11-0656 (MECH)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 11-00000656
Property Address: -55855 TURNBERRY WY
APN: 767-560-003- -
Application description: MECHANICAL
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 13327
Applicant:
(f4t� °Fat4aQ"
Architect or Engineer:
a l A -
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of.perjury that I am liI�Pl visions of Chapter 9 (commencing with
Section 7000) of Division 3 of the Business and Pr and my License is in full force and effect.
License Class: C20 No.: 686310
ate: 16 I \ Contra r:
OWNER -BUILDER DECLARATION
I hereby affum 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 ($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 _ 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 contractorls) licensed
pursuant to the Contractors' State License Law.).
(_ 1 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: {^,�
Lender's Address:
LQPERMIT
Owner:
DAWN LISK
55855 TURNBERRY WAY
LA QUINTA, CA 92253
Contractor:
GENERAL AIR CONDITIONING
31170 RESERVE DRIVE
THOUSAND PALMS, CA 92276
(760)343-7488
Lic. No.: 686310
VOICE (760) 777-7012
_ FAX (760) 777-7011
INSPECTIOW(760) 777-7153
Date: 6/16/11
JUIN r6 1011
CITYAF i q QUINTA
_
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
Y. issued.
I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor
-I- Code, for the performance of the work for which this permit is issued. My workers' compensation
insurance carrier and policy number are:
Carrier EVEREST NATL Policy Number 7600006147101
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 bme subject to the workers' compensation laws of California,
and agree that, if I should beco ubject to the workers' compensation provisions of Section
3700 of th Labor Code, I shall pfthwith comply with those provisions.
ate:6�6 pplicant:
WARNING: FAILURE TO SECURE WO � RS'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 i or ation is correct. I agree to comply with all
city and county ordinances and state laws relating to building con tion, and hereby authorize representatives
of this county to enter upon the above-mentioned property for iftion tion purposes.
Date: 6 Signature (Applicant or Agent):
Application Number . . . . . 11-00000656
Permit . .
. MECHANICAL
Additional desc .
Permit Fee
40.50
Plan Check Fee
10'.13
Issue Date . .
.
Valuation . . . .
0
Expiration Date
12/13/11
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
5 TON HVAC CHANGE
OUT, 13 SEER.
2010
CODES.
--------------------------------------------------------------=-------------
Other Fees . . .
. . . . . BLDG STDS ADMIN (SB1473)
1.00
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
LQPERMIT
Sim lified Prescriptive Certificate of Compliance: -2008 Residential HVAC Alterations CF -IR -ALT -HVAC
Climate Zones 10 to 15
2008 Residential Compliance Forms a.t.,,-ol, 7n to
Site Address:
Enforcement Agency:
Date:
Permit #:
Z
Conditioned Floor
—Equipment T et
List Minimum Efficiency
Duct insolation requirement
Area
Thermostat
❑ Packaged Unit
[[mace
❑ AFUE B0 %
❑ COP
Over 40 ft of ducts eor
added
XSetback
ndoor Coil
❑SEER 13
❑ HSPF
replaced in unconditioned space
Served by system
(lfnot already
Condensing Unit
❑ EER / /
❑ Resistance
❑ R 6 (CZ l0-13)
sf
present, nmst be
❑ Other
❑ R 3 (CZ i4-15)
installed)
1. Equipment Type: Choose the equipment being installed; if more than one system, use another CF- IR -AL T -HVA Cfor each system.
2. Minimtttn Equipment Efficiencies: 13 SEER, 73% AFUE, 7.7HSPF for h piccd 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 mast 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 -611 and registered CF -4R forms (no hand filled CF-4Rs allowed) are filled outand
ed. Be innin October I, 2010, a re istered co of the CF -IR and CF -6R shall also be on site for final ins ection.
. HVAC Changeout
fI
Required Forms:
• All HVAC Equipment replaced
CF -6R forms: MECH-04, MECH-2I-HERS and (for split systems) MECH- 25 -HERS
CF -4R forms: MECH- 21 and fors lits stems) MECH-25
• Condenser Coil and /or
• Indoor Coil and/or
CF -6R forms: MECH-2I-HERS and (for split systems) MECH- 25 -HERS
• Furnace
CF -4R forms: MECH- 21 and (for split systems) MECH-25
For Split Systems: Duct leakage < 15 percent; RC, CCA > 300 CFM/ton(Minimum Air Flow Requirement), TMAH
For Packaged Units: Duct leakage < 15 percent
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
❑ 2. New HVAC System
Required Forms:
• Cut in or Changeout with new
ducts: (all new ducting and all
CF -6R forms: MECH-04, MECH-20-HERS,and (for split systems) MECH-22-HERS, and MECH-25-HERS
new equipment)
CF -4R forms: MECH 20-, and (for split systems)MECH-22, and MECH 25
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 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
CF -4R forms: MECH-20 and (for split systems) MECH-25
coil and/or furnace. Not all 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
linear feet of duct in unconditioned space.
CF -6R forms: MECH-04, MECH-2I-HERS CF -4R forms: MECH-21
For split system or packaged units: Duct leakage < 15 percent
❑ EXCEPTiON: Existing ducts stems 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 I and 6 of the California Code of Regulations.
• The design features identified on this Certificate of Compliance are consistent with the' orm, tion documented on other app] ic ompliance forms, worksheets,
calculations, plans andspecifications submitted to the enforcement agency for appro al with t e pennit application . lication.
Name: �l,eeh
Sig tore:
Company:
0&il-e(-z41\r ConA;�o7t
Date:
(0 15 l�
Address:
3!-70
License:
se:
&076o3(v
City/State/Zip: -T-� Ou�SG� G� �I
Phone: 760-31,t13_-74fr2
2008 Residential Compliance Forms a.t.,,-ol, 7n to
Dill H
City of La Quinta
Building &r Safety Division
`
Permit #
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
1�
Building Permit Application and. Tracking Sheet
Project Address: T4f -ii be Owner's Name:
A. P. Number:
Address:
Legal Description:
City, ST, Zip: La ,5�da- C Q
Contractor:Co PnQal—
Telephone: i (� �(o
;;,-:'s'1? .iS i•�y: r:` .
::`:
Address: 3
Project Description:
City, ST, Zip:'—�"�
Telephone: '�
O :.•.'f•>':»:>>::><>
':-:ni g:.::.::: «y. :; ••'•:.: {,y.;::; >
'•City
�, �. (.� `♦i♦C� G
State Lic. # : 3 �
Lie.• A.
Arch., Engr., Designer:
Address:
City., ST, Zip:
Telephone:*s>»4
�.-.<•:••;; ��:;.>.<>�;;;:«:;;':;f�;;::;:::..
Construction Type: Occupancy
cy:
State Lic. #::;...
. Project type (circle one): New Add'n Alter Repair Demo
........:" <: >s.:•.<'«>:':>s
f
Name of Contact•Person:
Sq. Ft.:
#Stories:
#Units:
Telephone # of Contact Person:
Estimated Value of Project:
APPLICANT: DO. NOT WRITE. BELOW THIS LINE
N Submittal Req'd
Recd TRACKING PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance
Title 24 Calcs.
Plans picked up -
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2" Review, ready for corrections/issue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up.
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
7rd Reyiew,.ready for corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
Schodl Fees
Total Permit Fees