10-0738 (MECH)f
P.O. BOX 1504 '&tit 4 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: 8/09/10 "
Application Number: 10-00000738 Owner:
Property Address: 57870 TROON WY JIM WILLIAMS
APN:. 762-360-010- - - 57-870 TROON WAY
Application description: MECHANICAL LA QUINTA, CA 92253
Property Zoning: LOWDENSITYRESIDENTIAL
Application valuation: 4500
Contractor:
Applicant: Architect or Engineer: J ANTHONY PLUMBING HEAT/AIR
72216 -NORTH SHORE STREET, #101
THOUSAND PALMS, CA -92276
(760)343-2121
Y; Lic. No.: 777794
LICENSED CONTRACTOR'S DECLARATION - WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapte (commencing with I hereby affirm under penalty of perjury one of the following declarations:
Section 7000) of Division 3 of the Business and Professionals Code, and my Lic is in full force and effect. _ I have and willmaintain a certificate of consent to self -insure for workers' compensation, as provided
Licens Class: C20 -C36 n No.: 94 for by Section 3700 of the Labor Code, for the a performance of the work for which this permit is
issued.
e:�ontractor: � have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor
&.29
Ili 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 am exempt from the Contractor's State License Law for the Carrier STATE FUND Policy Number 1932451
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 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 become subject to the workers' compensation pr sions of Section
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or �4L37.CO of the L bor Code, I s all fo comply with those provisiothat he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 byXany applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars (5500).: DateEJ)icon:
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 WARNING: FAILURE TO SECURE WORKERS' COMPENSATION 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 arenotintended 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.).
(_) 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 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: A`
Lender's Address:
LQPERMIT
v
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 representative
of thisA ou y to /ncter upon he above-mentioned property for in tion purpo s. _
ate (!P g e (Applicant or Agent):
Application Number . . . . 10-00000738
Permit MECHANICAL
Additional desc .
Permit Fee . . . . 30.50 Plan Check Fee
7.63
Issue Date . . Valuation . . .
. 0
Expiration Date 2/05/11. -
Qty Unit Charge 'Per
Extension
BASE FEE
15..00
1.00 9.0000 EA _ MECH B/C <=3HP/100K BTU
9.00
1.00 6..5000 EA MECH OTHER MECH EQUIPMENT
6.50
Special Notes and Comments
INSTALL NEW 5 TON CONDENSER AND MATCHING
COIL. 2007•CODES.
-----------------------------------------------------------------------------
Other. Fees . . . . . . . . . BLDG STDS ADMIN (SB147.3)
1.00
Fee summary Charged Paid Credited
Due
Permit Fee Total 30.50 .00 .00
30.50
Plan Check Total 7.63 .00 .00
7.63
.Other Fee Total 1.00 .00 .00
1. 0,0
Grand Total 39.13• .00 .00
39.13
LQPEPMIT
.
3
Simplified Prescriptive Certificate of Compliance: 2008 Residential HVACAlterations CF 1R ALT HVAC
Climate Zones 10 to 15
S' ddress:
�� v TI�rJ� �A�
Enjorcentent Agency:
Date
�
'Permfl #:
�
/o-1 8
Equipment T
List Minimum Efficiency'
U
Duct insulation requirement
Conditioned Floor
Area
Thermostat
❑ Packaged Unit
❑ Furnace
❑ AFUE ❑ COP
Over 40 ft of ducts added or
�etback
AR Indoor Coil
.�SEER� ❑ HSPF
replaced in unconditioned space
Served b s
Y stein Y .
(/jnor already
J0 Condensing Unit
_
❑ EER❑Resistance
❑ R 6 !(CZ 10-13)
sf
present. must be
❑ Other
E3 R 8 (CZ 14-15)
installed)
1. Equipment Type: Choose the equipment being installed; ifmore than one system, use anotherCF-1R-ALT-HVACjoreach system.
2. Minimum Equipment Ej7lciencies: 13 SEER, 78%AFUE, 7.7HSPFfortypical 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 -1R and CF -6R shall also be on site for final inspection.
1. HVAC Changeout 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 litsystems),MECH-25
('*-Condenser Coilan
• lndoo Coil n
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 2!'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. Existin ducts stems are constructed, insulated or sealed with asbestos
❑ 2. New HVAC System
Required Forms:
• Cut in (a Changeout with new
ducts: (all new ducting and all
CF -6R forms: MECH-04 MECH-20-HERS and for lit
( 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 2:350 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 forts: 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 CFMRon, TMAH
For Packaged Units: Duct leakage < 6 percent
❑ 4. New Ductin 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-21- CF -4R forms: MECH-21
For split system or packaged units: Duct leakage < 15 percent .. "
❑ EXCEPTION: Existing duct systems constricted, insulated or sealed with asbestos.
Contractor (Documentation Author's /Responsible Designer's Declaration Statement)' r
• I cenify that this Certificate of Compliance documentation is accurate and complete. a
• 1 am eligible under Division 3 of the California Business and Professions Code to accept responsibility for the design identified on this Certificate of Compliance.
• 1 cenify 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 information docu. i on other appli lance forms, worksheets,
calculations; and s cifications .�
plans submitted to the enforcement a en fora royal with
Name:
Signature:
Company:
Date: >
am/ / G 0
7///0
(
Address: J AMONY SERVICES
/i
License:. -77-7
01
City/Statc/Zip: THOUSAND PALMS, CA 92276
Phone:, 760 Z I .'Z i
206 Residential Compliance Forms March 2010
Bin #
City of La Quint'a
Building 8r Safety Division
Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #P.O.
i01 v
Project Address:
Owner's Name: __.._ W, l
A. P. Number:
Address:
Legal Description:
City, ST, Zip:
Contractor:
Telephone• � ; `
Address:l-Z—L`-(:;)
(MS1bkt(t6 (
Project Description:
City, ST, Zip: •
NNV PibLI `S C Zzrg-
6ki
Telephone
State Lie. # :7 1-1-11
uz)'
—1-1
''
City'Lic. #; l(j`S
A [ Q 1
Arch., Engr., Designer. - ..
Address:
City., ST, Zip:
Construction Type: Occupancy:
Telephone:
State Lie. #:
;' .r
Project type (circle one): New Add'n Alter Repair Demo
nits:
Name of Contact Person eva J[
Telephone # of Contact Person-7
3 Z (
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structurak Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance
Title 24 Coles.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanlcal
Grading plan
2i° Review, ready for corrections/issue
Electrical
Subcoutactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
'd Review, ready for correctionsNssue
Developer Impact Fee
Planning Approval
'Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees