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11-0793 (MECH)P.O. BOX 1504 78-495 CALLE TAMPICO LA .QUINTA, CALIFORNIA 92253 T4hf 4 4. " BUILDING & SAFETY DEPARTMENT BUILDING PERMIT Applicant: Architect or Engineer: ------------------ 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 C e, and my License is in full force and effect. License Class: C20 aNO.: 374937 / J ate: 2� ontractor: � OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that 1 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 ($500).: 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 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 purpose of sale.).' . (_ 1 I, as owner of the property, am exclusively contracting with 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.). (_ 1 1 am exempt under Sec. - , B.&P.C. for this reason' 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, LQPERMIT VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Owner: 1 - - Date: 7/25/11 a 0 � MIKE HART 79305 TERRA COTTA COU 1! LA QUINTA, CA 92.253 f JUL 2 J 2011 (� C11"' OF LA QtilNiA �—vi FIIJd�VO� n� Contractor: PALM DESERT AIR COND CO INC 42081 BEACON HILL PALM DESERT, CA 92211 (760)346-0677 LiC. No.: 374937 WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury 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'FIRST COMP INS Policy Number 010111WC 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 Labor Code, I shall forthwith col ly with those provisions. Z6 icanu 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 whose behalf this application is made, each person at whose request and for whose benefit work is performed under or pursuant to any permit issued as a result of this 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 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 county ordinances and state laws relating to building construction, and hereby authorize representatives D�of thi county to enter upon a above-mentioned property for inspection purpo . �% �'7 ignature (Applicant or Agent).---,�� Application Number:, 11-00000793 Property Address: 78305 TERRA COTTA CT. APN: 604-Q22-003- - Application description: MECHANICAL Property Zoning: LOW DENSITY RESIDENTIAL Application valuation: 3325 T4hf 4 4. " BUILDING & SAFETY DEPARTMENT BUILDING PERMIT Applicant: Architect or Engineer: ------------------ 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 C e, and my License is in full force and effect. License Class: C20 aNO.: 374937 / J ate: 2� ontractor: � OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that 1 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 ($500).: 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 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 purpose of sale.).' . (_ 1 I, as owner of the property, am exclusively contracting with 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.). (_ 1 1 am exempt under Sec. - , B.&P.C. for this reason' 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, LQPERMIT VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Owner: 1 - - Date: 7/25/11 a 0 � MIKE HART 79305 TERRA COTTA COU 1! LA QUINTA, CA 92.253 f JUL 2 J 2011 (� C11"' OF LA QtilNiA �—vi FIIJd�VO� n� Contractor: PALM DESERT AIR COND CO INC 42081 BEACON HILL PALM DESERT, CA 92211 (760)346-0677 LiC. No.: 374937 WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury 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'FIRST COMP INS Policy Number 010111WC 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 Labor Code, I shall forthwith col ly with those provisions. Z6 icanu 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 whose behalf this application is made, each person at whose request and for whose benefit work is performed under or pursuant to any permit issued as a result of this 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 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 county ordinances and state laws relating to building construction, and hereby authorize representatives D�of thi county to enter upon a above-mentioned property for inspection purpo . �% �'7 ignature (Applicant or Agent).---,�� Application Number 11-00000793 _ Permit MECHANICAL Additional desc . Permit Fee 31.50 Plan Check Fee 7.88 Issue Date Valuation . . . . 0 Expiration Date 1%21/12 Qty Unit Charge Per Extension BASE FEE 15.00 1.00 16.5000 EA MECH B/C >3-15HP/>100K-500KBTU 16.50 -------------------_----.------------ Other Fees . --- -------------------------------------- . . . BLDG STDS ADMIN (SB1473). 1.00 Fee summary Charged Paid Credited =----------.--------- Due -------------------------- Permit Fee Total ---------- 31.50 .00 .00 •31:50 Plan Check Total 7.88 .00 .00 7.88 Other Fee Total 1.00 .00 .00 1.00 Grand Total .40.38 .00 .00 40.38 LQPERMIT Simplified Prescriptive Certificate of Compliance: 2008 Residential HVAC Alterations CF -IR -ALT, -HVAC Climate Zones 10 - 15 Site Address: - Enforcement_Aaency: Date: Permit #: 78 .7305 TERRA COTTA CA 922 City of� = ;3ul 22, 2011 . Duct insulation ... Conditioned Floor. Equipment Typel List Minimum Efficiency2 requirement Area Thermostat ❑ Package Unit ' ry ❑ Furnace ❑ Indoor Coil ❑ AFUEa p SEER 13.0 ❑COP © HSPF 7.7 [I R 6 (CZ 10-13) Served by system -1260 ac Setback � If not already present, must+ be p Condensing Unit 9 ❑ EER _. 