12-0902 (MECH)r
Tdy� 4.4 Q*
P.O. BOX 1504^'' VOICE (760) 777-7012
78-495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253. BUILDING. & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING_ PERMIT
Date:• 8/10/12
Application Number. �12 °00000902 '� • Owner:
Property Address: 48476-'STILLWATER DR MAIZE BRUCE D
APN: 623-480-01_9_ - - 48476 STILLWATER DR.
Application description: MECHANICAL LA QUINTA, CA 92253
Property Zoning: LOW DENSITY RESIDENTIAL (760)000'-0000
Application valuation: 2837 n
' Contractor: D " "
JP,�
Applicant: Architect or Engineer: GENERAL AIR CONDITIONING
31170 RESERVE.DRIVE 0 2012
lw 'v THOUSAND PALMS, CA 92276 L`
(760)343-7488
Lic. No.: 686310 CIiYQFLAQUINYA
FlRkNCE DEPT
LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION - r
I hereby affirm under penalty of perjury that I a-rallicensed 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 an rofessionals Code, and my Licenseisin full force and effect. I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided
License Class: :C20 License No.: 686310 - • for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
e.—•—p- _ir - issued.
Daterf� Contractor:) _ I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor
/ —r- 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:
1 hereby affirm under penalty of pe luny that I am exempt from the Contractor's State License Law for the Carrier ZENITH INS CO Policy Number Z071741501
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 t 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 be a 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 beco ubject 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 It
omply with those provisions.
-,that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by 8 > y
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).: Date: -S? 12� plicant '_'�
(_ 1 I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and T /
the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The - WARNING:, FAILURE TO SECURE W RKERS' OMPENSATION 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
r 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,
(_) 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 Quinta, 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.
1 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 for which this permit is issued (Sec. 3097, Civ. C.1• city and county ordinances and state laws relating to building coDstruction, and hereby authorize representatives
of this county to enter upon the above-mentioned property for •- pection purposes.
Lender's Name: .. n
. 0/10A
- - - - - - — -
Date: Signature (Applicant -or -Agent):
. ..-
Lender's Address:
LQPERMIT
Application Number . : . . 12=00000902
PermitMECHANICAL
Additional desc .
Permit Fee. 40.50
Plan --Check Fee
10.13
Issue Date . . .
Valuation . . .
0
Expiration Date 2/06/13
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 13 SEER -FURNACE
&
CONDENSING UNIT 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
Simplified Prescriptive Certificate of Compliance: 2008 Residential HVAC Alterations' CF -IR -ALT -HVAC
Climate Zones 10 - 15 - 1
Site Address:
Enforcement Agency:
Date:
Permit #:
48476 STILLWATER DRIVE La-Quinta, CA 92253 '�
City of La Quinta
Aug 8, 2012
'
'
Duct insulation
Conditioned Floor
Equipment Typel
List Minimum Efficiency2'
requirement
Area
Thermostat "
. ❑ Package Unit'
-
® Furnace'
® Indoor Coil
® AFUE 78%
® SEER 13,0
❑ COP
❑ HSPF
❑ R 5 (CZ 10-13)
Served by system
® Setback
If not already present, must be
® Condensing Unit
[j EER
❑Resistance
❑ R 8 (CZ 14 -IS)
2064 sf
. ,
installed)
❑Other
-
_
1: Equipment Type: Choose the equipment being installed; if more than one system, use another CF -IR -ALT -HVAC for each system.
2. Minimum Equipment Efficiencies: 13 SEER, 78% AFUE, Z7HSPF for typical residential systems. - • 1
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 -611 shall also be on site for final inspection.
0 1. HVAC Changeout ;
Required Forms:
• All HVAC Equipment
CF -6R forms: MECH-04, MECH-21=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 (for split systems) MECH-25-HERS
. Furnace ' ' ' t
CF -4R forms: MECH-21 and (for split systems) MECH-25 . -
For Split Systems: Duct lea kagei<t15 percent; RC, CCA <_ 300 CFM/ton (Minimum Air Flow Requirement), TMAH
Exempted from duct leakage testing'lf: I
❑ 1."Duct system was documented to have been previously sealed and confirmed through HERS verification, or t
❑ 2. Duct systems with less than 40 linear feet in unconditioned space, or
[13. Existing duct systems are constructed, insulated or sealed with asbestos
[14. Thesystemrwill not be Ducted (ie. Ductless MiFli-SplitS.ystem) (Also Exempt,f(IZm;Refrigeant=Charge)
❑ 2. New..HVAC System ,Required
Forms +. l ,x4 '`w`" l
. Cut rotor Chan eout with;
9
new dticts:'(all new
CF 61f0rms MECH-04 MECHY20 HERS hand"(for spilt systems) MECH�22 HERS and
;".
ducting all new'
MECH=25-HERS
w.r ' t •-� #'
MECH 20 ands(for split systems) MECH=22d MECH-25
equipment)
nn ,
..
For Split systemsi`D.uct leakage]< 6 pee ent,;RC,,CCA �1350`CFM/tan; FWD �4TMAH STMS, and_eitt er;HSPP & PSPP.
For Packaged Units: Duct leakage < 6'percent
❑ 3.'NewrDucts 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 -4R forms: MECH-20 and (for split systems) MECH-25
equipment changed.
For Split Systems: Dud 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: Dud leakage < 15 percent
❑ EXCEPTION: Existing duct systems'construded, 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: Danielle Garcia Signature: Danielle Garcia
Company: HARRISON ENTERPRISES INC Date: Aug 8, 2012
Address: 31-170 RESERVE DRIVE STE A License: 686310
City/State/Zip: THOUSAND PALMS / CA / 92276 , ". Phone: (760) 343-7488
Reg: 2121A0043161A-00000000-0000 •Registration Date/Time: 2012/08/08 20:40:04 HERS Provider: Ca10ERTS, Inc.
2008 Residential Compliance Forms July 2010
stn.#
Of U Quinita
Building a Safety Division
P.O. Box 1504,•78-495 Calle Tampico
4.Qu4nta, CA 92253 - (760) 777-7012 '
Building Permit Application and Tracking Sheet
Permit #
Project Address: 006
S UUICWY Di -
Owner's Name:.
A. P. Number. 3
Address:
Legal Description:
City, ST, Zip: C 1 C� Z S3
Contractor: ``
Telephone:
Address: . 1 O
Project Description: NV GIS 5 ton
City, ST, Zip: R 2 2 6
Telephone: 6 p 343-14 o ;
State Lic. N: 68 6 � f a City Lic. M
Arch., Fngr., Designer.
Address:
City., ST, Zip:
Telephone:
f
Construction Type:. Occupancy:
Project type (circle one): New Add'n Alter. Repair Demo
State Lic. #:
Name of Contact Person:Sq.
Ft.: 3 #Stories: # Unit,s:
Telephone # of Contact Person:
Estimated Value of Project: 2� 3-]
APPLICANT: DO NOT WRITE BELOW THIS UNE
!1
Submittal
Req'd
Reed
TRACMG
PERMIT FEES-
Plan Sets
Plan Check submitted
Item Amount
Structural Cafes.
Reviewed, ready for corrections
Plan Check Deposit. .
'Fuss Cales.
Called Contact Person
Plan Check Balance
Title 24 Catcs
Pians picked up
Construction
'Flood plain plea
Plans resubmitted
Mechanical
Grading plan
2id Review, ready for correctionsrissue
Electrical
Subcontactor List
Called Contact Person
Ylumb[ng
Grant Deed
Plans picked up
SALL
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
2d Review; ready for correcdonslissae
Developer Impact Fee
Planning Approval
Called Contact Person
AJLP.P.
Pub. Wks. Appr
Date of permit issue
School Fees "
Total Permit Fees