14-0604 (MECH)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 9225
Application Number:
14-00000604
Property Address:
52150 AVENIDA CORTEZ
APN:
773-202-008-15 -000000-
Application description:
MECHANICAL
Property Zoning:
COVE RESIDENTIAL
Application valuation:
7650
Applicant: Architect or Engineer:
------------------
LICENSED CONTRACTOR'S DECLARATION
BUILDING & SAFETY DEPARTMENT
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.
License�C`llass: C20 36 cert o.: 906115
Date: ✓ _'� ontractor1 t
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 ISec. 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).:
(_) 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 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.).
(_) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project ISec.
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_ 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 ISec. 3097, Civ. C.).
Lender's Name:
Lender's -Address: CNN D�
LQPERNiIT
Owner:
ROD WAITS
52150 AVENIDA CORTEZ
LA QUINTA, CA 92253
(
Contractor:
HYDES
42949 MADIO STREET
INDIO, CA 92201
(760)360-2202
Lic. No.: 906115
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
1�
Date: 5/08/14
-----------------------------------------------
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.
shave 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 NORGUARD INS Policy Number CEWC468841
_ 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 becom subject to the work s' compensation provisions of Section
5 J3700 of the Labor Code, I all orthwith ly " those provisions.
Date t_,Id Applican
WARNING: FAILURE TO SECURE WORK RS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS ($100,0001 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 omply with all
city and county ordinances and state laws relating to buildin!��F
n, and y authoriz epresentatives
of this countytooen on the above-mentioned property fp e
Dace / S nature (Applicant or Agent):
Application Number . . . 14-000.00604
Permit . . . MECHANICAL 2013
Additional desc . .
Permit Fee . . . 71.50 Plan Check Fee .00
Issue Date . . . . Valuation . . . . 0
Expiration Date . . 1.1/04/14
Qty Unit Charge Per Extension
1.00 35.7500 EA MECH FURNACE 35.75
1.00 35.7500 EA MECH CONDENSER/COMP 35.75
-------------------------------------------------------- -------------------
Special Notes and Comments
HVAC CHANGE OUT - 13SEER/78AFUE SPLIT
SYSTEM [2008 ENERGY] CARBON MONOXIDE
ALARM(S) TO BE INSTALLED PRIOR TO FINAL
INSPECTION. 2013 CALIFORNIA BUILDING
CODES.
----------------------------------------------------------------------------
Other Fees . . . . . . . . . PERMIT ISSUANCE M/P/E 90.57
PLAN CHECK, MECHANICAL 47.66
Fee summary Charged
Permit Fee Total 71.50
Plan Check Total .00
Other Fee Total 138.23
Grand Total 209.73
I
LQPEMIrr
Paid Credited Due
.00 .00 71.50
.00 .00 .00
.00 .00 138.23
.00 :00 209.73
Simplified Prescriptive Certificate of Compliance: 2008 Residential HVAC Alterations CF-lR-ALT-HVAC
Climate Zonas 10 - 15
Site Address:
Enforcement Agency:
Date:
Permit #:
52-150 Avenida Cortez La Quinta, CA 92253
City of Jurupa Valley
May 6, 2014
Duct insulation
Conditioned Floor
Equipment Typel
List Minimum Efficiency2
requirement
Area
Thermostat
® Package Unit
❑ Furnace
Indoor
9 AFUE 78%
❑ COP
❑ R 6 (CZ 10-13)
Served by system
® Setback
[3 Coil
® SEER 13,0
[3HSPF
❑ R 8 (CZ 14-15)
1400 sf
If not already present, must be
❑ Condensing Unit
❑ EER
❑ Resistance
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-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-6111 shall also be on site for final inspection.
® 1. HVAC Changeout
Required Forms:
. All HVAC Equipment
CF-6R forms: MECH-04, MECH-2I-HERS @Rd (far split systems) MC-GH 2&44E4�,&
replaced
CF-4R forms: MECH-21 and (for split systems) NEGH 2&
. Condenser Coil and /or
CF-6R forms: MECH-04, MECH-2I-HERS and (fer split systems) 049GW 2159 HERS
. Indoor Coil and /or
CF-4R forms: MECH-21 and (fete split systems) ^. ECH 2
. Furnace
For Packaged Units: Duct leakage < 15 percent
Exempted from duct leakage testiri.g.jf:
E31. Duct system was documented to have been previously sealed and confirmed through HERS verification, or
❑ 2. Duct systems with less 046.40 linear feet in unconditioned space, or
❑ 3: Existing duct systems are instructed, insulated or sealed with asbestos
❑ 4. The system will. not be Duci9 d (ie. Ductless Mini-Split System) (Also Exempt from Refrigerant Charge)
❑ 2:::New HVAC System
Requiretl:Forms:
• Cut in oChan eoutwith
x"A " ` d `
CF 6R forms MFECH 04,, MECH 20 HERS, ah %for split systems) MECH-22 HERS; and
new ducts al9new '
Budin n all new
9;
MECH 25 HERS uru t."
11
.
CF 4R forrnst MECH-20, a`d (for split systems)�MECH 22,and"MECH 25 .....
equipment
j......
For Split-Sy' stems:. Duct IeakageE«6;p∭ R�rC+, CCA >t350 CFM/ton;�FWD; TMAH; STMS and either HSPP or�PSPP+� s �°
,. J, E a z
Y k .4 r
'
P R a C
For Packaged Units Duct leakage < 6 percent y �* ,
s_
r tt
'.. �. i s:
❑ 3. New'D'ucts°with/or without;_
Re u�red":Forms•. ,:...:.
q
Replacement
. Includessreplacidbg'Or installing aff., hew
ducting and�oroufdoor. condensing unit
CF-6R forms: MECH-04, MECH-20-HERS, and (for split systems) MECH-25-HERS
and%or indoor coil arid]orfurnace`l o- 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: Dud leakage 2 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 dud in unconditioned space.
CF-411 forms: MECH-21
For split system or packaged units: Dud leakage < 15 percent
❑ EXCEPTION: Existing dud 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: Mark Hyde Signature: Mark Hyde
Company: CERTIFIED COMFORT SYSTEMS INC Date: May 6, 2014
Address: 42-949 MADIO STREET .. License: 906115
City/State/Zip: INDIO / CA / 92201 Phone: (760) 360-2202
Reg: 214-A0031893A-000000000-0000 Registration Date/Time: 2014/05/06 14:54:30 HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms July 2010
Bin #City
• _ '
of La QUinta .
Building .a Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La
Quints, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet -
Permit #
�
Project Address:- Z-- �� U Nrcr
Owner's Name: f
A P. Number:
Address: Z-- -0AUcl
Legal Description:
// d �
Cont uctor. ev r! t f o,,i g g/ -
Address: 1 Ll y' / "lct
City, ST, Zip:
Telephone:
Project Description:' C CG h
City, ST, Zip:C A ciZ Z d
Telephone: (j C7
State Lie. # : q C76, �. City Lic. #: Z.Z
Arch., Engr-, Designer.
Address:
City, ST, Zip:
Telephone:
Construction Type: Occupancy:
State Lic. #:
Project type (circle one): New Add'n Alter Repair Demo
Name of Contact Person:
Sq. Ft.:
# S-h'es:
# Units:
Telephone # of Contact Person:
Estimated Value of Project:
APPUCANT: DO NOT WRITE BELOW THIS UNE
#
Submittal
Reed
Reed
TRACKING.
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Cates.
Called Contact Person
Plan Check Balance
Energy Calc&
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan'
2" Review, ready for correctitiooslissue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
H2O.A, Approval
Plans resubmitted
Grading
1N HOUSE:-
r'' Review, ready for eorrectionslissue
Developer-lmpact Fee
Planning Approval
Called Contact Person
A.LP.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total rKake
V r. Lip
MAY 0 7 2014
CITY OF LA QUINTA
COMMUNITY DEVELOPMENT
IVA
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