10-0771 (MECH)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 10-00000771
Property Address: 78169 CRIMSON CT.
APN: 604 -024 -025 -
Application description: MECHANICAL
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 1500
Applicant:
ei,y
T4'!t 4 4 Q"
Architect or Engineer:
41N
------------------
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 70001 of Division 3 of the Business and Professionals Code, and my License is in full force and effect.
License Class: B -C10- - License No.: 856936
ntractor:
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 ($500).:
1 _ 1 I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and
the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The
Contractors' State License Law does not apply to an owner of property who builds or improves thereon,
and who does the work himself or herself through his or her own employees, provided that the
improvements are not intended or offered for sale. If, however, the building or improvement is sold within
one year of completion, the owner -builder will have the burden of proving that he or she did not build or
improve for the purpose of sale.). '
1 _) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.
7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of
property who builds or improves thereon,,and who contracts for the projects with a contractor(s) licensed
pursuant to the Contractors' State License Law.).
1 _ 1 I am exempt under Sec. , B.&P.C. for this reason
Date:
Owner:
CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the
work for which this permit is issued (Sec. 3097, Civ. C.).
Lender's Name:
Lender's Address:
LQPERMIT
Owner:
CHRISTIANSEN MICHAEL J
48400 PRAIRIE DR
PALM DESERT, CA 92260
Contractor:
TELFORDJONES, INC.
25920 IRIS AVE, STE 13A-400
MORENO VALLEY, CA 92553,.
(951)486-0337
Lic. No.: 856936 �Cl�
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 8/17/10
A �-
WORKER'SCOMPE��t
OhLDECLARAT4O�.. I hereby affirm under penalty of perjury one of the fo�mgilogs^
_ I have and will maintain a certificate of conserr t0 sg1tAr sGiAt r, ckRrs' compen i ?as provided
for by Section 3700 of the Labor Code, for the ptafce:iw,,wr&mi.} c permit is
issued. ""�>`'•1,t0
VII have and will maintain workers' compensation insurance, as ree Irr$"tiy Section 370 of the Labor
Code, for the performance of the work for which this permit is issue worker compensation
insurance carrier and policy number are:
Carrier STATE FUND Policy Number 0059112009
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 subject to the workers' compensation provisions of Section
370 or Code, 1 sh comply with those provisions.
D A Ilcant: •
WARNING: FAI RE TO S E WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMP O 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 information is correct. I agree to comply with all
city and county ordinances and state laws relating to building construction, and'"y authorize representatives
of this county to enter upon the above-mentioned pro arty for inspec ' pur e .
--�'9
D e- S' ature (Applicant or gent):
Application Number . .
Permit . . . MECHANICAL
Additional desc . .
Permit Fee . . . . 33.00
Issue Date . . . .
Expiration Date . . 2/13/11
10-00000771
Plan Check Fee . . .8.25
Valuation . . . . 0
Qty Unit Charge
Per
Extension
BASE
FEE
15.00
1.00 9.0000
EA MECH
FURNACE <=100K
9.00
1.00 9.0000
EA MECH
B/C <=3HP/100K
BTU
9.00
------------------------------------7---------------------------------------
Special Notes and Comments
INSTALL FAU-HEAT PUMP
SAME LOCATION 13
SEER R410A 5 KW. 2007
CODES.
----------------------------------------------------------------------------
Other Fees . . . . .
. . . . BLDG STDS ADMIN
(SB1473)
1.00
Fee summary Charged
-----------------
Paid Credited
Due
----------
Permit Fee Total
----------
33.00
----------
.00
----------
.00
33.00
Plan Check Total
8.25
.00
.00
8.25
Other Fee Total
1.00
.00
.00
1.00
Grand Total
42.25
.00
.00
42.25
LQPERMIT
Simplified Prescriptive Certificate of Compliance: 2008 Residential HVAC Alterations CF -IR -ALT -HVAC
Climate Zones 10 to 15
�idU�'1� C����.G� Zvi •
Sjyj.sQ �
Enflc me genet':
Date: �
Permit #:
Conditioned Floor
Equipment T el
List Minimum Efficiency Z
Duct insulation requirement
Area
Thermostat
❑ Packaged Unit
❑ Furnace
❑ AFS�
❑ COP
Over 40 ft of ducts added or
❑ Setback
11Indoor Coil
&SEERC-
❑ HSPF
replaced in unconditioned space
Served by system
(If not already
❑ ensing Unit
❑EER
_
❑Resistance
❑ R 6 (CZ 10-13)
❑ R 8 (CZ 14-15)
sf
present. must be
installed)
Othe T/�l.�/�
/. 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 CF4Rs allowed) are filled out and
sign eginning October], 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 replaced
CF -6R forms: MECH-04, MECH-2I-HERS and (for split systems) MECH- 25 -HERS
CF -411 forms: MECH- 21 and fors lits stems MECH-25
• Condenser Coil and /or
CF -6R forms: MECH-2I-HERS and (for split systems) MECH- 25 -HERS
• Indoor Coil and/or
CF -411 forms: MECH- 21 and (for split systems) MECH-25
• Furnace
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 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 ducts stems are constructed, insulated or sealed with asbestos
❑ 2. New HVAC System Required Forms:
• Cut in or Changeout with new CF -6R forms: MECH-04, MECH-20-HERS,and (for split systems) MECH-22-HERS, and MECH-25-HERS
ducts: (all new ducting and all CF -4R forms: MECH 20-, and (for split systems)MECH-22, and MECH 25
new equipment)
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 Replacement Required Forms:
• Includes replacing or installing all new ducting CF -6R forms: MECH-04, MECH-20-HERS,and (for split systems) MECH-25-HERS
and/or outdoor condensing unit and/or indoor coil CF -4R forms: MECH-20 and (for split systems) MECH-25
and/or furnace. No or some 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
Forms:
'Required
• Includes adding or replacing more than 40
CF -611 forms: MECH-04, MECH-21-HERS CF -4R forms: MECH-21
linear feet of duct in unconditioned space.
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 I and 6 of the California Code of Regulations.
• The design features identified on this Certificate of Compliance are consistent with the information documente n plicable compliance forms, worksheets,
calculations, plans ands specifications submitted to the enforcement agency forapproval with e e t a t
Name:
Signatu
Company: _
Date:
Addresc�3 � Q
Licenser ,
City/State/Zip: / %/W .r�-
Phone:
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ASSESSORS PARCEL NUMBER�D�fD�`Q'�f
Provide North Arrow REAR PROPERTY LINE
FRONT PROPERTY LINE
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Bin #
Qty Of La Quint 3
Building 8r Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
Project Address:42104%-1*1 ele
Owner's Name: *11v*W, a1101&7A
A. P. Number:
Address: A10
GwiT
Legal Description: �6
City, ST, Zip: `�
Contractor:
Telephone:
Address: v
Project Description:_ vO
City, ST, Zip:
h ne:
Telephone:
P
`Lic.
State Lic.# : YVC�
City #;
T �yfv
Arch., Engr., Designer: (a04 . Q24_ 40 -
Address:
City, ST, Zip:
Telephone:
ancY :
Construction Type: Occupancy:
State Lic. #:
S
.....................................................
Demo
Add' Alter a air D m
Project a circle one : New n R P
J tY P � )
Name of Contact Person:
Sq. Ft.:
# Stories: '-
# Units:
,��� 7
Telephone # of Contact Person: G�.� 7'
Estimated Value of Project: zSvCJ
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance
Title 24 Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
21d Review, ready for corrections/issue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
'"' Review, ready for corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees