10-0439 (MECH)r
P:O. BOX 1504 VOICE (760) 777=7012
78-495 CALLE TAMPICO`` FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT �i..r' -INSPECTIONS (760) 777-7153
BUILDING PERMIT
Application Number: C1.0'OA_0.00439
Property Address: 55393 TANGLEWOOD
APN: 775-152-024- - -
Application description: MECHANICAL
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 6000
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 License is in full force and effect.
LicenseClass: C/200 C36 L' e e No.: 906115
�D�. / �Z Contractor:
:
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).:
(_) 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
Date: 5/20/10
Owner: f
I
HANSENLARRY
55393 TANGLEWOOD. 0
PALM DESERT, CA 92211 JrD�- j
(760)564-9455.
- Contractor: I..
HYDES
77825 WILDCAT STREET
PALM DESERT, .CA 92211
(760)360-2202
Lic. No.: 906115
MAY 2 0 2010
CITY OF LA QwNTi�
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 the performance 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 DELOS INS Policy Number 02DKRM12004084
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
3700 of the Labor Code, I shallforthwithcomply ith those provisions.
Date:.—"5*'— f�E/GAppli� Z'l,
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 becomes null and voidifwork'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 hereby authorize representatives
of this county to enter upon the above-mentioned property for inspect n purposes. '
Date: sign 'ture(Applicant-or Agent):
LQPERNIIT
a
Application Number . . . . . 10-00000439
Permit . . . MECHANICAL
.� --
Additional desc
Permit Fee.. : 33.00 Plan Check Fees'.
8.25
Issue Date. . . . Valuation
0
Expiration Date 11/16/10 j`�
�F
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
A/C -CHANGE -OUT FURNACE
/ COIL 14 SEER (4).TON UNIT.PER 2008
HVAC.
----------------------------------------------------------------------------
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
Simplified Prescriptive Certificate of Com
Climate Zones 10 to 15
Site Address:
2008 Residential HVACAlterations CF -IR -ALT -HVAC
Enforcement Agency: Date:
Permit #:
Conditioned Floor
lation re uirement Area Thermostat
E ui ment Tv List Minimum ttttcienc - Duct insu
Packaged Unit Over 40 ft of ducts added or etback
�AFUE (3U E3COP
Furnace replaced in unconditioned space rvec(Uby system or already
Indoor Coil SEER � ® HSPF _ ®R 6 (CZ 10-13) v sf present. must be
Condensing Unit �EER2 Resistance R 8 (CZ 14-I5) installed)
Other
1. Equipment Type: Choose the equipment being installed: if more than one system, use another CF-/R-ALT-H6AC for each system.
2. Minimum Equipment Ef ciendes: 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 CF-4Rs allowed) are filled out and
sjoked. Beginning October 1, 2010, a registered copy of the CF -111 and CF -611 shall also be on site for final inspection.
1. HVAC Changeout Required Forms:
CF-61kforms: MECH-04, MECH-2I-HERS and (for split systems) MECH- 25 -HERS
• All HVAC Equipment replaced
CF -4R 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 -4R 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
F.xemnted from duct leakage testing if:
11
Company: Hyde's Air Conditioning
Address: 77.899 Wildcat Drive
City/State/Zip: palm Desert, CA 92211
Uate: _ 0 j(5
License: 906115
Phone: f 7m W-2202
2008 Residential Compliance Forms I March 2U16
1. Duct system was documented to have been previously seateu anu wuu,,,,�U --W- •. •- •...•-•- •-••, --
2. Duct systems with less than 40 linear feet in unconditioned space, or
rl 3. Existing duct systems 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, SIMS, and either HSPP or PSPP.
For Packaged Units: Duct leakage <6 percent
® 3. New Ducts with 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 CF -4R forms: MECH-20 and (for split systems) MECH-25
coil and/or furnace. Not all 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 Required Forms:
• Includes adding or replacing more than 40 CF -6R forms: MECH-04, MECH-2I-HERS CF -4R forms: MECH-21
linear feet of duct in unconditioned space.
For splits stem or packaged units: Duct leakage < 15 percent
EXCEPTION: Existing ducts stems constructed, insulated or sealed with asbestos.
Contractor (Documentation Author's /Responsible Designer's Declaration Statement)
• 1 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.
Compliance conform to the requirements of Title 24,
• I certify that the energy features and performance specifications for the design identified on this Certificate of
Parts 1 and 6 of the California Code of Regulations. f
• The design features identified on this Certificate of Compliance are consistent with the information documented on other applicable compliance forms', worksheets,
calculations, 21ans and specifications submitted to the enforcement agency for approval with the permit application.
Name: Michael Hyde Signature: /n/ y> >.
Company: Hyde's Air Conditioning
Address: 77.899 Wildcat Drive
City/State/Zip: palm Desert, CA 92211
Uate: _ 0 j(5
License: 906115
Phone: f 7m W-2202
2008 Residential Compliance Forms I March 2U16
Bin #
City of La Quin a
Building ei Safety Division
P.O: Box 15041 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit.#
✓
Project Address: �j �j ' ��� 1 ,ZvcJ
Owner's Name:4_(r-r-4 S f yj
A. P. Number: '+
Address:
Legal Description:-
Contractor:eU A
City, S'I, Zip: Lri as i rn4 C A ZZ J
Telephone: 5Z
Address: 7 Z U G{,t.
Description: Project Pro.1 P RR
1S
City, ST, Zip: A It-,,
� CIL
Telephone:(
l�_1'l
Tv
State Lie. # : a06 113 City Lic. #: Wg �
Arch., Engn, Designer:
Address:
City, ST, Zip:
Telephone:
I t
Construction Type: Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
Sq. Ft.: #Stories: #Units:
State Lic. #:
Name of Contact Person:
Telephone # of Contact Person:
Estimated Value of Project: Uc1U
APPLICANT: DO NOT WRITE BELOW THIS LINE s' i
#
Submittal
Req'd
Rec'd
TRACKING .
PERMTT FEES
Plan Sets
Plan Check submitted'
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit y
Truss Calcs.
Called Contact Person
Plan Check Balance }
Energy Calcs.
Plans picked up`
Construction .
Floodplain plan
Plans resubmitted ;
Mechanical
Grading. plan
2°" 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:-
'
1nd Review, ready for corrections/issue
Developer Impact Fee
'
Planning Approval
Called Contact Person'
A.LP.P.
Pub: Wks. Appr
Date of permit issue
School Fees
Total Permit Fees