11-0268 (MECH)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Applicant: Architect or E
ng
ine
er:
----------------- I
LICENSED CONTRACTOR'S DECLARATION
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
I hereby affirm underpenalty of perjury that I am licensed under provisions of Chapter 9 (commencing with
Section 7000) of Division 3 of the Business d Profession Code, and my License is in full force and effect.
License Class: C20 cense No.: 794315
Date: �'' 1' i► Contractor: ^
OWNER -BUILDER 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
that he or she.is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by
any applicant for apermit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).:
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 (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 _ 1 I, 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. , 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
VOICE (760) 777-7012'
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 3/17/11
Owner:
HILSABECK JOHN
79095 SHADOW TRAIL
(7 0)619-, 89 92253
(760)619-3489
1
MA
R 1► 2011
Contractor: 4
DOVE AIR INC
69749 RISUENO ROAD Cl-fyofLAfrO{NYA►
CATHEDRAL CITY, CA 92234 ri_,,,ii.--t" 'p
+�
(760)327-1890
Lic. No.: 794315
------------------
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 work for 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 should ome subi t to the workers' compensation provisions of Section
3700 of the Labor Cod all forth fi 4t com with those provisions.
Date: I - I r — Applicant:
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 andfor
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 comply with all
city and county ordinances and state laws relating t0
buildin co struction, and ereby authorize representatives
of this county to enter upon the above-mentioned property i spection pur es.
Date: 31111 Signature -(Applicant or Agent):
6
Application Number:
11-00000268'
Property Address:
79095 SHADOW TR
APN:
649-030-069-14 -31310 -
Application description:
MECHANICAL
Property Zoning:
HIGH DENSITY RESIDENTIAL
Application valuation:
1699
Applicant: Architect or E
ng
ine
er:
----------------- I
LICENSED CONTRACTOR'S DECLARATION
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
I hereby affirm underpenalty of perjury that I am licensed under provisions of Chapter 9 (commencing with
Section 7000) of Division 3 of the Business d Profession Code, and my License is in full force and effect.
License Class: C20 cense No.: 794315
Date: �'' 1' i► Contractor: ^
OWNER -BUILDER 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
that he or she.is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by
any applicant for apermit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).:
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 (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 _ 1 I, 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. , 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
VOICE (760) 777-7012'
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 3/17/11
Owner:
HILSABECK JOHN
79095 SHADOW TRAIL
(7 0)619-, 89 92253
(760)619-3489
1
MA
R 1► 2011
Contractor: 4
DOVE AIR INC
69749 RISUENO ROAD Cl-fyofLAfrO{NYA►
CATHEDRAL CITY, CA 92234 ri_,,,ii.--t" 'p
+�
(760)327-1890
Lic. No.: 794315
------------------
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 work for 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 should ome subi t to the workers' compensation provisions of Section
3700 of the Labor Cod all forth fi 4t com with those provisions.
Date: I - I r — Applicant:
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 andfor
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 comply with all
city and county ordinances and state laws relating t0
buildin co struction, and ereby authorize representatives
of this county to enter upon the above-mentioned property i spection pur es.
Date: 31111 Signature -(Applicant or Agent):
Application Number
11-00000268
Permit . . .
MECHANICAL
Additional desc .
Permit Fee . . . .
24.00
Plan Check Fee
6.00
Issue Date
Valuation
0
Expiration Date
9/13/11
Qty Unit Charge
Per
Extension
BASE
FEE
15.00
1.00 9.0000
EA MECH.APPL
REP/ALT/ADD
9.00
Special Notes and Comments
REPLACE 4 TON EVAP.
COIL IN ATTIC.
---•-----------------------------------------------------=-------------------
Other Fees . . . .
. . . BLDG STDS ADMIN (SB1473)
1.00
Fee summary
Charged
Paid Credited
Due
Permit Fee Total
24.00
.00 .00
24.00
Plan Check Total
6.00
.00 .00
6.00.
Other Fee Total
1.00
.00 .00
1.00
Grand Total
. 31.00
.00 .00
31.00
LQPERMIT
Simplified Prescriptive Certificate of Compliance: 2008 Residential HVAC
CF -IR -ALT -HVAC
Alterations '
Climate Zones 10 - 1S
Site Address:
Enforcement Agency:
Date:
Permit #:
79095.Shadow TRL La Quinta, CA 92253
City of La Quinta
Mar 17, 2011
Duct insulation
Conditioned Floor
Equipment Type1
List Minimum Efficiency2
requirement
Area
Thermostat
❑ Package Unit
ElFurnace
* Indoor Coil
ElAFUE
[I SEER
❑COP
❑ HSPF
❑ R 6 (CZ 10-13)
Servedsystem
p Setback
If not already present,
❑ Condensing Unit
C] EER
E] Resistance
❑ R 8 (CZ 14-15)
1600 sf
must be 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 -4R forms (no hand filled CF-4Rs allowed) are filled out and signed.Beginning
October 1, 2010, a registered copy of the CF -1111 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
. 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
For Packaged Units: Duct leakage'A< 15 percent
Exempted from duct leagage 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. Existingrdiactsystems are or_ sea, led, with fasbestos i"i!w+ -
�costructed;"insulateclw
❑ 2. New HVAC., f:r t
Re uiredlForms -Te �f,�r
q t r_;.� yw `
System,
ir, fa` _
• Cut in or Changeout
with new ducts (all a
z
CFw6Ryforms MECH-04, MECH 2O=HERS, and (for split systerrs)'MECH 22 HERS,:,and ,
MECH°ZS-HERS•,
new ductirig and alit-
c�� ,i
CF -4R forms 'MECH+20 and (for split systems) MECH 22, and MECH 25�
new equipment)
$
xM
- l ter. +fti "
For Split Systems: leakage'<j6;percent;`RC, CCA 2! 350'CFM/t6n, FWD; TMAH, STMS, and -either HSPP or PSPP"
-Duct
For Packaged, Units: Duct leakage: < 6 percent
❑ 3. New Ducts with/or without'
Required Forms:
Replacement
. Includes replacing or installing all,
new ducting and/or outdoor`.•�7CF-6R
condensing unit and/or indoor•coil
forms: MECH-04, MECH-20-HERS, and (for split systems) MECH-25-HERS
and/or furnace. No or some
CF -411 forms: MECH-20 and (for split systems) MECH-25
equipment changed.
For Split Systems: Duct leakage < 6 percent; RC, CCA z 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 of duct in
CF -611 forms: MECH-04, MECH-2I-HERS
unconditioned space.
CF -411 forms: MECH-21
t
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: Gary Laster Signature: Gary Laster
Company: DOVE AIR INC Date: Mar 17, 2011
Address: 68-749 RISUENO ROAD License: 794315
City/State/Zip: CATHEDRAL CITY / CA / 92234 Phone: (760) 327-1890
Reg: 211-A0014129A-00000000-0000 Registration Date/Time: 2011/03/17 15:21:59 HERS Provider: Ca10ERTS, Inc.
2008 Residential Compliance Forms July 2010
.1L/a:L/LVVO MN O;LL L, J%A L0. VUL11ra DLLLLC1111 (�l :761 ,y jj�JVVa; VVL
Bin #
Permit #
\V WULa
Project Address:
5
I
City f Chu i nta
Building at Safety Division
P.O. Box 1$04, 78-495 Calle Tampico
Quinia, CA 92253- (.760). 777-7012
Building Permit Application and 'Tracking Sheet .
Owner's Name: 0 „� A CC
A. P. Number:
7`
Address: S Sh o 0 rG
Legal Descriptiow.
Contractor_ J�
S
City, ST, Zip: ` 53
=Ilophou,0 k
Ada�ess; b
e'
�04
YrojeciDescription: G� L Cb'
City, sr, zip: C-
C (1 VL3 i
o a
Telephone: d 6 a�
State Lic. # :
Arch., Engr., Designer:
City Lia M It)
Address:
City, SL', Gip:
,i elepltutte:
;tate Lie. #;
Narne of Contact Person:
Gb h
Constctction Type: Occupancy.
Project type (circle one): New Add'n Alter Repair Demo
Sq. Ft.:
#Stories:
#Units:
Telephone Al of Contact Person: S D
i ' Estimated Value of Project:
APPUdANT: DO. NOT WHITE BELOW THIS UNE
6
Submittal
Plan Sets
Req'd '
Rec'd
TRACKING. ,
Pian (heck submittgd
PERNUT FEES
Item Amount
Structural Cates,
Reviewed, ready for corrections
Pian Check Deposit
Truss Coles.
Called Contact Person
Plan Check tiais.aee
Energy Calm
Plans bieked up
Contraction .
Flood plain plan .
Plans resubmitted
Mechanical
Grading, plan
r' Review, ready for corrections/lssat
Electrical
Subcou6ctor Lint
Called Contact Person
Ptantbing
Grant Deed
Plans picked up
g,M,L'
H.O.A. Approval
Piaes resubmitted
Cradldg
IN HOUSE:-
'"' Revlew, ready for correctionstissue
Developer Impact Fee
Planning Approval
Called Contact Person
Pub. Wks. Appr
Date of permit issac
School Fees
_
Total Peratit Fees