11-1141 (MECH)4:
4
P.O. BOX 1504 Qalba 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: 10/17/11
Application Number: _T1-000 0114 1`— ' Owner:
Property Address: 54384 SHOAL CREEK ALEX GOLDMAN
APN: 775-071-088 - - 54384 SHOAL CREEK/J)
Application description: MECHANICAL LA QUINTA, CA 927, t.
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 7000 U ��
_ Contractor:
Applicant: Architect or Engineer: BEST IN THE W ST
255 N. EL CIELO,!¢
PALM SPRINGS, CA 92.26
(760) 343-1002
Lic. 'NO..: 826714
------------------ ----------------------------------------------------- --- -------------------
UrEEN�CO, tJTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury,Cab am lican d 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 Busi e19 and rof s ie als 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 -C38 JAI,- License No.: 826714 for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
issued.
at .� 1 tel• ontractor: VI.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 - r 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 STATE FUND Policy Number 1932774-2011
following reason (Sec. 7031 .5, Business and Professions Code: Any city or county that requires a permit to _ I certify that, in the performanc 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 an manner s as to be e_s ect to the workers' compensation laws of California,.
Y p tt P
permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State and agree that, if I sh ldrn ubject t7o the workers' compensation provisions of Section
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or 3700 of the Lab9WORKERS'COMnPEN
l fZhh omply with those Provisions.
that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by -any -applicant fora-permit.subjects-the.applicant toa..civil..penalty-of-not more-than-five-hundred-dollars-($500)x:—� - pplas 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 SECUATION 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 PENALTIES AND 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 ($100,000). IN 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 ATTORNEY'S 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 _ 1 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 Lavv 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
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
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 b ull and void if work is not commenced -
within .180 days from date of issuance of suc permi - - ssation of work for 180 days will subject
permit to cancellation. -
I certify that I have read this application and state that a ab a in. arm ion is correct. I agree to comply with all
city and county ordinances and state laws relating to uildi nstrucn*ereby authorize representatives
of this county
to enter upo a above-mentioned pr vin'pec ur ses. -
D e 11—
! ignature (Applicant or Agent):
Application Number 11-00001141
Permit . . MECHANICAL
Additional desc .
Permit Fee . . . 40.50 Plan Check Fee
10.13
Issue Date . . . . Valuation . . . .
0
Expiration 'Date ,. 4/14/12
Qty Unit Charge Per
Extension
BASE FEE
15.00
i.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
- - - - - - - - - -
HVAC CHANGE -OUT - INSTALL NEW 4 TON
" SYSTEM, FURNACE, KCOIL,.AND CONDENSER.
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
LQPERMIT
i
Simplified- Prescriptive Certificate -of Compliance: 2008 Residential l•/VACAlterations CF-1R=A1LT-HVAC
Climate Zones 10 - 15 �•
Site Address:
Enforcement Agency:
Date:,
Permit#:
54384 Shoal Creek La Quinta, CA 92253 .0
[City of -La Quinta
Oct 14, 2011
Equipment Typel
I
List Minimum Efficiency?
Duct insulation
requirement
Conditioned Floor
Area
- -
Thermostat
❑ Package Unit
G Furnace .
Indoor Coil
® AFUE 7gn/°
®SEER .13.0
n COP
❑ HSPF I.
R 6 (CZ 10-13)
Served by system
®Setback •
If not already present must be
LTJ Condensing Unit
EER
Resistance
❑ R 8 (CZ 14-15 )
1600 sf
installed)
L] 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, 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 -111
and CF -611 shall also be on site for final inspection.
21. HVAC Changeout '
Required Forms:r .
. All HVAC Equipment
CF -611 forms: MECH-04, MECH-2I-HERS and (for split systems) MECH_-25-HERS
replaced
CF -411 forms: MECH-21 and (for.split systems) MECH-25
. Condenser Coil and /or
. Indoor Coil and /or
CF -6R forms: MECH-04, MECH=21-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;:FRC, CCA <_ 300 CFMjton (Minimum Air Flow Requirement), TMAH
Fer
Exempted from duct leakage testing
I. Duct system was documehted to have been previously sealed and confirmed. through HERS verification; or
2. Duct systems with less than=40 linear feet in unconditioned space, or.'
F-13. Existing duct systems are constructed,, insulated or sealed with asbestos
4. The system i?till not be Ducted (ie..., Catless Mang. SPltt System) (Also .Exempt fromz:Refrigerant £[xa.rge)
2. Neat EIVAC System
_,,..
Requir?sd Forms Y,c "
:.
. Cut mot Changeout withl!
new darts: (all new
CF 6R forms N1EChi-04, MEG -ii 20 HERS, �tttl {forsplit systerT►s) MECH�22 HERS and MECH 25 -HERS.
ducting and all nev
r
ahs (fist split systems>J MECH-Z2 and:=.NaEGH25:.-...-:r, ;<:,. s="t-`=s;.
CF-4R<fortns MECH 20equ
-.,-... ::. .... ...... ..
.iu.. .........,. :s. :.:, .:.>....... .. ..fin. ... .::..:
For Split Systems :Duct=leakage
<'sb percent 1� ,'��A >..350 C1 NIJti3it;<?FWD, TMAkI >:S Ni5, andl—thee KS'PP or PSPP
For Packaged Units: Duct
leakage; <::6. percerif
•C 3. New.::Ductwithout:?>:
Required Forms:
Replacement:`"':.: I
. Includes replacing or installing att;new ducting
and/or outdoor condensing,unit aKd)DT indoor.
CF -115R forms:. MT -_C"4)4, 4alECli-20-HERS, and tfor split systems) MECH-25-HERS
Coil and/or furnace. No or someequipment I
CF -4R forms: MECH-20 and (for split systems) MECH-25
changed.,
For Split Systems: Duct leakage < 6 percent;'RC, CCA a 300 CFM/ton, TMAH
For Packaged Units: Duct leakage < 6 percent
0 4. New Ducting over 40 feet I
Required Forms: ,
. Includes adding or replacing more than 40 I
CF -611 forms: MECH-04, MECH-2I-HERS
linear feet of duct in unconditioned space. I
CF -4R forms: MECH-21
For split system or packaged units: duct teakage < 15 percent ,
Q 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 Codeto accept responsibility for the design identified on this Certificate of
Compliance. f r -
. 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
-worksheets,
forms, calculations, plans and specifications submitted to the enforcement agency for approval with the permit application.
Name: Wendy StewartSignature: Wendy Stewart
Company: BEST IN THE WEST Date: Oct 14, 2011
Address: 1188 ADOBE WAY.
I License: 826714
City/State/Zip: PALM SPRINGS / CA / 92262
Phone: (760) 322-0202
Reg:-211-A0053474A-00000000-0000 Registration Date/Time: 2011/10/14 16:10:38 HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms July 2010
Bin #
t City of La Quinta
Building at Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012 '
Building Permit Application and Tracking Sheet
Permit #
' J�a
1`
Project Address: Sh 0,4L e-
Owner's Name: cL
A. P. Number:
Address: � 3
Legal Description:
City, ST, Zip:
Contractor: ^� -�h,� �.y
Telephone:
Project Description:
Address:25sAj, gL P I -z-
City, ST, Zip-PWAIVI tips C�19' , �Z uv 2,
'�o-vim- Cf is
Telephone:: W3 ' /,002,
State Lic. # :qa 71 V
City Lic. #:
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone:
Construction Type: Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
State Lic. #:
Name of Contact Person:
Sq. Ft.:
#1. Stories:
#Units:
Telephone # of Contact Person: (-p 3 4 3 % o o. 2-
Estimated Value of Project: o
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Rec'd
TRACMG _
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Cates.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance
Energy Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading.plan
2" Review, ready for corrections/issue
Electrical y
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