12-0880 (MECH)TW4
0/
BUILDING & SAFETY DEPARTMENT
BUILDING. PERMIT
Owner:
JERRY DAUDERMAN
54563 SHOAL„CREEK
LA QUINTA, CA 92253
Contractor:
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 8/07/12
Q 11 -
' :mc,
Applicant: Architect or Engineer:
PALM DESERT AIR. COND CO IN �c � A! U1NTA ,
p,n. BOX 1501
CITY
42081 BEACON HILL Fly��,?V EBEPT
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
12_00000880"_i
Property Address:
54563 SHOAL CREEK
APN:
775-071-039- -
Application description:
MECHANICAL
Property Zoning:
LOW DENSITY RESIDENTIAL
Application valuation:
3371
TW4
0/
BUILDING & SAFETY DEPARTMENT
BUILDING. PERMIT
Owner:
JERRY DAUDERMAN
54563 SHOAL„CREEK
LA QUINTA, CA 92253
Contractor:
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 8/07/12
Q 11 -
' :mc,
Applicant: Architect or Engineer:
PALM DESERT AIR. COND CO IN �c � A! U1NTA ,
CITY
42081 BEACON HILL Fly��,?V EBEPT
PALM DESERT,'CA 92211
(760) 346-0677
Lic. No..: 374937
' 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
1-51mse Class: C20 L' ase No.: 374937:
for by Section 3700 of the Labor Code, for the performance of the work for which this. permit is
,, _ �yf'�
/ate: Y17ntractor:c3 %' - -
issued.
1 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 f
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 MID CENTURY Policy Number A09454905-12 .
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 that, 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
that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by' r
3700 of the Labor Code, I shall forthwith co ly with those provisions.
7 ��
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).:
Date:d pplicant
(_ 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 -
'WARNING: FAILURE TO SECURE WORKERS' COMPENSATION 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.).
(_ 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.).
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 ofthe
work for. which this permit is issued ISec. 3097, Civ: C.).
,
Lender's Name:
Lender's Address
LQPERMIT
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 comply with all
city and county ordinances and state laws relating to building construction, and hereby authorize representatives
of his county to enter upon a above-mentioned property for inspection pur ses. - -
Date: "� % h- Si ature (Applicant or Agentlop: >= �� _ti�/t�
Application Number . . . . . 12-00000880
Permit MECHANICAL
Additional desc .
- Permit Fee . . . . 31.50 Plan Check Fee ..
7.88
Issue Date . . . . Valuation . . . .
0
Expiration Date 2/03/13
Qty Unit Charge Per
Extension
BASE FEE
15.00
1.00 16.50.00 EA' MECH B/C >3=15HP/>100K-500KBTU
16.50
------ ------------------------------
Special.Notes and Comments
• REPLACE (1) AIR CONDITIONING CONDENSER.
2010 CODES.
Other Fees _ . . . ... .`BLDG STDS ADMIN (SB1473)
.1.00
Fee summary Charged Paid Credited
Due
Permit Fee Total 31.50 .00 .00
31.50
Plan Check Total. 7•.88 .00 .00
7-88
Other Fee Total 1:00 .00 .00
1.00
Grand -Total 40.38 .00 .00
40.38'
LQPERMIT
C&
�t�I61 a�T# �c
P.O. Box 1504.78=495 Calle Tampico, -.La Quinta, California 92211'°
Tel: -(760)'777-7012 • Fax: (760) 777-7112C& OP4.
--cr�,�rwoeseur_ Website: www.La-Quinta.Org • Email: Building@La-Quinta.Org
-gin #: Permit #:I -fry I Building Permit Application & Tracking Sheet
Project Address: 54-563 SHOAL CREEK
Owner's Name: DAUDERMAN, JERRY
A.P: Number:
Address:. 54-563 SHOAL CREEK
Legal Description:
City, State, Zip: LA QUINTA, CA 92253 `
;Contractor. Palm Desert Air Conditioning & Heating Company
Telephone: , (760) 771-2713
Address: 42-081 Beacon Hill
� ,.
Project Description:
Pity, State, Zip: Palm Desert, CA 92211
REPLACE (1) AIR CONDITIONING CONDENSER.
r °
r
Telephone No.: (760) 346-0677`M�f
.State- Lic. #: • 374937
City Lic. #: 100886
Arch:7Engr./Designer:
Address:
City; State,..Zip:
Teleph6he No::
y y
.i �i"'ri.�S* a j
'"F "
Construction Type:
Occupancy:
Project Type::, , ❑.New ® Add'n • ❑:Alter • ❑ Repair w ❑ Demo
Name of Contact Person: KARL BROWN
Sq. Ft.:
# Stories:
#Units:
Contact Telephone No.: (760) 346-0677
Estimated Value of Project: $3,371.00
APPLICANT:
DO NOT WRITE
BELOW THIS LINE
#
Submittal
Req'd t
Recd
Tracking
Permit Fee's
Plan Sets . »
Plan Check Submitted
-
Item
Amount
Structural Calcs.
Reviewed, Ready for Corrections
Plan Check Deposit
`fru§s Cabs.
,Called Contact Person
Plan Check Balance
Title:24 Calcs.
Plans Picked Up
Construction
2
Flood Plain Plan
Plans. Resubmitted
Mechanical
Grading Plan
2"d' Review, Ready for Corrections
`
. Electrical
Subcontractor List
Called -Contact Person
Plumbing.,
Grant Deed
Plans Picked Up
H.O.A. Approval
Plans Resubmitted
Grading
IN HOUSE
3'd Review, Ready for Corrections
Developer Impact Fee
;
Planning.Approval
Called Contact Person
A.I.P.P.
,
Pub. Works Appel
•
Date of Permit Issue
School Fees
R
f ;
Total Permit Fee's
Simplified Prescriptive Certificate of Compliance: 2008 Residential HVAC Alterations r CF -IR -ALT -HVAC
Climate Zones 10 - 15
Site Address:
Enforcement Agency:-
Date:
Permit #:
54-563 SHOAL CREEK La Quinta, CA 92253 _
City of La Quinta
Aug'6,-2012 '
Equipment Type1
List Minimum Efficiency2
Duct insulation
Conditioned Floor
requirement
Area
Thermostat
❑ Package Unit
❑ Furnace
❑ Indoor Coil
❑ AFUE -
p SEER 13.0
❑ COP
❑ HSPF
❑ R 6 (CZ 10-13)
Served by system
0 Setback
if not already present, must be
* Condensing Unit
❑ EER
❑ Resistance
❑ R 8 (CZ 14-15)
1600 sf
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 -111
and CF -611 shall also be on site for final inspection.
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 OF Split Systems` Duct leakage <,:15 percent; RC, CCA <_ 300 CFM/ton (Minimum.Air Flow Requirement), TMAH
s; --wet leakage L4 15 P&6mk
Exempted from duct leakage testing if:
•.❑ 1. Duct system was documented to have been previously sealed and confirmed through HERS verification, or
El 2. Duct systems with less than 40 linear feet in unconditioned space, or
[13. Existing duct systems are constructed, insulated or sealed with asbestos '
❑'4. The systern,will not be Ducfed,(ie.•Ductless,Mini-Split 5ystem).(AIso7Exempt fro mlRefri g era nt4C-ha rge)
❑ 2. Ne 'HVAC System
Required f ms:,' �; ' fr �• }+� • '
. Cut m 'or,Changeout with4
ducts: (all
-` 1 k '! " M
CF 6R forms MECH-04, MECH-20 HERS,'Iand (for split systems) MECH„ 22 HERS and �—
new new
ductingk all new �' '
MECH-25 HERS
CF -4R forma MECH 20, and (for split systems) MECH-22, MECH-25 r
equipment),
and J-
For Split Systems:, D6ct.lea kage <�6 pie rcent,RC,' CCA',,>_1350`CFM/ton;. FWD;.TMAH,,STM S, and either, HSPP'or'PSPP.
For Packaged Units: Duct leakage. < 6 percent ' •�
❑ 3. New,Ducts with/or without #
Required Forms: '
Replacement-
eplacement'.Includes
..Includesreplacing or installing,all'new
ducting and/or outdoor concl&sing'unit
CF -6R forms: MECH-04, MECH-20-HERS, and (for split systems) MECH-25-HERS
and/or indoor coil 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 >_ 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 -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 -
❑ 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: Karl Brown Signature: Karl Brown
Company: PALM DESERT AIR CONDITIONING CO INC Date: Aug 6, 2012
Address: 42-081 BEACON HILL License: 374937
City/State/Zip: PALM DESERT / CA / 92211 Phone:,(760) 346-0677
Reg: 212-A0042357A-O6O6Oob6loo00``Registration Date/Time: 2012/08/06 14:43:58 HERS Provider: CalCERTS, Inc.
-2008-Residential-Compliance-Forms,-J '1 -July 2010