10-0517 (MECH)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA,. CALIFORNIA 92253
Application Number: (_10-00000517
Property Address:
79710 NORTHWOOD
APN:
762 -022 -021 -
Application description:
MECHANICAL
Property Zoning:
LOW DENSITY RESIDENTIAL
Application valuation:
12895
T-ityl 4 46 Q"
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
L
License No.: 872703
aItContrjrD».�
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 1$500).:
(_) 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
Contractors' State License Law does not apply to an owner ofproperty 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 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 contractorls) 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
r
Owner:
BAYSHORE'SALLY
79710 NORTHWOOD
LA QUINTA, CA 92253
(760)771-0631
Contractor:
CR FRIEND LD TOLLEY
P.O. BOX 12100
A/C & H
PALM DESERT, CA 92255
(760)346-0434
Lic. No.: 872703
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
- Date: 6/15/10
WORKER'S COMPENSATION DECLARATION
1 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 TRUCK INS EXCH Policy Number B01109591
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, I shall forthwith oom/pllygwith those provisions.
Date: / applicant;*
WARNING: FAILURE TO SECURE RKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT 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 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 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 county to enter upon the above-mentioned prope f inspection purposes.
Dater �� Signature (Applicant or Agentlc.
LQPERMIT
Application -Number 10-00000517
Permit. . . . MECHANICAL
Additional desc -
Permit Fee 51.00 Plan Check Fee
12.75
Issue Date . . . Valuation
0
Expiration Date 12/12/10 .
Q Qty Unit Charge Per
Extension
BASE FEE
15.00
2.00" 9.0000 EA MECH FURNACE <-,100K
18.00
2.00 9.0000 EA MECH B/C <=3HP/100K BTU'.
18.00
Special Notes and Comments
REPLACEMENT -- (2 )— 3-5' TON PACKAGE' UNIT ..-
J
14.25 SEER 12.EER HVAC CHANGE OUT.
Other Fees . . . . . . . . . 'BLDG STDS ADMIN (SB1473)
1.00
Fee summary Charged Paid Credited
Due
--------------------------------------=------------------
Permit" Fee Total 51.00 .00 .00
51.00
Plan Check Total 12.75 .00 .00
12.75
Other Fee Total. 1.00 .00 00
1.00
Grand Total 64.75 00 .00
64.75
LQPERMIT
Simplified Prescriptive Certificate of Compliance: 2008 Residential HVAC Alterations CF-IR-ALT-
ClimateHVAC
Zones 10 to 15
Jrte Address: En orcement Agency: `)91110 % 8 ry: Date: Permit #:
Equipment T List Minimum Efficiency' Conditioned Floor
,,Packaged Unit Duct insulation requirement Area Thermostat
❑ Furnace (J' AFUE800 O COP Over 40 ft of ducts added or !'Setback
O Indoor Coil KSEERr1j. a 5 O HSPF replaced in unconditioned space Served by system pfnot already
_
❑ Condensing Unit 0 EERJjO Resistance OR 6 (CZ 10-13) sf
—
Ptretalled) be
O Other OR 8 (CZ 14-15)
L Equipment Type: Choose the equipment being installed: if more than one system, use another CF -1 R -ALT -HVAC for each system.
7. Minimum Equipment E,f4ciencies: 13 SEER, 78.0 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 be left
shall 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. BeginningOctober 1 2010 a r tered co of the CF -1R and CF -6R shall also be on site for final Inspection.
1. HVAC Changeout Required Forms:
e All HVAC Equipment replaced CF -611 forms: MECH-04, MECH-2I-HERS and (for split systems) MECH- 25 -HERS
CF -4R forms: MECH- 21 and fors lit systems). MECH-25
• Condenser Coil and /or
• Indoor Coil and /or CF -611 forms: MECH-2I-HERS and (for split systems) MECH- 25 -HERS
• Furnace CF4R 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 Rom duct leakage testing if:
O 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
0 2. New HVAC System
Required Forms:
CF -6R forms: MECH-04, MECH-20-HERS,and (for split systems) MECH-22-HERS, and MECH-25-HERS
• Cut in or Changeout with new
ducts: (all new ducting and all
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
O 3. New Ducts with Replacement, - Requ"I�rms:
• Includes replacing or installing all new ducting CF -611 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
D 4. New Ducting over 40 feet
Required Forms:
• Include; adding or replacing more than 40
linear feet of duct in unconditioned space.
CF -611 forms: MECH-04, MECH-2I-HERS CF4R forms: MECH-21
For split system or packaged units: Duct leakage < 15 percent
❑ EXCEPTION: Existing ducts stems constrticted 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 Califomia Business and Professions Code to accept responsibility for the desigri identified on this Certificate of Compliance.
• 1 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 information documented on other applicable compliance forms, worksheets,
calculations, plans and specifications submitted to the enforcement agenc fo approval
with the Wrmit application.
Name: Lw fA Signature:. ,/ ,� Q/ ��1
cdA &
Company: "-
eh (l�Q l 12 J��C�_. Date.
Address: `71 y 1�j l 1 �, h Wi /� � License:
[ S ��6
City/Statcl7ip: t Phone: 2&t) 3W, 693E
2008 Residential Compliance Forms March 2010
Bin #
City of La Quinta
Building & Safety Dlvaslon
P.O. Box 1504, 78-495 Calle Tampko
la Quanta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit # / `1
S
Project Address:
Owner's Name:. l
A. P. Number.
Address:
City, ST, Zip: aA
Lu a
Legal Description:
Contractor:C RL,( �1 I.1 CD Tb �Y �r`� _
Telephone:
Project Description:
Address: I D
City, ST, Zip:
Telephone: '7 (PQ 3 (1b 019-1
State Lic. #: ")a ?D
V .-2201
q
City Lia #;
hl 12 1/
Y
J: -3, 7D10 0LCV- 0' W)l
as SE4
Arch., Engr., DesignerILI,
Address:
F— �, D
—
City., ST' Zip:
-
a + b& 4
Telephone:
State Lic. #:
Name of Contact Person:
Construction Type: Occupancy:
Project type (circle one): New Add'n Alter Repair
Demo
Sq. FL:
# Stories:
#Units:
e2
Telephone # of Contact Person: 1. 0 34 L(I
Estimated Value of Project: -� iF951
APPLICANT:
DO NOT WRITE BELOW THIS UNE
#
Submittal
Req'd
Reed
TRACKMG
PERMIT !PEES
Plan Sets
Plan Cheek submitted
Item
Amount
Structural Coles.
Reviewed, ready for correedons
Plan Check Deposit
Truss Cala.
Called Contact Person
Plan Check Balance
Title 24 Coles.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2'' Review, ready for correctioniAssue
Electrical
Subcoutector 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 correcdons/icsue
Developer Impact Fee
Planning Approval
Called Contact Person
A.LP.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees