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12-0789 (MECH)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number:12--0000177.8:91 J Property Address: 5121 0^ AVENIDA VELASCO APN: 773-091-001-1 -000000- Application description: MECHANICAL. Property Zoning: COVE' RESIDENTIAL Application valuation: 9916 Applicant: T4'�v 4 4 Q" Architect or Engineer: BUILDING & SAFETY DEPARTMENT BUILDING PERMIT. VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 7/17/12 Owner: ARLEEN REVILLA 51260 AVENIDA VLEASCO LA'QUINTA, CA 92253 r Contractor: D S`` 1 `Z012 1 PALM DESERT AIR COND CO IN �17L 42081 'BEACON HILL of LA, PALM DESERT, CA 92211 (760) 346-0677 C1� 6,?IGEi3Ei'i.._- Lit. No.: 374937 - -------=----------------------------------------- - LICENSED CONTRACTOR'S DECLARATION ----------------------------------------------- WORKER'S COMPENSATION DECLARATION I 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 Licey.i4e Class: C20 Licens 374937 for by Section 3700 of the Labor Code, for the performance of the work for which this permit is . Date: ontractor: / 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 • - 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 MID CENTURY. Policy Number A09454905-12 following reason (Sec. 7031.5, Business and Professions Code: Any city 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 License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or and agree that 'f.I should become subject to the worker ' compensation• provisions of Section 3700 of th abor Code, I shall forthwith comply wi se provisions. " that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by �•s 17/� any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars IS5001.: Dater pplicanV (_ 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 PENALTIESAND 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 1$100,0001• SIN 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 ATTORNEYS 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, 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.). whose benefit work is performed under or pursuant to any permit issued as a result of this application, (_ 1 I am exempt under Sec. , 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 an .county ordinances and state laws relating to building construction, and hereby a orize representatives " of t ' county to enter upo the above-mentioned property for inspection purposes. Lender's Name: " '7 ate: �%- nature (Applicant or Agent) -lv�►-� Lender's Address: j LQPERMIT Application Number 12-00000789 Permit . . . MECHANICAL ' Additional desc . Permit Fee 40.50, '• Plan Check Fee.. 10.13 Issue Date . . . . Valuation . . . . 0 Expiration Date 1/13/13 Qty Unit Charge Per Extension BASE FEE 15..00 1.00 9.0000 EA MECH FURNACE <=100K 9.00. 1:00 16.5000 EA MECH B/C >3=15HP/>100K-500KBTU 16.50 Special Notes and Comments REPLACE (1) HEAT PUMP SPLIT SYSTEM. 2010 CODES. ---------------------------------------------------------- Other Fees BLDG STDS ADMIN (SB1473) 1.00 Fee summary Charged - - - - --- ------- Paid Credited Due -- - - - - - - - - Permit Fee Total 40.50 .00 00 40.50 Plan Check Total 10.13 .00 00 10.13 Other Fee Total 1.00 00 00 1.00 , Grand -Total 51.63 .00 . 00 51.63' LQPERMIT - t 4 Simplified Prescriptive Certificate of Compliance: 2008 Residential HVAC Alterations CF -IR -ALT -HVAC Climate Zones 10 - 15 ' Site Address: + Enforcement Agency: - Date: Permit #: 51-260 ADA. VELASCO Ca Quinta, CA 92253. City of La Quinta Jul 17, 2012 Duct insulation Conditioned Floor Equipment Typel List Minimum Efficiency2- requirement Area Thermostat ❑ Package.Unit " p Furnace • ❑ AFUE 1 ❑ COP❑ 12 6 (CZ,10-13) Served by system 0 Setback ❑ Indoor Coil 0 SEER 13,0 p HSPF 7.7 ❑ R 8 (CZ 14-15) 1600 sf If not already present, must be * Condensing Unit [I EER ❑ Resistance 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 CF74R forms (no hand filled CF-4Rs allowed) are filled out and signed.Beginning October 1, 2010,'a registered copy of the CF -IR and CF -6111 shall also be on site for final inspection. D 1. HVAC Changeout Required,Forms: . All HVAC Equipment . ' CF -6R forms: MECH-04, MECH-2I-HERS and (for split systems) MECH-25-HERS replaced CF -4R forms: MECH-21 and (for split systems) MECH-25 . Condenser Coil and /or . Indoor Coil and /or CF -6R 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; 1.7 -Duct system'was documented to have been previously sealed and confirmed through HERS verification, or ❑ 2. Duct systems with -less th5n:40 linear.feet in unconditioned space, or ❑ 3. Existing duct systems are constructed, insulated or sealed with asbestos 04. The systemtwill not be Ducted -(ie,;Doctiess fromIRefrigerrant7Charge) sMiniY-Split=5ysteM),(AIso=Exempt; ❑ 2. Nevv;HVAC System. Required!Forms.w; Cut inorChan eout with er rr•y •;,,..' -6R forms:,MECH-04, MECH-20 HERS,and,(for split systems) MECH 22 HERS, and'`r" --• new ductsi;(allnew 'CF ducting -� all new r''' MECH-251HERS;. t r CF forms:iMECH-20, MECH-22, 25 equipment).l�cs -4R and (for split systems) and!MEI, r 4 11 tom: _ For Split Systems: ;Duct leakage' r6, percent;: RC, CCA >_1350 CFM /ton;,FWD, TMAH STMS; and'eithbr,HSPP or'PSPP.' For Packaged Units: Duct lea kage4<;6.pe�cenf:h`- ❑ 3. New Ducts with/or without Required Forms: Replacement' . 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 furnace: 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 -611 forms: MECH-04, MECH-2I-HERS linear feet of duct in unconditioned space. CF -411 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 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: Karl Brown I .. - Signature: Karl Brown Company: PALM DESERT AIR CONDITIONING CO INC Date: Jul 17, 2012 Address: 42-081 BEACON HILL ' License: 374937 City/State/Zip: PALM DESERT / CA / 92211 Phone: (760) 346-0677 • ...------------- Reg: 212-A0037774A-00000000-00001JRe6istraticn Date/Time: 2012/07/17 11:40:33 HERS Provider-,Ca10ERTS,_In-_.j 2008 -Residential Compliance Forms July 2010 r. P.D., Box 150.4.78-495 Calle •Tampico, La :Quinta; California 92211 4(v Q Tel F`60),717-7.012 -Fax: (760) 777-71 I2 Website: www:La=Quinta:Org:- Email: Building@La=Quin#a:Org t Bin #: Permit #` ,��q Building Permit Application & Tracking Sheet" - 3 Project Address 51-260 AVD. VELASCO Owner's Name: REVILLA, ARLEEN ,. A.P. Nury Address: 51-260 AVD. VELASCO Legal. Description: City,'State, Zip: LA QUINTA, CA 92253 t Contractor: Palm Desert Air Conditioning & Heating Company Telephone: (310) 895-4522 Address: 42-081 Beacon Hill Project Description: , City, .State; Zip: Palm Desert, CA 9221.1 REPLACE�HEAT PUMP SPLIT SYSTEM. r •- 1 Telephone; No.: (760) 346-0677 State:'Lic. #: 374937 City Lic: #: 100886 ArchaEngr./Designer k Address: :City, State,. Zip: i. Telephone No.: �h , = k Construction Type: Occupancy: State:'Lic. #' -�• )` ",...._� .w._._�.. Project Type: ,0 New,- ® Add'n • O Alter - 0 Repair • ❑ Demo Name-of contact Person: KARL BROWN v Sq. Ft.. #Stories: # Units: Contact Telephone No.: (760) 346-0677 ` Estimated Value of Project: $9,916.00 r ' `APPLICA.NTC`DO�NOT WRITE,.BELOW:THIS'LINE # Submittal Req'd Recd: Tracking Permit 041. • , Pian Sets } Plan Check Submitted a Item Amount Structural Cales. i , Reviewed', Ready for. Corrections Plan Check Deposit , Truss•CaGbs: Called,.Conta.ct Person Plan Check Balance ' T108:24 C161cs. .Plans Picke.&Up Construction ` Flood Plain Plan 'Plans, Resubmitted Mechanical , Grading Plan r 2nd Review, Ready for Corrections , ' Electrical t Subcontractor List Called Contact Person Plumbing GrantDeed '. M Plans Picked Up S.M.I. - '+ H.O.A. Approval •Plans`Resubmitted Grading W MO.US.E ; Ta Review, Ready.fbr,Corrections Developer lmpact`Fee .:. Planning #Approval 'Galled Contact Person A•I.P"P, ' Pub. Works Appe-1 Date of Permit Issue , School Fees +� " Total Permit Fee's.