10-1302 (MECH)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
T4hf4 4 Qu&Z
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Applicant: Arcfiitect or Engineer:
---------------------------------------------------
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury 10;,l am Ii ensed under provisions of Chapter 9 (commencing with
Section 7000) of Division 3 of the Bu ess nd P ofessional �C.ode, and my License is in full force and effect.
License Class: C20 / �ense No.: -48'9046
OWNER -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 ($500)•:
1-1 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 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 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.)'.
(_) I am exempt under Sec. , BAP.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: ., l
Lender's Address: N
LQPERMIT
Owner:
POWELL LARRY T
78-.711 SIENA COURT
LA QUINTA, CA 92253
Contractor:
E88ER AIR CONDITIONING & HTG
P.O. BOX 1636
CATHEDRAL CITY, CA 92.235
(760)324-0550
Lic. No.: 489046
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 11/30/10
---------------------------'--------------------
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
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 MAINTSTAY BU Policy Number MBS-SIP0051610
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 shall I .with Comply with those provisions.
PPlicant: .� (i►�ir✓L�7_.-- ».,......�
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 ASPROVIDEDFOR IN
SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
- tf ,
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 Ouinta, 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 th a information is correct. I agree to comply with all
city and county ordinances and state laws relating to 'Iding co tr tion, an hereby authorize representatives
of this c my o enter upon the bove-mentioned p 2 perty fo
�te: 1� (O Si cure (Applicant or Agent):
Application Number:
10--0 0 0 013 0 2-
Property Address:
<78711 SIENA CT
APN:
609-530-002-2 -28457 -
Application description: MECHANICAL
Property Zoning:
LOW DENSITY RESIDENTIAL
Application valuation:
8880
Applicant: Arcfiitect or Engineer:
---------------------------------------------------
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury 10;,l am Ii ensed under provisions of Chapter 9 (commencing with
Section 7000) of Division 3 of the Bu ess nd P ofessional �C.ode, and my License is in full force and effect.
License Class: C20 / �ense No.: -48'9046
OWNER -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 ($500)•:
1-1 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 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 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.)'.
(_) I am exempt under Sec. , BAP.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: ., l
Lender's Address: N
LQPERMIT
Owner:
POWELL LARRY T
78-.711 SIENA COURT
LA QUINTA, CA 92253
Contractor:
E88ER AIR CONDITIONING & HTG
P.O. BOX 1636
CATHEDRAL CITY, CA 92.235
(760)324-0550
Lic. No.: 489046
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 11/30/10
---------------------------'--------------------
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
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 MAINTSTAY BU Policy Number MBS-SIP0051610
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 shall I .with Comply with those provisions.
PPlicant: .� (i►�ir✓L�7_.-- ».,......�
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 ASPROVIDEDFOR IN
SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
- tf ,
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 Ouinta, 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 th a information is correct. I agree to comply with all
city and county ordinances and state laws relating to 'Iding co tr tion, an hereby authorize representatives
of this c my o enter upon the bove-mentioned p 2 perty fo
�te: 1� (O Si cure (Applicant or Agent):
1
Application Number . . . . 10-00001302
"Permit . . . MECHANICAL
Additional desc .
Permit Fee 33.00 Plan Check Fee
8.25
Issue Date Valuation
0
Expiration Date . 5/29/11
"Qty - -Unit 'Charge Per
Extension
BASE FEE
15.00
1.00 9.0000 EA MECH FURNACE <=100K
9.00
1.00 9.0000 EA MECH B/C <=3HP/100K BTU
9.00
Special Notes and Comments
REPLACE HVAC SYSTEM WITH NEW 5 TON 16
SEER SYSTEM. 2007 CODES.
------------------------------------------------
Other Fees . . . . . . BLDG STDS ADMIN (SB1473)
1.00
Fee summary Charged Paid Credited
Due
Permit Fee Total 33.00 .00 .00.
33.00
Plan Check Total 8.25 .00 .00
8.25
Other Fee Total 1.00 .00 .00
1.00
Grand Total 42.25 .00 .00
42.25
LQPERMIT
Simplified Prescriptive Certificate of Compliance: 2008 Residential HVAC CF-1R-ALT-HVAC
F
Alterations , ; ,.
Climate Zones 10 - 15 1;.
Site Address:
Enforcement Agency:
Date:
Permit #.
78711 SIENNA COURT La Quinta, CA 92253
City of La Quinta
Nov 30, 2010
Dud insulation
Conditioned Floor
Equipment Typel
List Minimum Efficiency2
requirement
Area
Thermostat
❑ Package Unit
® Furnace '
0 Indoor Coil
0 AFUE 78%
® SEER 16.0
❑ COPE]
❑ HSPF
R 6 (CZ 10-13)
Served by system
® Setback
If not already present
® Condensing Unit
[]EER_
❑ Resistance
❑ R 8 (CZ 14-15)
1900 sf
must be 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 Effidendes: 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 fad the work completed by the installer. The inspector also verifies that
each appropriate CF-611 and registered CF-411 forms (no hand filled CF-4Rs allowed) are filled out and signedAeginning
October 1, 2010, a registered copy of the CF-1R and CF-61R shall also be on site for final inspection.
® 1. HVAC Changeout
Required Forms:
• All HVAC Equipment
CF-611 forms: MECH-04, MECH-2I-HERS and (for split systems) MECH-25-HERS
replaced
CF-411 forms: MECH-21 and (for split systems) MECH-25
• Condenser Coil and /or
CF-611 forms: MECH-04, MECH-2I-HERS and (for split systems) MECH-25-HERS
• Indoor Coil and /or
• 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
For Packaged Units: Duct leakage < 15 percent
Exempted from duct leagage testing if:
❑ 1. Dud system was documentedto 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-dud,systems are constructed; Insulated_ or_,sealed with asbestos j a.rrj
❑ 2. New HVAC x`
Required Forms: R t
System if
. Cut in or Changeout
with new duds: (all
6-611 forms.MECH-04, MECH-20-HERS, and (for split systems) MECH-22-HERS, and
"
new ducting;'all
MECH-25;HERS /( f r
CF-4R forms: MECH 20, and (for split'systems) MECH-22, and MECH25.
new equiprrment) �•
For Split Systems: Duct leakage < 6 percent; RC, CCA >_ 350 CFM/ton, FWD, TMAH, SIMS, and either HSPP or PSPP.
For Packaged Units: Duct leakage < 6 percent
❑ 3. New Ducts with/or without
Required Forms:
Replacement
• Includes replacing or installing all
new ducting and/or outdoor
condensing unit and/or indoor coil
CF-611 forms: MECH-04, MECH-20-HERS, and (for split systems) MECH-25-HERS
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 CF-611 forms: MECH-04, MECH-2I-HERS
than 40 linear feet of duct in
CF-411 forms: MECH-21
unconditioned space.
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: Kevin Hampton Signature: Kevin Hampton
Company: ESSER SERVICES INC Date: Nov 30, 2010
Address: P O BOX 1636 License: 489046
City/State/Zip: CATHEDRAL CITY / CA / 92235 Phone: (760) 324-0550
�D
Reg: 210-A0027962A-00000000-0000 Registration Date/Time: 2010/11/30 14:06:52 HERS Provider: Ca10ERTS, Inc.
2008 Residential Compliance Forms July 2010
a
Total Permit
Bin #
Qty of La Uinta
Building K Safety Division
Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012 �.
Building Permit Application and Tracking Sheet
Permit #P.O.
z �
�0
Project Address: $'71 ( Si E�ry✓,r
Owner's Name: 4,Yaw POW CL-L—
t,L—A.
A.-P.
P. Number:
Address: 7$ j I s l EN o k Cr 12-2 53
-Contractor:
Legal Description:
City, ST, Zip:
ESSER SERVICES INC.
,I.•:�:�}y_i�
Telephone: . . !.. ,f4 = 5 .; ;
i�v;:� i:•i:,+.i:? iii �$ii i:;i
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ti+'i%:J,•+%/.:ii'�iil6:i:!i?YC:li Si:!:4:}`
Address: BANRSIDE DR STE C
Project Description: /�LT�I,� er �X15T/ ao JYL �M
City,ST,Zip: CATHEDRAL CITY CA 92235
W 11� c��t•1_ 1� 5aicQ fi-65a/Tepilli4'
hone:
Telephone:
760 324 nsR'n
t. RT e i
cJ J
W
State Lic. # : 4 8 9 0.4 6
City Lie. #-. 264 .
Arch., Engr., Designer:.
Address:
City., ST, Zip:
Telephone:
Construction Type: Occupancy:
P cY:
a
St to Lic. #:
Project t type (circle one): : N ew Add' n Alter Repair Demo
Name of Contact Person: n,, ,,
7,41v &L -i -A W7
Sq. Ft.: t C(0
# Stories:
# Units:
Telephone # of Contact Person: ?&,'c,-:
Estimated Value of Project: �.
APPLICANT: DO'NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACHIIYG
PERMIT FEES
-Plan Sets
Plau Check submitted
Item
Amount
Structural Cales.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.Called
Contact Person
Plan Check Balance ,
Title 24 Cales.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2°" Review, ready for correctionsrissue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up.:
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
M Review,.ready for correctionstissue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit