12-0738 (MECH)�P.O.-BOX 1504 '
78-495 CA LLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 12-00000738
Property Address: 79260 TORCO)
APN: 7 -72 -340 -023 -
Application description: MECHANICAL
Property Zoning: LOW• DENSITY RESIDENTIAL •.
Application valuation: 3600
BUILDI Y DEPARTMENT
p' ILDI PERMIT
Owner:
JU02 2019 2 CLIFF 'GRAFFUIS.:
l�l� 79260 TORONJA
^may OF LAQu'�T� LA QUINTA, .CA .92253
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Applicant: Architect or Engineer:
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----------------------- ---------------------------
' 1
�.
LICENSED CONTRACTOR'S DECLARATION ,
-I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with
Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect.
License Class: C20 - License No.: 872703
Date: 14V Contract..
OWNER -BUILDER DECLARATION - • - -
hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the
following reason (Sec..7031.5, Business and Professions Code: Any city or county that requires a permit to
construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the
permit to, file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State '
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or
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 IS500)•:
( _•) 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 `
Contractors' State License Law does not apply to an owner of property; who builds or improves thereon,
and who does the work himself or herself through his or her own employees, provided that the '
.. _ improvements are not intended or offered for sale. If, however, the building or improvement is sold within ,
one year of completion, the owner -builder will have the burden of proving that he or she did not build or
improve for the purposebf sale.).
(_ 1 I, as owner of the property, am exclusivelycontractingwith licensed contractors to construct the project (Sec. ,
7044, Business and Professions Code:•, The Contractors' State License Law does not apply to an owner of
property who, builds or improves thereon, and who contracts for the projects with a contractor(s) licensed
pursuant to the Contractors' State License Law.).
4_ 1 I am exempt under Sec. B.&P.C. for this reason
Date: Owner: _
r
CONSTRUCTION LENDING AGENCY .
I hereby affirm under penalty of perjury that there is a constructionlending agency for the performance -of the
work for which this permit is issued (Sec. 3097, Civ. C.). '
Lender's Name:
Lender's Address:
LQPERMIT
VOICE (760) 777-701.2
FAX (760) 777-7011
ti INSPECTIONS (760) 777-7153
Date: '. 7/02/12
Contractor:
CR FRIEND LD TOLLEY A/C & HEAT
P.O. BOX 12100 .
PALM DESERT,,CA 92255
(760)346-0434
Lic. No. 872703
. WORKER'S COMPENSATION DECLARATION
hereby affirm under penalty of p&jury-one of the following declarations: '
_ I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided
for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
issued. - -
_ 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
- insurance carrier and policy number are: '
Carrier TRUCK INS EXCH . Policy Number B01109591 f
I certify that, in the performance of the work for which this permit is issued, I shall not employ any
person in any manner so as to become subject to the workers' compensation laws of California,
and agree that, if I should become subject to the workers' compensation provisions of Section
• 3700 of the Labo Code, I shall forthwith comply with those provisions. .
Date:. iv Applicant:
WARNING:' FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL "
SUBJECT'AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
`DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN_
SECTION 3706 OF. THE LABOR CODE, INTEREST,AND ATTORNEY'S FEES.
• APPLICANT ACKNOWLEDGEMENT
IMPORTANT. Application is hereby made to the Director of Building and Safety for a permit subject to the
conditions and restrictions set forth on this application.
1 . Each person upon whosebehalf this application is made, each person at whose request and for" e
whose benefit work is performed under or pursuant to any permdissued as a result ofthis application,
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.
2. Any permit issued as a result of this. applicationbecomes hull 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.applicatioh and state that the above information is correct. I agree to comply with all
city and county ordinances and state laws relating to building construction, and hereby authorize representatives
of this c u ty to enter upon the above-mentioned prope y for inspection purposes.
+.
Da, te:_ �' L o--Signature-(Applicant or Agent):— '
Application.Numher. '12-00000738
Permit MECHANICAL
Additional desc
- Permit -Fee 33.00 Plan Check Fee .-
8.2'5
Issue Date Valuation
0
Expiration Date 12/29/12
Qty_, Unit Charge Per
Extension
BASE FEE."
15.00
2.00 9.0000 EA MECH APPL REP/ALT/ADD
18.00
Special Notes and Comments
._TWO EVAPORATIVE COILS .REPLACEMENT.
_
Other Fees BLDG STDS ADMIN (SB1473)
1.00
Fee summary Charged Paid Credited. ..
