08-0611 (MECH)P.O. BOX 1504
78-495 CALLE TAMPICO
LA, QUINTA, CALIFORNIA 92253
4
'08-00000611 - '
Application Number:
-�
Property Address:
54585 AVENIDA JUAREZ
APN:
774-262-016-4 -000000-
Application description:
MECHANICAL
Property Zoning:
COVE RESIDENTIAL
Application valuation:
4000
Applicant: 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 Busin ss and Professionals Code, and my License is in full force and effect.
License Class: C200License No.: 596456
�Da'te: %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 (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 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 whobuilds or improves thereon, and who contracts for the projects with a contractor(s) licensed
pursuant to the Contractors' State License Law.).
1 1 I am exempt under Sec. B.AP.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:
LQPERi111T
Owner:
TAMARA MELCHOR
54-585 AVENIDA JUAREZ
LA QUINTA, CA 92253
(
Contractor:
J & J INCORPORATED
P.O. BOX 966
PALM DESERT, CA 92260
(760)346-4477
Lic. No.: 596456
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 4/14/08
-----------------------------------------------
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 ENDURANCE REINS Policy Number WEN100280802
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, 1 all forthwith comply with those provisions.
2ate:�1/q�plican"t"�
v
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 1$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 certifythatI 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 buildin construction, and hereby authorize representatives
of thisto/u/nty to enter uon the above-mentioned property f r inspection purposes.
�.D e --.(� igaatur�plican
Application Number . . . . . 08-00000611
s, Permit . . . MECHANICAL
Additional desc .
Permit:Fee 33.00
Plan Check Fee
8.25
Issue Date
Valuation . . .
.
0
Expiration Date 10/11/08
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
B/C <=3HP/100K BTU
9.00
----------------------------------------------------------------------------
Special Notes and Comments
REPLACE HEATING & COOLING EQUIPMENT 13
SEER
Fee summary Charged
----------------- ---------- ----------
Paid Credited
---------- ----------
Due
Permit Fee Total .33.00
.00 .00
33.00
Plan Check Total 8.25
.00 .00
8.25
Grand Total 41.25
00 .00
41.25
LQPFRA11T
CERTIFICATE OF COMPLIANCE: RESIDENTIAL a e 1 of 1 CF -IRA
Project Title 9-
Date
�/�
Building Permit #
project Address
-`
e
2J
C
I ExistiM duct systems that are extended, which are constructed insulated or scaled with asbestos.
Plan Check/ Date
C
Ducts stems with less than 40 linear feet of ducts in unconditioned s acc.
y° -
Documentation Author
2
Telephone
Field Check/ Date
s elLrL
Compliance Method (Prescriptive - HVAC and/or Duct.
Climate Zone
Enforcement Agency Use Only �
System Alteration - § 152 (b) I C.
D and E)
LAC F;YT1V.NN
If anv of the following three excentinnc arr ✓ thn flirt cvc#,A rvm ie nvc+. -t. r--- i J J.._._
#
Minimum
Efficiencv
(AFUF. or Hplit
PF)
]Excejpfions-
1
n
Duct systems that are documented to have been previously scaled as confirmed through field
verification and diagnostic testing in accordance with procedures in the Residential ACM Manual.
2J
C
I ExistiM duct systems that are extended, which are constructed insulated or scaled with asbestos.
3
C
Ducts stems with less than 40 linear feet of ducts in unconditioned s acc.
U v AL J X,'I'L- 1.1
Heating Equipment Type
and Capacity (furnace, heat
pump. boiler, etc.)
Minimum
Efficiencv
(AFUF. or Hplit
PF)
Distribution Typc
and Location (ducts.
attic, Cu..)et)
Duct or piping
R -Value
Thermostat Ty
Configuration
or
packngc)
y° -
l3 S
K. Z
L
s elLrL
Cooling Equipment Type Minimum
and Capacity (NC, heat Efficienev Duct Location
pump, evap. cooling) (SEER or (attic, etc,*)
U- ER)
Duct R -Value
Thermostat T
Type
Configuration
(split or
packoee)
ea. A JritU%-TZ&W 1 Uft"GE (TXV) AND EER
The prescriptive requirement for either a refrigerant charge or a TXV does apply to packaged units.
Before the permit can be finalized, a sighed CF -4R must be provided to the building department for any of
the following ✓ emmnliance. renniro.."k-
✓ Compliance Requirernemts
Sealed Ducts (climate Zones 2 and 9-16) (installer testing and certification and HERS rater field verification required.
C TXV (climate zones 2 and 8-15 only) (Installer testing and certification and HERS Rater field verification required.)
-� Refrigerant Charge (climate zones 2 and 8-15 only) (Installer testing and certification and HERS Rater field
verification required.)_
i� EFR as indicated in Table 8-3 of Residential Compliance Manual (climate Tones 2 and 9-16 only) (installer testing
and certification and HERS Rater field verification required.)
SPECIAL FEATURES REQUIRING HERS RATER VERIFICATION
A ✓ Indicates which compliance requirements are part of this project and need HERS rater verification.
✓ Compliance Requirements Installer Forma if Applicable) HERS Rater Forms (if applicable)
Duct Sealing CF -6R page 4 of 12 CF -4R page 1 of 8
Q Thermostatic Expansion Valve (TXV) CF -6R pages 5 and 6 of 12 CF -4R pages 3 of 8
Refrigerant Charge CF -6R pages 5 and 6 of 12 CF -4R pages 3 and 4 of 8
[ EER CF -6R page 8 of 12 CF -4R pages 5 of 8
Bin # •• • --
Permit #
Project Address: j
A. P. Number:
Contractor: ; Y'
Address:
City,'ST, Zip:
Telephone:
LState Lie. #
Arch., Engr., Designer:
Address:
City,' ST, Zip:
Telephone:
State Lie. #: -
Name of Contact Person:
Telephone # of Contact -Person:
# Submittal
Plan Sets
Structural Calcs.
Truss Cities.
Energy talcs.
Flood plain plan
Grading. plan
Subcontactor List
Grant Deed
H O.A. Approval
IN HOUSE: -
Planning Approval
Pub. Wks. Appr
School Fees
City of La. Quints
Building u Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quilita, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Q AAer Owner's Name:
Address:
City, ST, Zip: (� F1- I %�I,Q % 7 r --Z . .
Project Description:
Lic. #:.
- Construction Type: Occupancy:
a
Project type (circle one): New Add'n Alter Repair Demo
Sq. Ft : # Stories:...- — #'-Units:
Estimated Value of Project: i.
APPLICANT: DO NOT WRITE BELOW THIS LINE .
I'd Recd TRACKING
Plan -hek b
FEES
Amount
su
c mated
Reviewed; ready for corrections
Called Contact Person
Item
Plan Check Deposit
Plan Check Balance
Plans picked up
Construction '
Plans resubmitted
Mechanical
2°" Review, ready for correctionsrssue
b
Electrical
tailed *Contact Person
Plumbing
S.M.I.
Plans. picked up
Plans resubmitted
Grading
Developer Impact Fee
Review, ready for correctionsfissue
Called Contact Person
A.I.P.P.
Date of permit issue