12-0600 (MECH)P.O. BOX 1504
787-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
= AP.N:
Application description:
Property Zoning:
Application valuation:
BUILDING .& SAFETY DEPARTMENT
BUILDING- PERMIT
12-00000600- =' Owner:
80898ySPANISH BAY BR6G KENNETH,C
775-310-008- - - 80898'SPANISH BAY
MECHANICAL LA-QUINTA, CA 92253
LOW DENSITY RESIDENTIAL y D
10000
VOICE (760),777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 5/31/12
Contractor: MAY 31
Applicant: Architect or Engineer: HYDES
42949•MADIO STREET
• INDIO, CA 92201
(760) 360-2202F�N�4NC�p ��TTA
�l Lio. No.: 906115
_ ' - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - _ _
U SED CONTRACTOR'S DECLARATION - - + WORKER'S COMPENSATION DECLARATION
I hereby affiim under penalty of perjury t t l am licen ed rider provisions of Chapter 9 (commencing with I hereby affirm under penalty of perjury.one of the following declarations:
Section 7 0) of Dion 3,of the Busin s nd Profes io Is Code, and my License is in full force and effect. _ I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided
Li c n I s : 20 C3 License Nd^: 90 115 ' - for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
�/ issued.
Date' ontractor: —1 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 workerscompensation
OWN UILDE DE�r RATION insurance carrier and policy number are: ^
I hereby affirm under penalty of perjury that pt th Co tractor's State License Law for the Carrier NORGUARD INS - Policy Number CEWC243358
following reason (Sec. 7031 .5, Business and Professions Code: Any city or county that requires a permit tof _ I certify that, in the performance of the work for which this permit is issued, I shall not employ any
construct, alter, improve, demolish, or repair any structure, prior. to its issuance, also requires the.applicant for the ' person in any manner to become subject to the workers' compensation laws of California,
permit to file a signed statement that.he or she is licensed pursuant to the provisions of the Contractor's State an agree that, if I oul ecome subject o t workers' compensation provisions of Section
License Law (Chapter 9 (commencing with Section 7000)ofDivision 3 of the Business and Professions Code) or �� 0 f the Labor o , I shall forthwith y'with rhos provisions.
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).: ate• pplicant:
( :) �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 WARNIN FAI URE TO SECURE WORKE 'COMP NSATVERAGE IS UNLAWFUL, AND SHALL
Contractors' State License Law does not apply to an owner of property who builds or improves thereon, _ SUBJECT AN EMPLOYER -TO CRIMINAL PEN A S ND CIVI NES UP TO ONE HUNDRED THOUSAND
and who does the work himself or herself through his or her own employees, provided that the DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
improvements are not intended or offered for sale. If, however, the building or improvement is sold within SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. -
- - 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.). - - ' APPLICANT ACKNOWLEDGEMENT
(_) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. IMPORTANT .Application is hereby made to the Director of Building and Safety for a permit subject to the
7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of conditions and restrictions set forth on this application. ,
property who builds or improves thereon, and who contracts for the projects with a contractors) licensed 1. Each person upon whose behalf this application is made, each person at whose request and for
- pursuant to the Contractors' State License Law.). whose benefit work is performed under or pursuant to any permit issued as a result of this application,
(_) I am exempt under Sec. , B.&P.C. for this reason . the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City
of La Quinta, its officers, agents andemployeesfor any act or omission related to the work being
• - _ performed under or following issuance of this permit.
Date: Owner: 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+
CONSTRUCTION LENDING AGENCY- - - - - permit to cancellation. -
I hereby affirm under penalty of perjury that there is a construction lending agency .for the performance of the I certify that I ave read this application and state thaeildi
abo information is correct. I agree to comply with all
work for which this permit is issued (Sec. 3097, Civ. C.). city and c or in ces and state laws relating to construction, and ereby authorize representatives
of this c ntete the above-mentioned pro or inspection pur o o es.
Lender's Name: "
D e: ignature (Applicant or Agent):
Lender's Address: •I '
. .,;Q
L4ERM
IT`f,- ,
:xx'
Application Number 12=00000600
Permit MECHANICAL
Additional desc .
Permit Fee 40.50 Plan Check Fee
10.13 .
Issue Date Valuation
0
Expiration Date 11/27/12
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
HVAC CHANGE -OUT: INSTALL 5 TON SYSTEM,
FURNACE, CONDENSER, INDOOR COIL. 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
-
Y
Reg: 212-A0027868A=00000000-0000 Registration Date/Time: 2012/05/31 13:15:28 HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms • July 2010 =
Simplified Prescriptive Certificate of Compliance: 2008 Residential HVAC Alterations CF-iR=ALT-HVAC
Climate Zones 10 - 15
Site Address:. , Enforcement Agency: Date: - Permit #:
80-898 Spanish Bay La Quinta,•CA 92253 `• City of La Quinta May 31, 2012
Duct insulation Conditioned Floor i -
Equipment Typel List Minimum Efficiency2 requirement Area Thermostat
❑ Package Unit
I
Furnace '® AFUE 78% ❑ COP �. 10 Setback
indoor Coil' ® SEER o ❑ HSPF ❑ R 6'(CZ 10-13) • Served by system If not already y present must be
Condensing Unit ❑ EER ❑ Resistance 13, 8 (CZ 14-I5) . 2000 sf installed)
Other
3: �alp►nent Type: Choose the equipment being installed; if more than one system, use another CF -IR -ALT -HVAC for each system.
Fil -•lirtOm Equipment Efficiencies: 13 SEER, 78% AFUE, 7.7HSPF for typical residential systems. '
HER V RIFICATION SUMMARY Listed below are FOUR HVAC alteration Options. The installer decides what work is being done
a`hd:picks one of the appropriate Options. Each Option lists the HERS measures that must be'conducted. A copy of the forms shall
6 left bn site for final inspection and a copy given to the homeowner.. At final, the inspector verifies that the work listed on this -
ffir'M ryas in fact the work completed by the installer: The inspector also verifies that each appropriate CF -6R and registered CF -4R
f&Mn -(60-hand,filled CF-4Rs allowed) are filled out and signed.Beginning October 1, 2010, a registered copy of the CF -1R
anti i=+6R shall also be on site for final inspection.
2 •HVAC Changeout Required Forms:
'all HVAC Equipment CF -6R forms: MECH-04; MECH-2I-HERS and (for split systems) MECH-25-HERS
:� F replaced CF -4R forms: MECH-21 and (for split systems) MECH-25
• Condenser Coil and /or CF -6R forms: MECH-04, MECH-2I-HERS and (for split systems) MECH-25-HERS
• Indoor Coil and /or CF -4R forms: MECH-21 and (for split systems) MECH-25
. Furnace '.
For Split Systems: Dud leakage < 15 percent; RC, CCA 5 300 CFM/ton (Minimum Air Flow Requirement), TMAH
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 dud systems are constructed, insulated or sealed with asbestos
❑ 4. The systerti will not be Ducted (ie. Ductless int-5pliSysterLt(Alsao Exemp�(og�ger txharge)
❑ 2. Ne�tIV,'C Sy em Required FG msAW,
. Cut in or,Ckiangeout, with ,r� fix:r: �+y
CF6R forms MECH-04, M CM -2 ERS, ands( or split sy tem) MECH 22=HERS, a'nd
new ducts: (all new MECH=25°HERS '
ductit", all n w 3 "'
equip ` entj G�- forms 'MECH- •0, nd (fors ,, its stem_ MECH-2' , and. ME25
Ra is >`
For Split Systems: Duet leakage; 67petcenY;pRC CCA��r3503CFM/ton,>* WDkT.MAH' SIMS, and either H9PP'or'PSPP.
For Packaged Units: Duct leakage.<.6 percent' x
❑ 3. New Duets with/or without Required Forms:
Replacement
. Includes replacing or installing all new -
ducting and/or outdoor condensing unit CF -6R forms: MECH-04, MECH-20-HERS, and (for.•split systems) MECH-25-HERS.
and/or indoor coil and/or -furnace. No or some CF -4R forms: MECH-20 and'(for split systems) MECH-25
equipment changed. ,• .
For Split Systems: Duct leakage -< 6 percent; RC, CCA a 300 CFM/ton, TMAH „
For Packaged Units: Duct leakage < 6 percent ti
114. 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 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 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. • •" • - I
• 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 31, 2012 ,.
Address: 42-949 MADIO STREET License: 906115
City/State/Zip: INDIO / CA / 92201 - Phone:, (760)
360-2202
Reg: 212-A0027868A=00000000-0000 Registration Date/Time: 2012/05/31 13:15:28 HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms • July 2010 =
Simplified Prescriptive Certificate of Compliance: 2008 Residential HVAC Alterations CF-iR=ALT-HVAC
Climate Zones 10 - 15
Site Address:. , Enforcement Agency: Date: - Permit #:
80-898 Spanish Bay La Quinta,•CA 92253 `• City of La Quinta May 31, 2012
Duct insulation Conditioned Floor i -
Equipment Typel List Minimum Efficiency2 requirement Area Thermostat
❑ Package Unit
I
Furnace '® AFUE 78% ❑ COP �. 10 Setback
indoor Coil' ® SEER o ❑ HSPF ❑ R 6'(CZ 10-13) • Served by system If not already y present must be
Condensing Unit ❑ EER ❑ Resistance 13, 8 (CZ 14-I5) . 2000 sf installed)
Other
3: �alp►nent Type: Choose the equipment being installed; if more than one system, use another CF -IR -ALT -HVAC for each system.
Fil -•lirtOm Equipment Efficiencies: 13 SEER, 78% AFUE, 7.7HSPF for typical residential systems. '
HER V RIFICATION SUMMARY Listed below are FOUR HVAC alteration Options. The installer decides what work is being done
a`hd:picks one of the appropriate Options. Each Option lists the HERS measures that must be'conducted. A copy of the forms shall
6 left bn site for final inspection and a copy given to the homeowner.. At final, the inspector verifies that the work listed on this -
ffir'M ryas in fact the work completed by the installer: The inspector also verifies that each appropriate CF -6R and registered CF -4R
f&Mn -(60-hand,filled CF-4Rs allowed) are filled out and signed.Beginning October 1, 2010, a registered copy of the CF -1R
anti i=+6R shall also be on site for final inspection.
2 •HVAC Changeout Required Forms:
'all HVAC Equipment CF -6R forms: MECH-04; MECH-2I-HERS and (for split systems) MECH-25-HERS
:� F replaced CF -4R forms: MECH-21 and (for split systems) MECH-25
• Condenser Coil and /or CF -6R forms: MECH-04, MECH-2I-HERS and (for split systems) MECH-25-HERS
• Indoor Coil and /or CF -4R forms: MECH-21 and (for split systems) MECH-25
. Furnace '.
For Split Systems: Dud leakage < 15 percent; RC, CCA 5 300 CFM/ton (Minimum Air Flow Requirement), TMAH
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 dud systems are constructed, insulated or sealed with asbestos
❑ 4. The systerti will not be Ducted (ie. Ductless int-5pliSysterLt(Alsao Exemp�(og�ger txharge)
❑ 2. Ne�tIV,'C Sy em Required FG msAW,
. Cut in or,Ckiangeout, with ,r� fix:r: �+y
CF6R forms MECH-04, M CM -2 ERS, ands( or split sy tem) MECH 22=HERS, a'nd
new ducts: (all new MECH=25°HERS '
ductit", all n w 3 "'
equip ` entj G�- forms 'MECH- •0, nd (fors ,, its stem_ MECH-2' , and. ME25
Ra is >`
For Split Systems: Duet leakage; 67petcenY;pRC CCA��r3503CFM/ton,>* WDkT.MAH' SIMS, and either H9PP'or'PSPP.
For Packaged Units: Duct leakage.<.6 percent' x
❑ 3. New Duets with/or without Required Forms:
Replacement
. Includes replacing or installing all new -
ducting and/or outdoor condensing unit CF -6R forms: MECH-04, MECH-20-HERS, and (for.•split systems) MECH-25-HERS.
and/or indoor coil and/or -furnace. No or some CF -4R forms: MECH-20 and'(for split systems) MECH-25
equipment changed. ,• .
For Split Systems: Duct leakage -< 6 percent; RC, CCA a 300 CFM/ton, TMAH „
For Packaged Units: Duct leakage < 6 percent ti
114. 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 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 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. • •" • - I
• 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 31, 2012 ,.
Address: 42-949 MADIO STREET License: 906115
City/State/Zip: INDIO / CA / 92201 - Phone:, (760)
Invoice
.'Certified Comfort Systems, Inc.
dba Hyde's Air Conditioning
42-949 Mad; St
o .
Indio CA 92201
760-360-2202 FAX: 760-360-3350 Invoice # 334911'
Account # 102702 Date: 05/12/12
Page # 1 of 1
Service At: .
Kenneth Brog Kenneth Brog
86-898 Spanish Bay Dr. 80-898 Spanish Bay Dr. .
La Quinta CA 92253 La Quinta CA 92253
§6itiIde bate. 05/12/12. PO # Job # 239886
***5 YEAR LABOR AND 12 YEAR PARTS AND 20 YEAR HEAT EXCHANGER WARRANTY***
`Description Of Service
Quantity . ;
Unit Price Extended Price Tx
JOB PER QUOTE
1
$11,680.00 $11,680.00
15SEER 5TON 410A.COND
1
$0.00
M#4A7A5061E1000BA S#12144B5T2F
1
5 TON AMER STAND VS FURNACE
1
$0.00 $0.00
M#AUD2C100B9V5VBA S#11404S511G
1
5 TON UPFLOW EVAP COIL R4 10A TXV
1
$0.00 .$0.00
M#4XUC1365/100 S#RDE220027
1
FOCUSPRO 5-1-1 PROG.TSTAT 2H/2C
1
$0.00 $0.00
FOCUSPRO 5-1-1 PROG TSTAT 21-1/2C .
I
TRADE-IN,
1
($1,000.00) ($1,000.00)
Total $10,680.00
.5/14/2012
Payment $10,680.00
Visa
.************9582'
Auth: 05196A
Balance Due $0.00
Paid in Full. We appreciate your business!
#
City. of- La Qut*n: td
Bulldlrlg er Safety Division
P.O. Box 1504,78-495 Calle Tampico
ta.Qulnta, CA 92253 -:(760) 777-7012
Building Permit Application and Tracking Sheet
Minh #
1�
Project Address:
Owner's Name:. LL
A- P. Number
Address:
Legal Description:
City, ST, Zip:
Contractor. Q.
Telephone: ? — 9 O MEMO= , su.
Address:
Project Description:
City, ST, Zip:
Telephone:
City Lia #;
State Lia #:
rzz
Arch., Eagr., Designer
Address:
City., ST. Zip:
Telephone:
State Lia #: ; ,<.,.. ..
Construction Type:. Occupancy:
Project type (circle one): Now Add'n Alter Repair Demo
Sq. FL: # Stories: # Tin iv
Name of Contact Person:
Telephone # of Contact Person:
Estimated Value of Project i af— '
APPLICANT: DO NOT WRITE BELOW THIS UNE
q
Submittal
Req'd'Rec'd
TRACMG
PERMiT FEES
Plan Sets
PIan Check submitted
Item Amount
Structural Calls.
Reviewed, ready for corrmdous
Plan Chcck Deposit. .
Truss Cates.
Called Contact Person
Plan Cheek Balance_
Titre 24 Calls.
Plans picked up
Construction
Flood plain plan
Plans resubmitted..
Mechanical
Grading plan
2'! Review, ready for corrections/cssue
Electrical
Subeontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
&IVLL
H.O.A. Approval
Plans resubmitted
Grading
DY HOUSE;-
''' Review; ready for correctionslissue
Developer Impact Fee
Planning Approval.
Called Contact Person
Ad.P.P.
Pub. Wks. Appr -
Date of permit issue
School Fees
Total Permit Fees