10-0043 (MECH)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA
92253 .
Application Number:
C10=000_O
Property Address:
78106 CALLE NORTE
APN:
770-011-046- - -•
Application description:
MECHANICAL
Property Zoning:
LOW DENSITY RESIDENTIAL
Application valuation:
19000
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 Professio als Code, and my License is in full force and effect.
License lass: C 2 0 License 791437
Date: Cont
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of pe ury that 1 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 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 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 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 Law.).
I—) 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:
LQPER 11T
Owner:
DEWVEALL LANEIL
78106 CALLE
LA QUINTA,
(281)467-50
Contractor:
MENDEZ AIR
72096 DUNHA
THOUSAND PA
(760)345-60
Lic. No.: 7
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 1/19/10
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 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 FARMERS INS Policy Number B09242175
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 subj to the workers' compensation laws of California,
and agree that, if 1 should b u ' the workers' compensation provisions of Section
,p 3j00 of the Labor Code 11 comply with those provisions.
WARNING: FAILURE TO SECURE WORKERS' 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 ' is corre I agree to comply with all
city and county ordinances and state laws relating to building ctio , he y authorize representatives
of this cou ty to enter upon the above-mentioned proper or inspect S.
Signaatture'f(Applicant,or'Agent
Application Number . . . . . 10-00000043-
Permit
0-00000043
Permit . . . . . MECHANICAL
Additional desc . .
Permit Fee 51.00
Plan Check Fee
12.75
Issue.Date . . . .
Valuation . . .
. 0
Expiration Date 7/18/10
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
REPLACE (2)A/C & HEATING UNITS 16
SEER
----------------------------------------------------------------------------
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
Alternative Component Package Method: (check one) I C DD (Alternative)
' Package C.and Package D choices require HERS rater field verification and/or diagnostic testing (see CF -1R page 3)
For Package D Alternative see Appendix B Table 151-C Footnotes 8-14 in the Residential Compliance Manual (RCM)
GENERAL INFORMATION
Total Conditioned Floor Area (CFA) f
Average Ceiling Height: ft
Gbedc Applic" Boxes
Building Type: (check one or more, Single Family Multifamily Addition Alteration
(If adding fenestration fill -out WS:41 Fenestration Maximum Allowed Area Worksheet and see Section 8.3.2
for Additions and 8.3.3 for Alterations in the RCM.)
• Maximum Allowed Total Fenestration Area lam' ft (from WS -4R)
• Maximum Allowed West Facing Fenestration Area ft2 (from WSAR)
• Number of Stories: _ Number of Dwelling Units:. �•
• Floor Construction Type: Slab/Raised Floor (circle one or both)
• Front Orientation: North / South / East / West : All Orientations (input front orientation. in degrees
from True North and circle one).
❑ RADIANT BARRIER (check box if required in climate zones 2.4. 8-151
OPAQUE SURFACES INCLUDING OPAQUE DOORS
Component
Type (Wall,
Roof, Floor,
Slab Edge,
Doors)
Frame
Type Cavity
(Wood or Insulation
Metal) R -Value
Asseriibly U-`:'
factor (for wood,
Continuous metal frame and
Insulation mass
R -Value assemblies)'
Joint
Appendix'.:;'
IV
Reference
{'
s
,t
�`:. °'typical,
Location
Comments
(attic, garage,
etc.
1) See Joint Appendix IV in Section IV.2, IV.3, and IVA, which is the basis for the U -factor criterion. U -factors can not exceed ..
prescriptive value to show equivalence to R=values.
2) This column is for the Inspector to verify installation of roof radiant barrier.
Residential Compliance Forms December 2005
t- r
FENESTRATION PRODUCTS — U -FACTOR AND SHGC
❑ FENESTRATION MAXIMUM ALLOWED AREA WORKSHEET WS4R — must be included for New
Construction, Additions, and Alterations.
Fenestration
#/Type/Pos. (Front, Orien-
Left, Rear, Right, tation, Area U -factor
S li t N S E W1 ft' U -factor' Source SHGC°
Exterior
Shading/Overhane7
SHGC v" box if WS -3R is
Sources included
Distribution
Type and Location
ducts attic etc.
❑
A
11
F
L1. a701 d
13
13
c.l
0&
- c t
13❑
1) Skylights are now included in West -facing fenestration area if the skylights are tilted to the west or tilted in any direction when
the pitch is less than 1:12. See § 151(f)3C and in Section 3.2.3 of the Residential Manual.
2) Enter values in this Column from either NFRC Certified Label or from Standards Default Table 116-A.
3) Indicate source either from NFRC.or Table d 16-A,
4) Enter values in this column from NFRC or from Standards Default Table 116B or adjusted SHGC from WS -3R.
5) Indicate source either from NFRC, Table 116B or WS -3R
6) Shading Devices are defined in Table 3-3 in the Residential Manual and see WS -3R to calculate Exterior. Shading devices.
7) See Section 3.2.4 in the Residential Manual. -
HVAC SYSTEMS.
IS,50W- %A1M 1V*AA
Heating Equipment.
Type and Capacity
furnace heat pwnp, boiler etc.
Minimum
Efficiency
AFUE or HSP
Distribution
Type and Location
ducts attic etc.
.
Duct or Piping Thermostat Configuration
R -Value • T (split or package)
C�
F
L1. a701 d
c.l
0&
- c t
Cooling Equipment
Type and Capacity .
(A/C, heat pump, evap.
Cooling)
Minimum
Efficiency Distribution
(SEER or Type and Location
EER) (ducts attic etc.
Duct or Piping Thermostat Configuration
R -Value Type,(split or package)
(brMsy
KO- 0 Atl I
Residential Compliance, Forms December 2005
COMPLIANCE STATEMENT
This certificate of compliance lists the building features and specifications needed to comply with Title 24,
Parts 1 and 6 of the California Code of Regulations, and the administrative regulations to implement them. This
certificate has been signed by the individual with overall design responsibility. The undersigned recognizes that
compliance'using duct design, duct sealing, verification of refrigerant charge and TXVs, insulation installation
quality, and .building envelope sealing require installer testing and certification.and field verification by an
approved HERS rater.
D
esi er or Owner
Business and Professions CodeDocumentation Author
Name:
, . ,
Name:
Title/Firm`;
Title/Firm:
Address:
p
•
C)v
CN27
'Telephone:'
Telephonrj
License #:
a
License .-
(signature) "
(date
sr ,
(date)
Enforcement Agency
z
V.
4
r December 2005
4
I
Bin #
City of La Quinta
Building lit Safety Division
P.O. Box 1504, 78-495 Calle Tampico �..
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
�3
Project Address:
Owner's Name:
A. P. Number:o
1 f
Address: lJ l,f/
Legal Description:
Contractor � 9
' �<
City, ST, Zip: Cl V l IAe
_ Fj l
Telephone: �� (/ ' �•., '�`
Address: Qx L.
Project Description:
City, ST, Zip: AQ C
. �, A' -t5
Telephon 64,;z
State Lie. City Lie. #;
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone: , .
Construction Type: Occupancy:
(circle one): New Add'n Alter Repair Demo
State Lie. #:ProJect
Name of Contact Person:
Sq. Ft :
#Stories:
# Units:
Telephone # of Contact Person: 97 5— Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
N
Submittal
Plan Sets
R."'d
Recd
TRACKING
Plan Check submitted
PERMIT FEES
Item Amount
Structural Calci.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance
Title 24 Calcs.
Pians picked up
Coustmcdon
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2'' Review, ready for corrcctions/usue
Electrical
Subcoutactor List.
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
M HOUSE:-
Review, ready for correctionstissue
Developer Impact Fee
Planning Approval
Called Contact Person
A.LP.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees