11-0833 (MECH)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
11-00000833
Property Address:
54200 AVENIDA JUAREZ
APN:
774-194-010-15 -000000-
Application description:
MECHANICAL
Property Zoning:
COVE RESIDENTIAL
Application valuation:
1650
Applicant: Architect or Engineer:
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 Business and Professionals Code, and my License is in full force and effect.
License Class: C20 Ligense No.: 690601
Date Contractor.
`.. r OWNER -BUILDER DECLARATION
I h reby 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 itsissuance, 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 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:
REED RESIDENCE
54200 AVENIDA JUAREZ
LA QUINTA, CA 9225.3
(
Contractor:
BTU AIR & HEAT rD
53750 AVENIDA OBREGON I
LA QUINTA, CA 92253;(
(760)202-0204 j
Lic. No.: 690601 r,
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Adi
Date: 8/04/11
OUM IA
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 STATE FUND Policy Number 1795590-2010
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
subject to the workers' compensation provisions of Section
00 of the Labor Code,. " forthwith comp) ith those provisions.
t
Date: Applicant:•
WA
D/
FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
S JECT 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 Ouinta, 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 1.80 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 c/yount to enter upon the above-mentioned property
/for
riinspection
_ purposes
,..,y�%
„Date:O Signature (Applicant or Agent):
Application Number . . . . 11-00000833
Permit MECHANICAL.
Additional desc
Permit Fee . . . . 24.00
Plan Check Fee
6.00
Issue Date . . .
Valuation
0
Expiration Date 1/31/12
Qty Unit Charge Per
Extension
BASE FEE
15.00
1.00 9.0000 EA MECH B/C
<=3HP/100K BTU
9.00
-----------------------------------------------------------------------------
Special Notes and Comments
CONDENSING UNIT CHANGE OUT 13 SEER
APPROVED PER A.J. 2010 CODES
----------------------------------------------------------------------------
Other Fees . . ... . . . . . BLDG
STDS ADMIN (SB1473)
1.00
Fee summary Charged Paid
----------
Credited
--------------------
Due
---------------------------
Permit Fee Total 24.00
.00 .00
24.00
Plan Check Total 6.00
.00 .00
6.00
Other Fee Total 1.00
.00 .00,
1.00
Grand Total 31.00
.00 .00
31.00
LQPERMIT
P,
Zones 10 to 15
9 I A,CAlterations CF4R-ALT-HVAC t-.
f
Site Address: /n
EnforcementAgency.
Date.
Permit i1:
Equipment T '
'
List Minimum Efficien Z
Duct insulation requirement
Conditioned FloorArea
Thermostat
O Packaged Unit
❑ Furnace
D E ❑ COP
Over 40 ft of ducts added or
D Setback
door Coil
EER Li� ❑ HSPF
replaced in unconditioned space
Served by system
pfnot already
Condensing Unit
O EER "^-' ❑ Resistance
OR 6 (CZ 10-13)
sf
present must be
❑ Other
D R 8 (CZ 14-15)
installed)
1. Equipment Type: Choose the equipment being installed. if more than one system, use another CF -IR -ALT -HVA Cfor each system.
2. Minimum. Equipment Effldendesr 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 fort was in fad the work completed by the
instal*.The inspector also•verifies thaYeach
appropriate CF=6R and reg6lei+ed CF4R forms (no hand filled CF-4Rs allowed) are filled out and
sigWM. BeginningOctober l 2010 a registered = ofthe CF -1R and CF -6R t hall idso be on for final i ` 'on.
I. HVAC Changeout Required Forms:
• All HVAC Equipment replaced CF-61(forms: MECH-04, MECH-2t-HERS and (for split systems) MECH- 25 -HERS
CF -4R forms: MECH- 2:1 and for split steins MECH-25
• Condenser Coil and /or
• Indoor Coil and/or am CF-611forms: MECH-2I-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? 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
O 2. Duct systems with less than 40 linear feet in unconditioned space, or
❑ 3. Exi sting ducts stems are constructed,, insulated or sealed with asbestos
O 2. New HVAC $ ,stem
Regdired' Forms:
• Cut in or Changeout with new
ducts: (all new dulling ntf 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 leak -age <6 percent
O 3. New Ducts with Replacement
Required Forms:
• Includes replacing or installing all new ducting
CF -6R forts: MECH-04,,MECH-20-HERS,and (for split systems) MECH-25-HERS
and/6r' outdoor condensing unit and/or indoor
CF4R 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 Packa ed, Unitsr Duct' I e < 6jwroent
O 4. New Ducting over 40 feet _.
R nixed Forms:
• Includes adding or replacing more than 40
linear feet of duct in unconditioned sDace.
CF -6R fortes: MECH-04, MECH-2I-HERS CF -4R forms: MECH-21
For split system or packaged units: Duct leakage < 15 percent
O EXCEPTION: Existing duct systems eonstru 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 cenify that the energy features and performance specifications for the design identified on this Certificate of C pliance 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 on other applicable compliance forms, worksheets•
calculatio0g. plans ands ifications submitted to the enforcement a for rove! with, :cation.
Name: �A�1. VI��►.(— �
Sign
Comp . -1� /7 /e- 3�/ l/ 2
Addres.&, _l
Z�a �1�-�dl/�(Yj� �i�� License -
Z73 001 11
City/State/Zip: G4 !-V Phone:•
ZUUu Kestaential Compliance Forms
March 2010
Bin #
City of La Quinta
Building & 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:
Owner's Name:
A. P. Number:
Address:
Legal Description:
City, ST, Zip: Z 3
Contractor: iii �Iv
TelephonelS-/ / i s:>•N;<>:. >>:;; > s>v c,:
Address:
Project Description:
City, ST, Zip:�A)
Telephone:
n,.:,<:....•};}�:.:;';}:o:x.
State Lic. # :
City Lic. #;
Arch., Engr., Designer:
Address: '
City., ST, Zip:
Telephone: >::>::;;t""<•' }:<;:::
State Lic. #: s%>":`:I ;>?3fi
:.orr..y :,.------yf i. ......
Name of Contact Person:
Construction Type: Occupancy.
Project fv a /circle one New Add'n Alter Repair Demo
type \ �•
Sq. Ft.:
# Stories:
#Units:
Telephone # of Contact Person:
Estimated Value of Project: Fx�l 6—r% IV—
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACKING
PERMIT FEES
Pian Sets
Plan Check submitted
Item
Amount
Structural Cities.
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
2e° Review, ready for corrections/issue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
3" 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
FI
Total Permit Fees