12-0593 (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: 5/29/12
Application Number:12�0.0:0.0.0� Owner:
Property Address: 8"1550"TIBURON DR SCOTT RO N
APN: 767-522-007- - - 81550 T�1I O D_�'
Application description: MECHANICAL LA QUICA 92253
Property Zoning: LOW DENSITY RESIDENTIAL U
Application valuation: 7801 Mpq�H` 29 12
Contrac or: CITY0 1 fUr
Applicant: Architect or Engineer: GENE A�� bND�IO§iG4
31170 RESERVE DRI E
THOUSAND PALMS, CA 92276.
(760)343-7488
t LiC. No.: 686310
------------------------------------------------ --
LICENSED COL
TOR'S DECLARATION - WORKER'S COMPENSATION DECLARATION -
I hereby affirm under penalty of perjury that I,am licens 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 Profesode, 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
Lice se Class: C20 No.: 686310 for by Section 3700 of the Labor Code, for the performance of the work for which this permit is .
issued.
' Date: 5 Z< C tractor: 11have 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
-BUILDER DECLARATION insurance carrier and policy number are: . t
I hereby affirm under penalty of perjury tha 4 m exe pt from the Contractor's State License Law for the Carrier ZENITH INS CO ' Po' y 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 ork 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 Ishould becom bject 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 she hw' 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 .
any applicant -for a permit subjects the applicant to a civil penalty of not'more than five hundred dollars. I$ 500)•: 0 Date: I plicant:
(_)
1, -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: AILURE TO SECURE 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 (600,000). 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 3706OFTHE 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
(_) 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,
(_) 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 beco null and void if work is not commenced
within 180 days from data of issuance of such per r cessation of work for 180 days will subjectr
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 abov . n ormation is correct. I agree to comply with all
work for which this permit is issued (Sec. 3097, Civ. C.). city and county ordinances and state laws relating to building c 9 ruction hereby authorize representatives .
of this county to enter upon the above-mentioned property for ec ' urposes.
Lender's Name: -
Lender's Address:
LQPERMLT
Date: 9Si tura (Applicant or Agent):
Application Number 12-00000593
Permit MECHANICAL
Additional desc .
Permit Fee . . . 40.50
Plan Check Fee
10.13
Issue Date . . .
Valuation
0
Expiration Date 11/25/12
-"
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: INSTALL NEW 5 TON SPLIT
SYSTEM OUTDOORS AT GROUND LEVEL.
2010
—CODES.,
---------------------------------------------.--------------------
Other Fees . . . . . .... BLDG STDS ADMIN (SB1473)
11.00
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
LQPEEMIT
Simplified Prescriptive Certificate of Compliance: 2008 Residential HVAC Alterations CF -IR -ALT -HVAC
Climate Zones 10 - 15
Site Address:
Enforcement Agency:
Date:
Permit #:
81550 TIBURON DRIVE Ea Quinta, CA 92253
City of La Quinta
May 26, 2012
Equipment Type1
List Minimum Efficiency2
Duct insulation
requirement
Conditioned Floor
Area -
Thermostat
❑ Package Unit
-
® Furnace ..
® AFUE '78%
❑ COP
❑ R 6 (CZ 10-13)
Served by system
® Setback
® Indoor Coil
® SEER 13.0
❑ HSPF
'
[3 R 8 (CZ 14=15)
2100 sf
If not already present, must be
® Condensing Unit
. ❑ EER
❑ Resistance
installed)
❑ Other
k•.'
1. Equipment Type: Choose the equipment being installed; if more than one system, use another CF -1 R -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 -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 -1111 '
and CF -6111 shall also be on site for final inspection.
® 1. HVAC Changeout
Required Forms:
• All HVAC Equipment
CF -611 forms: MECH-04, MECH-2I-HERS and (for split systems) MECH-25-HERS w
replaced
CF -4R forms: MECH-21 and (for split systems) MECH-25
• Condenser Coil and /or
• Indoor Coil and /or
CF -6R forms: ME6-04, MECH-2I-HERS and (for split systems) MECH-25-HERS
Furnace
CF -4R forms: MECH-21 and (for split systems) MECH-25
•
4
For Split Systems: Duct leakage<F15 percent; RC, CCA <_ 300 CFM/ton (Minimum Air Flow Requirement), TMAH
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 ;
[13. Existing duct systems are constructed, insulated or sealed with asbestos .
❑`4. The system=will not be Ducted=(ie: Ductless Mini-SplitwSystem)=(AlsorExempt from Refrigerant Charge)
❑ 2. New HVAC System
Required Forms i_ f'•
. Cut in',or Changeout with",
CF 6R forms: MECH-04 MECH-20 HERS and (for split systems) MECH-22 HERS andnew
ducts:". all new
ducts.(all a
ducting )all new
g
MECH 25!HER5 �z° P h
CF 4R1orms MECH 20 and (for split systems) MECH=22, and MECH-25 i g
equipment) =
1
..
�. ".,I'Et, "O, -rte :�:
For Split Systems:, Duct leaks a c+;6 ercent RC;CCA >'350 CFM/ton; FWD,-jTMAH, STMS, and:.either,HSPP of -PSPP.
For . Packaged Units:Duct leakag"-? 6 percent'
❑ 3. New,Ducts with/or without L.
Required,Forms:
Replacement "'• _ ,'' '
• Includes replacing or installing allnew
r
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: 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
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. e
• 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: banielle Garcia ,
Company: HARRISON ENTERPRISES INC Date: May 26, 2012
Address: 31-170 RESERVE DRIVE STE A License: 686310
City/State/Zip: THOUSAND PALMS / CA / 92276 Phone: (760) 343-7488
H
Reg: 212-A0027045A-00000000-0000 Registration Date/Time: 2012/05/26♦ 17:58:16 HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms July 2010
isin.#
City Of La QuiCl
Bulk ft 8z Safety Duron
P.O. Box 1504,78-495 Calle Tampico
La.Qulnta, CA 92253 -:(760) 777-7012
Building Permit -Application'and Tracking Sheet
Permit #
Project Address:
Owner's Name:. C S
A. P. Number.
Address: ISS U 1 ' .
Legal Description:
City, ST, Zip: 4 'Z 6
Contractor. C �rloral A �r Cbnd�trci [lTelephone:
-(3 nQ • (D
Project Description: U Q — CD � r)
p t(..
Address: 3ft'ry'[ o
�Q}
City, ST, Zip: 1 F 1a d PU I yyb, C x'12 V"0.
Telephone •-7Aq�
5 S S— o f u
U
State Lie. # ; CityLic, #;
Arcfi., Bag., Designer.
Address:
City., ST, Zip:
Telephone:
State Lic. #:
Name of Contact Person: �4 1 1�i
Construction Type:. Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
Sq. Ft.: 2''� #Stories: #Univ:
Telephone # of Contact Person ,—j (DD)3-14q(a
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS UNE
#
Submittal
Req'd
Reed
TRACKNG
PERMrr FEES
Plan Sets
Plan Check submitted
Item
Amount
S"ctural Coles.
Reviewed, ready for corrections
Plan Check Deposit. .
Truss Coles.
Called Contact Person
Plan Check Balance.
Title 24 Calci.
Plans picked up
Construction
'Flood plain plan
Pians resubmltted ,
MechaNcai
Giading plan
Z'! Review, ready for correctiourmue
Electrical
Subeontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
2" Review; ready for correedonsAssue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr '
Date of permit issue
School Fees
Total Permit Fees