10-1056 (MECH)P.O. BOX 1504 VOICE (760) 777-7012 .
78-495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 10/12/10
Application Number: 10700001056 Owner:
Property Address: .77855 CALLE TAMPICO # 2 NORTHWEST ROBIN'S NEST, LLC
APN: 773-075-013-2 -000000- 420 MAIN STREET O
Application description: MECHANICAL OREGON CITY, OR 97045 1
Property Zoning: VILLAGE COMMERCIAL R ;
Application valuation: 4300 OCT j 122010 )
Contractor: CITY QF LA QUINTA
Applicant: Architect or Engineer: EMPIRE HEATING & AIR COND _ _R.t;.ncL= nEPT
68845 PEREZ ROAD, #25R
CATHEDRAL CITY, CA 92234
(760)328-6016
•Nl �•I' Lic. No.: 306745
------------------
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed. under provisions of Chapter 9 (commencing with
Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect.
/late:
ense Class: C20 Lice a No. 5
o -.I ontractor:
NER-BUILDER DECLARATION
I hereby affirm under penalty of perjury that I a 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 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.).
(_) 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.).
(_) I am exempt under Sec. , BAP.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: Q -
Lender's Address: "
LQPERMIT
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.
_ I have and will maintain workers' compensation insurance, as required by Section 3700 of. the Labor
Code, for the performance of the workfor which this permit is issued. My workers' compensation
insurance carrier and policy number are:
Carrier EXEMPT Policy Number EXEMPT
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 shouldbecome subject to the workers' compensation provisions of: Section
3700 oft Labor d , I shall fo ith com ly with t e pr _
ate: O dApplicant:
WARNING: FAILURE TO SECURE WORKERS' CO ENSATION COVERAGE IS UNLAWFUL,AHALL
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 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• h all
city and county ordinances and state laws relating to building construction, and hereb a e representatives
Of t is county to enter upo he above-mentioned prop for inspe ion pu osg�.
Date: f+�=�,� gnature (Applicant or Agent
LQPERNI IT
Application.Number . . . 10-00001056
Permit MECHANICAL
Additional desc .
Permit Fee 33.00
Plan Check Fee
8.25.
Issue Date . . . .
Valuation . . .
. 0
Expiration Date 4/10/11
Qty Unit.Charge. Per
Extension
BASE
FEE
15.00
1.00 9.0000 EA MECH
FURNACE <=100K
9.00
1.00 .9.0000 EA MECH
w
B/C <=3HP/100K BTU
9.0.0
-------------------------
Notes and Comments
CHANGE OUT 2.5 TON A/C & FURNACE
COMBO.
2007 CODES.
--------------------------------------------------------------------
Other Fees . . . . . . . . . BLDG STDS ADMIN (SB1473)
--------
1.00
Fee summary Charged
Paid Credited
Due
Permit Fee Total 33.00
.00 .00
33.00
Plan Check Total 8.25
.00 .00.
8.25
Other Fee Total 1.00.
.00 00
1.00
Grand Total 42.25
.00 .00
42.25
;icriptive Certificate of Compliance: 2008 Residential HVA CAlterations CF -IR -ALT -HVAC
to 15
Site Address:
L
En oreementen
A8 ry:
Date:
Permit #:
E ui rent T List Minimum Efficiency'
Duct insulation requirement
Conditioned Floor
Area
Thermostat
ackaged Unit
❑ Setback
O Furnace ❑ AFUE_ ❑ COP
Over 40 ft of ducts added or
❑ Indoor Coil ❑SEER ❑ HSPF
replaced m unconditioned space
Served by system
pjnot already
❑ CondensingUnit ❑ EER ❑Resistance
❑ R 6 (CZ 10-13)
sf
present, mus(be
❑ Other
❑ R 8 (CZ 14-15)
installed)
1. Equipment Type: Choose the equipment being installed; if mote than one system. use another CF -1 R-ALT-HVACjor each system.
2. Minimum Equipment E,(jlciencles: /3 SEER 78•/ AFUE, 7.711SPFjortypical 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 be left
shall 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 -111 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-2l-HERS and (for split systems) MECH- 25 -HERS
CF4R forms: MECH- 21 and UOLRlit systems). MECH-25
• Condenser Coil and/or
• Indoor Coil and/or
CF-61tforms: MECH-2I-HERS and (for split systems) MECH- 25 -HERS
• FurnaceCF-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), T IAH
For Packaged Units: Duct leakage < 15 percent
Exempted from duct leakage testing if -
f❑
01. Duct system was documented to have been previously sealed and confirmed through HERS verification, or
O 2. Duct systems with less than 40 linear feet in unconditioned space, or
❑ 3. Existing duct systems are constructed,insulated or sealed with asbestos
0 2. New HVAC System Required Forms:
• Cut s: al 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 all
CF -4R forms: MECH 20-, and for lit
new a ui enc ( sP systems)MECH-22, and MECH 25
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... -
ftf�S:
• Includes replacing or installing all new ducting
CF -611 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
O 4. New Ducting over 40 feet
Required Forms:
• Includes adding or replacing more than 40
linear feet of duct in unconditioned space.
CF -6[t forms: MECH-04, MECH-2I-HERS 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)
• 1 certify that this Certificate of Compliance documentation is accurate and complete.
• 1 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 fors, worksheets,
calculations, plans and specifications submitted to the enforcement a for approval with the it application.
Name: / —
Signature:
Company: _
Date:
l
Address:
J f
License:
C -
City/State/Zip: a C
Phone:
L� Z �
2008 Residential Compliance Forms March 2010
Bin #
City of La Quinta
Building 8r Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit # O h(�
d
Project Address:Owner's
Name: e — C
A. P. Number:
Address: - Iv
Legal Description:
City, ST, Zip:
o 07
Contractor. .�
Telephone:
Address: 2
Project Description:
City, ST, zip: C^
CIL il—pfl GtT 7 Lc—
Telephone:71, 3
Stats Lic. # : p 6.7 s City Lic. #;
Arch., Engr., Designer.
Address:
City., ST, Zip:
Telephone:
tf !`' ctv
Construction Type: Occupancy:
State Lic. #:
Project type circle one New Add'n . Alter 4epair Demo
Name of Contact Person:
Sq. Ft.:
# Stories:
# Units:
Telephone # of Contact Person:
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 Cal cs
Reviewed, ready for corrections
Plan Check Deposit
Truss Calls.
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.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
1;