12-1163 (MECH)P.O.
BOX 1504 VOICE (760)377-7012
78-495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
..�-...-.r - ,� Date:. 10/02/12..
Application Number: 12-000.01163_ Owner:. ,
Property Address: 78895 'SUNBROOK LN BRUCE BLOMGREN REALTY
APN: 604-292-002-23 -23995 74996 HIGHWAY 111 '
Application description: MECHANICAL e n INDIAN WELLS, CA 92210
Property Zoning: LOW DENSITY RESIDENTIAL rZ u
Application valuation: 5236. D
OCT2 20' Contractor:
Applicant: Architect or Engineer: - DESERT AIR CONDITIONING, INC.
LIYYOFLAQUINTA 590.WILLIAMS ROAD :.
DE``'11 PALM SPRINGS, CA 92264-
(760)323-338a J r;
. Lic.'No.: 276586
---'----------------- --------------'----=-�-- ----=-----------------------------=----------.----------
•LICENSED CONTRLoyisions
CLARATION WORKER'S COMPENSATIONDECLARATION '
I hereby affirm under penalty of perjury that I am lic sed nof C apter 9 (commencing with - I h_ ereby affirm under penalty of perjury one of the following declarations:Section 7000) of Divi ion 3 of the Busin nd P ass' nalmy Lic [ase is in full force and effect. I have and will maintain a certificate of consent to self-insure for workers' compensation, as provided
s• �C2 C43 L76 r86 - for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
issued.i
ate: ontractor: ,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
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 theCarrier EVEREST NATL Policy Number 7600007908121
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 y6hich this permit'1F 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 su a to workers' c mpensation 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 sho ecom ubj t he rkers' comp nsation provisions of Section . - • ,
_ License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or , 37 of the Labor C de shat h the w' se visions. - that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by )A . • Y ,
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).: te: ant:
( 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 - 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, 4 - 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 1$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. ` -
t 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 - - -
( ) 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 contractor(s) licensed 1. Each person upon whose behalf this application is made, each person awhose request and for - -
pursuant to the Contractors' State License Law.). - I t•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 and void if work is not commenced
'- within 180 days from date of issuance of such permit, or cessat' f work for 180 s will subject ;
+ - CONSTRUCTION LENDING AGENCY permit to cancellation. ,
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 above inf do is rect. I agree to'co ply with all . .
work for which this permit is issued (Sec. 3097, Civ. C.). city and county ordinances and state laws relating to o ion, ereby authorize rep sentatives
of this county toe ijupon the above-mentioned-grope o ion p
Lender's Name: �n.t.re • (Applicant or Agent
Lender's Address:
LQPERMIT
Application Number 12-00001163 '
Permit . ... MECHANICAL 1 -
Additional desc `
Permit Fee 40.50 Plan Check Fee 10.13
4 - -
Issue Date Valuation 0
Expiration Date 3/31/13 f
4 3 Qty Unit.Charge Per Extension
BASE FEE. 15.00,
t 1.00• 9.0000 EA MECH FURNACE <=100K 9.00,
1.00. ';-1 16.5000 EA' MECH B/C >3-15HP/>100K-500KBTU 16.50-
' - ---- - - - - -- - - -- ---'-
- - - - - -- ----- - - - --- ----------------- - - - - -> -
f Special.Notes and Comments'? ;
!, f HVAC:,CHANGE-OUT: REPLACE 4 -TON SPLIT
SYSTEM -AT GROUND LEVEL. 2010 CODES. ,.r
- - -- - - - -- - - -- - - - - --
Other Fees .; . . . BLDG STDS ADMIN (SB1473), -- -- 1.00 �•. f
t
Fee summary Charged Paid • Credited- Due
-------------------------------------------------------
1 Permit Fee Total •40.50 • .00 .00 • 40.50 -
Plan Check Total' 10.13 .00 .00 10.13' ,
' Other Fee Total1.00 .00 .00 1.00
Grand Total 51.63. .00. .00 .51: 63
At
LQPERMIT r. 4 . • + : - , y
Reg: 212-A0048486A-00000000-0000` Registration Date/Time: 2012/08/31 14:10:58 'HERS Provider:'CalCERTS, Inc.'
