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13-1039 (MECH)44 P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT BUILDING PERMIT Application Number: 13-00001039 Property Address: 55237 TANGLEWOOD APN: 775-152-005- - - Application description: " MECHANICAL Property Zoning: LOW DENSITY RESIDENTIAL Application valuation: 2587 y Applicant: Architect or Engineer: ------------------ LICENSED CONTRACTOR'S DECLARATION 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 Lic se is in full force and effect. License�Cllaass: C20License No.: 3 0 Date:r /it7//J2 Contractor. , _ I hereby affirm under penalty of perjury that) 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 equires 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 1$5001.: (_) 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. , 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: JOANNE THORSON 55237 TANGLEWOOD LA QUINTA, CA 92253 ( Contractor: GENERAL AIR CONDITIONI 31170 RESERVE DRIVE THOUSAND PALMS,, CA 922 (760)343-7488 Lic. No.: 686310 VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 8/16/13 Q.D. NC P[_AUO 1E 2013 76CITY OF LA QUINTA FINANCE DEPT. 1 ------------------------------------------------ WORKER'S COMPENSATION DECLARATION hereby affirm under penalty of perjury one of the following declarations: 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. ave 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 ZENITH INS COPolicy Number Z071741502 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 work nsation laws of California, and agree that, if I should become subject to the w rs' compens on provisions of Section (_ 3700 of the Labor Code, I nhwith com with those prov' ions. Applic .I WARNING: FAILURE TO SECURE WORKERS' GP PENSATIVIL FINES UPGE I ONE HUNDRED THOUSAND UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PE gN L(TIES AW DOLLARS ($100,000). IN ADDITION TOT 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. 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 hereby authorize representatives of this county t enter upon the above-mentioned property f ' p tion purposes. // Date:jj [ r Signature (Applicant or Agent): Application Number . . . . 13-00001039 Permit-'. MECHANICAL 2013 Additional desc Permit Fee. -11.92 Plan Check Fee .00' ' Issue- Date Valuation 0 Expiration Date2/12/14 ' Qty Unit Charge Per Extension 1.00 -11.9200 EA MECH APPL REP/ALT 11:92 Special Notes and Comments. HVAC CHANGE OUT - COIL ONLY [2.008 - ENERGY) CARBON MONOXIDE ALARMS) -TO BE . -INSTALLED PRIOR TO FINAL INSPECTION. CALIFORNIA BUILDING CODES ; --,_--2010 -------------------- Fees . . . . PERMIT ISSUANCE,M/P/E 90•.57 PLAN -CHECK, MECHANICAL 4.77 Fee summary Charged Paid Credited Due Permit Fee Total 11.92 .00 .00 11.92 Plan Check Total .00 .00 .00 .00 Other Fee Total 95.34 .00 .00 95.34 Grand Total 107.26 .00 .00 107.26 1 ' LQPERMIT - - . �L r, City of La Qui eta Ferrrtit P.O. Box 1504,"78.49S CAe Tampico I l� E4.QaPr4 CA 92453 -.(760) 777-7012 BuIlding Permit Application- and Tracking Sheet . Pm JedAd*m' 55237 TANGLEWOOD Owaer'aNmne: JOANNE THORSON A. P. Kumber: Addrq: 55237 TANGLEWOOD Legal d0! City. ST, Zip; LA QUI NTA, CA 92253 Contactor. GENERAL A/C & HEATING Te1op ww. Addro=: 31170 RESERVE DRIVE pmJ C�•� rP- THOUSAND PALMS, CA 92276 CHANGE OUT COIL ONLY Tdcphouc: 760-343-7488 S= t;c :886310; �, 4po Dower . Addmw. ' Tcicptwno: Cwtthucdou type p y. SW Lim d: xameefCootnc�tppy�: (' TRICK Projcd 4'Pe (code atl6): 'Now Add'a Aft=Pip& pip 9Q Ft —: _-- : in Stoner ilnit� T i�ofConteccpct9on.760-3434488' 8sl4matod•v1wc0ft! 2587.00 APPUOAKT: DO N07 Wim eaoW 7FB8 UUg N Sobmlttal jWd BeC'd 1*laa SobPia* PERhiir F$£8 aaieaabmftd " Yka Alaoaat Skadwl Caps •k�eea, trady fef ew..dam i • Trar Ctlu. p Ckrdc 1kPOsit CA06d patact Pam, Plan Ckttk Baiaace- i rAc 24 "ck place *kid up . Flood Fldv PUB CeaaQaatoa ; Pl�taa rapbesltOpA Meckm" cr.al.� P1aa W BMew, reaey for carrabeaWj m Elecalftl ' SabeOibletpr List C.ikd Ceotaa ptssoa Grant Decd --------------- Pians ilkked cep Yl9ufila� . 10A. proraf Ptaw sesabroitted ' . 1Sl)i1BB7- Or; Emily for tm'reeHoas aft craeWg . Developer impact Pee Pbaula=APP ai Cal[cdiCoalaetrem" Pub.Wb.Affr - • Date of Pernik 4iKe AJF.P. &how Pea Total Permit Hees tate of Compliance: 2008 Residential HVAC Alterations CF -IR -ALT -HV Site Address: SS237 TANGLEWOOD La Qu.inta, CA 92253 Equipment Typel List Minimum Efflclency2 p Package Unit rcement Agency: of La.Quinta Duct insulation Iconoitwne requlrement Area Furnace D AFUe 17 COP ❑ R 6 (CZ 10-13) ® Indoor Coll 13 SEER 0 HSPF Q R 8 (CZ 14-15) 0 Condensing Unit C] EER 0 Resistance ❑ Other 1. ,Equipment type: Choose the equipment being installed; if mole than one system, use another Cr -1 R -ALT --HVAC for each system. 2. MInfmum Equipment Efficlencles: 13 SEER, 7S% AFUE, 7.7HSPF ror 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 flnal, 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, 2.010, a registered copy of the CF -1R and CF -6R shall also be on site for final Inspection. ® 1. HVAC Changeout Required Forms: . rms: MECH-04, MECH-2I-HERS and (for split systems) MECH-2S-HERS All HVAC Equipment CF -6R fo replaced CF -4R forms: MECH-21 and (for split systems) MECH-25 . Condenser Coil and /or CF -6R forms: MECH-04, MECH-21-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: Duct leakage:.• 15 percent; RC, CCA 5 300 CFM/ton (Minimum Aifor Pasloaqed4hlAaf-� ------ peiiis@R4 r Flow Requirement), TMAH Exempted.from. duct leakage testing:jf: 1. •Duct system •was documented to have been prev lously sealed and confirmed through HERS verification, or p 2, Duet systems with less tha6:40 linear feet In unconditioned space, or Q-3.'Existing 'ducf systenls•ar6:e6hstructed, insulated or sealed with asbestos xe ptr, iRefi� a nr: ` rge) 11 g The �she7%jili not be Du 'd -(ie u�et� S tlMia�. ll „ern: ,. � , t AJ. Q 2 Ne Iik'C Sy..fe... equ :... . R . m_•�`• ME t.+ , Cut inaJ: 9hangeout witlt?R °'` r ', RS f. :edit S. ). MEC gRS., �Mcl a c f} h0tCH-04, _ . N new a �(all new }I?.�_ryducti a d all new:,d-0lrn�ru.�n "�?iCftnr cralit s m_ . CH:r . � i Cki'2 :?„ Date: Permit #; Aug 16, 2013 or Thermostat by system 0 Setback If not already present must be. sf installed) For Split Sy steMS1-;s APjCe-:feaKagen�i?�a:F1er. uiuNnn i_� .^:; vW.�.,.,,.. !•!, ,,.,.... -• -- :: .. p.i,..: y:,, .:::s. r :r..: • :... ,.,... :. For Packaged Units: Duct leakage,"; percent 773. -K V'r!h/or without,''.:` Required Forms: Replaceme'i�ki'.�` Includes replacing or installing all hew ducting and/or outdoor condensing unit CF -6R forms: MECH-04, MECH-20-HERS, and (for split systems) MECH-25-IiERS and/or indoor toll and/or ftirnaee; Nb 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: Duct leakage. <.6 percent '0 4, Nq*'Q'ucting over 40 feet Required Forms: . Includes adding or replacing more than 40 CF -6R forms: MECH-04, MECH-2I-HERS linear feet of dOa f 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. . The design features• Identified on thls Certificate of Compliance are consistent with the information documentedwith n other aptplicable compliance forms, worksheets, calculations, plans and specifications submitted to the enforcement agency rot approvalpp Name: Danielle Garcia Signature: banlelle 64rein Company: HARRISON ENTERPRISES INC Date: Aug 16, 2013 Address: 31-170 RE=SERVE DRIVE STE A License: 686310 Clty/State/Zip: THOUSANA PALMS / CA / 92276 Phone: (760) 3437488 Reg! 213-A0063522A-000000000-0000 Regiatra.tion Late/Time: 2013/08/16 16:02!09 HERS Provider.- ca10ERT8,.Inc. 2000 Resid.ential.Compliance Forme July 2010'.