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12-1377 (MECH)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number:. 12-00001377 Property Address: 57381 SPANISH HILLS LN APN:. 762-210-012- - Application description: MECHANICAL Property Zoning: LOW DENSITY RESIDENTIAL Application valuation: 8316 . TA-iyl aF44" BUILDING & SAFETY DEPARTMENT BUILDING PERMIT Owner: HINES FRED W 57381 SPANISH HILLS LA QUINTA, CA 92253 VOICE (760) 777-7012 } FAX (760)777-7011 + INSPECTIONS (760)'777_7153 Date: 11/26/12 Applicant: Architect or Engineer: Contractor:/// ��� /D` _�L_ PALM DESERT AIR COND CO_ INCFPO 42081 BEACON HILL �0—� PALM DESERT, CA 92211 Ern, p (760) 346-0677 141 ? 2012 Lic. No.: 374937 - CITY OF L, QUINTA FINANCE �Et'T ----------------------------------------- - LICENSED CONTRACTOR'S DECLARATION _ WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with I hereby affirm under penalty of perjury one of the following declarations: Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect._ I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided License Class: C20 a se No.: 374937 for by Section 3700 of the Labor Code, for the performance of the work for which this permit is /ate: ontrac�° issued. ?sal 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 • OWNER -BUILDER DECLARATION insurance carrier and policy number are: I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the Carrier MID CENTURY I Policy Number A09454905-12 following reason (Sec. 7031.5, Business and Professions Code: Any city or county that requires a permit to- _ I certify that, in the performance of the work for which this permit is issued, I shall not employ any construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the person in any manner so as to become subject to the workers' compensation laws of California, - permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State and agree that, if I should become subject to the workers' compensation provisions of Section License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or 3700 of the Labor Code, I shall forthwith,09mply with those provisions. 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).: te: .0 l's. plicant: (_) I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure isnot intended or offered for sale (Sec. 7044, Business and Professions Code: The - WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL Contractors' State License Law does not apply to an owner of property who builds or improves thereon, SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND and who does the work himself or herself through his or her own employees, provided that the ' DOLLARS ($100,000)• IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN improvements are not intended or offered for sale. If, however, the building or improvement is sold within SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. - - 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.). APPLICANT ACKNOWLEDGEMENT ( 1 I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of conditions and restrictions set forth on this application. property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed 1. Each person upon whose behalf this application is made, each person at whose request and for .. pursuant to the Contractors' State License Law.). whose benefit work is performed under or pursuant to any permit issued as a result of this application, . (_ 1 I am exempt under Sec. , B.&P.C. for this reason 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. Date: - Owner: - 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 ' CONSTRUCTION LENDING AGENCY permit to cancellation. I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the - I certify that I have read this application and state that the above information is correct. I agree to comply with all - work foi which this permit is issued (Sec. 3097, Civ. C.)• - city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this county to enter upon t above-mentioned property for inspection purposes. - Lender's Name: Date: 1&J41 Si ature (Applicant or Agent): Lender's Address: LQPERMIT LQPERMIT Application Number 12-000.01377 Permit, MECHANICAL Additional desc Permit Fee . . . . 40.50 Plan Check Fee 10.13 - - Issue Date Valuation 0 - Expiration Date 5/25/13 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: REPLACE (1) SPLIT SYSTEM, FURNACE, CONDENSER,•INDOOR 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 Simplified Prescriptive Certificate of Compliance: 2008 Residential HVAC Alterations CF-IR-ALT-HVAC Climate Zones 10 - 15 Site Address: 57-381 SPANISH HILLS La Quinta, CA 92253 Enforcement Agency: City of La Quinta Date: Nov 26, 2012 Permit #: Equipment Typel List Minimum Efficiency2 Duct insulation requirement Conditioned Floor Area Thermostat ❑ Package Unit ® Furnace ® Indoor Coil ® AFUE 78% ® SEERY ❑ COP HSPF ❑ R 6 (cz to-13) Served by system ® Setback ® Condensing Unit ❑EER ❑Resistance 0 R 8 (CZ 14-15) 1800 sf If not already present, must be installed) [3 Other 1. Equipment Type: Choose the equipment being installed; if morethan 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-611 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-411 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 fors lits stems 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. Duct systems with less than 40 linear feet in unconditioned space, or ❑ 3. Existing duct systems are constructed, insulated or sealed with asbestos [14. Th ,—Yptemowill not be Ducted (ie. Duetless,Min Split System)1(Also Exempt•,from Refri,pecant Charge) y)r ❑ 2. New`,HVAC System Requirried Forrins•- 4l . Cut iWorChangeout with* ' yN . CF 6R•forms ¢MECH-04 MECH=20-HERS hand (forspht systems) MECH 22 HERS and new dui is (all new -' MECH"25 HERS Ir;` `_` Ems; S ductmgall new a equipment) CF-4R f+orms.iMECH--20, aend (for spilit systems) MECH-2H2, a�n{d MECgH=25 + i �N*' .. .. °t >�� For Split Systems: Duet.leakage <-6 percent;' RC, CCA!z'350 CFM/tors;, FWD;- MAH SIMS, and either HSPP &'PSPP. ;< For Packaged Units: Duct leakage6 percent ❑ 3. New Ducts with/or without Required Forms: Replacement . Includes replacing or installing all new 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-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 than 40 CF-611 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 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 Compliance. of • 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: Karl Brown Signature: Karl Brown Company: PALM DESERT AIR CONDITIONING CO INC Date: Nov 26, 2012 Address: 42-081 BEACON HILL License: 374937 City/State/Zip: PALM DESERT / CA / 92211 Phone: (760) 346-0677 •=y• — ...... —�-uvuuuuuvu-uuuu Registration Date/Time: 2012/11/26 12:02:22 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms July 2010 qy­% P.O. Box"! 5.0.4 - 78495 Calle. Tam picio,- -'La QuinW,ifbfN z ev UZI al 16`92211 Tel (760) 777-70.12 -Fax' 76 777;7112:1 1 ftb�if6� Em6ll, Bbildi h4@1-6i-Ou�0 - inta. - F9 -A In M._.J.Perit-#� Building Permit`Application&,Tracking Sheet Project Address: 57-381 SPANISH HILLS Owner's Narfie:'HINES FRED A.P: N6rnber: Address: 57-381 SPANISH HILLS Lego- Qes�crilptiqri::C __ tY,§taltes Zip; LA QUINTA, CA 92253 ConlmctQr. Palm Desert Air Conditioning.& Heating Company_ Telephone: (425) 359-2415 Address:. 42-081 Beacon Hill Project Description:. City, State; Zip: Palm Desert, CA 92211 REPLACE (1) AIR CONDITIONING SPLIT SYSTEM. `Ul 'phone No.: (760) 346-0677 r :State'- LiC.#:. 374937 City.Lic.`.#: 100886 .Arbfi-./Engr)1Yb46ner.' :Address-' ,City, State;: Zip: Tel6phdheft;: �Construction Type: Occupancy: State: Lic.'#:: A !'A El -.-Alt&:-�13 Repair 0 DemoProject Type! New- 0 Addh - 13 ,NairriObf Contact- Peribh-.' KARL BROWN Sq. Ft I .: — . I #.,st6rie T # Units: Contact Telephone -No.: (760) 346-0677 Esti mated Value -d Project:. $8,316.00 APPLICANTJ. DQ NOT: WRITE: BELOW THIS: LINE # Submittal Req.d Rbc;d_ Tracking Pe`rmit Fee's Pldin'Sets '"Plin,theck.S6biiiifted Item Amodnt Structural CaIcs. I 'Re'viewed, Ready for Co&ecfiohs'1 Plain CK6c-k Deposit Truss Calm Called, Contact Person Plan Check Balance, TitIe'24 CaIcs..an k PI s Pic 6d Up. Construction Flood Plain Plan, PIans,R ubmitted, eP Mechanical bradir,ig Plan 2'Aeview, R eady for Correctl6ns: Electrical, Subcontractor List Called.Untadt Peiion Pibmbing Grant De'bd Plan's Picked Up 'S*.M.I. H.6.A.Approval'. Plans.ReiubMitt6d IN HOUSE, 3ra Review,` Ready for Corrections, Developer Impact Fee Planning Approval Cil led. Contact. Person - X 15JO.. Pub. Wbrks App?l b6te of Permit Issue SchoolFees __Total Permit: Fee' . s.