12-0036 (MECH)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253 BUILDING& SAFETY DEPARTMENT
BUILDING PERMIT
Application Number: - 12-00000036 Owner: ,ID
Property Address: -78130 CALLE NORTE LESTER CHARLES II
APN: 770-011-037- - - 78130 CALLE NORTE
Application description: MECHANICAL 'LA QUINTA, CA 92253
Property Zoning: LOW DENSITY RESIDENTIAL !
Application valuation: 4200 j
Applicant: Architect or Engineer:
-- -------------------------------------------------
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 Busines and Professionals Code, and my License is in full force and effect.
Licen eClass: C20 LicenseNo.: 838711
Date: 1: '2'—f L ontractor: -
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury tl 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 Coder 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 I, 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. , 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: 1A
LQPERMIT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Contractor:
PACIFIC AIR HEATING & AIR COND
PO BOX 635
LA QUINTA, CA 92248 '
(760)771-6971
Lic. No.:. 838711
s-Sd-�'.�. 11 -�
JAN 12 201
OF LA OUINTA
/12
-----------------------------------------------
WORKER'S COMPENSATION DECLARATION
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 E CEMPT Policy Number EXEMPT
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 bject to the workers' compensation provisions of Section
37700 of the Labor Code, 1 shall f hw' h comply with those provisions.
ate: . plicant:
WARNING: FAILURE TO SECURE WORKER COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PE ALTIES 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 buildi ons action, and hereby authorize representatives
of thpi ounty to enter upon a above-mentioned propert If€ction purposes.
a6 te: C"n/ L' ' nature (Applicant or Agent):
Application Number . . . . . 12-00000036
Permit . . . MECHANICAL
Additional desc .
Permit Fee . . . . 40.50
Plan Check Fee
10.13
Issue Date . . . .
Valuation
0
Expiration Date 7/10/12
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
-----------------
INSTALL INSURANCE SUPPLIED EVAP COIL.
PACIFIC AIR INSTALLS CONDENSER &
FURNACE. 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
LQPERMIT
Si'mplified'Peescriptive Certificate ofCompliance. 2008 Residential HVM-Alterations CF-M-ALT HVAC
Climate Zones 10 - 15
Site Address:
Enforcement Agency:
Date.
Permit #:
78130 calle Norte La Quinta, CA 92253
City of La Quinta
]an 12, 2012
Duct insulation
Conditioned Floor
Equipment Typel
List Minimum Efficiency2
requirement
Area
Thermostat
Package Unit
_
✓ Furnace
*1Indoor Coil
✓ AFUE 78%
✓ SEER 13.0
COP
HSPF •
R 6 (CZ 10-13)
.Served by system
✓Setback
7f not,already present, must be .
✓ Condensing Unit
EER
Resistance
R 8 (CZ 141-15)
1200 sf
installed)
Other
1. Equipment Type: Choose the equipment being installed; if more than one system, use another CF-IR-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-411
.forms (no hand filled CF-4Rs allowed) are filled out and signed.Beginning October 1, 2010, a registered copy of the CF-111
and CF-611 shall also be on site for final inspection.
✓ 1. HVAC Chan.geout
Required Forms:
. All HVAC Equipment
CF-6R forms: MECH-04, MECH-2I-HERS and (for split systems) MECH-25-HERS
replaced
CF-411 forms: MECH-21 1 1 1 NOand (for split systems) MECH-25
. Condenser Coil and /or
. Indoor Coil and /or
CF-6R forms: MECH-04, 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
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
4. The system-will not be Ducted (ie,Ductless, Mini -Split System) -(Also,Exempt from Refrigerant Charge)
2. New HVAC System
Required Forms:
. Cut inior Changeout with;'
" j-� -
CF 6R forms: MECH-04, MECH-20-HERS, anti for split systems) MECH-22-HERS, and
new ducts: (all. new
ducting all new
��"�":
MECH-25�HERS I d I i _ \ ' �! !'
CF-4R forms: MECH 20, and (for split systems) MECH-22, and MECH-251
equipment) �
/1 +
� ../.� � j 1
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/or without
Required Forms:
Replacement
. Includes replacing or installing all new
ducting 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 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
'linear feet of duct in unconditioned space.
CF-4R forms: MECH-21 _
For split system 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 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 documented on other applicable compliance
forms, worksheets, calculations, plans and specifications submitted to the enforcement agency for approval with the permit application.
Name: victor estrada Signature: victor estrada
Company: PACIFIC AIR HEATING & AIR CONDITIONING SERVICES Date: ]an 12, 2012
Address: P 0 BOX 635 License: 838711 .
City/State/Zip: LA QUINTA / CA / 92253 Phone: (760) 771-6971
Reg: 212-A0002011A-00000000-0000 Registration Date/Time: 2012%01%12 .40:5733 HERS Provider: Ca10ERTS, Inc.
2008 Residential Compliance Forms il July 2010
11
Bin .....
' ":
Ci.
ty of La Quints .
Building 8T Safety Division
P.O. Boz .1504,78.495 Calle Tampico;
La Quanta, CA 92253 - (760) 777-7012 '
Building Permit Application and Tracking Sheet
Permlt #
�IO
Project Address:
.
Owner's Name: /
C. �t1 C !�:
A. P. Number:
Address: A -Q
Legal Description:
; City; ST, Zip:
ContractorM>-<>�
A C F/
.
Telephone: 6 — %7og ;,,, x
UN
Address: A0. R,0K
Project Description:
City, ST, Zip: u/A to C- 2ZS
ri4// 1NSv¢a�/ LC
we
Telephone: 7-7-71(9-7(
State Lia #: S71C61 11. City Lic. #.:
Arch., Engr., Designer:
VV
'`^ ' / O A S c 4
Address:
City, ST, Zip:
Telephone:
State Lic. #: %";•'':�::
Name of Contact Person: V JGlazt
pe.p�i
Construction Ty-fA-M '
Project type (circle one): New Add'n Alter Repair Demo
Sq. Ft.: / 2 0 10-T Stories: # Units:
Telephone # of Contact Person: — 05 Is
Estimated Value of Project: Z (90
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Rec'd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item Amount
Structural Caics.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance
Title 24 Calfs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
20° Review, ready for corrections/issue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
Review, ready for correctionslissue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue .
School Fees
Total Permit Fees