10-0860 (MECH)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 10-00000860
Property Address: 79750 TANGELO
APN: 772-230-002- -
Application description: MECHANICAL
Property Zoning: LOW DENSITY RESIDENTIAL.
Application valuation: 9950
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
PIMENTEL RICHARD A
79750 TANGELO
LA QUINTA; CA 92253
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 9/03/10
Architect Engineer:
Contractor:
GENERAL AIR CONDITIONING
Applicant: or
RESERVE31170 DRIVE
THOUSANDPALMS, CA 92276
(760)343-7488 �pT,
1pe
LiC. No.: 686310
----------------------------------------=---------------------------------------------------------
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 B siness and Professionals Code, and my License is in full forceand effect.
_ I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided
,l Licens o : 686310
Licensyyl�zCode, Cl
for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
M
vi�
issued.
I have insurance, as required by Section 3700 of the Labor
ate:'actor: l'
and will maintain workers' compensation
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 PREFERRED EMPL Policy Number WKN1295355
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
w't
alllll (fortwith comply wleilth thYosese%prolivisions.
700 of the LaboMde,
that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by
i
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred.dollars ($500).:
1
,Da;t4�?q pp icant: / \ '/ ,
T b
_ _ —1._.1_I, as owner_of-the property, or_my employees_with.wages as -their -sole compensation, will ..do-the_work,.and.______.
_ . -. _ __ .-_ . _- - ._ — __..-- - Tthe
structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The
WAILURE 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 havethe burden of proving that he or she did not build or. -
- - - - - -
improve for the purpose of sale.). -
APPLICANT ACKNOWLEDGEMENT
1—) 1, 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 _ 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
Date: Owner:
CONSTRUCTION LENDING AGENCY .
I hereby affirm under penalty of perjury.that there is construction lending agency for the performance of the
work for which this permit is issued (Sec. 3097, Civ. C.).
Lender's Name: IMP
Lender's Address:
LQPERMIT
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 c unty ordinances and state laws relating t building construction, and hereby authorize representatives
ofy+is co my o e ter upon the above-mentioned p op for in ectr�es.
Date: ignature fApplicant or Agent):
LQPERMIT
Application Number . . 10-00000860
Permit MECHANICAL
Additional desc .
Permit Fee . . 33.00 Plan Check Fee
8.25
Issue Date* . . . . Valuation
0
Expiration Date 3/02/11
Qty Unit Charge Per
Extension
BASE FEE,
15.00
1.00 9.0000 EA MECH FURNACE <=100K
9.00
1.00 9.000.0 EA MECH B/C <=3HP/100K BTU
9.00
Special Notes and Comments
INSTALL NEW 5 TON 13 SEER HORIZONTAL;
SYSTEM. 2007 CODES
----------------------------------------------------------- -----------------
Other Fees BLDG STDS ADMIN (SB1473)
1.00
Fee summary Charged Paid Credited
Due
Permit Fee Total 3.3.00 .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 Alterations CF -IR -ALT -HVAC
Climate Zones 10 to 15
Site Address:
Enforcent t4gen :
Da�:
Permit
Conditioned Floor
Equipment T e'
List Minimum Eff cienc Z
Duct insulation requirement
Area
Thermostat
❑ Papkaged Unit
�
d"�
Over 40 ft of ducts added or
ack
a
or Coil
❑ AFU
❑SEER
❑COP
❑ HSPF
replaced in unconditioned space
❑ R 6 (CZ 10-13)
Served by system
sf
(If not already
present, must be
Condensing Unit
❑EER
❑ Resistance
Other
1313 R.8 (CZ 14-15)
installed)
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, 7.7HSPFfor 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 -6R and registered CF -4R forms (no hand filled CF-4Rs allowed) are filled out and
sign a inning October 1, 2010, a registered copy of the CF -1R and CF -6R shall also be on site for final inspection.
1. HVAC Changeout
Required Forms:
• All HVAC Equipment replaced
CF -6R forms: MECH-04, MECH-2I-HERS and (for split systems) MECH- 25 -HERS
CF -4R forms: MECH- 21 and fors lits stems MECH-25
• Condenser Coil and/or
CF -6R forms: MECH-21-HERS and (for split systems) MECH- 25 -HERS
• Indoor Coil and/or
CF -4R forms: MECH- 21 and (for split systems) MECH-25
• Furnace
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:
❑ I. 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 ducts stems are constructed, insulated or sealed with asbestos
❑ 2. New HVAC System
Required Forms:
• Cut in or Changeout with new
ducts: (all new ducting and all
CF -6R forms: 'MECH-04, MECH-20-HERS,and (for split systems) MECH-22-HERS, and MECH-25-HER5
CF -4R forms: MECH 20-, and (for split systems)MECH-22, and MECH 25
new equipment)
For Split Systems: Duct leakage < 6 percent; RC, CCA >_ 350 CFNVton, FWD, TMAH, STMS, and either HSPP or PSPP.
For Packaged Units: Duct leakage < 6 percent
11.3. 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 > 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 CF -4R forms: MECH-21
linear feet of duct in unconditioned s ace.
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 I and 6 of the California Code of Regulations.
• The design features identified on this Certificate of Compliance are consistent with the information docume d on other applicable compliance forms, worksheets
calculations, plans ands ecifications submitted to the enforcement agency for approval with the ermit a is tion.
Name:
Signature:
Company: J 000
ey\20
Date: t�U.
Address:1 1 O V n
�fCIb
License: ' (� ( �
1(J
City/State/Zip:Phone:
Din rt .
City of La Quin is
Building U SafetyMislon
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
- Building Permit APplication and Tracking Sheet
.
Permit # �(�
Project Address:
Owner's Name: I A.
A. P. Number:
Address: 6
6� S
Legal Description:
City, ST, Zip:
Contractor:
Telephone :�';.
Address:
Y
Project Description:
City, ST, Zip:
Telephone
2
State Lie. # :
3
City Lie. #;
Arch., Engr., Designer:
Address:
City., ST, Zip:
Telephone:
State Lie.#:
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�Construction Type: Occupancy:
. Project type (circle one): New Add'n Alter Repair Demo
Sq. FL: # Sto 'es: #Units:
Name of Contact Person:
Telephone # of Contact Person:
Estimated Value of Project:
APPLICANT: DO. NOT WRITE. BELOW THIS LINE
#
Submittal
Plan Sets •
Req'd
Recd
TRACMG
Plan Check submitted
PERMIT FEES
Item Amount
Structural Cafes.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance
Title 24 Calcs.
Plans picked up
Construction -
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
tad Review, ready for corrections/issue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up.
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
3rd Review,.ready for corrections/issue
-
Developer Impact Ree
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr.
Date of permit issue
School Fees
Total Permit Fees