-_ -
Due'
-
Permit Fee Total 33.00`: ."00 .00
33.00
Phan Check Total; 8:25 00 00,
8.25
Other Fee. Total T-.0.0 .00 00
1.00
Grand Total. 42.25 .00 .00
42.25
.. LQPERMIT
Simplified Prescriptive Certificate of Compliance: 2008 Residential HVAC Alterations CF-lR-ALT-HVAC
Climate Zones 10 - 15
Site Address:Enforcement
Agency:
Date: - ,
Permit
79260 toronjo La .Quinta, CA 922531
City of La Quinta
Jul'2,'2012 '
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Duct insulation
Conditioned Floor
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♦
Simplified Prescriptive Certificate of Compliance: 2008 Residential HVAC Alterations CF-lR-ALT-HVAC
Climate Zones 10 - 15
Site Address:Enforcement
Agency:
Date: - ,
Permit
79260 toronjo La .Quinta, CA 922531
City of La Quinta
Jul'2,'2012 '
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Duct insulation
Conditioned Floor
M ,
Equipment Type1
List Minimum Efficiency2.
requirement
Area
Thermostat _
❑ Package Unit
❑Furnace
® Indoor Coil' +
❑ AFUE
❑ SEER
❑ COP
❑ HSPF
❑ R 6 (CZ 10-13)
Served by system
® Setback
If not already present, must be
❑ CondensingUnit
❑ EER
❑ Resistance
❑ R 8 (CZ 14-15)
2700 sf,
,.
installed)-
❑ Other..
1. Equipment Type: Choose the equipment being installed; if more than one system, use another CF -1R -ALT -HVAC for each system.
2. Minimum Equipment Efficiencies: 13 SEER, 78% AFUE, 7.7HSPF for typical residential systems., L • -
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 fad 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 -IR"
and CF -611 shall also be on site for final inspection:
® 1: HVAC Changeout _.
Required Forms:
. AII'HVAC Equipment
CF -611 forms: MECH-04, MECH-217HERS 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 .
-systems)
• Furnace
CF -4R forms: MECH-21 and (for split MECH-25
. Z k:
For Split Systems: Duct leakages 15 percent; RC, CCA 5 300 CFM/ton (Minimum Air Flow Requirement), TMAH , -
Exempted from dud leakage testing if:
'1❑'1'Ductsystem was documented'to have been previously sealed and confirmed through HERS verification, or
❑ 2. Dud systems with less than'40!linear,feet in unconditioned space, ori
3. Existing duct systems are'constructed; insulated or sealed with asbestos t '
❑'4. The system will not be Ducted,(ie.;Ductless,Mini-Spllt_System)*(Also-Exempt from;Refrige�rant_Charge)
❑ 2. New HVAC System
Required Forms
Cut m or,Ch'an eout with,
•
>';
- -� `�°^
CF 6R forms MECH-04, MECH 20 HERS and (for split systems) MECH-22I HERS, and {
new ductsr,(all new
l
ducting Akall new
:
MECH:'25yHERS � - s -' '^ a
CF 4R`forms.,MECH-20; and (for split systems) MECH-22, and MECH 25
equipment): ::
Wil' tX S +. ,iY,. , ytr, .. �° .J c . . i ,,� �.' y
For Split Systems: Duct leakage'. 6 percent;- RC CCA >_-350 CFM/ton; FWD;`TMAH; STMS, and either HSPP"or PSPP` '^ ..
For Packaged Unitsc'Duct leakage,. 6 percent
❑ 3. New Ducts with/or without ' '
Required Forms:
Replacement. ;,.,. fi-1 '(,,: ,,..
,
.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: Dud leakage < 6 percent; RC, CCA >_ 300 CFM/ton, TMAH
For Packaged Units: Duct leakage'< 6 percent '
114. New Ducting over 40 feet
Required Forms: T- :
. Includes adding or replacing more than 40
CF -6R forms: MECH-04, MECH-2I-HERS '
linear feet of dud in unconditioned space..
CF -4R forms: MECH721
For split system or packaged units: Dud leakage < 15 percent - �+'•
❑ EXCEPTION: Existing dud systems constructed;. insulated or sealed with asbestos. t
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: Robert Powell ` , Signature: Robert Powell
Company: C R FRIEND L D TOLLEY AIR CONDITIONING & HEATING Date: Jul 2, 2012 ,
Address: 73714 HIGHWAY 111 k License: 872703
City/State/Zip: PALM DESERT / CA /. 92260'�'� Phone: (760) 346-0434 '
Reg: 212-A0034927A-00000000-0000 Registration Date/Time: 2012/07/02 11:19:39 HERS Provider: Ca10ERTS „ Inc.
2008 Residential,Compliance Forms +', July 2010
Bin #
City of La Quinta
Building 8t' Safety Duron
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
nV
Project Address:
Owner's Name:
A. P. Number:
Address:
Legal Description:
City, ST, Zip: '9A -
Telephone: —
Project Description: `""WO
Contractor: e
Contractor:
Address: d
City, ST, Zip: � 9a�
Telephone:
State Lic. # : City Lic. #, .9L9 ff
1 S
Arch., Engr., Designer:
Address:
City., ST, Zip:
Telephone:
State Lic. #:
Name of Contact Person:
Construction Type: Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
Sq. FL:
# Stories:
# Units:
Telephone # of Contact Person:— ((
Estimated Value of Project:
APPLICANT:
DO NOT WRITE BELOW THIS UNE
#
Submittal
Req'd
Rec'd
TRACKMG
PERMrf FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Cala.
Reviewed, ready for corrections
Plan Check Deposit
Truss Cala.
Called Contact Person
Plan Check Balance
Title 24 Cafes.
i Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading pian
2" Review, ready for correctionsfissue
Electrical
Subcoutactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
''' Review, ready for correctionstissue
Developer Impact Fee
Planning Approval
Called Contact Person
A.LP.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees