11-0554 (MECH)W
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: �11-00000554
Property Address: -'78810 SUNBROOK' LN
APN: '604-291-001-1 -23995 -
Application description: MECHANICAL
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: • 4397
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 License No.: 681746
1
te: / tractor:
OWNER -BUILDER DECLARATION
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 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 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 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: 1
Lender's Address
LQPERMIT
Owner: .
PETRI RICHARD F
78810 SUNBROOK LANE
LA QUINTA, CA 92253
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 5/27/11
Contractor:
ADVANCED AIR COMFORT, I d Q
42335 WASHINGTON ST, •S' �32
�'T
PALM DESERT, CA 92211 r
(760)360-5955 MAY�!
Lic. No.: 681746 £ f ��'�� J
------------------
WORKER'- 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.
_ 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
insurance carrier and policy number are: '
Carrier EXEMPT Policy Number EXEMPT
_C.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, 1 shall forthwith comply with those provisions.
'ant:
WARNING: FAILURE TO SECURE WORKERS' 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 ofsuch 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
tto/enter upon th above-mentioned property
�zfor
riinspection purposes. .
nature (A:PPlicant or Agent): e _
LQPERMIT
Application Number 11-00000554
Permit MECHANICAL INV FEE
Additional desc .
Permit Fee . . . . 63.00 Plan Check Fee
7.88
Issue'Date. Valuation
0
Expiration Date . 11/23/11
Qty. Unit Charge Per
Extension
BASE FEE
30.00
1.00 33.0000 EA MECH B/C >3-15HP/>100K-500KBTU
33.00
Special Notes and Comments
HVAC CHANGE -OUT CONDENSER (14.5 SEER) &
EVAP. COIL. INVESTIGATION'FEE ASSESSED
.PER 1997 UNIFORM ADMINISTRATIVE CODE
§304.5 FOR WORK BEGUN WITHOUT BUILDING
PERMIT.2010 CODES.
--------------------------------------- ----------------------------------------
Other Fees BLDG STDS ADMIN (SB1473)
1.00
Fee summary Charged Paid Credited .Due
Permit Fee Total 63.00 .00 .00
63.00'
Plan Check Total 7.88 ..00 .00
7.88:
Other Fee Total 1.00 .00 .00
1.00
Grand Total 71.88 .00 .00
71.88
Stm lined Prescriptive Certificate of Compliance: 2008 Residential HVAC Alterations CF -IR -ALT -HVAC
Climate Zones 10 to 15
Site Address;Enorcemenf
A en
Dale:
Permit #:
,9V7 -a -2
Equipment T i
❑ Packaged Unit
List Minimum Efficiency'
Duct insulation requirement
Conditioned Floor
Area
'thermostat
❑ Setback
pjna already
O Furnace
0: oor Coil
❑ AFUE_ O COP
QSfER_I—` 13y
HSPF
Over 40 ft of ducts added or
replaced in unconditioned space
Served b system
s
93Tondensing Unit
O EER 13 Resistance
O R 6 CZ 10-13
� )
sf
present must be
O Other
OR 8 (CZ 14-15)
installed)
L Equipment Type: Choose the equipment being installed. if more thanone system use another CF- I R-ALT-NYAC jot each system.
2. Minimum Equipmenl Effidendes: 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 -411 forms (no hand filled CF4Rs allowed) are filled out and
Beginning
signed. October 1 2010 a registered copy of the Milk and CF -6R shall also be on site for final inspection.
631- HVAC Changeout
Required Forms:
• All. H VAC 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 -411 forms: MECH- 21 and (for split systems) MECH-25
For Split Systems: Duct leakage < i5 percent; RC, CCA >_ 300 CFM/ton(Minimum Air Flow Requirement), TMAH
For Packaged Units: Duct leakage < 15 percent
Exempted from duct leakage testing if:
O 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
0 2. New HVAC System Required Forms:
• Cut in or Chang 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
ng armor I all
CF -4R forms: MECH 20-, and fors ht stems MECH-
newequipment) ( split sY ) 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
0 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
O 4. New Ducting over 40 feet
Required Forms:
• includes adding replacing more than
linear feet of ductt in unconditioned space,
CF -6R forms: MECH-04, MECH-2I-HERS CF -411 forms: MECH-21
For split system or packaged units: Duct leakage < 15 percent
O EXCEPTION: Existina 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 Califomia 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 information documented on other applicable compliance forms, worksheets,
calculations Tans and specifications submitted to the enforcement agency for approval with the application.
Name:
2Mit
Signature:
Company:
Date:
�2
Address:
r �. �
License:
CirylStatc/Lip:
Phone: 6
dUU6 Kestdential Compliance Forms March 2010
Bin #
Qty
Qty of La Quinta
Building 8'r Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit # ij(
Project Address:
Owner's Name:
A. P. Number:'
Address:
Legal Description:
City, ST, Zip:
Contractor:
Telephone:
«� ;.:•
Address:�—
.3 �
roject Description:
City,"ST, Zip: •aZAZ
'y..`}- <..:.y"::°�-.::ii•';
Telephone: �Q_ _ `� «~%�:•,>xo?rs111-1,
w
2 ,
State Lic. # : O City Lic. #.-
;
Arch.,
Arch., Engr., Designer:
Address:
City, ST, Zip:
•
r,
Telephone:'
".:�' '�,,;;
State Lic. #:
,,�.,,�;-
Name of Contact Person:
Construction Type: Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
Sq. Ft.:
# Stories:
# Units:
Telephone # of Contact Person:
Estimated Value of Project: 34 %
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Cala.
Called Contact Person
Plan Check Balance
Tide 24 Cates.
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:-
''' Review, ready for corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees