12-0255 (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: 3/ 19/12
Application Number: x,12 000.00255! ` Owner:
Property Address: 79'242—,S �`SUNSET RIDGE DR STEPHEN MITCHELL
APN: 604-110-073-113 -19903• 79292 NORTH'SUNSET.RIDGE s
Application description: MECHANICAL LA QUINTA, CA 92253
t Property Zoning: LOW DENSITY RESIDENTIAL + t
Application valuation_: 5465
• J:
Contractor: r'm�
Applicant: Architect or Engineer: PREFERRED_ PLUMBING HTG I.-�--�
P.O. BOX 5120 t 4
CA 92263
(760)322-3173 t . °-�#,�a�� � J ���'� . 1 •
/ Lic. No.: 457554=--
..
LICENSED CONTRACTOR'S DECLARATION - WORKER'S COMPENSATION DECLARATION
Thereby affirm under penalty of perjury that I am licensedunder-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 andF7ofessionals Code, 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 '
Li5pmige Class: C10 C16 . C2 Lic ns 457554 .for by Section 3700 of the Labor Code,, for the performance of the work for which this permit is
issued.
Date: J %r ntractor: _ �,... I have and.will maintain workers' compensation insurance, as required by Section 3700 of the Labor
wCode, for the performance of the work for which this permit is issued. My workers' compensation
WN -BUILDER DECLARATION insurance carrier and policy number are:
I hereby affirm under penalty of perjury that I am a pt from the Contractor's State License Law for the Carrier EVEREST NATL Policy Number 7600006445121
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 ome 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 I should be rhe subject to thew s' compensation provisions of Section
License Law (Chapter 9 (commencing with Section 7000),of Division 3 of the Business and Professions Code) or 3700 of e Labor Code 11 fort wit k mp it tho .provisi�orts. -
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).: ate: 3 / / Applicant:-
(_ 1
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 WARN NG: AILURE TO SECURE WORKERS' COMB N ATION COVERAGE IS UNLAWFUL, AND SHALL
r • •Contractors' State License Law does not apply to an owner ofpropertywho builds or improves thereon, SUBJECT N 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 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. '
(_ 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 contractorls) 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 becomes null andvoid if work is not commenced
within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject
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 formation is correct. I agree to comply with all
work for which this permit is issued (Sec. 3097, Civ. C.)• city and county ordinances a state•laws relating to building struction, and hereby riz epresenta[ives
of this county to enter upo the above-mentioned property f-inspecti p pose
Lender's Name:
te: _Si ature (Applicant or Agent):
Lender's Address:
LQPERMIT - -
Application Number, 12-00000255
' Permit MECHANICAL
Additional desc
" Permit Fee 40.50
-Plan Check Fee
10.13
Issue Date . . . .
Valuation
0
Expiration Date 9/15/12
Qty Unit Charge Per.
Extension
BASE
FEE
•15.00.
1.00 9.0000'EA MECH
FURNACE c.=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 FURNACE & "
CONDENSING UNIT. 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
Simplified Prescriptive Certificate of Compliance: 2008 Residential RVA C Alterations CF -IR -ALT -HVAC
Climate Zones 10 to 15
Site Address: �Q
l �nse�- Q. /
Enforcement Agency:
Date:
3-Ili-�a
Permit #:
�
Conditioned Floor
Equipment T et
List Minimum Efficiency,
Duct insulation requirement
Area
Thermostat
❑ Packaged Unit
umace
❑ AFUE
❑ COP
Over 40 ft of ducts added or
Setback
❑ Indoor Coil
�BEERJS
"SPF
replaced in unconditioned space
❑ R 6 (CZ 10-13)
Served by system
1, O0() sf
nor already
present, resent, must be
Condensing Unit
MJEER 11
Resistance
❑ R 8 (CZ 14-15)
installed)
❑ Other
1. Equipment Type: Choose the equipment being installed; if more than one system, use another CF -1 R -ALT -HVAC far 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 CF4Rs allowed) are filled out and
simd. Beginning October 1, 2010, a registered copy of the CF -1R and CF -6R shall also be on site for final inspection.
HVAC Changeout
Required Forms:
• All HVAC Equipment replaced
CF -6R forms: MECH-04, MECH-2I-HERS and (for split systems) MECH- 25 -HERS
CF4R forms: MECH- 21 and fors lits stems) MECH-25
• Condenser Coil and/or
CF -6R forms: MECH-2I-HERS and (for split systems) MECH= 25 -HERS
• Indoor Coil and/or
CF4R forms: NISCH- 21 and (for split systems) MECH-25
• Furnace
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 ducts stems are constructed, insulated or sealed with asbestos
❑ 2. New HVAC System
Required Forms:
• Cut in or Changeout with new
CF76R forms: MECH-04, MECH-20-HERS,and (for split systems) MECH-22-HERS, and MECH-25-HERS
ducts: (all new ducting and all
CF4R forms: MT -CH 20-, and (for split systems)MECH722, 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
O 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 -411 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
I
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 performanoe 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 C&rtificate of Compliance are consistent with the information documented on other applicable compliance forms, worksheets;
calculations, p1w a d specifications submitted to the enforcement agency far approval with the permit a lication.
Name: LSA ✓�� �.
Signature:
Company: (' �
� /
Date:
• �-'t !J
Address:v� JLQ
License:
City/State/Zip: �,^ �.-'1 .'• •, �l a
Phone: .7333 / 7�
zvuo nestaenrutt Lompuance Porms March 2010
Bin #
City of La Quinta
Building at Safety Division
' P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Application and Tracking Sheet
Building Permit App g
Permit #
�- :.
Project AddressCl� N. j� n v
Owner's Name: S
A: P. Number
Address:Or
Legal Description _ :. ; :` ,.
referred. Air:= Condit"inning dba
Con a(tor:preferred: Plumbin - Heatin &Ai
City, ST, Zip:
Tele hone: 1/ ' !
p l9L 3� 3
Project Description:
Address: pp:. Box '5j12.0.:.'
City,.ST;"' p:p.alm;::,5` r. % s, CA: -92263
0,
Telephone:. (. 7.6 0;:)= : 3:2>.2,='3.17 3
State Lie.:# 4 5:745'5.`4 :::.:... City Lie. #'
r_ .1 e
Address:
City,'.ST' Zip:.,.
Telephone:.,. - ::: ::• .
State.Lic: #.: '._ ' .. `N; :` : `,>'
ro:
Construction Type: Occupancy:
Project; type (circle on New Add'n Alter Repair Demo
Stories:NameCaf # Units:
Telephone•#-Of,Contact:Persont . '
Estimated Value of Project: p
s,. ::; ;': •'.;`::: APPLICANT: DO NOT WRITE BELOW THIS LINE
Req!d
Recd
TRACMG:
PERMYT FEES
Plan_Set@ ; ; y '
Plan Check ININnitted
Ite
Amount
strict, ral Calcs:.
Reviewed, ready for corrections
Pla Check Deposit
Truss'Cales...:.: -
Called Contact -Person
Pia Check Balance
Enei gy Calcs, :
Plans Ricked up
Con tructlon
Flood plain plan '.
'.
Plans.resubmitted
Me apical
Grading: plan'
2nd Review, ready for'correctlons/issue
Elec trical
Subcontactor List
Called Contact Perqon
Plumbing
Grant Deed
Plans picked up
S.M L
H.O.A. Approval .
Plans resubmitted
Gra ing
IPi HOUSE:=
''d Review, ready for corrections/issue
Developer Impact Fee
Planntgg Approval.
Called Contact Person
AXI .P.
Pub. WV 9_ Appr
Date of permit Issue
school Fees '.
Totgl Permit Fees -
RY /' /r e<