2008'Residential Compliance Forms `, July 2010
Simplified'Prescriptive Certificate of Compliance: 2008 Residential HVAC Alterations ' CF -IR -ALT -HVAC
Climate Zones 10 - 15
Site Address: Enforcement Agency: Date: Permit #:
78-895 SUNBROOK La Quints, CA 92253. City of,La,Quinta Aug 31, 2012, *�
Duct insulation ' Conditioned Floor
Equipment Typel List Minimum Efficiency2 ; requirement Area Thermostat
❑ Package Unit * -;• '-
® Furnace ® AFUE 78% ❑ COP . ® Setback , 4
® Indoor Coil -. ❑ R 6,(CZ 10-13) Served by system
® SEER 13.0 ❑ HSPF ❑ R g (CZ 14-15) 1600 sf If not already present, must be
® Condensing Unit ❑ EER ❑ Resistance installed) ,
❑ Other s •,'�, i
1. Equipment Type: Choose the equipment being installed; if more than one system, use another CF -IR -ALT -HVAC for each system.
2. Minimum Equipment Efficiencies: 13 SEER,- 78% AFUE, 7.7HSPF for 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 Wthe 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 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. 7 a
. Condenser Coil and /or CF -6R forms: MECH-04, MECH-2I-HERS and (for split systems),MEC_H-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 CFM/ton (Minimum Air. Flow Requirement), TMAH
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 ' • t
[14. Thesystem=will not be Ducted (ie�Ductless; Min i-Split_System),(AIsoiExempt from�Refrigerant-Charge) :
❑ 2. New HVAC System Required Forms: )', j • �* ,'-!P.:( t, Y
• Cut in4or Changeout with ' ' 'µ' ' & l �� � 4 -
CF -6R forms: ME -CH -04 MECH-20-HERS, and °(for split systems) MECHz22-HERS and
new ducts:.(all new _ <
ductin and all new MECH-25--HERS y '
'equipment),
CF 4R forms: MECH-20, and (forsplit systems) MECH-22, end MECH-25
if) ch ,, , � jf.., --+ : r . a ,J " .4, f f
For Split Systems: Duct leakage < 6 percent; RC, CCA >_.350 CFM/ton, FWD, TMAH, STM S, and either.HSPP'or PSPP.
For Packaged Units: Duct leakage < 6 percent
❑ 3. New Ducts with/or without .. Required Forms:`;, ,
Replacement I '
. Includes replacing or installing all new v r • f
ducting and/or outdoor condensing unit CF -6R forms:,MECH-04,°MECH-20-HERS, anti for split systems) MECH-25-HERS
and/or indoor coil and/or furnace. No it some CF -4R forms: MECH-20 and (for split systems) MECH-25 i
equipment changed.
For Split Systems: Duct leakage < 6 percent; RC, CCA >_ 300 CFM/ton, TMAH
For Packaged Units:'Duct leakage <;5'percent
❑ 4. New Ducting over 40 feet Required Forms:. , :�. ,.
. Includes adding or replacing more than 40 CF -6R forms: MECH-04, MECH-2I-HERS +x r }
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— — . ti , • , � , - , - ' •
• 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 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: Jacqueline Zabik' • • Signature: Jacqueline Zabik
Company: DESERT AIR CONDITIONING INC •� Date: Aug 31, 2012
Address: 590 WILLIAMS ROAD 4 �- License: 276586
City/State/Zip: PALM SPRINGS/
CA / 92264' . ' ° ,, •. - r Phone: (760) 323-3383
Reg: 212-A0048486A-00000000-0000` Registration Date/Time: 2012/08/31 14:10:58 'HERS Provider:'CalCERTS, Inc.'
2008'Residential Compliance Forms `, July 2010
Simplified'Prescriptive Certificate of Compliance: 2008 Residential HVAC Alterations ' CF -IR -ALT -HVAC
Climate Zones 10 - 15
Site Address: Enforcement Agency: Date: Permit #:
78-895 SUNBROOK La Quints, CA 92253. City of,La,Quinta Aug 31, 2012, *�
Duct insulation ' Conditioned Floor
Equipment Typel List Minimum Efficiency2 ; requirement Area Thermostat
❑ Package Unit * -;• '-
® Furnace ® AFUE 78% ❑ COP . ® Setback , 4
® Indoor Coil -. ❑ R 6,(CZ 10-13) Served by system
® SEER 13.0 ❑ HSPF ❑ R g (CZ 14-15) 1600 sf If not already present, must be
® Condensing Unit ❑ EER ❑ Resistance installed) ,
❑ Other s •,'�, i
1. Equipment Type: Choose the equipment being installed; if more than one system, use another CF -IR -ALT -HVAC for each system.
2. Minimum Equipment Efficiencies: 13 SEER,- 78% AFUE, 7.7HSPF for 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 Wthe 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 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. 7 a
. Condenser Coil and /or CF -6R forms: MECH-04, MECH-2I-HERS and (for split systems),MEC_H-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 CFM/ton (Minimum Air. Flow Requirement), TMAH
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 ' • t
[14. Thesystem=will not be Ducted (ie�Ductless; Min i-Split_System),(AIsoiExempt from�Refrigerant-Charge) :
❑ 2. New HVAC System Required Forms: )', j • �* ,'-!P.:( t, Y
• Cut in4or Changeout with ' ' 'µ' ' & l �� � 4 -
CF -6R forms: ME -CH -04 MECH-20-HERS, and °(for split systems) MECHz22-HERS and
new ducts:.(all new _ <
ductin and all new MECH-25--HERS y '
'equipment),
CF 4R forms: MECH-20, and (forsplit systems) MECH-22, end MECH-25
if) ch ,, , � jf.., --+ : r . a ,J " .4, f f
For Split Systems: Duct leakage < 6 percent; RC, CCA >_.350 CFM/ton, FWD, TMAH, STM S, and either.HSPP'or PSPP.
For Packaged Units: Duct leakage < 6 percent
❑ 3. New Ducts with/or without .. Required Forms:`;, ,
Replacement I '
. Includes replacing or installing all new v r • f
ducting and/or outdoor condensing unit CF -6R forms:,MECH-04,°MECH-20-HERS, anti for split systems) MECH-25-HERS
and/or indoor coil and/or furnace. No it some CF -4R forms: MECH-20 and (for split systems) MECH-25 i
equipment changed.
For Split Systems: Duct leakage < 6 percent; RC, CCA >_ 300 CFM/ton, TMAH
For Packaged Units:'Duct leakage <;5'percent
❑ 4. New Ducting over 40 feet Required Forms:. , :�. ,.
. Includes adding or replacing more than 40 CF -6R forms: MECH-04, MECH-2I-HERS +x r }
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— — . ti , • , � , - , - ' •
• 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 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: Jacqueline Zabik' • • Signature: Jacqueline Zabik
Company: DESERT AIR CONDITIONING INC •� Date: Aug 31, 2012
Address: 590 WILLIAMS ROAD 4 �- License: 276586
City/State/Zip: PALM SPRINGS/
sin .#
Citi}/ Of %a Qumb
Builtiing at Safety Division
Box 1504,78-49S Calle Tampico
4.Quinta, CA 92233 -:(760) 777 7012
Budding Permit -Application' and Tracking Sheet
PerrWt #P.O.
1 �p�
ProjectAadnss: 7.$-$95 SUNBROOK
Owner's Name:. BRUCE BLOMGREN REALTY
A- P. Number:
Address: 74-996 HIGHWAY 111
Legal Description:
Contractor. DESERT AIR CONDITIONING, INC
City, ST, Zip: I N D IAN WE LLS; CA 92210
Telephone: 760-779-1653
Address: 590 WILLIAMS RD -
Project Description:
City, ST, Zip: PALM SPRINGS, CA 92264
REPLACE 4 TONSPLIT SYSTEM ON
Telephone: 760-323-3383
GROUND LIKE FOR LIKE'.
State Lia # : 276586 City Lie-. 1k 363
Arch., Eng , Designer
Address:
City., ST, Zip:
Telephone:
State Lia #:
Name of Contact Person: JACQUELINE RATLIFF
Construction Type:. MECH Occupancy:
Project type (circle one): New Add'n Alter Repair, Demo
Sq. Ft:
# Stories: #Univ
Telephone # of Contact Person: 760-323-3383
Estimated Value of Project: '$5,236.00
APPLICANT: DO NOT WRITE BELOW THIS UNE '
N
Submittal •
ReWd
Rcc'd
TRACKING
PERMIT FEES
Plan Sets
Pian Check submitted
Item Amount
Structural Cates.
Reviewed, ready for corrections
Plan Check Deposit. .
Truss Calcs.
Called Contact Person
Plan Check Balance
Title 24 Cales.
Plans picked up
Construction
Flood plain plan
Plans resubmitted'
Mecbarilcal
Grading plan
2id Review, ready for corrections/issue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans pled up +
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN "OUSE:-
''d Review, ready for corrections/hsne ,
Developer Impact Fee
Planning Approval.
Called Contact Person
A".P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees