14-0724 (MECH)P.O. BOX 1504
7&495 CALLE TAMPICO
SLA QUINTA, CALIFORNIA 92253
Application Number: 14-00000724
Property Address: 78701 SIENA CT
APN: 609-530-003-3' -28457 -
Application description: MECHANICAL
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 8200
T� - �- Qu&k
Applicant: Architect or Engineer:
BUILDING & SAFETY DEPARTMENT
--------------------------------------------------
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 , and my License is in .full force and effect.
Lice CI ss: C20 cense No.: 756658
Kate:
Contra or:
OWNER -BUILDER DECLARATION
I hereby affird 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.apermit.subjects.the applicant.to.a civil.penalty,of-notmore .than .five hundred dollars -0500).:._
(_ 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
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 applyto 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.).
(_) 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
PERMIT
Owner:
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (7.60) 777-7153
Date: 5/30/14
DELFIN SUMULONG r _
78701 SIENA CT.
LA QUINTA, CA 92253
------------------------------------------------
WORKER'S COMPENSATION DECLARATION
I 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
r 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 9072087
I certify that, in the performance of the work for which this permit is issued, I shall not employ any
arson in any manner so as to become subject to the workers' compensation laws of California,
and agree that, if I s come subject to the workers' compensation provisions of Section
3700 of the L r Code, [ all forthwith com ons.
--Da e:. 6 • __.Applicant: - - -- --- ---
WARN NG: FA LURE 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
SF_r,.T10N 3706 OF THF I AROR 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 it 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 th rmation is correct. I agree to comply with all
city angcount ordinances and state laws rel to building constru ion, and hereby authorize representatives
of this0 enter upothbove- coned property for insp tion purDate:� Signature (Applicant or Agent):
Contractor:
VIC' S AIR CONDITI
`'�
INC'�•.1 '� 2g14
P.O. BOX 215
1 I
THOUSAND PALMS, CA
92 CI _.__ Q__
(760) 343-5033
FINANCED P -
Lic. No.: 756658
------------------------------------------------
WORKER'S COMPENSATION DECLARATION
I 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
r 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 9072087
I certify that, in the performance of the work for which this permit is issued, I shall not employ any
arson in any manner so as to become subject to the workers' compensation laws of California,
and agree that, if I s come subject to the workers' compensation provisions of Section
3700 of the L r Code, [ all forthwith com ons.
--Da e:. 6 • __.Applicant: - - -- --- ---
WARN NG: FA LURE 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
SF_r,.T10N 3706 OF THF I AROR 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 it 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 th rmation is correct. I agree to comply with all
city angcount ordinances and state laws rel to building constru ion, and hereby authorize representatives
of this0 enter upothbove- coned property for insp tion purDate:� Signature (Applicant or Agent):
Application Number . . . . . 14-00000724
J
Permit . . . MECHANICAL 2013"
Additional desc .
Permit Fee . . . . 71.50 Plan Check Fee
.00
Issue Date Valuation . . .
. 0
Expiration Date 11/26/14
Qty Unit Charge Per
Extension
,1.00 35.7500 EA MECH FURNACE
35.75
1.00 35.7500 EA MECH CONDENSER/COMP
35.75
--------------------------------------_--------------------------------------
Special Notes and Comments'
HVAC CHANGE OUT - 16SEER/78AFUE, 5 TON
SPLIT SYSTEM (2008 ENERGY] CARBON
MONOXIDE ALARM(S) TO BE INSTALLED PRIOR
TO FINAL INSPECTION. 2013 CALIFORNIA
BUILDING CODES.
----------------------------------------------------------------------------
Other Fees . . . . . . . . . BLDG STDS ADMIN (SB1473)
1.00
PERMIT ISSUANCE M/P/E
90.57
PLAN CHECK, MECHANICAL
47.66
Fee summary Charged Paid Credited
Due
Permit Fee Total 71.50 .00 .00
71.50
Plan Check Total .00 .00 .00
.00
Other Fee.Total 139.23 00 .00
139.23
Grand Total 210.73 .00 .00
210.73
LQPERMIT
1
Bin #
City ®f LQ Q{.1inta
-Building 81' Safety Division
P.O. Box 1504,78-495 Calle Tampico .
b Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking -Sheet
Permit #
Project Address: ��/ s� elf,74 f
Owner's Name:
A. P. Number:
Address:
Legal Description:
City, ST, Zip:
'
Contractor. AX
/ J �
Telephone:
:. 4;:,;:; •::.,l ::>;:•:
Address: 400 02 / 5-1
Project Description: tJ
City, ST, Zip:
Telephone: -7&4,.,
`k '
State Lic. #:
City Lie.
Arch., Engr., Designer.
Address:
City, ST, Zip:
Telephone:
Construction Type: Occupancy:
State Lic.
Project type (circle one): New Add'n Alter Repair Demo
Name of Contact Person:
Sq. FL:
# Stories:
#Units:
Telephone #,of Contact Person:Z y
Estimated Value of Project: Z�Z)
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACKING
PERMIT FEES,
Plan Setts
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Cala.
Called Contact Person
Plan Check Balance
Title 24 Cales.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
god Review, ready for corrections/issue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
Ii.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
'"' Rcyiew, ready for correctionsCssue
Developer Impact Fee
Planning Approval
Galled Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees
Simplified Prescriptive Certificate of Compliance: 2008 Residential HVAC Alterations . CF -IR -ALT -HVAC
Climate Zones 10 - 15
Site Address: {
Enforcement Agency:
Date:
Permit #:
78.701 Siena Ct La Quinta, CA 92253
City of La Quinta
May 30, 2014
Equipment Typel
List Minimum Efficiency2l
Duct, insulation"
requirement
Conditioned Floor
Area
Thermostat
❑ Package Unit,.
IM Furnace
Indoor Coil
® AFUE 78%
❑ COP
[3R 6'(CZ 10-13)
Served by system
® Setback
®
H SEER 16.0
[3HSPF
0 R 8 (CZ 14-15)
2000 sf
If not already present, must be'
® Condensing Unit
❑ EER
❑ Resistance
installed)
❑ Other
1. Equipment Type: Choose the equipment being installed; if more than one system, use another CF -1R -ALT -HVAC for each system.
2. Minimum Equipment Efficiencies: 13 SEER, 78% AFUE, Z7HSPF 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 -6111 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 Split Systems: Duct leakage < 15 percent; RC, CCA <_ 300 CFM/ton (Minimum Air Flow Requirement), TMAH
Exempted from duct leakage testing if:
❑ 1. Duct system was documented to have been previously sealed and confirmed through HERS verification, or
❑ 2. Dud systems with less than 40 linear feet in'unconditioned space, or
❑ 3. Existing duct systems are constructed, insulated or sealed with asbestos
❑ 4. The system will not be'Ducted (ie. Ductless M_ ini-Split System) (Also Exempt from Refrigerant Charge) '
❑ 2. New HVAC System
Required Forms: "
. Cut in or CHangeout with"¢
l "*, €:� rr ''
CF -6R forms iMECH 04, MECH-20 HERS, and (for split systems) MECH 22 HERS, and
new duds: (all new
ddmg
uall new
MECH
-forms
equipment) .f
CF -4R MECH-20, and fors lits sterns {MECH-22 land MECH'25
'4 1 aT=.b ia(,--- Y )�,' qac w ,
For Splrt Systems,, Duct leakage-' 61pei cent RC, CCA >.350 CFM/fon, FWD, TMAH STMS; and either,HSPP or PSPP:
} .:,
%110
For Packaged Units: Dud leakacie'< 6 percent,
t 111---l-.. .. ... ..
1 i-
❑ 3. New Duc_ ts'with%or without ` ." `
Required Forms:; •'
Replacement
-
. Includesreplacing'or installing all new
u
ducting_ and/or outdoor condensing 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 -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 -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 dud 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: Blanca Victoria Signature: Blanco Victoria
Company: VIC"S AIR CONDITIONING INC Date: May 30, 2014
Address: P 0 BOX 215 • License: 756658
City/State/Zip: THOUSAND PALMS / CA / 92276 Phone: (760) 343-5033
t
Reg: 214-A0038942A-000000000-0000 Registration Date/Time: 2014/05/30 07:27:37 HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms July 2010
t r