10-0970 (MECH)P.O- BOX 1504
78-495 CALLE TAMP ICO
LA QUINTA, CALIFORNIA 92253
Tit!t 4 4Q"
Application Number: 10 _00000970
Property Address: 54886 TANGLEWOOD
APN: 775-052-006- - -
Application description: MECHANICAL
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 12000
Applicant: Architect or Engineer:
---------.----------------------------
LICENSED CONTRACTOR'S DECLARATION
BUILDING'& SAFETY DEPARTMENT
BUILDING PERMIT
6. hereby affirm under penalty of perjury that 1 am licensed under provisions of Chapter.9 (commencing with
Section 7000) of Division 3 of the Business and Professionals Code, and y License is in full force and effect.
License C ss: 20-C36 Waense
777294
Date 1ZI %U ontractor:
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 withwages 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 (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. , B.&P.C. for this reason
Date:
Owner:
y, CONSTRUCTION LENDING AGENCY '
1 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:
GRAEME BAILLIE
54-886 TANGLEWOOD
LA QUINTA, CA 92253
Contractor:
J ANTHONY PLUMBING
72216 NORTH SHORE
THOUSAND PALMS, CA
(760)343-2121
LiC. No.: 777794
HEAT/
STREET
92276
VOICE (760) 777-7012
FAX (760) 777-70.11
INSPECTIONS (760) 777-7153
Date: 9/21/10
------------------
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 theperformance 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
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' compens provisions f -Section
ryY 37 0 of the Labor Code, all fo ith comply with those ions.
D e:Z� pplicant:
WARNING: FAILURE TO SECURE WORKERS' 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 becomesnull and void if work isnot commenced
within 180days 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. .1 agree to comply with all
city and county ordinances and state laws relating to building construction, and hereby authorize rep tatives
of this '%cou ty to mer upo the above-mentioned propeerty f insp n pur
pate: ` 21 w ignature (Applicant or Agent):v ��
Application Number . . . . 10,00000970
Permit . . . MECHANICAL
Additional desc .
Permit Fee . . . . 33.00
Plan Check Fee
8.25
Issue Date . . . .
Valuation . . .
. 0
Expiration Date 3/20/11
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
----------------------------------------
Special" Notes and Comments
-
CHANGE OUT 3 TON SPLIT SYSTEM TO
NEW 3.5
TON, 14 SEER SPLIT SYSTEM. 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
icriptive Certificate of Compliance: 2008 Residential-BVACAlterations C. R ALT HVAC''
to Is
bj �f rcenre trAge tg�:^ ---- e; .Z) '\ .:Permit #
O Packaged Unit e�v� -"--• ��+c...vu+ uucinrrtt Area Thermostat
llrFurnace tPER
'6V�8 O COP Over 40 ft of ducts added or Setback
I door Coil O.HSPF _ replaced In unconditioned space Served by system (ljnot already
®'Condensing Unit R O Resistance 0 R 6 (CZ.10-13) sf
Present. must be
O Other OR 8 (CZ 14-15) installed)
1. Equip --t Type: Choose the equipntent being installed: ifmore than are system, use another CF -1 R-ALT-HVACjor each system.
2- Miftimuni 44me'd Effulencies: 13 SEER 78%AFUE, 7.7HSPFf or
typical residential systems.
HERS VERIFICATION �y L fisted below are four HVAC alteration Options. The installer decides what work is being done artd
picks one of "e appropriate Options. Each Option lists the HERS measures that must be conducted. A.copy of the forms shall be left onsite for find
ins pcctio d a copy given to the homedwaer. At final; the inspector verifies that the work listed on this form was in fact the work completed by tEe
install . The inspector also verifies that each appropriate CF -6R and registered CF -411 forms (no hand filled CF -411s allowed) are filled out and
si Beginning October 12010 a -r tered copy of the CF -IR and CF-6R•shau also be on site for final inspection.
zr 1. HVAC Changeout Required Forms:
• All HVAC Equipment replaced CF -6R forms: MECH-04, NMCH-2I-HERS and (for split systems) MECH- 25 -HERS
CF -411 forms: MECH- 21 and fors lit stems MECH 25
• Condenser Coil and /or
• Indoor Coil and /or CF -6R fomu: MECH-21-HERS and (for split systems) MECH- 25 -HERS
• Furnace - CF -011 forms: MECH- 21 and (for split systems) MECH-25
For Split Systems: Duct leakage < 15 percent; RC, CCA 2 300 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.
