13-0408 (MECH)P.O. BOX 1504 '
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application. Number: 13-00000408
Property Address: 55441 TANGLEWOOD
APN:.. 775-152-028- - -
Application description: MECHANICAL
Property Zoning: LOW DENSITY RESIDENTIAL.
Application valuation: 3100
Applicant: Architect or Engineer:
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
LIC SED CONTRACTOR'S DECLARATION 7
I hereby affirm under penalty of perjury that m licensed under Arovisions of Chapter commencing with
Section 7000) of Division 3 of the Busine s d Professionals o e, and my License i n full force and effect.
License Class: r C20 -C36 Li n e No.: 77779
Contractor:
—t 1 OWNEXBUILDER 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 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.).
(_) 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
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 ISec. 3097, Civ. C.). '
Lender's Name:
Lender's Address: n 1
LQPERA7IT
Owner:
CAROL HOFFMAN
55441 TANGLEWOOD
LA QUINTA, CA 92253
(760)342-2121 -
Contractor:
J ANTHONY PLUMBING
72216 NORTH SHORE
THOUSAND PALMS, CA
(760)343-2121
Lic. No.: 777794
VOICE (760) 777-7012.
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
?AA
Date: 4/04/13
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.
_/'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 WESCO INS Policy Number -3051016
'I certify that, in the perform ice of the work for which this permit is issued, I shall not employ any
person in any manner so s to become subject to [he wor compe tion laws of California,
and agree that, if I sh become subject to thew s' compensation provisions of Section
3700 of the Labor a for ith com with those provisions.
Dat(e/. - Applicant,
WARNING: FAILURE TO SECURE 0 KERS' 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 ofthis applica ion becomes null and void if work isnot commenced
within 180 days from date of issuance o such permit, or cessation of work for. 180 days will subject
permit to cancellation.
1 certify that I have read this application and state t t the above information is correct. I agree to comply with all
city antl u ty ordinances and state laws latin building construction, and hereby authorize representa . es
of this nt to enter upon the above -me lone operty for i ection pu S.
Data.
Signature (Applicant
-Application Number . . . . . 13-00000408
_ Permit" MECHANICAL
Additional desc ..
Permit -Fee. .. 24..00' Plan Check
Fee
6.00
Issue Date. Valuation
0 -
Expiration Date 10/01/13
Qty Unit Charge Per
Extension
BASE FEE
15.00
1.00 9.0000 EA MECH.APPL REP/ALT/ADD
9.00
Special Notes .and Comments
HVAC CHANGE OUT - 13SEER/5-TON,
60,OOOBTU [2008 ENERGY] 2010 CALIFORNIA
BUILDING CODES.
--------- - -----------
Other Fees . . . . . . BLDG STDS ADMIN (SB1473)
1.00
Fee summary Charged Paid Credited
Due
Permit Fee Total 24.00 .00
.00
.24.00
Plan Check Total 6.00 ..00
.00
6.00
Other Fee'Total 1.00'., .00
.00
1:00
Grand Total 31.00 .00
.00''
31.00
LQPE"11T
Bin. #
t '
City. Of .'Lel QuIn-U. .
Building a3z Safety Division ... :. •
P.O. Boz. 1504, -78-495 Calle Tampico
la.Quinta, CA 92253 -:(760) 177-7012
Building Permit Application and Tracking Sheet
Permit # :
�.
Project Address: �5l�G�/ �f}iU P toco o
Owner's Name:.
A P. Number
S Address:
Legal' Description:
Contractor.
City. ST, Zip:
Telephone:
Address: J ANTHONY SERlO SProjeaDe=iption:
1Z -e �� c , '('c7 N
h JI.S 101
City, ST. ZipTHOUSAND PALMS, CA 92276
Telephone: %6Pto
2 O
State Lia#:' '?7-7/' City Lic.C./0JUs�
Arch, EW., Designer.-
Address:
`D�
City, ST. Zip:
l
Telephone: Construction Type: _ Oceupaacy:
Statc Lia #:-
type (circle one): New Add'n Alter Repair. Demo
Name of Coast Person: Sq. FL: # Stories: # Ututs:
Telephone # of Conal Person: Estimated Value of Project
APPLICANT: DO NOT WRITE BELOW THIS UNE
#
Submittal
13eq'd
Reed
'MCISYNG PERwr FEES
Plan Sets
Plan Check submitted Item Amount
Strgdural Cales.
Reviewed, ready for corrections Plan Check Deposit. ".
Truss Calcs•
Caged Contact Person Pian Check Balance.
We 24 CRIaL
Plans picked up Constraedod
Flood plain plan
Pians resubmitted ., . Wchafiical
Giading plan
2'! Review, ready for correctioWnsue Electrical
Subeontador List
Called Contact Person Plumbing
Grant Deed.
Plans picked up
H.O.A. Approval
Plans resubmitted Grading
IN HOUSE:'
Review; ready for eorreetioaslissue Developer Impact Fee
Plaaoing Approval.Called
Contact Person A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees
Simplified Prescriptive Certificate of Compliance: 2008 Residential HVAC Alterations CF-IR-ALT-HVAC
Climate Zones 10 = 15 , ' :
Site Address:
Enforcement. Agency:
Date:
Permit #:
55441 TANGLEWOOD DR La Quinta, CA 92253
City of La Quinta ,
Apr 4, 2013
I
Duct insulation
Conditioned Floor
Equipment Tgpel
List Minimum Efficiency2
requirement
Area
Thermostat
❑ Package Unit
I •
"
❑ Furnace
[3 Indoor Coil
❑ AFUE
® SEER 13.0
❑ COP13
[3HSPF,
R 6 (CZ 10-13)
R gCZ
Served by system
1 800 sf
® Setback
If not already present, must be,
W Condensing Unit
[3 EER
❑ Resistance
14-15)EER
(
installed)
❑ Other' -
•
1. Equipment Type: Choose the equipment being installed; if more than one system, use another CF-IR-ALT-HVAC for each system.
2. Minimum Equipment Efficiencies: 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 signed.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:
• All HVAC Equipment
CF-6R forms: MECH-04, MECH-2I-HERS'and (for split systems) MECH-25-HERS
replaced I
CF-4R forms: MECH-21 and (for split systems) MECH-25
• Condenser Coil and /or
• Indoor Coil and /or
CF-611 forms: MECH-04, MECH-2I-HERS and (for split systems) MECH-25-HERS
• Furnace
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
Exempted from duct leakage testing if;
�.❑ Duct system was documented to'have been previously sealed and confirmed through HERS verification, or
❑ 2. Duct systems with less tha9y40 linear feet in unconditioned space, or
❑ 3. Existing duct systems are constructed, insulated or sealed with asbestos '
[3 4. The, system will not be Ducted*(ie:,Ductless Mini-Split System) � (Also Exempt,from,Refrigerant:.Charge)
❑ 2. New HVAC System
Required Forms + o:
. Cut in'or.Changeout with
-
' ' W -•-- �.� -.
CF-6R forms: MECH-04, MECH-20 HERS and (fci split systems) MECH-22-HERS and
new ducts:`(all new ..'
ducting an all newt
r
MECH-25-HERS <• f •;.
CF-4R:forms:,MECH-20, and (for split systems) MECH-22, and MECH-25
equipment)
,.
For Split Systems Duct leakage. < 6 percent; RC; CCA >_ 350 CFM/ton, FWD,-TMAH,:STMS, and either HSPP or PSPP.
For Packaged Units: Duct_leakage,< 6.,percent.
❑ 3.. New Ducts with/ or without :;'
Required Forms:
• 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 f6enace:,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 >_ 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 r
linear feet of duct in unconditioned space:
CF-4R forms: MECH-21
For split system or packaged units: Duct leakage < 15 percent
p 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 this Certificate of Compliance are consistent with the information documented on other applicable compliance
fortes, worksheets, calculations, plans and specifications submitted to the enforcement agency for approval with the permit application.
Name: Kevin Robinson Signature: Kevin Robinson
Company: I ANTHONY PLUMBING HEATING & AIR CONDITIONING Date: Apr 4, 2013
Address: 72216 NORTH SHORE ST #101 License: 777794
City/State/Zip: THOUSAND PALMS / CA / 92276 Phone: (760) 343-2121
Reg: 213-A0020002A-000000000-0000 Registration Date/Time: 2013/04/04 11:40:30 HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms July 2010