11-1212 (MECH)` P.O. BOX 1504
78-495 CALLE TAMPICO
LA _QUINTA, CALIFORNIA 92253
Application Number: X11-00001212
Property Address: C55161 SHOAL CREEK ,
APN: 775-142-030- - -
Application description: MECHANICAL
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 6400
'Tii!t' 4 4a Q"
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Applicant: Architect or Engineer:
P` A.
------------------
LICENSED CONTRACTOR'S DECLARATION
I 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 Professionals Code, and my License is in full force and effect.
License Class: C20 License No.: 834471
ate/tractor:
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that) 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 apermit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).:
(_ 1 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 nr nffered for sale. If, however, the building ur 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 1, 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 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
Owner: .
MAXINE DYKSTRA
55161 -SHOAL CREEK
LA.QUINTA, CA 92253
[J
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: , 11/07/11
Contractor: {}
SPEEDY AIR CONDITIONINQ tig O1 20 1
54685 AVENIDA HERRERA t
LA QUINTA, CA 92253
(760)567-013344 �dglyY
Lic. No.: 834471Dr °a
WORKER'S COMPENSATION DECLARATION
hereby affirm under penalty of perjury 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. EXEMPT Policy Number EXEMPT
.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 should become subject to the workers' compensation provisions of Section
3700 of the Labor Code, I sha forthwith compl�ith a provisions.
t F -WA> p cant:
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION 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 henefit 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 this county to enter upon the above-mentioned property for ins tion purposes.
Oate:Si ure (Applicant or Agent): `
LQPERMIT
Application Number . . . . . 11-00001212
Permit MECHANICAL
Additional.desc .
Permit Fee . . 40.50 Plan Check Fee
10.13
Issue Date Valuation
0
Expiration Date 5/05/12
Qty Unit Charge Per
Extension
BASE FEE
15.00
1.00 9.000.0 EA MECH FURNACE <=100K
9.00
1.00 16:5000 EA MECH B/C >3-15HP/>100K-500KBTU
16.50
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Special Notes and Comments
REPLACE HVAC 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
Sim 11fed.Prescri tive.Certtficate
Climate Zones 10 to 15
CF -IR -ALT -HV
JKC A44lesr - •
Ot°aABY
Permit p.
ZZZ
u' ent T List Minimum Efficien =
O Packaged Unit
Duct insolationuirement
Conditioned Floor
Q Setback
Served by synem pj,Q/�Qp
Erfurrt$ce ❑ AFUE O COP
nd" Coil 8S1rER O HSPF
Over 40 ft of ducts added or
� f in unconditioned space space
_
X�Cah&nsing Unit O EER O Resistance
0:116 (Ci 1O-13)
sf present', aunt be
O Other
Q R 8 (CZ 14-15)
iaswped)
/. F.ajKJparteat Type: Choose theequ Nttixu bmg installed; —if more than One system, use another CF- /R -ALT -HVAC or ea system.
2. Mbdmwtr F4,*mew speotdo /.I Sagjt 78% ApUE. 7.7HSPF for typteal rrsidenlial systems.
HEELS VERIFICATION SUMMARY Listed below ate four HVAC alteration Oliflow. 'rite kstaila =Z what work is ;;in; done and
picks one of the appttptiate Options
inspection and agiven`` . n eWM that rAttst bo ooQducted. A OfQte forms dWI be lyft do (site. rot.ftosl.
cePY to qio tktpte6 n& At f DW, the Wpeototy 'dW tbo wotik Ilsted on Ibis j in
. Ct Qie w ot1C ogatpletaQ the
installer. The ittspoctor also vedfibs'tiWd6t ate CF -6R ttttd ( are filled out .
N �g d e%4R tom Do hand MM CP
si October t 2010 a 00 f WL eF4R t{EF-bR' also he on-site fet't3iRlitl '
.
1. HVAC Chan t orms: "
• All HVAC Equipment replaced CF -6R forms: 44, a>tid (fa spin
CF -4& fotmx - 2d and for IAECH-25
• Condenser Coil and /a
• Indoor Coil and /or CF -6R forms: MECH-2I-HERS at�d (for R to 4ems) MECH- 25 -HERS
• Furnace CF -4R forms: MECH- 21 and. (for s olit. "a") MECH-25
For SRUt Systems; Duct leakage < 15 Percent RC, CCA it 300 CFM/ton(Minimum Air Flow RequiremedE), TMAH
For Packaged Units: Duct leakage
< 15 percent
f Tempted from duct leakage testing if:
0 1. fhkt system was dowmentbti''to ldtve been previously sealed atnd conf tmed tht•ough HERS verification, or
0.2. Duct systems with less than 40 linear feet in uneonditioned,spabe, or
O 3. Fxisting ducts stems or
O 2. New HVNE
I�ot�rs:
• Cut in or Changaottt vAth new
duds: (all new ducting gird all
.. .
CF.6R fortnss MECH-, MECH-2"11MSAnd (fbt toft and l�ECH-25-H 1�S
new e
CF4 foams: MECH 2tt, and (foa810 systems%W MECH 2-2'l-HEIFS.
.
For Split Systems: Duct leakage < 6 percent; RC, CCA > 350 CFM/ton, FWD, TMAH, RM9, aid either HSPP or PSPP.
For Packaged Units: Duct I <6
O 3`. N& Duets with Re ` aceaientRequired ltorms:
• Includes replacing or uuWling W new ducting
dadoot'condaaa
CF -6R forms: NECH-04,.MECH-?, 4W S,snd (for split systeau) MECH-25-MIM
an&(% ig unit anNor indoor
CF -411 forms: MECH-20 and (for split systems).MECH-25
coil Itndlor flume. Not an .
For Split Systems: ' leakage < 6 �etCettt, C, A > 300 CVM/ton, TMAH
For P Utattstouct,1 e < 6.
O 4. New Duty over 4 kit b;
• Inclntdes adding or replacing more than 40
linear feet of duct in tdteonditionedact CF -6R fortes: MECH-04, MECH-21-HERS CF -4R fonts: MECH-2t
Fbr split sysfpm otpackaged uh . Duct leakisee < 15 percent
O EXCEPTION: Existing duct stems insulated or sealed with
Contractor (Documentation Author's /Responsib a Designer's Declaration tonjent)
• 1 certify that this Certificate of Compliance documentation is accurate and complete.
• 1 aur 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 perfomuum specifications for the design identified
on this Certificate of Compliance.conform.to the requirement; of Tide 24,
Parts 1 and 6 of the California Code of Regulations.
• the Je -ign features identified on this Certirwatc of Compliance an consistent with the itd'otmafw* n on other applicable compliance f0filts. worksheet's,
calculations lata and 'fications submitted to the etfortxmentagar-f vat the
.
Name: Si
Company:
<-
Address: �--
License:
"
rc ity/Statc/Zip:_ -
`-
Phone r-), i A i r� _ pq �f
2008 Residential Compliance Forms March 2010
Bin #
City of b :Quin '
Building &Safety Division,
P.O. Box 1504, 78=495 Calle Tampico
La Quinta' CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit # \7i
, \�
Project Address: a
Owner's Name: '
re
Address:S'r-
A. P. Number:
Legal Description:
City, ST, Zip: G� Z Z - 3
Contractor:f°
�:>., ,,...�,:.,:.k' z,,,•.x--• ,�
Telephon
Address:zlt d
Project Description:
City, ST, Zip:
Telephone 61% .S6
State Lic. # :.CZY? City Lic. #;
Arch., Engr.,' Designer:
. (/ .
/1fall'
Address:
City, ST, Zip.
Telephone:
State Lic. #:
{b `.'.- t4
^•�:�c:':�k:-;«��: ,F'�! t
�`'f.y<yY'ki':;±v 4f✓:;;w:,v',Y :
xcb>>�✓ °.:,�,,<�
Construction Type: Occupancy:
Pro's circle one): New Add'n Alter Repair Demo
Name of Contact Person:
Sq. Ft.:
#Stories:
#Units:
Telephone # of Contact Person:
Estimated Value of Project:
'APPLICANT: DO NOT WRITE BELOW THIS UNE
#
Submittal
Req'd
Rec'd
TRACWNG
PERMIT FEES
Plan Sets
Plan Check submitted
Item Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Cates.
Called Contact Person
Plan Check Balance
Title 24 Cala.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2°' Review, ready for corrections/issue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
''d 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