0 2. Duct systems with less than 40 linear feet in unconditioned space, or
O 3_ Existin duct Systems are constructed, insulated or sealed with asbestos
E3 2. New. HVAC System Required Forms:
• Cut s: al Chang outucti with new CF -6R forms: MECH-04 MECH-20-HERS,and for lit stems MECH-22-HERS, and MECH-25-HERS
ducts: (all new ducting.and all ( split system) new e' ui ment — CF -4R forms: MECH 20-, and (for split systems)MECH-22, acid MECH '25 -
For Split Systems: Duct leakage < 6 percent; RC, CCA >_ 350 CFM/ton FWD, TMAK
For Packaged Units: Duct leakage <.6 ercent STMS, and either HSPP or PSPP.
O 3: New'Ducts-with Replacement Required Forms:
• Includes replacing or -installing all new ducting CF -6R forms: MECH-04, MECH-20-HERS,and (for spli
and/or t systems) MECH25-HERS _
outdoor condensing aniCand/or indoor CF -4R forms: MECH-20 and (for split systems) MECH-25 . '.
coil and/or'-fiunace. 'Not allequipnient.changed.
For Split. Is Duct Leakage < 6 percent, RC, CCA>_ 300 CFMfton, TMAH
ForTacka ed Units: Duct -1 a <-6. 0:ercent
l7 4..New DucHn over 40 feet , Re aired Forms:.
• Includes adding or rt placing more than 40
linear feet of duct iri unconditioned s ace.' CF-6R•forms:'MECH=04, MECH-21-HERS .. < CF -4R forms 1VIECH-21
For split system orpackaged. units:= Duet,leakage < 15 pe
❑ EXCEPTION:.Existm duct sterns constrtr� insulated orsealed-with asbestos:
Contractot:(Docuinentation Authors /Responsiblb Designer's.:Declaration Stafemeat)'
• l cehify that, this Certificate of compliance documentation is accuiate.and complete .
• , 1 am eligible underDivisioe3 of the Californi@ Business and: Professidns Code to accept responsibility for the design identified on this Certificate of Compliance.
1 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 ofthe Califomia Code of Regulations. .
o . i h� design feawres identified on this Cemficate of Compliance arc .consistent with ttie infotmanon.documented on other applicable compliance forms; worksheeu,
calculations;f.lens ands i6cations stibmitted to the enfe • ent' a -Corarbval:with the ` i an- `
Name: �`
(FU V Signatttte.
Company:. ..Date
--S RVICE9
:Address: t .
72216 NORTH SHORE ST STEt09 _
PAWIS CA 92276 -%-T-1-1771%
Ltcense
CitylStatc2ip:
:. . Photie• :" t
2008 Resideirhal Compftance Forms March .2010.-"
e
Simplified Prescriptive Certificate of Compliance: 2008 ResidendaIRVAC-Alterations CF -1R ALT -HVAC
Climate Zones 10 to 15
nl rcen6L, �mA ency
'� e: z � :Permit #r
N
—Equipment T : Conditioned Floor
List Minimum Efficiency' Duct insulation reuirement Area Thermostat
❑ Packaged Unit
er urnaoc gFUE801 ❑ COP Over 40 ft of ducts added or III/Setback
GryI
door Coil ER ❑.HSPF replaced in unconditioned space Served by system afno, already
iH"Condensing Unit ER O Resistance ❑ R 6 •(CZ /0-13) sf
presenr, must be
❑ Other ❑ R 8 (CZ /4-/5) installed)
L Equipment Type: Choose the equipment being installed: if more than one system, use another CF-IIt-ALT-H�ACfor each system.
2. Minimrun Equipment Efficiencies: 13 SEER 78%AFUE, 7 7HSPF or
f typical rat entra/systems.
HERS VERIFICATION SUMMARY Listed below are four HVAC alteration Options. The installer decides what work is being done and
pVo�nea appropriate Options. Each Option lists the HERS measures that must be conducted. A.copy of the forms shall be left
on site for finwina 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
innspector also verifies that -6R
each appropriate CF and registered CF-4Rforms (no hand filled CF-4Rs allowed) are filled out and
sinin October 12010 a registered copy of the CF -1R and CF-6R.shaff 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 -4R forms: MECH- 21 and for lit stems MECH 25
• Condenser Coil and /or
• Indoor Coil and/or CF -6R forms: MECH-21-HERS and (for split systems) MECH- 25 -HERS
• Furnace I CF -4R 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
lixempted from duct leakage testing iE
❑ 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. Existin ducts stems are constructed, insulated or sealed with asbestos
❑ 2. New HVAC System Required Forms:
• Cuts: (a new eoutdu ti with new CF -6R fortes: MECH-04, MECH-20=HERS,and (for split systems) MECH 22 -HERS, and MECH-25-HERS
ducts: (all new ducting all
new a ui ment CF -4R forms: MECH 20- and fors ht stems MECH-22 and MECH 25
For Split Systems: Duct leakage < 6 percent; RC, CCA >_ 350 CFM/ton, FWD
For Packaged Units: Duct leakage <•6 percent , Tr�rAH, SIMS, and either HSPP or PSPP.
❑ 3: New'Ducts with Replacement''
Required Forms:
CF -6R forms: MECH-04, MECHtem
-20-HERS,and (for split MECH-25-HERS
-CF-4R forms: MECH-20 and (for split systems) MECH-25
• Includes replacing orinstalling all new ducting
and/or outdoor condensing unit and/or indoor .
coil and/or furnace. -Not all equipment changed. .
.. . .
For Sp1it.Systems: Duct leakage < 6 percent, RC, CCA >_ 300 CFMRon, TMAH
For Packaged Units: Duct l e <16 :ercent
❑ 4. New Ductink over 40 feet 'Required -Forms:.
• Includesaddingo or replacing more than 40 CF -6R forts: MECH=04, MECH-21-HERS .. CF -4R forms: MECH-21
linear feet of duct. in uncoddttaoned space.,
For split system or packaged units.:- Dact leakage < 15 percent
❑ EXCEPTION:. Existin dtict sterns c6i:
ristructed, insulated or sealed with asbestos
Contractor (Documentation Author's /Resp6nsiblh Designer's: Declaration Statement)'
• 1 certify that this Certificate of Compliance documentation is accurate.and complete.
I am eligible.under-Divi Won 3 of the Calafomia Business and Pmfessi ris Code to accept responsibility fol the design identified on this Certificate of Compliance.
• I certify that the energy features and perman
rfoce specifications for the design identified on this Certificate of Compliance conform to the requirements of Title 24,
Pans
1 and 6 of the Califomta.Code o_fRegiiIii on&
• . _ The design features identified on this Certificate of Compliance are consistent with the information.documented on other applicable compliance forms; worksheets,.':
calculations;, lens ands cifi cations submitted to the info ent : en -fora -oval
with the t li tion:
Name: -
.�� � : . Signattare:. :
Company:
RVICES
Date:'
. _
Address:-`
722113 NORTH SHORE'ST STE 109
PALMS :CA 92276 .
License:
City/Statc/Zip: .
.M
Thohei. 6.0
2008 Resideh6.1 Coirtpliance Forms March =2010
Bin #
City of La Quinta
Building Safety I tsion
P.O. Box 1504, 78-495 Calle Tamptco
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit # �(�
Project Address:54 !E 6 - TA �J G l G 1, ti W
A P. Number.
Owner's Name: GRA GM G 'V>A I LIU C
Address:r f ice_
City, ST, Zip:
Telephone:—) 60 ly
Project Description: C—P7� Vib 6, a
Legal Description:
Contractor:
Address:
City, ST, Zip: •. THOUSAND PALMS; CA 92276 .
---------------
Telephone:
State Lic. # : -7 City Lic. #; j () S 4
Arch., Engr., Designer.
Address:
City., ST, Zip:
Telephone: Construction Type: Occupancy:
P cY:
State Lic. #: Project type (circle one): New Add'n Alter . Repair Demo
Name of Contact Person: Sq. Ft: #Stories: #Units:
Telephone # of Contact Person: Estimated Value of Project: Z
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Plan Sets
Req'd
Reed
TRACMG
Plan Check submitted
PERMIT FEES
Item Amount
Plan Check Deposit
Structural Cates.
Reviewed, ready for corrections
Truss Cates'
Called Contact Person
Plan Check Balance
Title 24 Cates.
Plans picked up
Construction
Flood plain plan
Pians resubmitted
Mechanical
Grading plan
2•" Review, ready for correctionsiissue
Electrical
Plumbing
Subcontactor List
Called Contact Person
Grant Deed
Plans picked up
SSI
H.O.A. Approval
Plans resubmitted .
Grading
IN HOUSE:-
''d Reylew, ready for comctionstissue
Developer Impact Fee
Planning Approval
Called Contact Person
A.LP.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees