11-0478 (MECH)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: r-11-00000478
Property Address: 78203 CRIMSON CT
APN: 604 -025 -024 -
Application description: MECHANICAL
Property Zoning: MEDIUM DENSITY RES
Application valuation: 3000
Applicant:
Tiht aF44"
Architect or Engineer:
Ilo Of
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
UCENS9Y CONTRACTOR'S DECLARATION
I hereby affirm under penalty of ry that I a kens nder provisions of Chapter 9 (commencing with
Section 7000) of Division 3 of t e B 'nes a Prof sion Cot)g and my License is in full,force and effect.
License Class: C20 -C36 Lie No.: 777794
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 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 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.).
(_ 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: a
Lender's Address: 1
IF
LQPERMIT
Owner:
GENTZ JEROME L & NELLA
Contractor:
J ANTHONY PLUMBING
72216 NORTH SHORE
THOUSAND PALMS, CA
(760)343-2121
Lic. No.: 777794
HEAT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 5/09/11
tD-1
MAY 10 2011
CITY OF LA QUINTA
FINANCE DEPT.
STREET, #101
92276
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 STATE FUND Policy Number 1932451-2011
1 certify that, in the performance of a work for which this permit is issued, I shall not employ any
person in any manner so as to ecome subject to the workers' compensation laws of California,
and agree t 'f I&hdoma je o theorkers' compensatio rovisions of Section
37f00 of the Lab ll rthw' m with those provisio
ab t �ltOSEi'C�URE
WARNING: FAIL RE W KERS' 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 st that the ab a infor ation is correct. I agree to comply with all
city and county ordinances and state laws rela ng ildi con ucti n and reby authorize representa '
;fthis c tty to ae tt upon the above -mention d pr er r i specti p rp ee: `0 t/SSiigp3tuurre (Applican
Application Number . . . . . 11-00000478
Permit . . . MECHANICAL
Additional desc . .
Permit Fee . . . . 40.50
Plan Check Fee
10.13
Issue Date . . . .
Valuation . . . .
0
Expiration Date 11/05/11
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 NEW 14 SEER SPLIT SYSTEM,
HEAT
PUMP. 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
Simplified Prescriptive Certificate of Compliance: 2008 Residential HVAC CF -IR -ALT -HVAC
Alterations
Climate Zones 10 - 15
Site Address:
Enforcement Agency:
Date:
Permit #:
78203 CRIMSON CT La Quinta, CA 92253
City of La Quinta
May 9, 2011
Dud insulation
Conditioned Floor
Equipment Typel
List Minimum Efficiency2
requirement
Area
Thermostat
❑ Package Unit
Ed Furnace
C1 Indoor Coil
❑ AFUE
6T SEER 14.0
❑ COP
R HSPF 7.7
-
R 6 (� 10-13)
Served by system
Setback
If not already present,
0 Condensing Unit
21 EER
❑ Resistance
�] R 8 (CZ 14-15)
1200 sf
must be 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 Ef/Idendes: 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 fad the work completed by the installer. The inspector also verifies that
each appropriate CF -611 and registered CF -411 forms (no hand filled CF-4Rs allowed) are filled out and signedBeginning
October 1, 2010, a registered copy of the CF -1R and CF -611 shall also be on site for final Inspection.
ET 1. HVAC Changeout
Required Forms:
• All HVAC Equipment
CF -611 forms: MECH-04, MECH-2I-HERS and (for split systems) MECH-25-HERS
replaced
CF -411 forms: MECH-21 and (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 -411 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
For Packaged Units: Duct leakage < 15 percent
Exempted from duct leagage 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 dud systems are constructed, insulated or sealed with asbestos
❑ 2. New HVAC
Required Forms:
System
• Cut in or Changeout
with new ducts: (all
CF -6R forms: MECH-04, MECH-20-HERS, and (for split systems) MECH-22-HERS, and
new ducting Aad all
new equipment)
MECH-25-HERS
CF -411 forms: MECH 20, and (for split systems) MECH-22, and MECH 25,
For Split Systems: Duct leakage < 6 percent; RC, CCA >_ 350 CFM/ton, FWD, TMAH, SIMS, 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 and/or indoor coil
CF -611 forms: MECH-04, MECH-20-HERS, and (for split systems) MECH-25-HERS
and/or furnace. No or some
CF -411 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
E'] 4. New Ducting over 40 feet
Required Forms:
. Includes adding or replacing more
than 40 linear feet of duct in
CF -611 forms: MECH-04, MECH-2I-HERS
unconditioned space.
CF -411 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 Tide 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: Kevin Robinson Signature: Kevin Robinson
Company: l ANTHONY PLUMBING HEATING & AIR CONDITIONING Date: May 9, 2011
Address: 72216 NORTH SHORE ST #101 License: 777794
City/State/Zip: THOUSAND PALMS / CA / 92276 Phone: (760) 328-8096
Reg: 211-A0022202A-00000000-0000 Registration Date/Time: 2011/05/09 11:40:11 HERS Provider: Ca10ERTS, Inc.
Bin #
City Of is Quinta
Building &r Safety Davislon
P.O. Box 1504, 78-495 Calle Tampico
La Quanta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
ik • Alt
Project Address:
Owner's Name:GL tZ
A. P. Number.
Address:
Legal Description:
Contractor: `,,�. A &I �
City, ST, Zip: Z
Telephone:—
Project Description:
Address:
City, ST, Zip:
Telephone.0 �'a�y!
�A�4�—
State Lic. City Lia #:
Arch., Engr., Designer.
Address: iN
City., ST, Zip:
Telephone: Construction Type: Occupan :
State Lia #: Project type (circle one): New Add'n Alter epair Demo
Name of Contact Porson `() Sq. Ft :,
# Stories: % #Units:
Telephone # of Contact Person- F Estimated Value of Project:
APPLICANT: DO NOT WHITE BELOW THIS LINE
#
Submittal
Req'd
Rec'd
TRACIWG PERAUT FEES
Plan Sets
Plan Check submitted
Item Amount
Structural Cafes.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calm.
Called Contact Person
Plan Check Balance.
Tide 24 Cales.
Plans picked up
Construction
Flood plain pian
Pians resubmitted
Mechaulcal
Grading plan
20! Review, ready for correctioas(tssue
Electrical
Subcoutactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S M.I.
ILO A. Approval
Plans resubmitted .
Grading
IN HOUSE:-
3" Reytew, ready for eorrectleawlssue
Developer Impact Fee
Planning Approval
Called Contact Person
A.LP.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees