12-0785 (MECH)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: 7/16/12
Application Number: 12-00000785 Owrier:
Property Address: 79405 TORONJA DEXLER KATHY
APN: •772-340-044 - - 79405 TORONJA
Application description: MECHANICAL- • LA QUINTA,CA 92253
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 16895 w O
• Contractor:
Applicant: Architect or Engi r: JUL 2012 BURGESONS HTG & A/C INC
• 'P.O. 'BOX «7310
-REDLANDS, CA.92375 -
CITYOPLAQUiNTA (909) 793-3685
PfNA�Ji''ED=� Lic. No.: 263871
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, .C43 - LicenseNo.: 263871 for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
\���aaa /' issued.
Date:; Contractor - _ 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
/ O R-BUI ER DEC RAT N ' • insurance carrier and policy number are: •'
I hereby affirm under penalty of perjury that I am exempt rom the Contrac is State License Law for the Carrier INS CO WEST Policy Number WPL500698900 .
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 asto 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 "I forthwith comply 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 fora permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).: Date.: ' ' I Applicant:
l _ 1 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 WARNING: FAILURE TO SECURE WORKERS' CO ' ENS ION 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 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 restrictionsset forth on this application. . ' ' _
property who builds or improves thereon, and who contracts for the projects with a contractor(sl 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—) I am exempt under Sec. BAP.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'.
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. CJ. If city and county ordinances and state laws relating to building construction, and hereby authorize representatives '
of this county to enter upon the above-mentioned propert i ction purposes-
Lender's Name: ��; '
- Date: �— — Signature (Applicant or Agent): .
Lender's Address:
LQPERMIT t
Application Number.,... 12=00000785
Permit MECHANICAL
' Additional desc ...
Permit Fee 66:00 - Plan Check Fee
16.50'
Issue Date Valuation
0
Expiration_Date :., 1/12/13 -
Qty Unit Charge Per
`Extension
BASE -FEE
„
15.00.
" 2':00 9..0.000 EA MECH FURNACE <=10,0K
18.00
2:'00 16.5000. EA ' MECH'B/C >3=15HP-/>100K-500KBTU
- -
- 33.-.00 a
- ----- ----
--------------•---:--=------- - - ------------ - -- - -----.-----
-Special Notes and Comments
- -
_ REPLACE (2)FAU &_ COILS REPLACE (2)
CONDENSERS (1.)73,TON 16 SEER_ (1) 4 TON
15 SEER. 2010 CODES.-.
-----Other Fees , BLDG STDS ADMIN (SB1473)----
1.00
'Fee summary Charged. Paid Credited'
----------
Due
------------------------------
Permit Fee^Total 66.00 .00 .00
66.00
Plan Check Total 16.50-- .00 00
.16.501, '
Other' Fee'::Total 1.00' :100 .00
-•1.00
Grand .Total 83..50. .00' 0'0
83•.50
LQPERMIT
I
Sim lified Prescri tive Certificate of Compliance: 2008 Residential HVAUA[Iterations C-IR—ALT-11VAC
Climate Zones 10 to IS
Site . t rtdress: �—
��VV
Enforcemet t A cy:
Date:
Permit #:
Conditior d Flgpr
f: ui merit T�' et List Minimum Efficiency' .
Duct insulation requirement
Area
Thermostat
❑ Packaged Unit �j
�"'
COP
Over 40 ft of ducts added or
etbad;
Furnace FUE
door Coil ER��`
❑ HSPF
replaced in unconditioned space
6 10-13)
Served by s stem
(IJno Irendr
present. must be
Condensing Unit ❑EER •
D Resistance
❑ R (CZ
❑ R g (CZ 1•l-15)
installed)
Other
I. Equipment Type: Choose the equipment being installed: y more ittan one system, use unurner Lr -a n -ria., r na Jul &u- s Jy4. I
Minimum Equipment Efficiencies: 13 SEER, 78%AFUE, 7.7HSPFfor typical residential systems.
HERS VERIFICATION SUMMARY Listed below are four HVAC alteraddn Options. The installer decides what wort: 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
sigDed, Beginning October 1, 20101 a registered copy of the CF -1R and CF -611 shall also be on site for final inspection.
1. HVAC Changeout Required Forms:
• All HVAC Equipment replaced CF -6R m
fors: MECH-04, MECH-2I-HERS and (for split systems) MECH- 25 -HERS
CF-411forms: MECH- 21 and (fors lit 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
r. Furnace
For Split Systems: Duct leakage < 15 percent; RC, CCA 2:300 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
❑ 2- Duct systems with lessthan 40 linear feel in. unconditioned space, or
❑ 3- Existing duct•systems are constructed, insulated or sealed with asbestos
❑ 2. New FIVAC System Required Forms: .
• Cut in or Changeout with new 6F -6R fors: MECH-04, MECH-20-HERS,and (for -split systems) MECH-22-HERS, and MECH-25-HERS
ducts: (all new ducting and all CF -4R forms: MECH 20-, and (for split systems)MECH-22, and MECH 25
—new-equi merit
For Split Systems: Duct leakage < 6 percent; RC, CCA 2 350 CFM/tan, 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 forins: MECH-04, MECH-20-H�RS,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 I CF -6R fors: MECH-04, MECH-2I-HERS CF -4R forms: MECH-21
linear feet of duct in unconditioned space
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)
• 1 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 ofTitle 24. _
Parts 1 and 6.ofthe California Code of Regulations.
• The. design features identified on this Certificate of Compliance are consistent with info on ocumented on other cable compliance fors, worksheets,
calculations, lans ands specifications submitted to the enforcement aeon • for a eal wi e e i;application.
Name:•'O� `- o _ �.,,. Si)ent.VA
Company �SllVls a'lt Y ll7YtMAI - ---
Address: ) v Licens :
City!State/ZiiDp: CprO �. 3 Phone:
I
1'
Total Permit Fees
Bin if
City of La Quinta
Building 8t Safety Division
Permit #
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
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Project Address:
� wner's Name:
A. P. Number:
Address: fid„
Legal Description:
City, ST, Zip:
Contractor: A�v-v�
� / � S
elephone:
Address:
Project Description:
City, ST, Zip:
2�7
dr
Tele P h one;
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State Lic. #
City Lic.
x'02
Arch., Engr., Desi er:
Address:
/
City, ST, Zip:
Telephone: hon
e
Construction rue
tt on e:
Type:
P a
Occupancy:
n c Y•
State Lic
/�1
Name of Contact P on:kV
Project t (circle le
type one New Add'n
'/ n Alter Repair Demo
�l�
` /'`I
S Ft.:
9. # Stories:
# Units:
Telephone Al of C&itTct Person:
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
Submittal Req'd Rec'd TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted FItem
Structural Calcs.
Amount
Reviewed, ready for corrections
ceposit
Truss Calcs.
Called Contact Person Plan Check Balance
Title 24 Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2nd Review, ready for corrections/issue Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.1.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
''d Review, ready for corrections/issue Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P. P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees