13-0015 (MECH)P.`O: BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: t 13 -00000015 -
Property Address: 77370 CALLE SINALOA
APN: 773 -122 -010 -7 -000000 -
Application description: MECHANICAL
Property Zoning: COVE RESIDENTIAL .
Application valuation: 395
Applicant: Architect or Engineer:
PIP
4 _ !„ VOICE (760) 777-7012
FAX (760)
BUILDING & SAFETY DEPARTMENT �. INSPECTIONS (760) 777-70153
BUILDING PERMIT
Date: 1/03/13
Owner:
+ CURT PARKINSON
77370 CALLE SINALOA
LA QUINTA, CA 92253
Other struct info . . . . . C
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 o the Business and Professionals Code, and my License is in full force and effect.
License�Class: License No.:
Date: - Contractor:
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).:
ILI ) 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.). - -
(_) 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
/ate: t L. -.1;f 3 /ner..e
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:
LQrcafvii7
Contractor:
Owner
DITION
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 - - - - - - - - - - - - - - - - - - - - -- - Policy Number
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 forthwith comply with those provisions.
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 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 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
o
oft is,county
�to enter upon the above-mentioned property for ins pe tion purposes.
Date: � i!j�/ J S' ature (Applicant or Agent):
Application Number .
. . . 13-00000015
Permit . . .
MECHANICAL
Additional desc .
Permit Fee . . . .
24.00 Plan Check Fee
6.00
Issue Date . . . .
Valuation
0
Expiration Date
-7/02/13
Qty Unit Charge
Per
Extension
BASE FEE
15.00
1.00 9.0000
EA MECH FURNACE <=100K
9.00
Special Notes and Comments
REPLACE 35000 BTU GAS
WALL FURNACE IN
HALLWAY OF RESIDENCE.
MINIMUM 78 AFUE
2010 CODES.
-------------------------------------------------------
Other Fees . .
--------------------
. . . . BLDG STDS ADMIN (SB1473)'.
1.00
Fee summary Charged:
Paid Credited
Due
Permit Fee Total
24.00 .00 .00
.24.00
Plan Check Total
6..00 .00 .00
6.00
Other Fee Total
1.00 .00 .00
1.00
Grand Total
31.00 .00 .00
31.00
LQPSRIN IT - .- _
Simplified Prescriptive Certificate of Compliance: 2008 Residential HVAC Alterations CF -IR -ALT -HVA >,r
Climate Zones 10 to 15
`1.
Site Address.
x...1.3-) o Cc.I\ o
Enforcement Agency:
-
Date:
Permit #:
Equipment T e'
❑ Packaged Unit
List Minimum Efficiency'
Duct insulation re TMESnt
Conditioned Floor
Area
Thermostat
2fumace
❑ AFUE ❑ COP
Over 40 ft of ducts added or
6
13 Setback
13 Indoor Coil
❑ Condensing Unit
❑SEER 13HSPF _
❑ EER ❑ Resistance
replaced in unconditioned space
P
❑ R 6 (CZ 10-13)
Served b system
Y Y
It sf
(If not already
❑ Other
❑ R 8 (CZ 14-15)
present, must be
installed)
1. Equipment Type: Choose the equipment being installed; if more than one system, use another CF -1 R -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 the forms
of 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. Beginniag BeginningOctober 1, 2010, a registered co of the CF -111 and CF -6R shall also be on site for final inspection.
[94. HVAC Changeout Required Forms:
• All HVAC Equipment replaced
All HVAC Equipment r!eplacedHERSCF-4R
CF -6R forms: MECH-04, MECH-2I-HERS and (for split systems) MECH- 25- HERS
forms: MECH- 21 and fors lits stems MECH-25
• Condenser Coil and/or
• Indoor Coil and /orC�F-,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
11111. 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 s: al Chang outucti 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
new equipment) CF -4R forms: MECH 20-, and (fors lit systems)MECH-22, and MECH 25
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:
• 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 2:300 CFM/ton, TMAH
For Packaged Units: Duct leakage < 6 percent
❑ 4. New Ducting over 40 feet
Required Forms:
• Includes adding or replacing more than
linear feet of duct in unconditioned space.
CF-6R forms: MECH-04, MECH-2I-HERS 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 for
agency approval with the permit application.
Name: �� �� v, Signature:
Scsr
Company:
Date:
Address:--
-) -7 J70 Co,'Xt e S � .� c (c� c,
License:
City/State/Zip:
Phone:
I mmMrnnno i+nrmc I A.fnrrH lntn
P.O. BOX 1504
LA QUINTA, CALIFORNIA 92247-1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
BUILDING do SAFETY DEPARTMENT-
PROPERTY OWNER'S PACKAGE
(160) 777-7012
FAX (760) 777-7011
Disclosures & Forms for Owner-Bullders Applying for Construction Permits
1 NUTIC$1�Q PRQp RTY QVYNF,R
Dear Panpcny Owner.
An tion for abuilding paw has boon submitted is your moat Iist7ing yourself as the buiWet of the prop"
SPOClficd at 7 7 3� C n �� e S c I O q
We we pmviding you VOO an Uwmcf-Budde Ac lamb t.aod. lsifb a u Vajfk tier Form to make you awaa of yew.
rwavarasiland possrbk risk you may i� by havft � pmt � gi in yousage as the
ta�ee-8
Owe&er. We trill Kot imee a buNdlog PKa uatdl
and interned yv. have read, your . usd�astatadia�g of e.cll erKvldoq
��+ this form to us at oar eluded address indicated. An agent of the owner carmot exocutc dais ootiK---
unless Yom, the Property owner, obtain the prior approval of the permitting authority.
(f -V 1. 1 understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner -Build'
building permit that erroneously Mies that the property owner is providing his or her own labor and material personally. I, as
an Owner -Builder, may be held liable and subject to serious financial risk for any injuries sustained by an unlicensed person
and his or her employees wee worlang on my property. My homeowner's insurmee may not provide coverage for those
inyurics. I am willfully acting as an Owner -Builder and am aware of the limits of my insurance coverage for injuries to worlmrs
on my property -
understand buikhDg permits are not required to be signed by property owners unless they are responsible for the
construction Arad are not hiring a licensed Contractor to assume this r+espon"baity.
�3. 1 understand as an "Owner -Builder" I am eke responsible party of rword on the permit. I understand that I may protect
myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or, her namt instmd of my
own.
4. 1 understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on
permits and contracts.
5. I understand if 1 employ or otherwise engage any persons, other than California licensed Contractors, and tht total valu
Of my construction is at least five hundred dollars ($500) including labor and materials, I may be. considered an "cWloya
under state and federal law.
6. 1 understand if I am considered an "employee" under state and federal taw. I must mgister with the static and fed=
government, withhold payroll taxes, provide workers' compensation disability insurance, and contribute to unearpl)yme
risk. m
compensation for each "eployee.^ I also understand my failure to abide by these taws may subject me to serious financ
(�L7. I understand under California Contractors' State License Law, an Owner -Builder who builds single-family resideu
structures cannot legally build them with the intent to offer them for sale, unless all work is performed by Been
subcontractors and the numbs of structures does not exceed four within any calendar year, or all of the work is perforr
under contract with a licensed general building Contractor.
8. 1 understand as an Owns -Builder if 1 sell the property for which this permit is issued, l may be held liable for any
financial or personal aV°ieg wanined by any subsequent owrxr(s) that result from any latent construction defects in the
workmanship or mate ials.
C#09. I understand I may obtain more information regarding my obligations as an "employee' from the 18abea64 Ravtnua
Service, the United States Small Busioess Administration, the California Department of Benefit Payments, and the California
Division of Industrial Accidents. I also understand I hay contact the California Contractors' State License Bond (CSM at 1
800-321-CSLB (2752) or www.csib.ca.gov for more information about licensed contractors.
IO. 1 am aware of and consent to an Owner -Builder building permit applied for in my name, and understand that l am the
PAY legally and financially responsible fon proposed construction activity at the following address:
11. 1 agree that, as the Party legally and fiaaaciallyresponsible for this proposed construction activity, [will abide by all
applicabk laws and requirements that govern Owner -Builder: as well as employers.
Ce 12.1 agree to notify the issuer of this form immediately of any additiooa, deletions, or chtinew W nay of the iaforanatim 1
have providod on this form. Licensed contractors are regulated by laws designod to protect the public. If YOU oentract with
seams who don not have a lioanw, sloe Contractors' State [.tomos Board may be unable W moist you with amy 61011111MW loss
You may main as a result of a compkint. Your only remedy against unlicensed Contractees may be in c ivrd event. It is also
� 4-4" for You to understand that if an U ke"W cawaetor at eotployce of fiat individilai or 8rm is b*vmd rri k wwIdng
on Y'W Fwcrty: you may be Tedd liabk Sw daasages. If you obtain a permit as Owiw-Bailda and wish to him Contraolocs,
you wig be � for vetkfymg sandbts or net those: Coaetr*ctors aro psepedy lioeaeed cad the axaars of elMir woeleera'
a MOF Faasation iasRrraece eovexam
Before a baildiag permit can be kaarued, ting form must be completed and signed by the property Owner and returned to
the abeacy r-espous&le for invift lira (Ptaatt. Nide: A c"7 of dac propwV em aer's dWra'Y Aliwit*sr firaa "Ofth8*00, or
odder verification 40M94k Narks aeMexey is aratWivit to be pr+eztud d when do pandt Is iissaaal so w* Mie popaq
owner's signature.
Sipattme of property owner. Dstt l .3
Note • The followiing Authorization Form is required to be completed by the property owner only Whin designating
an agent of the property owner to apply for a construction permit for the Owner -Builder.
AUI'QORIZATION OF AGENT TO ACT ON IPROPERTY 0"EWS BAHAI.F
Excluding the Notice to Property Owner, the extcution of which I underataad is my paaond responsibility, I hereby authoriu
the following peraoo(c) to act as my agwgr-) to apply for, sign, and file the &MMMs noccMary to obtain an Owna-Builder
Permit for my project.
Scope of Construction Project (or Description of Work):
Project Location or Address:
Name of Authorized Agent:
Address of Authorized
Bin. >
City. Of La Quinta.
Bul*i 8E Safety Duron
P.O. Box 1504,78-495 Calfe Tampico
U.Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking.Sheet
Permit #
1�
Project Address: 7 3-)C>
Owner's Name:. C
A P. Number.Address:76
Legal Description:
Contractor.
City, ST, Zip:
Telephone: 6(P -.&9z -.313_".T
Address:
Project Description:
City, ST, Zip.
Telephone: '
State Lic. #: City Lia #:
Arch., Engr., Designer.
35
LLA, .
Address:
City,, ST, Zip:
Telephone:
State Lic. #:
Construction Type: , Occupancy:.
Project type (circle one): New Add'n Alter Repair Demo
Sq. FL: #Stories: #Units.
Name of Contact Person:
Telephone # of Contact Person:
Estimatod Value of Project 3j
' APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd'Rec'd
TRACMG PERMIT FEES
Plan Seb
Plan Check submitted
Item Amoaat
Structural Calcs.
Reviewed, ready for correction
Plan Check Deposit_ .
Truss Cates.
Called Contact Penoa
Pian Check Balance
Title 24 Calm
Plans picked pp
Construction `
Flood plain plan
Pians resubmitted
Mechanical
Grading plan
2'! Review, ready for correctlonVissue
Electrical
Subeoutaetor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.L
H.O.A. Approval
Plans resubmitted
Grading
IN SOUSE:-
''' Review; ready for correctionsAssue
Developer Impact Fee
Planning Approval
Called Contact Person
A.LP.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees