.75 .00 .00
35.75
Plan Check Total .00 .00 .00
.00
Other Fee Total 115.40 .00 .00
115.40
Grand Total 151.15 .00 .00
151.15
LQPERMIT
Bin #
City of LQ Quinta
Building 8L Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
►� -�`��
Project Address: SZS70 Q vGreZ
Owner's Name: Atiate�
A. P. Number:
Address: 1
Legal Description:
Contractor -6
U� ia9Telephone:
S �
City, ST, Zip:
Lt C�,z • �. CA gzzL3
""'�a�:y;;:�.�r:>;: ^::::i %::-�+•.
Address: Z_ p'7 9Cocnmr-keOl
Project Description:
City, ST, Zip: ` hOV S 0.hc� Z Z-%(o
G a
rr
Telephone: 77(.0-31J3- JSb
State Lic. # : c?68 I LI I City Lie.
Arch., Engr., Designer:
Address:
City., ST, Zip:
Telephone: ..::«aft :�^>.,� i~:at•r.<:o:�:..
:�:i4!j*i:< N•f�'f,h.�{r'%%•.;rh�:^;h?�}•if7rtk::i
State Lic. #: :.r.: c. ;;t•;s:..r:.....r.�'»;;..::A,
>>.ysi" " f'``'
Construction Type: Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
Name of Contact Person:
Sq. Ft.:
# Stories:
# Units:
Telephone # of Contact Person:
Estimated Value of Project: OO
APPLICANT:
DO NOT WRITE BELOW THIS LINE
if
Submittal
Req'd
Ree'd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.
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
2°d Review, ready for corrections/issue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.1.
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
(760) 343-5566
72-078 Corporate Way # 101
Thousand Palms, CA 92276
Fax: (760) 343-5567
CERTIFICATE OF TESTING
YOU CAN NOW CALL THE CITY FOR YOUR FINAL
INSPECTION ON THE HVAC EQUIPMENT
WE INSTALLED
The attached is important information that must be kept in a safe place.
If you have any questions, or need help with this process please do not hesitate to contact
us at 760-343-5566.
Sincerely,
DCS Air Conditioning
Permit Department
r
Building Department Phone #
(v 0 - 7 7 7 `74
July 15, 2013
Stephanie Khatami
City of La Quinta Building Department
_ 78-495 Calle Tampico / P.O. Box 1504
La Quinta, CA 92253
Dear Stephanie,
I spoke with you over the phone recently about the attached HVAC documentation for my
building permit. Attached you will find a copy of my Certificate of Testing, which is necessary
for you to have on file in order to final my HVAC building permit for my rental house (and
former residence) at 52570 Avenida Juarez.
I will also forward a copy of this to my tenant, cell phone ( and have
him contact the Building Department for a final job inspection. I will make sure he gets the job
card to have on hand.
If you ever need anything, you can always reach me at my office in the Calaveras County
Planning Department at ( or at my home in San Andreas at ( 1
hope everything is going well down there and that everyone is doing well. I do miss everyone
and hope that things get back to normal someday. I really appreciate your help!
Thanks,
tyMogensen
Simplified Prescriptive Certificate of Compliance: 2008 Residential HVACAlterations CF-lR-ALT-HVAC
Climate Zones 10 - 15
Site Address:
Enforcement Agency:
Date:P
ermit #:
52570 AVENIDA JUAREZ La Quinta, CA 92253
City of La Quinta
Jun 13, 2013
Duct insulation
Conditioned Floor
Equipment Typel
List Minimum Efficiency2
requirement
Area
Thermostat
® Package Unit
p Furnace
❑ Indoor Coil
H AFUE 78%
® SEER 13.0
0 COP
® HSPF 7.7
0 R 6 (CZ 10-13)
Served by system
H Setback
If not already present, must be
p Condensing Unit
p EER
p Resistance
R 8 (CZ 14-IS)
1636 sf
installed)
Q 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, 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-411
forms (no hand filled CF-4Rs allowed) are filled out and signed.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:
• All HVAC Equipment
CF-6R forms: MECH-04, MECH-2I-HERS
replaced ;"
CF-4R forms: MECH-21 anri (fen Split S. tomS) MEGH W
• Condenser Coil and /or
CF-611 forms: MECH-04, MECH-2I-HERS
•Indoor Coil and /or
• Furnace
CF-411 forms: MECH-21
For Packaged Units: Duct leakag`ez<:15 percent
Exempted from duct leakage testing if::_
1: Duct" system was do me to have been previously sealed and confirmed through HERS verification, or
'p 2. Duct systems with less thari.`::40 linear feet in unconditioned space, or
0:3. Existing duct systems are constructed, insulated or sealed with asbestos
❑.4;The, ste gill not be Durtd:(ie:Ductiess*Mm S stem}(Afsofxemt€ra#teftgent'Ch _rge}
132. �New�,fl/AC
Cut In ot�rffangeouti�<;..:..->.�
�z ... 6 _ fgrsP�ECH-04, #r1E A ti 20� HERSnd(for'spllt systefrrs) MECH'- 2 HERS 'arid
new ducts~:;(all new .. =
ME. • ��..,�._ ��,� s . '� ..: � _
. C ,.,.25=ERS
tom:
ducting�a d all n.eyr' .:
x, GTF-d12 farm , MECH 30; aior sit:syst tns� ECff ZZ;ad MECIt 25
::.:��;. '��k��� .��.:�.�:. .u, ����t� �'•.��:..
.vr. .:... ... ....
For Split Sjrstem�P Quct leakage «6 percent, RC, CCA Z 50 CEM/ton; fWD; MAft, STMS; ansf'either HSPP or'P5F'P. `
For Packaged Uriitsf Duct leakages< 6: percent :
❑.3.:.NewD:ucYsvJith/or without;':?;?'
Required Forms:
. In.cludes replacing or instailing.adtn'ew
ducting and/or outdoor conderisiri�?:unit
CF-6R forms: MECH-04, MECH-20-HERS, and (for split systems) MECH-25-HERS
and/or indoor coil and/or farii:ace . No or some
CF-411 forms: MECH-20 and (for split systems) MECH-25
equipment changed.
For Split Systems: Duct leakage. < 5 percent; RC, CCA z 300 CFM/ton, TMAH
For Packaged Units: Duct leakage < 6 percent
17 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 duct in unconditioned space.
CF-4R forms: MECH-21
For split system or packaged units: Duct leakage < 15 percent
E3 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 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: BEATRIZ MORA-PICASO Signature: BEATRIZ MORA-PICA50
Company: HARRISON ENTERPRISES INC Date: Jun 13, 2013
Address: 72078 CORPORATE WAY #101 License: 968141
City/State/Zip: THOUSAND PALMS / CA / 92276 Phone: (760) 343-5566
Reg: 213-A0043815A-000000000-0000 Registration Date/Time: 2013/06/13 10:23:29 HERS Provider: Ca10ERTS, Inc.
2008 Residential Compliance Forms July 2010
CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-411-MECH-21
Duct Leakage Test — Existing Duct System ' (Pagel of 2)
Site Address: Enforcement Agency: Permit Number:
52570 AVENIDA 3UAREZ, La Quinta CA 92253 (System 1) City of La Quinta 13-0746
Enter the Duct System Name or Identification/Tag: System 1
Enter the Duct System Location or Area Served: Whole House
Note: Submit one installation Certificate for each duct system that must demonstrate compliance in the
dwelling.
This installation certificate is required for compliance for alterations and additions in existing dwellings to
space conditioning systems and duct systems.
Note: For existing dwellings, a completely new or replacement duct system can also include existing parts of
the original duct system (e.g., register boots, air handler, coil, plenums, etc.) if those parts are accessible
and they can be sealed. For a completely new or replacement duct system installed in an existing dwelling,
use the Installation Certificate titled "Duct Leakage Test - Completely New or Replacement Duct System. " v
Duct Leakage Diannostic Test - existino duct system
Select one compliance method from the following four choices.
® 1. Measured leakage less than 150/b of fan flow
2. Measured leakage to outside less than 10% of Fan Flow
p 3. Reduce leakage by 60% and conduct smoke and fix all leaks
4. Fix all accessible leaks using smoke and HERS rater verify
Note: (One of Options,l, 2, or 3 must be attempted.before,utilizing Option;4.)._
Determine,Lnominal Fan Flow using on of tr:e following three_. calculation: methods +r! , r
0 Cooling'system method: df ., Size ondenier in Tons 5 'x 400 i2000h"CFM
3+);'„
_ #�°•{;
�•r"r
, �'�' ,jFk�ztilt �r,f�"` 4Fi;
J r-'
. �,:
� Heating system method 21 7 x f Output Capacity in Thousands oi. Btu/hr = -CFM
i''.t
V ❑Measured:system low RA3!3 airflow test —CFM
.airf,using procedures:,- w ;4d
Option 1 used then: ai; , . --—.
