10-0754 (MECH)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
M
X10=00000754
Property Address:
54845 AVENIDA JUAREZ
APN:
774-265-017-5 -000000-
Application description:
MECHANICAL
Property Zoning:
COVE RESIDENTIAL
Application valuation:
7760
Tit�4XPQ"
Applicant: Architect or Engineer:
IL4--
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 Busi and Pro ssionals Cod nd my License is in full force and effect.
License las : C20 se No.: 489046
y"ID a �2 �o 7Contractar.
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, 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, 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:
MCCORMACK ANNETTR
54845 AVENIDA JUAREZ
LA QUINTA, CA 92253
(
Contractor:
ESSER AIR CONDITIONING & HTG
P.O. BOX 1636 -
CATHEDRAL CITY, CA 92235
(760)324-0550
Lic. No.: 489046
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
I
Date: 8/12/10
,.'� 12, 2016
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 1891568-2009
_ 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 Codde,III shall fo hw.th comply with those provisions.
-D�tate �4� �v APPS' licani: - d -r" "! I U, Vtif'�
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 Quima, 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 thea rmation is correct. I agree to comply with all
city and co my ordinances and state laws relating to bu' ing cons ctiChereborize representatives
i.
of this cou ty to enter upon the above-mentioned p� erty for ' pep
ti ..~so-.
TDa etet �'- Signature_(Applicant or'Agen
Application Number . . . . 10-00000754
Permit . . . MECHANICAL
Additional desc .
Permit Fee . . - 40.50
Plan Check Fee
10.13
Issue Date . . . .
Valuation . . . .
0
Expiration Date 2/08/11
Qty Unit Charge Per
Extension
BASE
FEE
15.00
1.00 9.0000 EA' MECH
FURNACE <=100K
9.00
1.00 16.5000 EA MECH
----------------------------------------------------------------------------
B/C >3-15HP/>100K-500KBTU
16.50
.Special Notes and Comments
REPLACE EXISTING SYSTEM WITH (5)
TON 14
SEER HEAT PUMP SPLIT AIR CONDITIONING &
HEATING SYSTEM TO EXISTING LOCATION.
2007.
----------------------------------------------------------------------------
Other Fees . . . . . . . BLDG STDS ADMIN (SB1473)
1.00
Fee summary Charged
-------------------------------------
Paid Credited
--------------------
Due
Permit Fee Total 40.50
.00 .00
40.50
Plan Check Total 10.13
.00 .00
10.13
Other Fee Total 1.00
.00 .00
1.00
Grand Total 51.63
_ .00 .00
LQPERMIT
Simplified Prescriptive- Certificate of Compliance: 2005 Residential HIIACAlteratiotis CF -IR -ALT -HVAC
Climate Zones 10 to 15 1
2008 Residential Compliance Forms March 2010
Site Address:
7 �Lri �y,� SJ/►�sv
Enforcement Agency:
Date:Perr`
�; lv, o
it #:
/CJ
Equipment Type
List Minimum Efficiency,
Duct insulation requirement
Conditioned Floor
Area
Thermostat
Packaged Unit
_ Furnace
[I AFUE
® COP
Over 40 ft of ducts added or
3:�_etback
door Coil
ondensing Unit
foctherAl
EER
EER Jl, std
.KHSPF
Resistance
replaced in unconditioned space
R 6 (CZ 10-13)
M
Served by system
1 t� sf
(/f not already
present, must be
0
R 8 (CZ 14-15)
instalted9
1. Equipment Type: Choose the equipment being installed; if more than one system, use another CF-IR-ALT-HVACfor each system.
V
2. Minimum Equipment Efficiencies: 13 SEER, 78%AFUE, 7.7HSPFfor 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 CF4R forms (no hand filled CF4Rs allowed) are filled out and
si ed. 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
CF4R forms: MECH- 21 and fors lit stems MECH-25
• Condenser Coil and /or
• Indoor Coil and/or
CF -6R forms: 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:
B1. 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 duct systems are constructed, insulated or sealed with asbestos
® 2. New HVAC System Required Forms:
• Cut in or Changeout with new CF -6R forms: MECH-04, MECH-20-HERS,and (for split systems) MECH-22-HERS, and MECH-25-HERS
ducts: (all new ducting and all
CF4R forms: MECH 20-, and (for split systems)MECH-22, and MECH 25
new equipment)
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 -6R forms: MECH-04, MECH-20-HERS,and (for split systems) MECH-25-HERS
and/or outdoor condensing unit and/or indoor CF4R forms: MECH-20 and (for split systems) MECH-25
coil and/or fiuitace. 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
CF -6R forms: MECH-04, MECH-2I-HERS CF -4R forms: MECH-21
linear feet of duct in unconditioned space,
For splits stem 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.
• 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 d ented on other applicable compliance forms, Worksheets,
calculations, plans andspecifications submitted to the enforcement agenEy for a22roval with the it ap ica '
Name: DAVID WILLIAMS
Signature:
Cornpany:*
ESSER SERVICES INC.
Date:
Address:
P.O. BOX 1636
License: 4 9 0 4 6
City/State/Zip: CATHEDRAL CI TY t CA . 9 2 2 3 5
Phone: 760174 nqq
2008 Residential Compliance Forms March 2010
Bin # City ®f La QuInta
Building 8t Safety Division
Permit # P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92233 - (760) 777-7012
b Building Permit Application and Tracking Sheet
Project Address: s4 �tlj /4Utf �JR�e Z- Owner's Name: A?j#6 C,,' M "e*Lo AGK
A.P. Number. Address: ,j-tj r/�tr�/�CJ 3J�4%1,tS2
Legal Description: City, ST, Zip: 6A ?010-fA. CA
Contractor: 5e -AV ICES hi C . Trlmhnn� �%�
Address: P o. '5C'X l'C3 6
Project Description:�p
c+
u1L� �7Y 5 ��/w
City, ST, Zip: CA-%NtDJL4(- C1y CAI
L�
Telephone: 76o, 3 Q it. O fi 5D
:`MUNE
City Lie. #;%
/!G/j'i l% of -P C kl r A L ao � �t111 d%4
State Lia # :
//t�i4T/Yv fie_ J�v �'( `(� li )'ff�/ItlE►
Arch., Engr., Designer:
/0 C't
Address:
City., ST, Zip:
Telephone: Q
State Lie. #: y" h
Name of Contact Person: T)A V t D W i i_ r-14 M s
Construction Type: Occupancy:
Project type (circle one): New. Add'n Alter Repair Demo
Sq. FL:#Stories:
# Units:
Telephone # of Contact Person: 76o -'b z °1' • o5 -57o
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS UNE
#
Submittal
F q'd
Recd
TRACKING
PERNM FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Cala.
Reviewed, ready forcorrections
Plan Check Deposit
Truss Cafes.
Called Contact Person
Plan Check Balance
Title 24 Cafes.
Pians picked up
Construction -
Flood plain plan
Pians resubmitted
Mechanical
Grading plan
2" Review, ready for correctionslissueElectrical
Subcoutactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.L
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:
''' Review, ready for corrcetions/issue
Developer Impact Fee
Planning Approval I Called Contact Person A.LP.P.
Pub. Wks. Appr Date of permit issue
School Fees
Total Permit Fees
0