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 - -
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City of La Qui eta
Ferrrtit
P.O. Box 1504,"78.49S CAe Tampico
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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
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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'.