13-0093 (MECH)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 13�-00000093
Property Address: 78375 TERRA COTTA CT
APN: 604 -022 -038 -
Application description: MECHANICAL
Property Zoning: MEDIUM DENSITY.RES*
Application valuation: 1400
Applicant:. . Architect or Engineer:
-------------------
LICENSED CONTRACTOR'S DECLARATION
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
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 LicenseNo.: 878533
,,D Contradtor:
OWNER -BUILDER DECLARAT ON
I 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 pursuani 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, 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 improve� 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, as owner of the property, am exclusively contracting with licensed contractors t ' o 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.).
I 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: I � I A I
Lender's Address: pi
LQPERMIT
Owner:
FRED KELLERHALS
78375 TERRA COTTA CT
LA QUINTA, CA 92253
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 1/30/13
contractor: 1-U � JAN 0 2013
ONE HOUR A/C & HTG
3030 MYERS STREET ITY OF A UINTA
PT
L��
QUINTA
RIVERSIDE, CA 92503 FINANCLE DEPT
(951)276-9744'
Lic. No.: 878533
--------------------------- --------------------
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.
>d I hav-e 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 INS CO OF WEST Policy Number WVE502266100
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 comply with those provisions.
jDatil. (740plic—an�
"C'
WARNING: FAILURE TO S LIFE WORKEV 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
of this county to enter upon the above-mentioned property for inspection purposes.
Date: Vignature (Applicant or Agent):
\J
f I
Application Number
. . . . . 13-00000093
Permit'
MECHANICAL
Additional desc
Permit Fee
33.00 Plan Check Fee
8.25
Issue Date
Valuation
0
Expiration Date
.7/29/13
Qty- Unit Charge
Per
Extension
BASE FEE
.15.00
2.00 9.0000
EA MECH B/C <--3HP/100K BTU
18.00
-------------------------------------------------
Special Notes and
7- -----------------------
Comments
REPLACE 3 TON HEAT
PUMP AND AIR HANDLER.
2010 CODES.
-----------------------------------------------------------------------------
'Other Fees . . .
. . . . . . BLDG STDS ADMIN� (SB1473)
1.00
Fee summary
Charged Paid Credited
---------- ----------
Due
-----------------
Permit Fee Total
------ 7 --- -----------
33.00 .00 .00
33.00
Plan Check Total
8.25 .00 .00
8.25
Other Fee Total
1.00 .00 .00
1.00
Grand Total
42.25 .00 .00
42.25
LQPERMIT
Bin. #
pen . nit #
ProjectAddress.-
of* La Quinta
BUIkOng &rSafeiy DhV6n
P.O. Box 1504,78-495 Catle Tampico
1A.QLqntq, CA 92253 -:(760) 77T7012
Building Permit Application'and Tracking Sheet
Owner's Nmnc:. -rs(,eA
A. P. Number LOO A D -Z%
Address: —I sa;l C-7
Legal Description:
City, ST, Zip:
Contractor �)V'(�A Otye.
Telephone: ............
Address: Y\kq-ev-s S�
ProjectDmription-
City, ST, Zip:
CA
'0\-W'&h. /k' K
Telepfione:!±5\)M� —ql LAq
M,
Abity Lie. M.
01kV
StateLic.#:
Arch, Engr., Designer..
Address:
City., STj Zip:
Telephone:
State Lic. M
Construction T . ypc-... Occupancy:
Project rype.(circte one): Now Add'n. Alter Repair Demo
-Sq. FL: # Stories:
Name of Contact Person: ��V\' e -
-
Telephone # of C . ontact Person: 2--)-3U (DL4:n
Estimated Value of Project: kDu)'
APPLICANT: DO NOT WRITE BELOW THIS LINE
N
Submittal
Req'd
Rec'd
TRACKNG
PERMrrFEES-
Pl�n Stu
Plan Check submitted
item Amount
Structural Cales.
Reviewed, ready for corrections
Plan Check Deposit.
Truss Cates.
Called Contact Person
Plan Check . Balance.
Tide 24 Calci.
Plans picked up
Construction
Flood plain pla a
Plans rtsub mitted'.
McchafikM
Grading plan_
2-! Review, ready for correctionslissue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grout Deed
Plans picked up
B.O.A. Approval
Plans resubmitted
Grading
IN IROUSE-,
I k4 Rxiew, ready for correctionsrissue
Developer Impact Fee
Planning Approval-
Called Contact Person
AXP.�-
Pub. Wks. Appr
Date of permit Issue
School Fees
tal Permit Fees
Simplified Prescriptive Certificate of Compliance: 2008 Residential HVA C Alterations CF -IR -ALT -HVAC
Climate Zones 10 to 15
Site Address: 78375 Terra Cotta Crt
Enforcement Agency: Cky .1 U0.1n.
Date: 1-30-13
Permit #:
Conditioned Floor
Equipment Type[
List Minimum EfficienCY2
Duct insulation 'requirement
Area
Thermostat
Packaged Unit
Furnace
13AFUE961.
COP-
Over 40 R of ducts added or
replaced in unconditioned space
Served by system
E] Setback
(If not already
Indoor Coil
IMSEER`13
HSPF
R 6 (CZ 10-13)
1200 sf
prevent, must be
C C ondensing Unit
OEER
Resistance
BR 8 (CZ 14-15)
installed)
Other klf� 121IM17
1. Equipment T�pe; Cdoi ose the equipment being installed; if more than one system, use another CF-1R-ALT-HVACjbr each system.
2. Minimum Equipment Efficiencies: 13 SEER, 78% AFUE, 7.7HSPFfor 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 -JR and CF -6R shall also be on site for final inspection.
E] 1. HVAC Changeout
Required Forms:
CF-6Rforms: MECH-04, MECH-2 I -HERS and (for split systems) MECH- 25 -HERS
• All HVAC Equipment replaced
CF -4R forms: MECH- 21 and (for split systems) 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
• Furnace
For Split Systems: Duct leakage < 15 percent; RC, CCA �: 300 CFTVVton(Minirnum Air Flow Requirement), TNIAR
For Packaged Units: Duct leakage < 15 percent
Exempted from duct leakage testing if
1. Duct system was documented to have been previously seated 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
2. New HVAC System
Required Forms:
Cut in or Changeout with new
CF -6R forms: 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 equipment)
For Split Systems: Duct leakage < 6 percent; RC, CCA � 350 CFM/ton, FWD, TMAH, STMS, and either HSPP or PSPP.
For Packaged Units: Duct leakage < 6 percent
3. New Ducts with/or without Replacement Required Forms:
Includes replacing or installing all new ducting CF -6R forms: MECH-04, MECH-20-HERS,and (for split systems) MECH-25-HERS
and/or outdoor condensing unit and/or indoor coil CF -4R forms: MECH-20 and (for split systems) MECH-25
and/or furnace. No or some equipment changed.
For Split Systems: Duct leakage < 6 percent, RC, CCA � 300 CFlvvton, TMAH
For Packaged Units: Duct leakage < 6 percent
_E74. New Ducting over 40 feet
Required Forms:
9 Includes adding or replacing more than 40
CF -6R forms: MECH-04, MECH-2 I -HERS CF -4R forms: MECH-21
I inear feet of duct in unconditioned space.
For split stem or packaged units: Duct leakage < 15 percent
ff EXCEPTION: Existing duct systems constructed, insulated or sealed with asbestos.
Contractor (Documentation Author's /Responsible Designer's Declaration Statement)
0 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.
0 1 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 I and 6 of the California Code of Regulations.
0 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 subm�itted to the enforcement agency f r I with the permit application.
Name: Jane Recktenwaid
Signature:
Company: Dial One
Date: 1-30-2013
Address: 3030 Myers St
License: 878533
F Ftyl-s- tatelZiP: Riverside, CA 92503
Phone: 951-276-9744
MAR Po�;do�t;�l 17--
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