13-1341 (MECH)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA; CALIFORNIA 92253
Application Number:
13-00001341
Property Address:
78137 CALLE NORTE
APN:
770 -011 -067 -
Application description:
MECHANICAL
Property Zoning:
LOW DENSITY RESIDENTIAL
Application valuation:
8160
Applicant: Architect or Engineer:
0),k� -
------------------
LICENSED CONTRACTOR'S DECLARATION
f
BUILDING & SAFETY DEPARTME
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 Business and Professionals Code, and my License is in full force and effect.
LicenseClass: C20 -C43 LicenseNo.: 276586
Date: 1.0-LHI Contractor: 14�
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 h ' a 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 Lice'nse 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 La w.).
I am exempt under Sec. BAP.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
VOICE (760) 777-7012
FAX (760) 717-7011
INSPECTIONS (760) 777-7153,
Date: 10/21/13
Owner:
KEITH GAGNON
78137 CALLE NORTE
LA QUINTA, CA 92253
(604)220-3732
---------
Contractor:
DESERT AIR CONDITIONING, INC. 2-12013
590 WILLIAMS ROAD
PALM SPRINGS_CA 92264
(760)323-3383
I C�"V OF �LAQQ1Uq0Nu1TrA-
Lic. No.: 276586 FIN NCE DEPT.
-----------------------------------------------
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 V;hich 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 CYPRESS INS CO Policy Number 3300065410131,
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 ecome su bject to the workers' compensation laws of California,
0 as
hat, if I sho
and agree I I I s hould b me subigct to the workers' compensation provisions of Section
r
3700 of the Lab Code, I all fort comply with those provisions.
Ddte Applicant:
WARNING: FAILURE TO SECUR�EORKERS* 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, 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.
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 tha eiabol isnform#on isd correct. I agree to comply with all
ngl to tru h
city and county ordinances and state laws relati build ereby authorize representatives
of this county to enter upon the above-mentioned prope 7yf Z4 oses.
Date:JJD��O�Q Signature (Applicant or Agent):
Application Number 13-00001341
Permit . . . . . . MECHANICAL 2013
Additional desc
Permit Fee . . . . 83.42 Plan Check Fee
.00
Issue Date . . . . Valuation . . .
. 0
Expiration Date 4/19/14
Qty Unit Charge Per
Extension
1.00 35.7500 EA * MECH FURNACE
35.75
1.00 11.9200 EA MECH APPL REP/ALT
11.92
1.00 35.7500 F -A MECH CONDENSER/COMP
35.75
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Special Notes and Comments
HVAC CHANGE OUT - 16SEER/80AFUE SPLIT
SYSTEM (2008 ENERGY] CARBON MONOXIDE
ALARM(Sj TO BE INSTALLED PRIOR TO FINAL
1NSPECTION. 2010 CALIFORNIA BUILDING
CODES.
----------------------------------------------------------------------------
Other Fees . . . . . . . . . PERMIT ISSUANCE M/P/E
90.57
PLAN CHECK, MECHANICAL
52.4.3
Fee summary.. Charged- Paid Credited
'Due
----------------- ---------- ----------- ---------- ----------
Permit Fee Total 83.42 .00 .00
83.42
Plan Check Total .00 .00 .00
.00
Other Fee Total 143.00 .00 .00
143.00
Grand Total 226.42 .00 .00
226.42
LQPERMIT
Bin #
Qty of La Quin't-a
Building a Safety Diwsion
P.O. Box 1504,78-495 Calle Tampico
La.Quinta, CA 92253 -:(760) 777-7012
Building Permit A001cation, and Tracking Sheet
Peninit #
Project Address: -2 '8'- /37 01 �t
Owner's NamF:. r, a C)
A- P. Number.
Addrm: 9437 C k1
7 u
Legal Description:
Contractor DESERT AIR CONDITIONING, INC
City, ST, Zip:
....... ...
'Telephone: 60Y-,;ZP-0�-373
Address: 590 WILLIAMS RD
Project Description: C
lr,- �e_ I/
City, ST, Zip: PALM SPRINGS, CA 92264
kn Eltj av'OLCOJ
Telephone: 760-323-3383
StateLic.#: 276586 City Lie'. #., .363
Arc,h., Engr., Designer NA
Ll
Address:
City, ST, Zip:
Telephone: Construction Type: MECH Occupancy:
State Lie. #: . . . . . . . . . Project type (circle one): New Add'n. Alter Repair Demo
Name of Contact Person: JAtQU ELI NE RATLIFF' Sq. Ft.; # Stories: Units:
T
Telephone # of Contact Person: 760-323-'3383 Estimated Value of Project 0 -
APPLICANT: DO NOT WRITE BELOW THIS LINE
N
Submittal
Req1d
Reeld
TRACMG PERMIT FEES -
Plan Sets
Plan Check submitted Item Amount
Structural Cates.
Reviewed, "Aft for corrections Plan Check Deposit.
Truss Cates.
Called Contact Person Plait Check Balance
Title 24 Cates.
Plans pickid up Construction
'Flood plain plan
Plans resubmi . tted". Mechanical
Grading pla�
2*! Review, ready for correctionslissue Electrical
Subcontactor Ust
Called Contact Person Plumbing
Grant Deed
Plans picked up SALL
H.O.AL Approval
Plans resubmitted Grading
IN HOUSE:-
Wylew, ready for correctionsfissue Developer Impact Fee
Planning Approval.
Called Contact Person AJ.P.P.,
Pub. Wks. Appr
Date of permit Issue
School Fees
Total Permit Fees
Simplified Prescriptive Certificate of Compliance: 2008 Residential HVAC Alterations CF-lR-ALT-HVAC
Climate Zones 10 - 15
Site Address:
Enforcement Agency:
Date:
Permit #:
78-137 CALLE NORTE LA Q . UINTA, CA 92253
City of La.Quinta
Oct 15, 2013
Duct insulation
Conditioned Floor
Equipment Typel
List Minimum Efficiency2
requirement
Area
Thermo�eat-
[3 Package Unit
0 Furnace
0 AFUE 80%
[3 COP
[3 R 6 (CZ 10-13)-'
Served by system
0 Setback
0 Indoor Coil
0 SEER 16.0
0 HSPF
[3 R 8 (Cz 14-15) 1
1600 sf
If not already present, must be
0 Condensing Unit
[] EER
Resistance
installed)
0 Other
1. Equipment Type: Choose the equipment being installed; if more than one system, use another CF-lR-ALT-HVAC 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 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 CF -4R
forms (no hand filled CF-4Rs allowed) are filled out and signed.Beginning October 1, 2010, a registered copy.of the CF -IR
and CF -611 shall also be on site for final inspection.
1. HVAC Changeout
Required Forms:
All HVAC Equipment
CF -611 forms: MECH-04, MECH-21-HERS and (for split systems) MECH-25-HERS
replaced
CF -4R forms: MECH-21 and (for split systems) MECH-25
Condenser Coil and /or.
Indoor Coil and /or
CF -611 forms: MECH-04, MECH-21-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 :5 300 CFM/ton (Minimum Air Flow Requirement), TMAH.
FeF Paskaged- Units, 0-i-iret leakage 4 15 peFeeRk
Exempted from duct leakage testing if:
[3 1. Duct system was documented to have been previously sealed and confirmed.through verification, or
'HERS
[3 2. Duct systems with less than 40 linear feet in unconditioned space, or
[3 3. Existing duct systems are constructed, insulated or sealed with asbestos
4. The system will not be Du-cted (ie. Ductless Mini -Split System) (Also Exempt from. Refrigerant Charge)
13 2. New HVAC System
Required Forms:
Cut in or Changeout with
CF -6R forms:-MECH-04, MECH-20!HERS,_and`(f6� s�lit systems) MECH722-HERS, and
new ducts: (all new
clucting and all new
MECH-25-HERS
equipment)
CF -4R forms: MECH-20, and (for split syseemsi,MECH-22, and MECH'-25 "A
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
1:13. New Ducts with/or without
Required Forms:
Replacement
Includes replacing or installing all new
clucting and/or outdoor condensing unit
CF -6R forms: MECH-04, MECH-20-HERS, and (for split systems) MECH-25-HERS
and/or indoor coil and/or furnace. No or some
CF -4R forms: MECH-20.and (for split systems) MECH-25
equipment changed.
For Spkit Systems: Duct leakage < 6 percent; RC, CCA � 300 CFM/ton, TMAH
For Packaged Unitj: Duct leakage < 6 percent
13 4. New Ducting over 40 feet Required Forms:, -
Includes adding or replacing more than 40 CF -6R forms: MECH-04, MECH-21-HERS
linear feet of duct in unconditioned space. CF -4R forms: MECH-21
For split system or packaged units: Duct leakage < 15 percent
[3 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 res6onsibility for the design identified on this Certificate of
Compliance.
• I certify that the energy features and performance specifications for the design identified on this Certiflcate 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 documented on other applicable compliance -
forms, worksheets, calculations, plans and specifications submitted to the enforcement agency for approval with the permit application.
Name: Jacqueline Zabik ISignature: Jacqueline Zabik
Company: DESERT AIR CONDITIONING INC Date: Oct 15, 2013
Address: 590 WILLIAMS ROAD License: 276586
City/State/Zip: PALM SPRINGS / CA / 92264 Phone: (760) 323-3383
Reg: 213-AO078268A-000000000-0000 Registration Date/Time:-'2013/10/15 16:49:30
I V 2008 Residential Compliance Forms
-HERS Provider: CalCERTS, Inc.
July 2010