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12-0581 (MECH)P.O BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 & t Y,,, 4. Ou"w* rc� BUILDING &'SAFETY DEPARTMENT BUILDING PERMIT - Application Number: J12=000005587, Property Address: 54935 SHOAL CREEK APN: 775-141-043- - - Application description: MECHANICAL; Property Zoning: LOW DENSITY RESIDENTIAL �. 'Application valuation: 6900 AF Architect or Engineer: Owner:, GEORGE RANDOLPH 54935 SHOAL CREEK LA QUINTA,. CA:92253 VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 5/24/12 D[rZ► Contractor: J ANTHONY PLUMBING HEAT/AIR MAY 24 • 72216 NORTH SHORE STREET, 4101 srrrl ?01� THOUSAND PALMS, CA 92276 CIiYQF 1 (760) 328-8096 �QUINT.9 Lic. No.: 777794 FINANCE DEPT CENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury t at I am licensed under provisions of Cha (commencing with Section 7000) of Division 3 of the Busi ss and Professionals Code, and ense is in full force and effect. License Class: C20 -C36 Licen 777794 3' Date: Xbn�r.clo, x - OWNER -BUILDER DECLARATION I hereby affirm under penalty of perj y that I am exempt from the Contractor's State License Law for the I hereby affirm under penalty of P.Y,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 t any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).: I :as owner of_theproperty, 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 willhave theburden -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 1 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: pip LQPERMIT m ---------------------------------------- WORKER'S'COMPENSATION DECLARATION - I heieby affirm under penalty of perjury one of the following declarations: - _ 1 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 V' 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 numb are: - Carrier GRANITE STATE olicy Number WC065255599 _ I certify that, in the performance the work for which this permit is issued, I shall not employ any. person.in any manner so a become subject to the workers' compensation laws of allfornia, and agree that, if I sho c e ubject to the workers' compensation provi ' of Section —00 /of the L II thwi mply with those provision 7 4"` 0 scant: WARNING: FAILURE TO SECURE WO KERS' COMPENSATION COVERAGE IS UNLAWFUL, AND.SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS (5100,0001• IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. y 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, indemnity 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 per it. 2. Any permit issued as a result of this application comes null and void if work is not commenced within 180 days from date of issuan of suc permit, or cessation of work for 180 days will subject permit�o cancellation. I certify that I have reaatR7SJi lication and state • t t above i rmation is correct. I agree to comply with all city and c my ordinances and state laws relatin to b di truction and hereby authorize representatives of this ty t enter upon the above-mentione y for spec • urposes. , e: �S nature (Applicant or Ag ` Application Number . . . . . 12-00000581 Permit . . . MECHANICAL Additional desc . Permit Fee 40.50 Plan Check Fee 10.13 Issue Date Valuation 0 Expiration Date 11/20/12 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 5 TON SYSTEM, FURNACE, INDOOR COIL,.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 , LQPERMIT 4 Simplified Prescriptive Certificate of Compliance: 2008 Residential HVAC Alterations CF -IR -ALT -HVAC Climate Zones 10 - 15 Site Address: Enforcement Agency: Date: Permit #: 54935 SHOAL -CREEK La Quinta, CA 92253 City of La. Quinta May 24, 2012 Duct insulation Conditioned Floor Equipment Type1 List Minimum Efficiency2 requirement Area Thermostat ❑ Package Unit m Furnace ® Indoor Coil ® AFUE 78% 2 SEER 16.0 ❑ COP 13HSPF ❑ R 6 (CZ 10-13) Served by system ® Setback If not already present must be Condensing Unit [I10 EER ❑ Resistance [I R gCZ 14-15 ( ) 0 sf 18 0 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 -411 forms (no hand filled CF-4Rs allowed) are filled out and signed.Beginning October 1, 2010, a registered copy of the CF -1R and CF -6R shall also be on site for final inspection. 0 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 -411 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 Exempted from duct leakage testing if: 4❑fl"Duct system -was documented to have been previously sealed and confirmed through HERS verification, or ❑ 2. Duct systems with less than`40 linear fleet in unconditioned space, or ❑ 3. Existing duct systems are constructed,'insulated or sealed with asbestos 0'4. The�system,will not be Ductedi(ie. Ductless, Mini-Split- System),(Also,Exempt from,Refrigerant=Charge) ❑ 2. New HVAC System Required_Forms ' , -L . Cut m or,Changeout with; ducts: • ' r F '�' r<=• - CF 6R forms MECH-04, MECH-20 HERS, and (for split'systems) MECH-22 HERS, and new (all new ducting and all new MECH-25sHERS . , M • P if is •..'-� --�-^ -. CF -4R forms: MECH-20; and (for split systems) MECH-22, and MECH-255 equipment) -t .,. • v.0 :tr y u . a 7 c s, s -. ,IV For Split Systems:::Ductleakage < 6-percent,'RC,CCA >_ 350 CFM/ton, FWD, TMAH, SIMS, and either HSPP orPSPP For Packaged Units: Duct leakage < 6 percent`-° ❑ 3.,NewDucts with_ /or without Required Forms: Replacement ± ' . Includes replacing or installing alfnew ducting and/or outdoor condensing. unit CF -611 forms: MECH-04, MECH-20-HERS, and (for split systems) MECH-25-HERS and/or indoor coil and/or furnace.; No or some CF -4R 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 -611 forms: MECH-04, MECH-2I-HERS linear feet of duct in unconditioned space. L 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: Kevin Robinson Signature: Kevin Robinson Company: I ANTHONY PLUMBING HEATING & AIR CONDITIONING Date: May 24, 2012 Address: 72216 NORTH SHORE ST #101 License: 777794 City/State/Zip: THOUSAND PALMS / CA / 92276 Phone:,(760) 343-2121 1 Reg: 212-A0026574A-00000000-0000 Registration Date/Time: 2012/05/24 12:27:23 HERS Provider: Ca10ERTS,:'Inc. 2008 Residential Compliance Forms July 2010 , Bin. # :.... . Cit}/. of.. bill . • . : ". '. ; . Btdk ft & Safety Division '.. .. . P.O. Boz • 1504,"78-495 Calle Tampico La.Quinta, CA'92253 - (760) 2'77-7012 . Building Permit Application and Tracking Sheet Permit #' :G ' Project Address: Owner's Name:. / e0-A j 4L A. P. Number. Address: Legal Description: Contractor. ES Address: = S 1VORTH SHORE.ST. "STE 101MIJ City, $T, Zip: City. ST, Zip: Telephone: 4",/j��� ZS�19 Pmject Description: ...Tp Telephone: 74.0 3 ''�LL State Lia # : 7 �77gT City Lie, &- 4q Arck. Bag, Designer. Address: City. ST. tip: _ Telephone: State Lia #: Name of Contact Pam: C(fI Lfs/!'JtL.S Construction Type:. Occupancy: Projecttype (elide one): New Add'n Alper Repair Demo Sq. R: #Stories TO Univ: Telephone # of Contact Person: �3 /�i( Estimated Value of Proj� � d0 p APPLICANT: DO NOT WRITE BELOW THIS UNE # SobnultWl Plan Sets Req'd Reed TRACKMG PERM rFEES Plan Cheek submitted Item Amount Str4daial CRIM Reviewed, ready for corrections Plan Check Deposit. . Trans Cala. Called Contact Person Plan Check Balance _ Title 24 Qalcs. Plans picked up Construction Flood plain plan Plans resubmitted .. Mechanical Gisding plan 2'' Review, ready for corttietions!oue Electrical Snbcontactor List Called Contact Person Plumbing Grant Deed. .Pians picked up S,lya, H.O.A. Approval Plans resubmitted Grading IN HOUSE:- ''• Review; ready for eorreetiona/issue Devdoper Impact Fee Planning Approval Called Contact Person A Y.P.P. Pub. Wks. APpr Date of permit Issue School Fees Total Permit Fees . � l