11-0356 (MECH)P.O: BOX. 1504 .
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application. Number: '.11 -000003516 -
.Property Address: 50610 NECTAREO
APN> .772-360-025- -
Application description: MECHANICAL
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: .15275
Applicant:
Architect or Engineer:
u�itiGu
BUILDING & SAFETY DEPARTMENT
- BUILDING PERMIT
Owner:
JAMES'PETERSON
50610 NECTAREO
LA QUINTA, CA 92253
Contractor:
GENERAL .AIR CONDITIONING
VOICE (760) 777=7012
FAX (760) 777-7011 .
INSPECTIONS (760).777-715'3
Date: 4/11/11
D.a p
APR 11 2011
31170 RESERVE DRIVE CITY QF --JJ
THOUSAND PALMS, CA 92276 LAGIUIPdTq
F1f1(A11fiEDEpT.
(760) 343-7488
Lic. No.: 686310
- LICENSED CONTRACTOR'S DECLARATION .
WORKER'S COMPENSATION DECLARATION
• I hereby affirm under penalty of perjury that 16 license rider provisions of Chapter 9 (commencing with
I hereby affirm under penalty of perjury one of the following declarations:
Section 7000) of Division 3 of the Business and Profess' Is Code, and my License is in full force and effect.
_ I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided
' License Class: C20 I License No.: - 686310
for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
ate: -1 ( r ontractor: jiii
t� issued.
V� 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
00 -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'E FEREST NATL Policy Number 76 0 000614 7101
' following reason (Sec. 7031.5, Business and Professions Code:Any city or county that requires a permit to
_ I certify that, in the performance 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
- person in any manner so as to becom ublect 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 .should become su lgct 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
3700 of the Labor Code, I. shall forth .ithcomply 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)•:
(_ 1 I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and
0—'7-'"��'•—
•' the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The
WARNING: FAILURE TO SECURE WORKERS' Co. ENSATION COVERAGE IS UNLAWFUL, AND SHALL
' Contractors' State License Law does riot 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 ofcompletion,the owner -builder will have the burden of .proving that he or she didnot build or
- -
improve for the purpose of sale.).
APPLICANT ACKNOWLEDGEMENT
(_ 1 .l, as.owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.
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 to 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 personupon whose behalf this application is made, each person at whose request and for
pursuant to the Contractors' State License Law.). _ _ _ _ - -
-. whose benefit work is performedunderor pursuant to any permit issued as a result of this application,
- - - I' I I am exempt under Sec. , B.&P.C. for this reason
the owner, and the applicant, each agrees to, and shall defend, indemnity 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. ,
• Date: Owner:
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
- CONSTRUCTION LENDING AGENCY
permit to cancellation. • -
I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of theI
certify that I have read this application and state that the above'inf r ation is correct. I agree to comply with all
work for which this permit is issued (Sec. 3097; Civ..C.)•
city and county ordinances and state laws relating to building cons) u7tion, and hereby authorize representatives
-
of this county to enter upon the above-mentioned property for ins p ion purposes. _
' Lender's Name:-
-
c
at "P -f Sign re (Applicantor Agent):
- Lender's Address: -
.. LQPERMIT
- .. ..
Application Number .11-00000356
Permit . . .. MECHANICAL
Additional desc .
Permit Fee 66.00 Plan Check Fee
16.50
Issue Date Valuation
0
Expiration—Date 10/08/11`
Qty Unit Charge Per
Extension
BASE FEE
15.00
...:,2.00 9.0000 EA MECH FURNACE -, <=100K
18_.00
2.00 16.5000 EA MECH -B/C >3-15HP/>100K-500KBTU
3.3.00
Special Notes and Comments
INSTALL 2 COMPLETE UNITS (FURNACES,
LINCOOR COIL & CONDENSERS, .13 SEER).2010
CODES.
-----------------_-.-------------------------------------------------
' Other .FeesBLDG STDS ADMIN (SB1473)
1.00
Fee.summary Charged Paid Credited
Due
Permit Fee Total 66.00 .00 00
66.00
Plan Check Total 16.50 .00 .00
.1'6.50
Other Fee Total -1.00 .00 .00
1-00
Grand Total 83.50 .00 .00
83.50
LQPERMIT .. ..
e9-
LM,
Sim lifted Prescriptive Certificate of.Compliance:- 2008 Residential HVAC Alterations. CF -IR -ALT -HVAC,,
Climate Zones 10 to 15
Site Address:
'51 h �G fa /'-c0
En orceme rt Agency:
Date •
Permit #:
Equipment T et
List Minimum Efficienc Z
Duct insulation requirement
Conditioned Floor
Area
Thermostat
11 Packaged Unit
Sif Furnace
❑ AFUEB��w
❑COP
Over 40 ft of ducts added or
Setback
Indoor Coil
_
❑SEER ! 3
❑ HSPF
replaced in unconditioned space
Served ty system
t1f„or already
ondensing Unit
❑ EER / /
❑ Resistance
❑ R 6 (CZ 10-13) '
sf
preset, must he
❑ Other
❑ R 8 (CZ 14-15)
installed)
1. Equipment Type • Choose the equipment being installed: if more than one system, use another CF -1 R-ALT-1-1VAC 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 decide; 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 wes 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
sign ed. Be innin October I, 2010, a registered copy of the CF -11R and CF -611 shall also be on site for final inspection.
L 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-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 Require_nent), TMAH
For Packaged Units: Duct leakage < 15 percent
Exempted from duct leakage testing if:
❑ I. 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
ducts: (all new ducting and all
CF -6R forms: MECH-04, MECH-20-HERS,and (for split systems) MEC:-{-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 -6R forms: MECH-04, MECH-20-HERS,and (for split systems) MECH-25-HERS
and/or outdoor condensing unit and/or indoor CF -4R 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
linear feet of duct in unconditioned s acee..
CF -6R forms: MECH-04, MECH-2I-HERS CF -4R ornis: 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)
• 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 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 I and 6 of the Califomia Code of Regulations.
• The design features identified on this Certificate of Compliance are consistent with the orm tion documented on other pplic oumpliance forms, worksheets,
calculations, and
plans specifications submitted to the enforcement agency for appro al with t e pennit application.
Name:C �ee`i �t%Q.tS �!'�
Si ture:
Company:
G,en er^aj 41'r COi1Gi.e f'.`o n ,`
Date:
Address: -311-311-70-311-70n_
�1/2>°S2�U� /o�_r` t/�
License: t✓r��o3�v
City/State/Zip:—r��BG4Sr;N�� ey
d��s, Gam•
Phone: 7ca0--3`�3-74ffg
UU,r Mesrclential Compliance Forms
March 2010
Lsrn ff
.City of La Quin to
"Building 8i' Safety Division
P.O. Box 1504, 78.495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit -Application and Tracking Sheet
Permit # / (0
Project Address: 15Q4! � Q h�GLt I^e0
Owner's Name:
A. P. Number:
Address:
Legal Description:
City, ST, Zip:_� 9aa-S
Contractor:
Telephone: % {
'.::sx<•;::>•,;:;::<.;k:,<: z:>::>
Address: 3
City, ST, Zip:
Telephone:
State Lic. # : 3 City Lic. C
Project Description:
Arch., Engr., Designer: '
Address:
City., ST, Zip:
Telephone::s:>:.::fy::<.:;:s.}}:w.::,>•>.>:>•:>>`v •,.:f
;:v.;;:.;J;;:y .:•}::;;:.:,::><y;..:..>y.N
q.� ff t{ \y t f h i\ f
f
State Lic. #:<:>:::<::<<:.>.>>:'<..<::»>;:;:<.::;•a;<.:s:.>,
'.>•'.•:::,<'••`'.>.<::<.;}::;:><:::«:=:N;> :}> •<
................. ;.<
Constructs n
o Type: Occupancy:
Project type (circle one) New Ad3'n Alter Repair Demo
Name of Contact Person:
Sq. Ft.:
#Stories:
# Units:
Telephone #'of Contact Person: Estimated Value of Project: / S0•-7.5"01
APPLICANT: DO. NOT WRITE. BELOW THIS LINE
#
Submittal
Req'd,
Recd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Cates.
Reviewed, ready for corrections
Plan Cheek Deposit
Truss Calc s..
Called Contact Person
Plan Cheek Balance
Title 24 Calcs.
Pians picked up
Construction
Flood plain pian
Plans resubmitted
Mechanical
Grading plan
2" 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:-
'"' Review, .ready for corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person
A.LP.P.
Pub. Wks. Appr
Date -of permit issue
School Fees
E41
Total Permit Fees