12-0720 (MECH)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253 -
Application Number:
1-2000:0`07.20w
448668S�TIBURO
Property Address:
DR
APN':
767-532-005- -
Application description:
MECHANICAL
Property Zoning:
LOW DENSITY RESIDENTIAL
Application valuation:
12500
BUILDING & SAFETY DEPARTMENT
. BUILDING PERMIT
Owner:
ADAME AARON D
81685 TIBURON DRIVE
LA QUINTA, CA 92253
I�
F
777-7012
777-7011
777-7153
6/28/12
Date: Owner:
` CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the
work for which this permit is issued (Sec. 3097, Civ. C.).
Lender's Name:
Lender's Address: Lr
LQPERMIT
w
of La Qnta, its officers, agents and employees for any act or omission re ate d tot a wor . emg
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 havereadthis application and state that the above information • correct. I agree to comply with all
city and county ordinances and state laws relating to building construction, a hereby authorize representatives
of this county to enter upon the above-mentioned property for inspection pu ses.
nature (Applicant or Agent):
Contractor:
Applicant: Architect or Engineer:
GENERAL AIR CONDITIONING
31170 RESERVE DRIVE
THOUSAND PALMS, CA 92276
(760)343-7488
N
LiC. No.: 686310
-------------------------------------------------------------------------------------------------
' LICENSED CONTRACTOR'S DECLARATION -
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty ofperjury that III 'ensed 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 afessonals Code, and my License is in full force and effect.
_ 1 have and will maintain a certificate of consent to self -insure for workers' compensation, as provided
Licen Class: C20 License No.: 686310
for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
—
ate: Contractor: _
issued.
/U 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
OWNER -BUILDER DECLARATION
insurance carrier and policy number are: ,
I hereby affirm under penalty of perjury that I On 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 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 bject 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 sub t 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 forth 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 for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).:
icant:
1 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 Cade: The
WARNING: FAIL E TO SECURE WORKERS' CO NSATION 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.000E, 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 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
I h kb•
Date: Owner:
` CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the
work for which this permit is issued (Sec. 3097, Civ. C.).
Lender's Name:
Lender's Address: Lr
LQPERMIT
w
of La Qnta, its officers, agents and employees for any act or omission re ate d tot a wor . emg
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 havereadthis application and state that the above information • correct. I agree to comply with all
city and county ordinances and state laws relating to building construction, a hereby authorize representatives
of this county to enter upon the above-mentioned property for inspection pu ses.
nature (Applicant or Agent):
Application Number . . . . . 12-00000720
Permit MECHANICAL
Additional desc .
Permit'Fee . . . . 40.50
Plan Check Fee
10.13
Issue Date . .
Valuation . . . .
0
Expiration Date 12/25/12
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
161.50
---------------------=------------------------------------------------------
Special Notes and Comments
HVAC CHANGE -OUT: INSTALL 5 TON SPLIT
SYSTEM•AT GROUND LEVEL OUTDOORS.
2010
CODES.
Fee summary 'Charged
------ --- ----------
Paid Credited
---------- ----------
Due
-----------------
Permit Fee Total 40.50
.00 .00 _
40.50
Plan Check Total 10..13'
.00 .00
10.13
Grand Total 50.63
.00 .00
50.63
LQPERMIT
Simplified Prescriptive Certificate of Compliance: 2008 Residential HVAC Alterations CF-IR-ALT-HVAC
Climate Zones 10 - 15
Site Address:
Enforcement Agency:
Date:
Permit #:
81685 TIBURON DRIVE La Quinta, CA 92253
City of La Quinta
Jun 27, 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 6 (CZ 1013)
Served by system
® Setback
If not already present, must be
H Condensing Unit
❑ EER
❑ Resistance
❑ R 8 (CZ 14-15), •
3222 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, 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-6R shall also be on site for final inspection.
® 1. HVAC Changeout
Required Forms:
. All HVAC Equipment
CF-6R forms: MECH=04, MECH-2I-HERS and (for split systems) MECH-25-HERS
replaced
CF-4R forms: MECH-21 and (for split systems) MECH-25
. Condenser Coil and /or
CF-6R forms: MECH-04, MECH-2I-HERS and (for split systems) MECH-25-HERS
. Indoor Coil and /or
Furnace
CF-4R forms: MECH-21 and (for split systems) MECH-25
.
, 1+
For Split Systems: Duct leakage<;15 percent; RC, CCA <_ 300 CFM/ton (Minimum Air Flow Requirement), TMAH
For. PaelGaged Units., Dw-Get
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 less than 40 linear feet in unconditioned space, or
❑ 3. Existing duct systems are constructed, insulated or sealed with asbestos
❑'4. The�systemwwill not be Ducted'(ieDuctless Mini-Split System)x(Also Exempt;fromwRefrigeant°Charge)
t
❑ 2. NeaHVAC System
Required Forms
. Cut inior Changeout with"
new ducts:;(all new
" ' s ` t ti w - - .
CF 6R forms: MECH-04, MECH-20 HERS and (for split systems) MECH-22 HERS and -
•x-..E
ducting all new
MECH 25�HERS
CF 4R forms :MECH-20, and fors lits stems MECH=22 and MECH-25
equipment) " /i..
y -�
For Split Systems:'Duct;leakage <16'percent, RC CCA >"350 CFM/ton FWD TMAH STMS, and either,HSPP oP PSPP
For Packaged Units: Duct leakage <,6,percent
❑ 3. New.Ducts 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: 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'
• 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: Jun 27, 2012
Address: 31-170 RESERVE DRIVE STE A License: 686310
City/State/Zip: THOUSAND PALMS / CA / 92276 Phone: (760) 343-7488
Reg: 212-AO033935A-00000000-0000' Registration Date/Time: 2012/06/27 15:33:21 HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms #' July 2010
lain.
City. 'f 4 Quinta
Building a Safety Dhdilon
P.O. Box 1504,78-495 Calle Tampico
La.Quinta, CA 92253 -:(760) 777-7012
Building Permit Application and Tracking Sheet
Permit # ^�
l�- 1
Project Address: 8 I b� �l bV O r
Owner's Name:. A'Arm T5E
A P. Number. O o S .
Address: S m
Legal Description:
City, ST, Zip:
Contractor.
Address:
Telephone:51p1 ' -31
Project Description: � 1
City, ST, Zip:
$ S
r
Telephone:
i�
State Lic. #:
City Lic. #; .
Arch., Engr., Designer-
esignerAddress:
Address:
City., ST, Zip:
Telephone:
Construction Type:. Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
Ft.: 3 Z # Stories: # Units:
State Lic. #: M.
Name of Contact Person:Sq.
Telephone # of Contact Person:
Estimated Value of Project: Q• Q
APPLICANT: DO NOT WRITE BELOW THIS UNE
#
Submittal
Req'd
Recd
TRACKING
PERMIT FEES
Plan Sets
Plan Cheek submitted
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit, .
Truss Calcs.
Called Contact Person
Pian Check Balance.
Title 24 Calcs.
Plana picked up
Construction
Flood plain plan
Plans resubmitted.'.
Mecharitcal
Grading plan
V Review, ready for correctionsfissue
Electrical
Subcontactor 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 correcdonslissue
Developer Impact Fee
Planning Approval
Called Contact Person
A.LP.P.
Pub. Wks. Appr
Date of permit Issue
School Fees
Total Permit Fees