12-0752 (MECH)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Application Number: ' `12 000-00752 Owner:
Property Address: 53124_AVENIDA NAVARRO - VIK STAN
APN: 774-065-006-19 -000000- 53124 AVENIDA NAVARRO
Application description: MECHANICAL LA QUINTA, CA 92253
Property Zoning: COVE RESIDENTIAL
Application valuation: 2500'
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 7/09/12
Contractor: D
Applicant: Architect or Engineer: ALL ABOUT AIR I
P.O BOX 5936 JUL O�
LA-QUINTA, CA 92248 2612
(760)57,8-7913
Lic. No.: 874583 CITYpFI,gQUINT/�
_ FIN4NDE DEPT.
---------
CTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of pfA
er provisions of Chapter 9 (commencing withI hereby affirm under penalty of perjury one of the following declarations:Section 7000) of Division 3 of theCode, and myLicense is in full force and effect. I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided
L'cense ass: C20 74583 for by Section 3700 of the Labor Code, far the performance of the work for which this permit is
issued.
Date: ,Contractor:- _ _ 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
OWNER -BUILDER DECLARATION - insurance carrier and policy number are:
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the Carrier EXEMPT .Policy Number EXEMPT
following reason (Sec. 7031.5. Business and Professions Code: Any city or county that requires a permit to - J I*certify that, in the perfor ance of the work for which this permit is issued, I shall not employ any
construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the i person in any manner as to become subject to the workers' Compensation laws of California,.
permit to file a signed statement that he or she is licensed, pursuant to the provisions of the Contractor's State and agree that, if I s d becomt
ect to the workers' compensation provisions of Section
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or 700 of the LaborC e, I shall fth comply with those provisions.
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).:/Date: t• p.rcant% - -
(_) 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 WARNING: FAILU E TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
Contractors'. State License Law does not apply to an owner of property who builds or improves thereon, SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND'
and who does the work himself or herself through his or her own employees, provided that the DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN '
improvements are not intended or. offered for sale. If, however, the building or improvement is sold within SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. - 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.). - APPLICANT ACKNOWLEDGEMENT _
1 1 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project ISec: IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the '
7044, Business and Professions Code: The Contractors' State License Law, does not apply tq, an owner of conditions and restrictions set forth on this application.
property who builds or improves thereon,.and•who contracts for the projects with a contractor(s) licensed 1. Each person upon whose behalf this *application is made, each person at whose request and for -
pursuant to the Contractors' State License Law.). whose benefit work is performed under or pursuant to any permit -issued as a result of this application,
(_) I am exempt under Sec. , BAP.C. for this reason the owner, and the applicant, each agrees to, and shall defend, indemnify, and hold harmless'the City
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: J-
Lenders Address: "�•
LQPERMIT
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 ermit, or cessation ofwork for 180 days will subject
permit to cancellation. '
I certify that I h e read this application and state that th a ve inform i n is correct. I agree to comply with all
city and c my rdinances and state laws relating to bui i constructi n and hereby authorize representatives
of this co tyGto i r upon the above-mentioned prope y or inspec rposes.
ate: ° \ S' ature (Applicant or Agent): -
Application Number . . . . 12-00000752
Permit MECHANICAL
Additional desc -
Permit Fee . . . . 40.50 Plan :Check Fee -.
10.13
Issue Date•.Valuation
0
Expiration Date 1/05/13
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
HVAC CHANGE -OUT: CONDENSER, AIR HANDLER.
2010 CODES.
-----------------_-_-------------
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
51.63
f
Simplified Prescriptive Certificate of Compliance: 2008 Residential MVAC Alterations CF -IR -ALT -HVAC
Climate Zones 10 to 15
Sim 1/1;�-
Site Address:/
Enforce nt Agency:
Date:
Permit !l:
r /
"!
Conditi ,ied Floor
Equipment T
List Minimum Efiicien Z
Duct insulation requirement
Area
Thermostat
Packaged Unit
Furnace
®AFUE
®COP
Over 40 ft of ducts added or
® Setback
door Coil
051MR�
HSPF
BResistance
replaced in unconditioned space
R 6 (CZ 10-13)
Served by system
/I D r� sf
(7f not already
present, must be
Condensing Unit
®® EER
R8 14-15)
installed)
ETOtber
_ (CZ
1. Equipment Type: Choose the equipment being installed; if more than one system, use another CF-IR-ALT-HVACfor each system.
2. Minimum Equipment Efficiencies: 13 SEER, 78.0 AFUE, 7.7HSPF for typical residential systems.
HERS VERIFICATION SUNE%IARY 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 n 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 -111 and CF -0R shall also be on site for final in ection.
1. 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 for spht stems MECH-25
• Condenser Coil and/or
CondeIndoor
• Coil and/or
CF -6R forms` MECH-2I-HERS and (for split systems) MECH-25-HERS
CF4R forms: MECH-21 and (for split systems) MECH-25
• Furnace
For Split Systems: Duct leakage < 15 percent; RC, CCA > 300 CFM/ton(Minimum Air Flow Requirem:.nt), 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 duct systems are constructed, insulated or sealed with asbestos
2. New HVAC System Required Forms:
• Cut in or Changcout 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
CF -4R forms: MEm
CH -20, and (for split systems) MECH-22, and MECH-2'
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
[33. 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 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 s ace.
CF -6R forms: MECH-04, MECH-2I-HERS CF4R fours: MECH-21
For splits stem or packaged units: Duct leakage < 15 percent.
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 identifies on this Certificate Compliance.
of
• 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 I and 6 of the California Code of Regulations.
• The design features identified on this Certificate of Compliance are consistent with the informatio do ented o othap lcable compliance forms, worksheets,
calcul ns tans ands ifications ub • ed to the enforcement en for approval with the it a licati
Name: VL c 7
Signature: -
Compan:
Date:
Address:
License: ✓
City/State/Zip: .
Phone:
2UU8 Residential Compliance Forms July 2010
Bin ff
Permit i# J�
Je Project Address: Z
A. P. Number:
90(of La Quinta
Building 8r Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
wner's Name:)i-
-16
Contractor: i ,,�,40
nstruction Type:
Address:
1
>ject type (circle one):
New Add'n Alter Repair Demo
Ft.: # Stories: #Units:
P
-•K
City, ST, Zip:
—1 D
4'
Tel P h
c� —
Item Amount
jC
State Lic. #
City Lic. #:
Arch., Engr., Designer:
Plan Check Balance
Address:
City, ST, Zip:
Telephone:
Mechanical
ins/issue
C
Electrical
t
S ate Lic.
Plumbing
Pr
S.M.I.
Name of Contact Per;
Grading
Sq
Telephone # of Contact Person:
(y v S e) i Es
APPLICANT: DO NOT WRIT
# Submittal Req'd
Recd TRACKI
Total Permit Fees
Plan Sets
Plan Check submitted
Structural Cales.
Reviewed, readv for correctic
Truss Calcs. _
Called Contact Person
Title 24 Calcs.
Plans picked up
Flood plain plan
Plans resubmitted
rading plan"d
Review, ready for eorrecti
ubcontactor List
fGrnt
Called Contact Person
aDeed
Plans picked up
H.O.A. Approval
Plans resubmitted
IN HOUSE:-
Jrd Review, ready for correctio
Planning Approval
Called Contact Person
Pub. Wks. Appr
Date of permit issue
School Fees
gess: <- 3 /, 2-
I
, ST, Zip:
phone:
ect Description:
i/ -
f
nstruction Type:
Occupancy:
>ject type (circle one):
New Add'n Alter Repair Demo
Ft.: # Stories: #Units:
imated Value of Project: Zv
E BELOW THIS LINE
VG
PERMIT FEES
Item Amount
ns
Plan Check Deposit
Plan Check Balance
Construction
Mechanical
ins/issue
Electrical
Plumbing
S.M.I.
Grading
is/issue
Developer Impact Fee
A.I.P.P.
Total Permit Fees