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12-0645 (MECH)s P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 T,,&t 4 4 Q" BUILDING & SAFETY DEPARTMENT BUILDING PERMIT Application Number: 12-00000645 Owner: Property Address: 53.895 AVENIDA CORTEZ GORDON A OKABAVASHI APN: 774-141-019-8 -00000'0- 53895 AVENIDA CORTEZ Application description: MECHANICAL LA QUINTA, CA 92253 Property Zoning: COVE REST'DENTIAL Application valuation: 5000 Applicant: Architect or Engineer: ------------------ LICENSED CONTRACTOR'S DECLARATION I hereby affirm•under penalty of perjury that) 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 uceenns'e No.: 619091 Date: Contractor: aewwC - OWNER -BUILDER DECLARATION I hereby affirm,under, penalty of perjury that l am exempt from the Contractor's; State License Lew 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 he, s issuance, also rsquires.the applicant for the permit to file a signed statement that he orshe 'Is licensedpursuant 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 doilirs (6500).: (_) I, as owner of the,property, or employees with wages as their sole compensation, will do•the work, and the structure isnot intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors'' State License Law does not;applyto 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 orimprovementis 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.).: f _) 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.Llcense 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 em exempt under Sec. ,: B.&P:C. for this reason Date: Owner: CONSTRUCTION LENDING AGENCY I hereby affirm,underpenalty of perjury that there Is a construction (ending agency for theperformance'•of the work for which this permff is issued (Sec. 3097, Civ. C.). Lender's Name: _ Lender's.Address: LQPBRMIT VOICE'(760) 777-7012 FAX (760) 7774011 INSPECTIONS (760) 777-7153 Date: 6/11/12 Contractor: r0 U PALOMA AIR CONDITIONING P.O. BOX 3501 ' S 1:2 2012 PALM DESERT, CA 92261 SUN 1 1 (760)347-1212 Lic. No.: 619091 j CITY 0F LA QUINTJ 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 selfAnsure•forworkers' compensation„as provided for by Seation,3700 of the Labor Code; for the performance of the work for which this permit is Issued. _ I haveand will maintain workers' compensation insurance, as required by Section 3700' of the Labor Code, for the performance of tha'work for which this permit is issued. My workers' compensation Insurance carrier and policy number are:: ,Carrier EVEREST NAIL Policy Number 7600007550111 _ I certify that, in the performance of, the work'forwhich 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 37 0 of the. Lebor Code, I shall hwith comply with�those provisions:. Date: �� Applicant: WA IN . FAILURE TO SECURE RKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINESUP TO ONE HUNDRED THOUSAND DOLLARS (9100,000). IN ADDITION TO THE COST OF COMPENSATION; DAMAGES AS PROVIDED FOR IN SECTION 3708 OF THE LABOR CODE, INTEREST-, AND ATTORNEY'S FEES. APPLICANT ACKNOWLEDGEMENT IMPORTANT Application is hereby made to the Director of,Buildingsand 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 worlris performed under orpursuantto any permit' Issued as a result of this application, the,owner, and the applicant, each agrees to,.and. shall defend, indemnity and hold harmless1he City of La Quints, its officers, agents and employees for any actor omission related.to the work being performed under or following issuance of this permit. 2. Any permitissued as.a result of this applicationbecomes null and void if work is not commenced within 180 days from dateof'issuanee.of such permit, or cessation of work for 180 days will subject permit to cancellation. I certify that 1 have read this application and state that the above Information is correct. I agree to comply with all city -and county_ ordinances and state Jaws relating to building construction, and hereby authorize representatives of this c ty enter upon the above-mentioned property for eotion purposes._ Date: / Signature (Applicant or Agent): �, _S_ ��'� Application Number . . . . . 12-00000645 Permit. . . MECHANICAL Additional desc . Permit Fee . . 24.00 Plan Check Fee 6.00 Issue Date . . . Valuation . . . . 0 Expiration Date 12/08/12 Qty Unit Charge Per Extension BASE FEE 15.00 1.00 9.0000 EA MECH $/C <=3HP/100K BTU. 9..00 ----- - ----- - Special Notes and Comments HVAC CHANGE OUT REPLACED HVAC EQUIPMENT CONDENSER COIL, INDOOR COIL AND FURNACE. 13:0 SEER 2010 CODES. --------------------------------------------------------- -- Other Fees .. . . . . . . BLDG STDS ADMIN (SB1473) .1.00 Fee summary Charged Paid Credited ------- Due ----------------- Permit Fee Total 24.:00 .010 .00 24.00 Plan Check Total 6.00 .00 .00. 6.00 Other Fee Total 1.00 .0,0 .00 1.00 Grand. Total 371.00 . 0.0 .00 31.00 LQPERMIT �OrAon OKabayasl�� Simplified Prescriptive Certificate of Compliance: 2008 Residential HVAC Alterations CF -IR -ALT -HVAC Clfmate,Zones 10 - 15 Site Address: Enforcement Agency: Date: Permit #: 53-895 Cortez La Quinta, CA 92253 City of La Quinta I May :30, 2012 Duct insulation Conditioned Floor Equipment Typel Ust.Minimum EfFiciency2 requirement . Area Thermostat ❑ Package Unit ® Furnace [3 Indoor Coil Condensing ❑ AFUE ® SEER 13:0 ❑ COP ® HSPF 7:7 p R 6"(cz 10-13) OR (CZ 14-15) Served'by, system 1400 sf ® Setback If not already present, must be ® Unit 13 EER p Resistance installed) - . ❑ Other. 1. Equipment Type: Choose the equipment being Installed, If more than one system, use another CFIR-ALT-HVAC each system. 2. Minimum Equipment triidenclesi 13 SEER, 78% ARIE, 7.7HSPF far typkaI iesldentlal 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: slgned.Beginning October 1, 2010, a registered copy of the CF -111 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 17-411 forms: 'MECH-21 and (for split systems) MECH-25 ., Condenser Coil and /.or CF -611 forms: MECWINI, MECH-2I-HERS and (for split systems) MECH=25-HERS . Indoor Coil and,/or CF74: Uforms: ME CH -21 and for split systems) MECH-25 . Furnace For Split Systems: Duct leakage `<'15?percent; RC, CCA 5 300 CFM/ton (Minimum Air Flow Requirement), TMAH Exempted from duct leakage to ❑ Duct syste,0i was docu d to have been previously sealed and confirmed through HERS verification, or ❑ 2 Duct systems with less th `4dilinear feet In unconditioned, space, or C13 Existing duct systems are tied, 'insulated or sealed with asbestos p�4 The Il;not be puo ke . xecjernt^Crge) 0.2 Ne Illi Requ – .^ - . Cut i angeout wl new 811 new - CH ��' lit sy )MEC ERS,, and ducts :all n ECH equip ... r For Split' For Paekag'edW111h ut�akag 0;3 /orwithot Required Forms: Rept .Inc desreplacing ons _ lling� new ducting and/or outdoor iron�e . n , unit CF -6R forms: MECH-04, MECH-20-HERS, and (for split systems) MECH-25-HERS and/or indoor coil and/or furha� o: or some CF -4R forms: MECH-20 and (for split systems) :MECH-25 equipment. changed. ; For Split Systems: Duct leakage;:<i6°percent: RC, CCA Z 300 CFM/ton, TMAH For Packaged.Units: Duct leakage < 6 percent ❑ 4. New Ducting over 40 feet Requiredforms•.----- - -- — - -- -- . 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*lth asbestos. Contractor (Documentation Author's /Responsibler Designer's Declaration Statement) • I certify that this Certificate of Compliance documentatlomIs'accurate,and complete. • I•am eligible underDiVlsion.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 Califomia Code of Regulations. • The design, features Identifie&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 theperrm application. Name: Herman Paredes Signature: Hernwn Paredes Company: PALOMA AIR CONDITIONING Date: May 30, 2012., Address: PO BOX 3501 License: 6190,91 City/State/Zip: PALM DESERT/ CAL/ 92261 Phone: (760) 347-1212 Reg: 212-A0027697A700000000-0000 Registration Date/Time: 2012/05/30 19:,21:49 HERS Provider: Ca1CBRTS, Inc. 2008 Residential Compliance. Forms July 2010 Sin. „ qty, of is Quinta -&d(mng 8r Safky DMWdn P.O Box 1504,'7849S Cage Tampko 1a..Qldntay CA 92253 - (760) 777-7012 , Bciklding Permit Appkkcatkon' and Tracking Sheet Peralt # Pmje�xAd&=:S8 -- g 9.S- �'oe> OwW-.Num. o�,�o�+v �ttr1_isa j',es A P. Number: - Addreas Legal Desaipt m City. ST.,Zip: Contractor /7�d�a/%G Te3ephone , Project Dwmiption: AI V,4'e, Aftw: yo, p City, ST. Tp, .e G CO Telephone: ;I;f o 3 .t State Lit. ># : city Lic, d: A tch• A, EV, Dosiga • Addrem City. ST. Zip: _ Telephone Stale;Lic. Name of Contact Person: . > O Coon Typm Oocupanry. Pmject typo (drde one): Now Add'u .Alta Demo Sq. FL: p p # Stories: p Uaitx Telephone+# of Coated Person: Essdmabod Value of Project:'— APPLICANT:' DO NOT, WRITE BELOW THIS UNE M 8obmltlal- RWd Reed 1RA4'[WIC' PBRM[I' FSFS PI�a Seb Pian Check sabWmd hem Amount Shvetswal Coles. R Mewed rad* for oortectlow Pian Check Deposit Truss Calea. Caped Costate Person Plan Check lwanct: IMe ZI Calm Plana picked sip Conduction Flood plain plan Pias reanbailtted., . Meehankal Giu ft plan 2'! Review. ready for torreetionsime Elewical Sabeoutactorldat Called CoubdPerson Plumbing Gnat Deed Plana picked up ILO:A. Approval Plans rembudlied Grading IN IiOISRt• ''` Btvlerr; ready for torrectlonall:sat Developer Impact Fee Phoning Approval• Called CoataetPann A.T.P.P. Pub. Wks. Appy - Date of permitissue School Fees Ld Total Permit Fees