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.