13-0952 (MECH)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
4
BUILDING & SAFETY DEPARTMENT -
BUILDING PERMIT
>r
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153 -
s
Date: ' 7/31/13
Application Number: 13-00000952
Owner:
Property Address: 47010 VIA ANTIBES
ROBERT HERRICK
APN: 643-160-013-139 -26152 -
47010 VIA ANTIBES
Application description: MECHANICAL
LA QUINTA; CA 92253
Property Zoning: LOW DENSITY RESIDENTIAL
(760) 485-0711 Q
Application valuation: 19754
Contractor:
Applicant: Architect or Engineer:
GENERAL AIR CONDITIONI20'331170
KD
5FINANCE
RESERVE DRIVE
THOUSAND PALMS, CA 922 UINTA
OI /�
(760)343-7488
PT.
C
o .:6
LiC. No.: 686310
-------------------------------------------
LICENSED CONTRACTOR'S DECLARATION
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with
I hereby affirm under penalty of perjury one of the following declarations:
Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect.
_ I have and will maintain a certificate of consent to self -insure for workers' compensation; as provided
License Class: C20 ' License No.: 686310
for by Section 3700. of the Labor Code, for the performance of the work for which this permit is
bate. �12-
issued.
I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor
� Contractor. ��ii. ..—��
Code, for the performance of the work for which this permit is issued. My workers' compensation
' OWNER -BUILDER DECLARATION
insurance carrier and policy number are:
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the
Carrier ZENITH INS CO Policy Number Z071741502
following reason (Sec. 7031.5, Business and Professions Code: Any or county that requires a permit to
_ I certify that, in the performance of the work for which this permit is issued, I shall not employ any
construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the
person in any manner so as to become subject to the workers' compensation laws of California,
- permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State
and agree that, if I should become subject to the workers' compensation provisions of Section ,
'
License Law (Chapter_9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or
3700 of the Labor Code; I shall forthwith comply with those provisions. +
that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by
cc — '
Z 13 s
• any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars IS500).:
Dattec 0 Applicant: �/Z.�lL.
1 _ 1 1, 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
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL '
Contractors' State License Law does not apply to an owner of property who builds or improves thereon,
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND ,.
and who does the work himself or herself through his or her own employees, provided that the
DOLLARS ($100,000)• IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN ,
' improvements are not intended or offered for sale. If, however,'the building or improvement is sold within
SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
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.).
APPLICANT ACKNOWLEDGEMENT
1 1 I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.
IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the
_
7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of
conditions and restrictions set forth on this application.
property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed
1. Each person upon whose behalf this application, is made, each person at whose request and for
pursuant to the Contractors' State License Law.l.
whose benefit work is performed under or pursuant to any permit issued'as a result of this application,
1 _ 1 I am exemptunderSec. , B.&P.C. for this reason -
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.
Date: Owner:
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
' - CONSTRUCTION LENDING AGENCY
permit to cancellation.
I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the
I certify that I have read this application and state that the above information is correct. I agree to comply with all
- work for which this permit is issued (Sec. 3097, Civ., C.)• '"
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 inspection purposes. ,
Lender's Name:
' -
Date: Z » Signatures (Applicant or Agent):- -
Lender's Address:
LQPERMIT ..
.
s
Application Number 13-00000952
Permit . . . MECHANICAL 2013
Additional dese .
Permit Fee . . . 143.00 Plan Check Fee
.00'
Issue Date Valuation
0
Expiration Date 1/26/14
Qty Unit Charge' Per
Extension
2.00 35.7500 EA MECH FURNACE
71.50
2.00 35.7500.EA MECH"CONDENSER/COMP
71.50
Special Notes and Comments
HVAC CHANGE OUT - 13SEER/78AFUE, REPLACE .
(1) 4 TON HVAC SPLIT SYSTEM & (1) 5 TON
HVAC SPLIT SYSTEM [2008 ENERGY] CARBON
MONOXIDE ALARMS) TO BE INSTALLED PRIOR
TO FINAL INSPECTION. 2010 CALIFORNIA
BUILDING CODES.
-------------------------------=------------------------------
--------------
Other Fees . . . . . BLDG STDS ADMIN (SB1473).
1.00
PERMIT ISSUANCE M/P/E
90:57 -
- PLAN .CHECK'," MECHANICAL ' "
47.66
Fee summary Charged Paid Credited
------
Due
----------------- ----------
Permit Fee Total 143.00 .00 .00
143.00
Plan Check Total 1.00 .00 .00
.00
Other Fee Total 139..23 .00 .00
139.23"
Grand Total 282.23 .00 .00
282.23
LQPERMIT
Bin #
City of La Quinta
Building &r Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
f'
Project Address: 4-4-70 1 D V ic,`)E)o
_
Owner's Name: j Y� arc. '� ro v �s �Obeta iexCl
A. P. Number:
Address: (-} i01 0%) i AY\A
Legal Description:
Contractor: Gerercz\ Q;r CowNa�ajpn�.n
City, ST, Zip: CA GZZS 3
Telephone: ?60-Li$S 07 I
Address: 311-70a SP�t v ]�^,
Project Description: • 1 S�pr
City, ST, Zip: �\�ojS0.r8 70.\M S C.i� g2Z�(�
\o.cp Zi %ori C qoy—�UT�+
Te `7
le hone: ;7 8
P fo 0= 4 8
3
<'•r>
v r t-1 ACt_ 'M
state Lic. # : City Lic. #:
Arch., Engr., Designer:
Address:
City., ST, Zip: .
Telephone:
Construction Type: Occupancy:
YP P Y
State Lic. #:
Project ProJ'circle one): New Addn Alter Re
tYPa � ) ' Pair Demo
Name of Contact Person:, Gh ����.
Sq. Ft.:
# Stories:
# Units:
Telephone # of Contact Person: Q 51 Z-14 � _ 6 $'7 G
Estimated Value of Project: - ) ej '-7,§}, OL--)
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Cafes.
Reviewed, ready for corrections
Plan Check Deposit
Truss Cafes.
Called Contact Person
Plan Check Balance
Title 24 Cafes.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
211 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:-
'^' Review, ready for corrections/issue .
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees
4_
LlSer-
SimDlified Prescriutive Certificate of COmDliance: 2008 Residential RVACAIterations CF -IR -ALT -HVAC I r
10 to 15
Site Address:
Enforcement Agency:
D e:
Permit #:
14-7010 Via- ArVIbs
Ci q Lc. c:
-7?-
Conditioned Floor
Conditioned
Equipment T e[
List Minimum Efficiency 2
Duct insulation requirement
Area
Thermostat
❑ Packaged Unit
Furnace ]g{ ce
Sumo
1S1 AFUE 78%
13 COP-
Over 40 ft of ducts added or
$I Setback
j Coil
,SEER t3
❑ HSP-
replaced in unconditioned space
Served by system
(If not already
JK Condensing Unit
❑ EER
❑ Resistance
13 R 6 (CZ 10-13)
13R 8 (CZ 14-15)
sf
present, must be
installed)
❑ Other
1. Equipment Type: Choose the equipment being installed, if more titan 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 -1R and CF -6R shall also be on site for final inspection.
jig 1. HVAC Changeout
Required Forms:
CF -6R forms: MECH-04, MECH-2I-HERS and (for split systems) MECH- 25 -HERS
• All HVAC Equipment replaced
CF -4R forms: MECH-21 and (fors lit 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 per -cent
Exempted from duct leakage testing if:
❑ 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. 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, STMS, 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 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 this Certificate of Compliance are consistent with the information documented on other applicable compliance forms, worksheets,
calculations plans and specifications submitted to the enforcement agency fora roval with the permit application.
Name: S*e-Vel SC��;� e�
Signature:
Company: G _
Date: -7Zq I I�
k
Address:
31170ese�v�
License:
l�c ivL
City/State/Zip:hOvS0.rc� �q`Yh S CA QZZ%l.
Phone: �(op - 3y3 _may Ho
2008 Residential Compliance Forms July 2010
s--0111. sy 4exl-1
Simplified Prescriptive Certificate of Compliance: 2008 Residential HVAC Alterations CF -IR -ALT -HVAC
Climate Zones 10 to 15
Site Address:
/
Enforcement Agency:
D e:
Permit #:
Conditioned Floor
E ui ment Typel
List Minimum Efficiency 2
Duct insulation requirement
Area
Thermostat
❑ Packaged Unit
j�$/'Fumace
E
j$(AFUE %g •
[3 COP
Over 40 ft of ducts added or
JKSetback
pi Indoor Coil
js�$EE
13 HSPF
replaced in unconditioned space
Served by system
(If not already
OCondensing Unit
❑ EER
❑ Resistance
13R 6 (CZ 10-13)
sf
present, must be
❑ Other
❑ R 8 (CZ 14-I5)
installed)
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 wgrk 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 CF4R forms (no hand filled CF4Rs allowed) are filled out and
signed. Beginning October 1, 2010 a registered copy of the CF -1R and CF -6R shall 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 (fors lit 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
Exempted from duct leakage testing if:
❑ 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. Existing duct systems are constructed, insulated or sealed with asbestos
❑ 2. New HVAC System
Required Forms:
• Cut in or Changeout with new
ducts: (all new ducting and all
CF -6R forms: MECH-04, MECH-20-HERS,and (for split systems) MECH-22-HERS, and MECH-25-HERS
CF4R 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
linear feet duct in
CF -6R forms: MECH-04, MECH-2I-HERS CF -4R forms: MECH-21
of unconditioned space.
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 this Certificate of Compliance are consistent with the information documented on other applicable compliance forms, worksheets,
calculations plans and specifications submitted to the enforcement agency for approval with the permit application.
Name: _ S�j_
Signature:
Company:
Date: —7 12—C. Its
Address: �"—?O eSeiU 1N 1 G
License: �g� 31(D
\\
City/StatelZip: ��OvS\0.�� Lti xv\ S CA R ZZ?C,
Phone: --?(-,0-3q:3- 7y 88
2008 Residential Compliance Forms July 2010