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12-1337 (MECH)P.O. BOX 1504 . 787495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: W -LI 00001337 ,D� Property Address: 54407 SHOAL -`CREEK APN: 775-071-052- - Application description: MECHANICAL Property Zoning: LOW DENSITY RESIDENTIAL Application valuation: 5000 Tit!t 4 4 um- BUILDING & SAFETY DEPARTMENT BUILDING PERMIT Applicant: Architect or Engineer: PC - - - - - - - - - - - - - - ----- - - - - - - - - - - --- - - - - - - - - - - - - LICENSED CONTRACTOR'S DECLARATION 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 Profess'onals Code, and my License is in full force and effect. License Class: B C10,20-,3 License No.: 856936 _7 t ate: t1 ntractor: .� 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 a permit 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 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 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 \ S CTIONS (760) 777-7153 Date: 11/13/12 Owner: HUGO FULLI 54407 SHOAL CREEK - LA QUINTA, CA 92253 Contractor: O 8 TELFORDJONES, 25920 IRIS AVF� TE 4_23 %012-2 MORENO VALLEY, 92551 (951)486-0337 CITY OFL"AQUI.NTA Lic. No'.: 856 36 FINANCE DEPT ----------------------------------------------- WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty ofperjury 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 STATE FUND Policy Number 238-0005911 _ 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 sh become subject to the workers' compensation provisions of Section i 3700 of the Labor o I s forthwith c ply with those provisions. Date: licant: WARNING: FAILA14 TO SECURE WORKERS' COMPE SATION 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 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 torr ct. I agree to comply with all city and county ordinances and state laws relating to buildi onstr tion, and h eby authorize representatives of Vs county to enter upon the above-mentioned grope y f r spec n pur s - Date: 1 �� Signa a (Applicant or Agent): Application Number . . . . . 12-00001337 Permit. . . . MECHANICAL. Additional desc . Permit Fee 40.50 Plan Check Fee 10.13 Issue Date Valuation . . . . 0 Expiration Date 5/12/13 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 HVAC CHANGE -OUT: INSTALL NEW 4 TON SYSTEM, FURNACE, CONDENSER, COIL. 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 LQPERMIT Simplified Prescriptive Certificate of Compliance: 2008 Residential HVAC Alterations CF-IR-ALT-HVAC climate Zones 10 -15 Site Address: Enforcement Agency: bate: I.Nov Permit Oi: 54407 Shoal Crk La Quinta, CA 92253 City of La Quinta 9, 2012 Duct insulation Conditioned Floor Equipment Type1 List Minimum EfficienCy2 requirement Area Thermostat ❑ Package Unit * Furnace * Indoor Coil IIS AFUE 780/. ® SEER 21.0 [3COP p HSPF 13 R_ 6 (CZ 10-13) 0 R 8 (CZ 14-15) Served by system 1627 sf ® Setback If not already present, must be . ® Condensing Unit [3EER p Resistance installed) ❑ Other 1. Equipment type: Choose the equipment being installed,' lrmore than one system, use another CF-IR-ALT-HVAC for each system. 2. RIAlmum Eauipment Eyficiancles, 13 SEER, 78% AFUE, 7.7H5PP for typical residentlal 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-611 and registered CF-411 forms (no hand filled CF-4Rs allowed) are filled out and signedAeginning October 1, 2010, a registered copy of the CF-IR and CF-611 shall also be on site for final inspection. ® 1. HVAC changeout RequiredForms: . All HVAC Equipment CF-6R forms: MECH-04, MECH-2I-HERS and (for split systems) MECH-25-HERS replaced CF-411 farms: MECH-21 and (for split systems) MECH-25 . Condenser Coll and /or CF-6R forms: MECH-04, MECH-2I-11ERS and (for split systems) MECH-25-HERS Indoor Coil and /or CF-4R forms: MECH-21 and (for split systems) MECH-25 . Furnace For Split Systems: Duct leakage < 15 percent; RC, CCA 5 300 CFM/ton (Minimum Air Flow Requirement), TMAH Exempted from duct leakage testing if: p 1. Duct system was documented to have been previously sealed and confirmed through HERS verification, or 0 2. Duct systems with less than 40 linear feet in unconditioned space, or [3 3. Existing duct systems are constructed, insulated or sealed with asbestos Q 4. The system will not be Ducted (ie. Ductless Mini-Split System) (Also Exempt from Refrigerant charge) • ❑ Z. New HVAC System • Required Forma: . Cut In or Changeout with CF-6R forms: MECH-04, MECH-20-HERS, and'(for split systems) MECH-22-HERS, and new ducts: (all new MECH-25-HERS ducting Aud all new CF-4R forms: MECH-70, and (for split systems) MECH-22,.and MECH-25 equipment) For Spilt Systems: Duct leakage < 6 percent; RC, CCA >_ 350 CFM/ton, FWD, TMAH, SEMS, and either HSPP or PSPP. For Packaged units: Duct leakage < 6 percent ❑ 3. New Ducts with/or without Required Forms: Replacement . Includes repladrig 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 colt and/or furnace. No or some CF-41Z 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 ❑ 4. New Ducting over 40 feet Required Forms: e 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 d EXCEPTION: Existing duct systems constructed, insulated or sealed with asbestos. Contractor (Documentation Author's /Responsible Designer's Declaration Statement) . I certify that this CertiMcate 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 identlned on this Certificate of Compliance. . I certiry that the energy features and performance specifications for the design identified on this Certificate of Compliance conform t0 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, work5heets, calculations, plans and specifications submitted to the enforcement agency for approval with the permit application. Name: Ken Telford Signature: Ken Telford Company: TELFORWONES INC Date: Nov 9, 2012 Address: 2S926IRIS AVE SUITE #13A-400 License: 856936 Citv/State/Zip: MORENO VALLEY / CA / 92551 Phone: (951) 496-0337 Reg: 212-8006309110.-000000000-0000 Registration Date/Time; 2012/11/09 11:32:25 HERS Provider: Ca10ERT8, Int. 2000 Res}dential Compliance For" July 2010 Bin. #.0ty Of La Qubta MOO er Safety Aivlclon P.O box 1504,78-495 Calle Tampico U.QuMra, CA 92255 - (160) 7777012 Building Perink-Appiicadw* and Tracking Sheet Pr'titlft # Pmjert.Address: V "l p 'i Ir Owner'sNeme:. A. P. Number. p� Addr=A4n Legal >, on. Contractor. Y Addrrss: , �t5 t IML. ,It +' �4j11 –`(1Uf'� city. sr. zip: JI/i��Cq Telephone: ►�� Pr e-4 Description: "Vr7 f City, ST- Mr.. %N( MU � '"'7h � V a L (MMY40A rtM f7 Telepbane:(kF %(D .&/ ArcJ6 , Bngr., Desigum. Address: City., ST, Zip: Uiphone: Stele i.ia_ #: Name of Contam Person: vction Typw.. �anc9: t type (oircle one): New Add'n Aker Repair Demo FSq.-: `1 U11 it Storfes # Units: Telephone # of OnflaetPensan: Estkawwd Value of Project; Titwo - APPLICANT: DO NOT WRITE BELOW THIS LINE N 9Pbmlttal Req'd • Reed TI,tACMG PERM[YTtttPB Plan Seta Plan Cheat submitted Item Afnowat Structural Calla.. Reviewed, ready hr corrections Man Cbhedx Deposit • MIM Calm Called Contact Person Plan Check Balance. Title 24 CLics. Pian® picked, np Conarmcdod Flood plAiu Visa Plans resubuifw Mecbarilcal G•rading plan 2e' Review, readyfor correttiabdi sue Electrical Subeontoctorlist Called ContactPeraou Phuahbit►g Grant Deed piaue PICM4 up BJH.L H.O.A. Approval Plans razubmitted Gradin Rl ROX4)z:. "" Review, ready fbr mrreetiomMme Itevrdoper Impa!;t Fee planning Approval. I Called Contact Person Pub. ". Appr Date of permit issue &had Fees Total Permit Fees