12-0784 (MECH)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA. 92253 BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Application Number:
12-00000784.
Property Address:
53940 AVENIDA VELASCO
APN:
774-165-011-12 -000000-
Application description:
MECHANICAL
Property Zoning:
COVE , RESIDENTIAL'
Application valuation:
7800
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 7Q.0.0) of Division 3 of the Business and Professionals Code, and my License is in full force and effect.
License CPass: C20 Li se No.: 752180
i _Date. Contractor:
OWNER LDER 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 t�
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 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
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.l• -
(_ 1 1, 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:
KATZMAN MARK
53940 AVENIDA VELASCO
P O BOX 1813
LA QUINTA, CA 92253
.VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 7/16/12
Contractor:
PRIORITY ONE A/C & HEATING CO
P.O. BOX 1681 ,
PALM DESERT, CA 92261
(760)773-0811
Lic. No.: 752180
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 ofthe 'Labor
Code, for the performance of the work for which this permit is issued. My workers' compensation
'
' insurance carrier and policy number are:
Carrier SOUTHERN 'INS CO Policy Number ' PWC00181212-12
_ 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 shall forthwith comply with those provisions. '
ib -16.,
� Dat Applicant: � -
WARNING: FAILURE TO SECURE WO KERS'ATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENAL IES AID CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS ($100,000). IN ADDITION TO THE C COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
• APPLICANT ACKNOWLEDGEMENT
+ J
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
f
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 iesult 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.
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
. �!
county to enter upon the above-mentioned prope or ins ectio purposes.
of thiscounty
/
Dathie:/ b:rl. L Signature (Applicant or Agent):']
l
Application Number . . . 12-00000784-
2-00000784Permit
PermitMECHANICAL
Additional desc .".
Permit Fee. . 40.50-
Plan Check Fee
10.13
Issue Date
Valuation.
0
Expiration Date 1/12%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
" A/C AND HEAT REPLACEMENT 13. SEER
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
r
I
Simplified Prescriptive Certificate of Compliance: 2008 Residential HVAC Alterations CF-lR-ALT-HVAC
Climate Zones 10 - 15
Site Address: -
Enforcement Agency:
Date:
Permit #:
53940 Avenida Velasco La Quinta, CA 92253
City of La Quinta
Jul 11, 2012
Equipment Typel
List Minimum Efficiency2
Duct insulation
requirement
Conditioned Floor
Area
Thermostat
❑ Package Unit
❑ Furnace
❑ Indoor Coil
❑ AFUE
p SEER ��
❑ COP
HSPF
0 7.7
❑ R 6 (CZ 10-13)
Served by system
p Setback
If not already present, must be
0 Condensing Unit
❑ EER
❑ Resistance
❑ R 8 CZ 14-15
1600 sf
installed)
❑ Other
1. Equipment Type: Choose the equipment being installed; if more than one system, use another CF -1R -ALT -HVAC for each system.
2. Minimum Equipment Efficiencies: 13 SEER, 78% AFUE, Z7HSPF 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.
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
CF -6R forms: MECH-04, MECH-2I-HERS and (for split systems) MECH-25-HERS
. Indoor Coil and /or
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 testingyif ,
.❑ 1: Duct system was documented: to have been previously sealed and confirmed through HERS verification, or
::❑:2: Ductaystems with less than,40 linear feet in unconditioned space, or
":❑ 3;;Existing duct systems are constru`cted, insulated or sealed with asbestos
❑ 4: The systeii4ijill not be,Duac d (ie�-IDuctless Mini Split System,)4(Also;ExemptfromtRefrigesanVCharge)
s-
❑ 2:,New HVAC System
Required Forms
.Cut infor Changeout with'4l
new ducts:�(a,11 new r
ducting � all new ,6F-4`Riw
a o, a
CF 6R formsMECH-04 MECH42'.4-HER-S)and (for split systems) MECH 22 HERS _and
r r A , »-
MECH 25 HERS: ; a1 a^ ,x
zY - -
20, `(for
egwprnent\ �._X
{:formsMECH and split systems) MECH 22, and M_ ECH,p25
For Split Systems:. Ductieakage < 6 percent RC; CCA+2;350 CFM/ton; FWD,'tTMAH; STMS, and either HSPP or PSPP.
For Package ..Units Duct leakage ,<'6 percent
❑ 3: New Ducts with/or without;: x
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*fu'rnace. 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
114. New Ducting over 40 feet
Required Forms:
. Includes adding or replacing more than 40
CF -6R forms: MECH-04, MECH-2I-HERS
linear feet of duct 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 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: Roy Meghnagi Signature: Roy Meghncgi
Company: PRIORITY ONE AIR CONDITIONING AND HEATING CO Date: Jul 11, 2012
Address: P 0 BOX 1681 License: 752180
City/State/Zip: PALM DESERT / CA / 92261 Phone: (760) 773-0811
Reg: 212-A0036693A-00000000-0000 Registration Date/Time: 2012/07/11 13:34:54
1 2008 Residential Compliance Forms
HERS Provider: CalCERTS, Inc.
July 2010
oin ff
Permit #
Project Address:
A. P. Number:
City of La Quinta
Building 8i Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
V�--l �owner's Name: 1M ✓a, n ,P ,-\.
N
Total Permit Fees
Legal Description:
City, ST, Zip:
Contractor: i� C� (�
elephone:
Address: ,�.
Project Description:
City, ST, Zip:
Telephone:.
3
State Lic. # :
City Lic. #:
Arch., Engr., Designer:
Address:
City, ST, Zip:
Construction rue tt •
on e:
Type:
P
Occupancy:
P an cY••
Telephone:
one:
State e Lic #-
r oJe
c[ (circle t
type cle one):
New A dd'n Alter Repair Demo
Name of Contact Person:
S Ft.:
4• # Stories:
# Units:
Telephone # Contact
of Person:
Estimated Value
of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
H Submittal Req'd
Recd TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance
Title 24 Calcs.
Plans picked up
Construction
Flood plain 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.nLl.
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