1
Allowed leakage = Fan Flow 2000 x 0.15 = 300 CFM
Actual Leakage = 245 CFM
Pass if Leakage Actual is less than
Allowed
Cg Pass Fail
Option 2 used then:
2
Allowed leakage = Fan Flow_ x 0.10 = CFM
Actual Leakage to outside = CFM
Pass if Leakage Actual is less than
Allowed
0 Pass Fail
Option 3 used then:
Initial leakage prior to start of work = CFM
Final leakage after sealing all accessible leaks using smoke test = CFM
3
!
Initial leakage _ - Final !eakage _ = Leakage: reduction CFM
_
((Leakage reduction r / initial ieakage _) x 100`%_ =/3 Reduction
Pass if % Reduction
>= 60%
Pass Fail
Option 4 used then:
4
All accessible leaks repaired using smoke test. HERS rater must verify (No sampling).
Pass if all accessible leaks have been repaired using smoke
Pass Fail
Reg: 213-A0043815A-M2100001A-M21A Registration Date/Time: 2013/07/03 23:46:50 HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms March 2010
CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-4R-MECH-21
Duct Leakage Test - Existing Duct System (Page 2 of 2)
Site Address:
52570 AVENIDA JUAREZ, La Quinta CA 92253 (System 7Enforcementgency:
Permit Number:
CSLB License:
13-0746
® Outside air (OA) ducts for Central Fan Integrated (CFI) ventilation systems, shall not be sealed/taped off
during duct leakage testing. CFI OA ducts that utilize controlled motorized dampers, that open only when OA
ventilation is required to meet ASHRAE Standard 62.2, and close when OA ventilation is not required, may
be configured to the closed position during duct leakage testing.
.. ,��. � ti .. � � - �i t
® All supply and return register boots must be seale ciao the drywall if,smoke testas utlllzed:for.; compliance
- applies to.duct leakage compliance option 3 (leakage'reduction by,60%) and option 4?(fix.all'accessible
leaks) described above.
® New duct installatlons'cannot utilize building cavities as plenumsFor platform returns.in lieu of ducts�,.
® Mastic and draw bands must be used in combination with cloth backed rubber adhesive duct tape to seal
leaks at all new duct connections.
DECLARATION STATEMENT
• I certify under penalty of perjury, under the laws of the State of California, the information provided on this form is true and correct.
e I am the certified HERS rater who performed the verification services identified and reported on this certificate (responsible rater).
• The installed feature, material, component, or manufactured device requiring HERS verification that is identified on this certificate (the
installation) complies with the applicable requirements in Reference Residential Appendices RA2 and RA3 and the requirements specified
on the Certificate(s) of Compliance (CF -SR) approved by the local enforcement agency.
• The information reported on applicable sections of the Installation Certificate(s) (CF -6R), signed and submitted by the person(s)
responsible for the installation conforms to the requirements specified on the Certificate(s) of Compliance (CF -SR) approved by the
enforcement agency.
Builder or Installer information as shown on the Installation Certificate (CF -6R)
Company Name: (Installing Subcontractor or General Contractor or Builder/Owner)
HARRISON ENTERPRISES INC
Responsible Person's Name:
CSLB License:
BEATRII MORA-PICASO
1968141
HERS Provider Data Registry Information
Sample Group # (if applicable): N/A
® tested/verified dwelling
❑ not-tested/verified dwelling in
la
HERS sample group
HERS Rater. Information CalCERTS Certificate # CC1-1798765654
HERS Rater Company Name:
Stratz Permit Service
Responsible Rater's Name: Responsible Rater's Signature:
Garrett Williams Garrett Williams
Responsible Rater's Certification Number w/ this HERS Provider: Date Signed: 6/25/2013
CC200620S
Reg: 213-A0043815A-M2100001A-M21A Registration Date/Time: 2013/07/03 23:46:50 HERS Provider: Ca10ERTS, Inc.
2008 Residential Compliance Forms March 2010