13-0362 (MECH)414a
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
Application Number:
Property Address:
APN:
Application description:
Property Zoning:
Application valuation:
Applicant:
IVS
13-00000362
54828 SHOAL CREEK
775-141-068- -
MECHANICAL
LOW DENSITY RESIDENTIAL
11217
Architect or Engineer:
-----------------
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT
I hereby affirm under penalty of perjury that licensed under provisions of Chapter 9 (commencing with
Section 7000) of Division 3 of the Busineo a d Prof ionals C le, and my License is in full force and effect.
License Class: C10 C16 C2 a seo.: 457554 `
Date: ,���Con-tect. r: -
/OW ER -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 15500).:
(_) 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 projectMsec.
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 I ani 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:- _ )
LQPEPMIT
Date: 3/26/13.
Owner:
MARY PREVO
LA QUINTA, CA 92253
(760)771-6730
Contractor.
PREFERRED PLUMBING HTG A/C
P.O. BOX 5120
PALM SPRINGS, CA 92263 `' 0
(760) 322-3173 %i
Lic. No. 457554
------------------------------ - - - - -- --- - - —
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
_ ave 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.
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 EVEREST NATL Policy Number 7600006445131
_ 1 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 dome subject to the workers' compensation laws of California,
and agree that, if I should b rfie subject to the wo ' compensation provisions of Section
3700 of the Labor Code, I all forthwit o I i tho a provi ' s.
Dat Applicant: •
�1
WARNIN� TTOO SE_ RE WORK S' COMP NSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PEN S D CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS ($100,000). IN ADDITION TO THE COST F 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 state4theaormation is correct. agree to comply with all
city and county ordinances and state laws relatinguctio he y thorize representativesof this county to enter upon the above-mentionedon purp s.Date�Signature (Applicant or Agen
Application Number` 13-00000362
-Permit ... MECHANICAL
- Additional desc .
Permit.Fee 40.50 Plan Check Fee
10.13
' Issue Date. Valuation
0
Expiration Date •. 9/22/13
_
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 14SEER/80AFUE SPLIT
SYSTEM [2008 ENERGY] CARBON,MONOXIDE
' ALARM(S) TO BE INSTALLED PRIOR TO FINAL:
INSPECTION: 2010 CALIFORNIA BUILDING
"
• CODES.
-------------------------------------------------------
Other Fees i.' 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
i
LQPERA11T ., ..
.
Big #
City Of La QU'inta
Building U Safety Division
Permit .# -P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
-Building Permit Application and Tracking Sheet
Project Address:":.; Owner's Name:
7!'.� .. = S d RL. GREE !�
A. P. Numbei? . Address:�/ra� cS�O A L GC'R�E/E'K
Legal -D ': ; City, ST, Zip: ,.,9 �f tllit/ ls! CA 7 ar2J 3
ppre€6-k e A>Lr Conditioning d b a
Coni:raotor. Ei o or o D 7 iii.i.l i n n. un a 1 i n rtR_ A'7 Telephone: '7461771-1073 D
Address:'PQ;:.'B'o; •iY;' ?,0.`'``. Project Description:
,��:':
city,S ;'Zip.pa�m92263 IfiL�' Dom/' GrR f� ✓
Telephone?j .(.76x0`:)- 3`2 2:=3173 010 ORi1 CSO!
State Lic:.# 4 7 5'5`4::''.:" City Lic. #: a
Arch, .°Eogr:;Designer ;:. L/. w
city'. ST." zip.:,
:.% ,.. .
Telepfione:.. Construction Type: Occupancy:
Prflject;type (circle one): New A.dd'n Alter Repair Demo
Nameof �EA(/�/t Sq. Ft. # Stories #Unit§:
Telephope # o#CoiiXactPesoEstimaied Value of Project: /.
a
APPLICANT: DO NOT WRITE BELOW THIS LINE
. PERmTr FEES
Amount
Check Deposit
Check Balance
bing
Impact Fee
# .
•$nbmittal''=:'.< 1. ;' 4
Reg'd
iZee'd
TRACKING
Plan Check fiftitted
Structural Calfs:.
Reviewed, ready for corrections
Trdss Calcs.
Called Contaet Person
Energy Cal.cs.:' :
Plans Ricked up
Flood plain plan
Plans:resubmitted
Grad[ngplan''''::,,
214 Review, ready foi'corrections/issue
,Subetiiitactor.LlSt
Called ContactPergon
'
GrantDeed.'
Plans picked up
gU t1. Approval .
Plans resubmitted
Review, ready for correctionsrssue
Plsiipigg Apprtrval.
Called Contact Person
•
Pub. Wks. Appr '
Date of permit issue
3ehool Fees
. PERmTr FEES
Amount
Check Deposit
Check Balance
bing
Impact Fee
Sim lifted Prescriptive Certificate of Compliance: 2008 Residential HVAC Alterations CF -IR -ALT -HVAC
Ctimate Zones 10 to 15
zuvo rtesiaenttai Gompliance Forms AA�r�b 901f)
Site Address:
Enforcement Agency:
Date.•
Permit #:
Equipment T e
List Minimum Efficiency,
Duct insulation requirement
onditi ed or
+ Area
Thermostat
❑ Packaged Unit
Furnace
__//''
erA. FUE 190
❑ COp
Over 40 ft of ducts added or
etback
door Coil
ER�
❑ HSPF
replaced in unconditioned space
rved b system
(If not already
Condensing Unit
�ER ��
❑ Resistance
❑ R 6 CZ 10-13
( )
sf
present, must be
❑ Other
❑ R 8 (CZ 14-15)
installed)
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
si . Beginning October 1, 2010, a registered copy of the CF -1R and CF -6R shall also be on site for final ins ection.
1. HVAC Changeout
Required Forms:
• All HVAC Equipment replaced
CF -6R forms: MECH-04, MECH-2I-HERS and (for split systems) MECH- 25 -HERS
CF -4R forms: MECH- 21 and fors lits stems MECH-25
Condenser Coil and/or
• Indoor Coil and/or
CF -6R forms: 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 < 15 percent
Exempted from duct leakage 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. Existing ducts stems are constructed, insulated or sealed with asbestos
❑ 2. New HVAC System Required Forms:
• Cut in or 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 and all
CF -4R forms: MECH 20-, and (for split systems)MECH-22, and MECH 25
new equipment)
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 Required Forms:
!P Includes replacing or installing all new ducting CF -6R 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
❑ 4. New Ducting over 40 feet Required Forms:
• Includes adding or replacing more than 40 CF -6R forms: MECH-04, MECH-2I-HERS CF -4R forms: MECH-21
linear feet of duct in unconditioned space.
For split system or packaged units: Duct leakage < 15 percent
❑ EXCEPTION: Existing ducts stems 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 Cgr ificate of Compliance con rm 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 inform on documented on other plica le compliance forms, w s eets,
calculations, plans andspecifications submitted to the enforcement a enc fora roval with ermi ti
Name:Te e F' "r , F M 5
.
Signature:
Codress- Ve_EP71✓M0 _f"LQ 0-6j4C_ Ra�AT G B
Date: �� aw.13
Address:
�® ��� 5- I Z C)
License:
�- 7 5-
City/State/Zip:
�. 6—i'Ej06 CV -9 Z 0 J
Phone: '�� " 5 ZZ – 3 1_73
zuvo rtesiaenttai Gompliance Forms AA�r�b 901f)
3 AL1-% 7/
HVAC Permit Checklist
Comfort Consultant (RSP): (�[
Service Order M. 8 (co a
Owner's Name:
Jobsite Address:
. j
Permit Application Declaration Page:
❑ Commercial Residential !I
❑. Single family residence ❑ Multi -family residence
❑ Condominium ❑-Other:
Name of Community:. .
Location of new unit on/in structure:
Plot plan required?: '
Line of. sight — screene p rapet / istance from lot line:
Components to be:' ❑ installed,/(replaced: "like for. like' or upgrade? (cirdeone)
Col/nd__enser r ' Size (tonnage):
XFAU / Air Handler SEER:
Evaporative Coil EER: -
❑ Package unit - PGE or HP .
O Other:
CF71R-A Form:
Project valuationA I
Date Permit Needed at Jobsite:
Other Information: