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10-0493 (MECH).. , P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: ' 10 -00000493 -- Property Address: �-' 53220 AVENIDA JUAREZ APN: 774-041-010-15 -000000- Application description: MECHANICAL Property Zoning: COVE RESIDENTIAL Application valuation: 5000 BUILDING & SAFETY DEPARTMENT BUILDING PERMIT VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Owner: DARR JOSEPH L 53220 AVE. JUAREZ LA QUINTA, CA 92253 ( //U Date: 6/08/10 r — -- -- - -- � - - - -- --- - Contractor. Applicant: Architect or Engineer: Owner ?�j p� j f _f ------------------------------------------------------------------------------------------------- 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: License No.: Date Contractor: 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 ISec. 70 1 .5, Business and Professions Code: Any city or county that requires a permit to construct, alter, impr , demolish, or repair any structure, prior to its issuance, also requires the applicant for the permit to file a s' ed statement that he or she is licensed pursuant to the provisions of the Contractor's State License Law apter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by a y plicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars (5500).: 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 proving that he or she did not build or improve for the purpose of sale.). (_) I, as owner of the propertyom 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 contractorls icensed pursuant to the Contractors' State License Law.). arT ex&QpI-gp#,je , B.&P.C. for thi re son Date: �!/���! o i 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 ISec. 3097, Civ. C.). Lender's Name: _ Lender's Address: LQPER114IT 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. 1 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 - - --------------- - - - - --Policy Number I certify that, in the performance of the w rk for which this permit is issued, I shall not employ any person in any manner so as to be a ubject to the workers' compensation laws of California, and agree that, if I shoul e e su ' ct to the workers' compensation provisions of Section 00 of the Labor C e, I s fo i comply with those provisions. V a Date: Applicant;-" L WARNING FAILURE TO SECURE W ERS' 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 nu n id if work is not commenced within 180 days from date of issuance of such permit, o cessati of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that th e i or ion is correct. I agree to comply with all city and co y rdinances and state laws relating to bui ing cc uction, an reby authorize representatives of this t enter upon the above-mentioned propert f in action po S. Date O Signature (Applicant or Agent): Z, Application Number . . . . . 10-00000493 Permit . . . MECHANICAL INV FEE Additional desc . Permit Fee . . . . 48.00 Plan Check Fee 6.00 Issue Date . . . . Valuation . . . . 0 Expiration Date 12/05/10 Qty Unit Charge Per Extension BASE FEE 30.00 1.00 18.0000 EA MECH APPL REP/ALT/ADD 18.00 , ---------------------------------------------------------------------------- Special Notes and Comments UPGRADE OLD -93 A/C UNIT 10 SEER TO NEW ---------- - ------------- ---- "--13-SEER'PACKAGE 'UNIT.—INVESTIGATION FEE ASSESSED PER 1997 UNIFORM ADMINISTRATIVE CODE §304.5 FOR WORK BEGUN WITHOUT PERMIT. APPROVED PER A.J. ---------- ----------------------------------------------------------------- Other Fees . . . . . . . . . BLDG STDS ADMIN (SB1473) 1.00 Fee,summary Charged Paid Credited --------------------=------------------------------------ Due Permit Fee Total 48.00 .00 .00 48.00 Plan Check Total 6.00 .00 .00 6.00 Other Fee Total 1.00 .00 .00 1.00 Grand Total 55.00 .00* . L 00 55.00 li LQPERM[T Simplified Prescriptive Certificate of Compliance: 2008 Residential HVA C Alterations CF -IR -ALT -HVAC Climate Zones 10 to 15 Site ddress: �ZZ� /h✓ �v �a t L Enforcement Agency: Dat o Permit #: / E ui ment Type' List Minimum Efficiency' Duct insulation requirement C nditioned Floor Area Thermostat ackaged Unit ❑ Furnace ❑ AFUE ❑ COP Over 40 ft of ducts added or ❑ Setback ❑ Indoor Coil ❑SEER ❑ HSP>� replaced in unconditioned space p Served by system (/jnot already ❑ Condensing Unit ❑ EER ❑ Resistance ❑ R 6 (CZ 10-13) sf present, must be ❑ Other -11 ❑ R 8 (CZ 14-15) installed) /. Equipment Type: Choose the equipment being installed; if snore 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 -4R forms (no hand filled CF-4Rs allowed) are filled out and siggpd. Beginning October 1, 2010, a registered copy of the CF -1R and CF -6R shall also be on site for final inspection. HVAC Changeout Required Forms: • 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 • Indoor Coil and /or CF -6R forms: MECH-21=HERS and (for split systems) MECH- 25 -HERS • Furnace CF -4R forms: MECH- 21 and (for split systems) MECH-25 For Split Systems: Duct leakage < 15 percent; RC, CCA 2:300 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: with new • Cut in (a l new ducting ducts: (all new ducting and all CF -6R forms: MECH-04, MECH-20-HERS,and (for split systems) MECH-22-HERS, and MECH-25-HERS new equipment) CF -4R forms: MECH 20-, and (for split systems)MECH-22, and MECH 25 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 -411 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 ' CF -4R forms: MECH-21 For split system or packaged units: Duct leakage < 15 percent ❑ EXCEPTION: Existing ducts stems 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. • 1 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 I 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, andspecifications plans submitted to the enforcement agency forapproval with the permit application. Name: 6-5r- Signature: Company: Date: Address:�0 6 6., ,� - rE 2 License: City/State/Zip: �" 22 j'-� Phone: & IMP wZ r r P.O. Box 1504 LA QUINTA, CALIFORNIA -92247-1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 f BUILDING & SAFETY DEPARTMENT PROPERTY OWNER'S PACKAGE (760) 777-7012 FAX (760) 777-7011 Disclosures & Forms. for Owner -Builders Applying for Construction Permits NOTICE T MPEE.TX OWNER Dear Property Owner. An. application for. a building permit has been. submitted in your name listing yourself as the builder of the property improvements specified at We are providing you with an Owner -Builder Acknowledgment -and Information Verification Form to make you aware of your responsibilities and possible risk you may incur by having this permit issued in your name as the Owner -Builder. We will not issue a buildingpermit untill you,have read, initialled your understanding of each` provision, signed, and returned this form to us at our official address indicated. An agent of the owner cannot execute this notice unless you, the property owner, obtain the prior approval of the permitting authority. Dead and initial eachstatement below to signify you understand or verify this information. I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner -Builder" Y permit that erroneously implies that the property owner is providing his. or her own labor and material personally. I, as er-Builder, may be held liable and subject to serious financial risk for any injuries sustained by an unlicensed person or her employees while working on my property. My homeowner's insurance may not provide coverage for those injuries. I am willfully acting as an Owner -Builder and am aware of the limits of my insurance -coverage for injuries to workers n� property. 2. I understand building permits are not required to be signed by property owners unless they are responsible for the co ction and are not hiring a licensed Contractor to assume this responsibility. 3: I understand as an "Owner -Builder" I am the responsible party of record on the permit. I understand that I may protect myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my o l ,4 I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on and contracts. d understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total value f y') construction is at least five hundred dollars -($500), including labor and materials, I may be considered an "employer" der,§tate and federal law. 6. I. understand if I am considered an "employer" under state and federal law, I must register with the state and federal inment, withhold payroll taxes, provide workers' compensation disability insurance, and' contribute to unemployment nsatioh for each "employee." I also understand my failure to abide by these laws may subject me to serious financial r I understand under California Contractors' State License Law, an Owner -Builder who builds single-family residential Tres cannot .legally build them with the .intent to offer them for sale, unless all work is performed by licensed atractors and the number of structures does not exceed four within any calendar year, or all of the work is performed contract with a licensed general building Contractor. 8. J understand as an Owner -Builder if I sell the property for which this permit is issued, I may be held liable for any financial or personal. injuries sustained. by any subsequent owners) that result from any latent construction defects in the Fi hip or materials. 9. I understand I may obtain more information regarding my obligations as an "employer" from the Internal Revenue ervice, the United States Small Business Administration,. the California Department of Benefit Payments, and the California Division of Industrial Accidents. I also understand I may contact the California Contractors' State License Board (CSI.,B). at 1- _,400321-CSLB (2752) or www.cslb.ca.gov for more information about licensed contractors. I am aware of and consent to an Owner -Builder building permit applied for in my name, and understand that I am the legally and financially responsible for proposed construction activity at the following address: I agree that, as the party legally and financially responsible for this proposed construction activity, l will abide by all !e laws and requirements that govern Owner -Builders as well as employers. 12. 1 agree to notify the issuer of this form immediately of any additions; deletions, or changes to any of the information I ave provided on this form. Licensed contractors are regulated by laws designed to protect the public. If you contract with someone who does not have a license, the Contractors' State License Board may be unable to assist you with any finaneial loss you may sustain as a result of a complaint. Your only remedy against unlicensed Contractors may be in civil court. It is also important for you to: understand that if an unlicensed Contractor or employee of that individual or firm is injured while working on your property; you may be held, liable for damages. If you obtain a permit asOwner-Builder and wish to hire Contractors, you will be responsible for verifying whether: or not those Contractors are properly licensed and the status of their workers' compensation insurance coverage. Before a building permit can be issued, this form must be completed and signed by the property owner and returned to the agency responsible for isstrittg; tfre.permit. : A copy of the property o.wner's diriver's Ikense, form. notarrxatlon; or other verification acceptable to t71- re iced to be presented when the permit is ued� to verify the property owner's signature. / C^ Signature of property owner Date: i Note: The following Authorization Form is 'required to be completed by the property owner only when designating an agent of the property owner to apply for a construction permit for the Owner -Builder. AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNEWS BEHALF Excluding the Notice to Property Owner, the execution of which: I understand is my personal responsibility, I hereby authorize the following person(s) to act as, my agent(s) to apply for, sign, and file the documents necessary to obtain an Owner -Builder Permit for my project. / t Scope of Construction Project (or Description of Work): ' �il G/� %y�3 / �J�f/1 • �7�'" Project Location or Address: V �-�--��� AD�-�.` Name of Authorized Agent: Tel No Address of Authorized Agent: I declare under penalty of perjury that I am the perty owner for the address listed above and I personally filled out the above information and certify its accuracy. e: cop_ of the owner's driver's license, form notarization or other verification acceptable to the agency is requi . ed Co Pres ted when the permit is issued to verify the proper own 's signature. . Property Owner'' -s Signature: Date: Schodi Fen Total Permit Fees Bin # City of La Quinta Building & Safety Dlvfslon P.O. Box 1504, 78-495 Calle T'ampko La Quanta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Permit # 'Project Address: Owner's Name: C� J �►2i2 Address: %r Z o Av t /) Y -C Z City, ST, Zip: r CGL !`� 2 2 S" 3 Telephone: Project Description: O s&� �� ,�✓.-� i 3 A- P. Number. Legal Description: Contractor: 013 Address: City, ST, Zip: Telephone: !#T State Lie. # : Ic!ity Arch., Engr., Designer. Address: City., ST, Zip: Telephone: Construction Type: Occupancy: State Lie. #: Project type (circle one): New Add'n Alter Repair Demo Name of Contact Person: Sq. FL: # Stories: #Units: Telephone # of Contact Person: Estimated Value of Project APPLICANT: DO NOT WRITE BELOW THIS UNE # Submittal Plan Seb Req'd Reed TRACMG Plan Check submitted PERbUr FEES Item Amount Structural Cates. Reviewed, ready for corrections Plan Check Deposit Truss Cala. Called Contact Person Plan Check Balance Title 24 Cales. Plans picked up Construction Flood plain plan Plans resubmitted Mechanical Grading plan 2" Review, ready for corrections/iuue Electrical Plumbing Subeoutactor List Called Contact Person Grant Deed Plans picked up S M L H.O.A. Approval Plans resubmitted Grading IN HOUSE:- >a Review, ready for corrections/issue Developer Impact Fee Planning Approval Called Contact Person A.LP.P. Pub. Wks. Appr Date of permit issue Schodi Fen Total Permit Fees