0 Resistance ❑ R 8 (CZ 14715) sf installed ) ❑ Other u . 1. Equipment Type: Choose the equipment being installed;. if more than one system, use another CF -IR -ALT -HVAC for each system. 2. Minimum Equip ment'Etfciencies: 13 SEER, 780WAFUE 7.7HSPF fir 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 onthis` form was in fact the work completed by the installer. The inspector also verifies that each appropriate CF -6R and registere&CF=41k' forms ,(no hand filled CF-4Rs allowed) are filled out and signed.Beginning October 1, 2010, a•registered copy of the'CO-111. . and CF -611 shall also be.ori site for final inspection. : 2 1. HVAC Changeout . r Required Forms: . 4 • 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 . or and /or CF -6R forms: MECH-04; MECH-2I-HERS and (for splitsystems) `MECH-25-HERS .• oil Furnace CF;4Wlr MECH-21'and (for split systems) MECH-25 it - For Split Systems: -Duct leakages<xl,5::percent;.RC, CCA•<_ 300 CFM/tom(Minimum Air -Flow Requirement), TMAH FGF naskaged URwtt-. n. f:� �c ? y r :^F^^..t r, Exempted:ffrroom duct leakage to ng if , - ❑ 1 Duct systemwas documented�to have been previously sealed and confirmed tFirough HERS verification; or ;❑ 2tDcise systemwillnof be Duct d (ieucElesMimi=SplitSystem)Iso Exemptfrom :RefrlgerantChacge) 0 2 New HYAC$ystem Regwred F�orm., :::• No . Cut i' or Changeoutkwith new dcts,t(all new 'tA+.tf�.»r.• ducting and all new f CF�6R forms: ICH 04, MECH=2© HERSH9110t'systems)H=2�2 HERS and MECH 25HE s, k d#' C *.. d'X'? I CF 20; and (for split systems) MECH 22, and MECH 25� ,4Rkforms:MECH , equlprneit) For Split 5 is ems Duct lealca g 9 e 6 ercent, RC, pip CCA z 350�CFMr tong FWD„TMAH, SIMS; and either HSPPyor PSPP- A d v - / Foc Packs ed Umts „Duct leaks e < 6. ercent g . .r 3 NewDucts with/por without Required Forms: . Ircludesreplacing or installing allnevr ducting and/dr*outdoorcondensing.,'u id0 _indoor CF -6R forms: MECH-04,•MECH-20-HERS, and: (for split systems) MECH-25=HERS coil and/or furnace..Nosome equipment ' CF -4R forms: MECH-20 and (for,split systems) MECH-25 g € ^" than ed.i...: r. For Split Systems: Duct lea kage1"<' 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-217HERS 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 9 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: Karl Brown Signature: Karl Brown' ' Company: PALM_ DESERT AIR CONDITIONING CO INC Dater Jul 22, 2011 Address: 42-081 BEACON HILL• License: 374937 u City/State/Zip: PALM DESERT / CA / 92211 Phone: (760) 346-0677 " Reg a211_A0036725A=00000000=000' 3 Registration'Date/Time: 2011/07/22. 11:47:20 HERS Provider: LCai10EWT_§—=Inc. 2008.Residential Compliance Forms ,. July L2010 .... h � Y P Ot Box 1504.78-495 CallekTamplco, •La Qwnta, California 9221`1; ;. }n - ' �• `' _ Tel (760)` 777 7012. `Fax`(760)-,7 '71-"T.11 3 �' lllfebsite www La-Quetta Orgy Email Buildiri La=Quetta Or `�` Y �v f DFSPTI 'mow ' . - - - s ...:.t ....... .,.... _... � ..._. ... �..:... �.._ Permit;#„Btuildng Perm`i# App:icat'ion Sheet': ,&.,Ta-c.ki:ng ProtdW,"ddress':. 78-305 TERRA COTTAOwne�'s.Name _ _.. HART, MIKE Number;. Address ; 78-305 TERRA COTTA. ............... .......................... .. ...... . Legal,Descnption;; ^TM CityState, Zip PALM DESERT, CA 92211 - - --- Contractor Palm Desert Air Conditioning &Heating Company T81ephOrle (760) 333 1517 ;Address.. 42-081 Beacon Hill - -- :. .. ........................ eet5Descnptlan.„ - City;;State; Zip Palm Desert, CA 92211 REPLACE .(1) HEAT PUMP CONDENSER. .... ..... _._....._. _.. Telephone„No (760j 346-067.7 State Lic # 374937 City Lic # 100886 ;�A�rcFi�Erigr /Designer - . .. Address: _ �_ :4Crty, State;,Zip Tele �lione Noas p � ” , ;� � Construcbon�Type� _ � ..... :Occupancy , State 1�c # Protect Type: O New ®:Add,h = D: Alter �.D::Repa1r •: D Demo _ .... . xNarne;of Coritaet P.,erson KARL BROWN ' Sq; Ft #Stories: #:Units: Contac 1,61eptione` No'r:; (760) 346-0677: Estifi ated Value.of`P$3,325:00 APPLICANT'DONOT<<,WRREBELOW-THISLINE` # Submittal Req'd Recd `.. Tracking per<riit Fees ' PIan4$ets Plan Check Submitted _ ; Item Amount” Sfructural;Celcs.:. : Reviewed: Ready#ort rrecGoos PIan:Check:.Oeposit; Truss Calrs, ;Called Contact F?erson P Ian.Cl%ecli=l3afance TtIe,24 scales ,, Plans PickedUP yConsiruchon Flood Plain Plan y�Pians Resubmitted Mechanical max. ... Grading Plah` !`2'� Review, Readyfo� Correcfaons ,�Eleolrical, '�. Su ;Galled Contacf:Person. �:Ptuintiing or pe >;Plans_Picked Up S M L HOA Approval; = yP>,lans'Resubmitted'' v Gradin 9' IN HOt1SE t3nd Revtew, Ready<forSCorrections Developer Impact Fee i_ ..... .... �.... M. _... _::; ......... _ . A PP ....�.... _... .., .., - P,,,lanning Approval ., -...._.................................. ........ _.._... .... _....... Celled CantactPs n> erso ,. ;.:. 4, >. -. f3ut%1Norks Appr'I 'Date of Permit-Issue= SeF"461 Fees otal. Permit F,ee s T,