11-0719 (MECH)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
4
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT.
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 6/30/11
rApplication Number:
11-00000719
Owner:
Property Address:
53965 AVENIDA VELASCO ."
JOHN M PENN
APN:
774-164-024-12 -000000-
53965 AVENIDA VELASCO
Application description:
MECHANICAL
LA QUINTA, CA 92253
Property Zoning:
COVE RESIDENTIAL
(760) 564-5465
_
Application valuation:
/'� �•��
.5000
Contractor:
Applicant:
Architect or -Engineer:
PALOMA AIR CONDITIONING
PO BOX 3501 1 ' J:q
PALM DESERT, CA 922610 p
(760)347-1212
L i c . No.: 619091
---------------------------- --------------------------------------------------------
. 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
License Class: C20 License No.: 619091 for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
issued.
Date: C��e Contractor: _ 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 workerscompensation
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 SOUTHERN INS CO Policy Number WSIO02303402
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 "and agree hat, 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 00,Bf e 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 ! �G 1a.. _
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($5001.: Date p'. V `Applicant: -
(_ 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 ISec. 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 throughhis 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 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 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
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 isued 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 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 ordinanc and state laws relating to building construction, and hereby authorize representatives
of this county to�rit�r�i{n the above-mentioned property for inspection purposes.
^'Date:/ S
/i/gnature (Applicant or Agent):
LQPERMIT
Application Number 11-00000719
Permit MECHANICAL
Additional desc .
Permit Fee . . . . 30.50
Plan Check
Fee
7.63
Issue.Date
Valuation
0
Expiration Date 12/27/11
Qty Unit Charge Per
Extension
BASE
FEE
15.00
1.00 9.0000 EA MECH
FURNACE <=100K
9.00
1.00 6.5000 EA MECH
-------------------
AH <=10K CFM
--------------------
6.50
------
-------------------------------
Special Notes and Comments
REPLACE HEAT PUMP SPLIT SYSTEM.
SEER
.13.0 HSPF 7:7
----=--------------------------------------------------
Other Fees . . . . . . . BLDG
STDS ADMIN (SB1473)
1.00
Fee summary Charged
-
Paid Credited
---- - - - - -• - - - - - -
Due
-- - - - - - - - - - - - - - ------------
Permit Fee Total 30.50-
.00
.00
30.50
Plan Check Total 7.63
.00
.00
7.63
• Other Fee Total 1.00
.00
.00
1.00
Grand Total 39.13
.00
.00
39.13
LQPERMIT
Simplified Prescriptive Certificate of Compliance: 2008 Residential HVAC Alterations CF -1R -ALT -HVAC
Climate Zones 10 - 15
Site Address:
Enforcement Agency:
Date:
Permit #:
53-965 Avenida Velasco La Quinta. CA 92253
City of La Quinta
Jun 29, 2011
Duct insulation
Conditioned Floor
Equipment Typel
List Minimum Efficiency2
requirement
Area
Thermostat
❑ Package Unit
0 Furnace
0 Indoor Coil
❑ AFUE
0 SEER 13.0
❑ COP
0 HSPF 7.7
fl R 6 (CZ 10-13)
R 8
Served by system
1400 sf
0 Setback
If not already present, must be
0 Condensing Unit
❑ EER
❑ Resistance
❑ (CZ 14-15)
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 -411
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.
0 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
CF4R; forms: MECH-21 and (for split systems) MECH-25
For Split Systems: Ductle6kage�<;15 percent; RC, CCA <_ 300 CFM/ton (Minimum Air Flow Requirement), TMAH
...-.
Exempted from duct leakage:testmg f
Q 1 Duet system was documented fo have been previously sealed and confirmed through HERS verification, or
2 Duct systems with less thari�40 linear feet in unconditioned space, or
3 Existing duct systems are constructed, insulated or sealed with asbestos
❑4 Thesystemwill not be Ducfetl (ieDuctlessMmSplit�System) (Also Exemptxfrom,Refrgerant*Charg,e)
...>x*n # .... ,r.�.� :+ ,,:.. , ., ..:der ,:: :- .... K5:
❑ 2. NewHVAC'System
Required Forms>k 'r:>.�"
. Cut ino�r�Changeout with
�(tx
new ducts: fall new
ductirigx all new h�
CF 6R forms MECH 04 MECH,20 HERS and (for split systems): ME-0-2-04QRS and MECH 54 ER .
CF 4yR forms MECH 20� ah- j or split systems) MECH 22�and;MECHT25
equipment)
�� �
+ LL u, jA .> , �K ...
For Split Systems�xDuct leakage <x6 percent RC CCAq> 350 CFM/ton, FWD TMAH, STMS and either HSPR 6FPSPP
For; Packaged Urnts Duct I akage <,,6 percent "'..
❑;�3,New Ducts with/or without
Required Forms:
Replacement° .:...:........... ...
. Includes replacingor installing all new ducting
arid/or outdoor condensing'unit aid/or indoor
CF -6R forms: MECH-04, MECH-20-HERS, and (for split systems) MECH-25-HERS
coil and/or furnace. Noor;"some equipment
CF -411 forms: MECH-20 and (for split systems) MECH-25
changed. ":i'ar :
For Split Systems: Duct leakage. 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 -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: Herman Paredes 4 ignature: Herman Paredes f"
Company: PALOMA AIR CONDITIONING - Date: -Jun -29,-2011— -
Address: P 0 BOX 3501 License: 619091
City/State/Zip: PALM DESERT / CAT92261 92261 Phone: (760) 347-1212
Reg: 211-A0031924A-00000000-0000 Registration Date/Time: 2011/06/29.20:04:52 HERS Provider: Ca10ERTS, Inc.
2008 Residential Compliance Forms I July 2010
Bin #
City of LaQuin!%7
Building ff Safety Division .
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking.Sheet An+ AAek, P,
Permit #
Project Address:
Owner's Name: 292
A. P. Number:
Address: Jr 3 t%
Legal Description:
City, ST, Zip: ,
Contractor:Telephone:
;:::•..;:•;:•;:;•:;:;;:n::.:::.......
Telephone:i:: ,:::::z:::„v :r•<
Address: !if atio
Project Description:
City, ST, Zip: A D f
lM
' .-'yiiT:' 4j{>>u+v:::v:4v1.'.>.•.!^'f,.::;i:'+\i+^Yi:?$rii:
Telephone: ...
(j'�
State Lie. A 00 City Lie. #:
Arch., Engr., Designer:
Address: .
City., ST, Zip:
Telephone:
State Lie.>r>:::
<s: »zz:>:'
Construction Type: Occupancy:
Pro ject type (circle one): New Add'n Alter Repair Demo
Name of Contact Person:pw 0)Sq.
Ft.:
#Stories:
#Units:
Telephone # of Contact Person: -7 6 Z Q 222=
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
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
Tide 24 Calcs.
Plans picked up
Construction '
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
T'l 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 correctionstissue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees
1n,