13-0704 (MECH)P.O. BOX 104,."
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address: K
APN:
Application description:
Property Zoning:
Application valuation:
Applicant:
13-0.0000704
81934 SUN CACTUS LN
764-270-999-92 -300231-
MECHANICAL
MED}UM HIGH DENSITY RES'
10459
Architect or En
1\P'
Air
}
BUILDING & SAFETY DEPARTMENT�1.
BUILDING PERMIT
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with
Section 70001 of Division 3 of the Business and Professionals Code, and my License is in full force and effect.
License Class: C20 License No.: 686310
Date, Contractor'.e '
OV
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 applicaAt for a permit subjects the applicant to a civil penalty of not more than five hundred dollars 1$5001.:
I _ I 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, 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 town 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.).
(_) I am exempt under Sec. , B.&P.C. for this reason -
Date: - Owner:
CONSTRUCTION LENDING AGENCY
1 hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the
work forwhich this permit is issued (Sec. 3097, Civ. C.).
Lender's Name:
Lender's Address:rj
\
LQPERMIT
0;/ f VOICE (760) 777-7012
0 FAX (760) 777-7011
INSPECTIONS (760) .777-7153
Date: 6/04/13
Owner:,
DON ORR
81934 SUN CACTUS LANE
LA QUINTA, CA 92253
.(760)777-4120
Contractor:
GENERAL AIR CONDITIONING
31170 RESERVE'DRIVE
THOUSAND PALMS, CA 92276
(760)343-7488
Lic. No.: 686310
----------------------------------------------
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
issued. -
.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 ZENITH INS CO Policy Number Z071741502
I certify that, in the performance of the woik 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, I shall forthwith comply with those provisions.
Date: 4 3 App- ica tt:
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 IS 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.
certifyThat 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 phis county to enter upon the above-mentioned property for inspection purposes. _
/fir•
Date Signature (Applicant or Agent- ): C
Application Number 13-0"0000704
Permit . . . . . . MECHANICAL 2013
Additional descl.
Permit Fee 71.50 Plan Check Fee
.00
Issue Date Valuation
0
. Expiration Date 12/01/13
Qty Unit Charge, Per.
Extension
1.00 35.7500 EA MECH FURNACE
35.75
1:00 - 35.7500 EA' MECH CONDENSER/COMP
35.75
Special Notes and Comments
HVAC, CHANGE OUT (1) 5 TON SYSTEM
- 13SEER/781AFUE [2008,ENERGY] CARBON`
MONOXIDE ALARM(S) TO BE INSTALLED PRIOR
TO FINAL"INSPECTION. 2010 CALIFORNIA
-BUILDING CODES.
Other Fees- BLDG STDS.ADMIN (SB1473)
1.00
PERMIT ISSUANCE M/P/E
90.57.
PLAN CHECK, MECHANICAL
47':66
Fee summary Charged Paid Credited
Due
Permit Fee Total 71.50 .00 .00
71:50
Plan Check Total' .00 .00 .00
.00.
"Other Fee Total.. 139.23 ..00 .00
139.23
Grand Total 210.73 .00_ .00
210.73
LQPFRA11T
j
Bin .#
C1W of ted Qui[1ta
BuilOg a Safety Division
P.O. Box 1504,78-495 Catfe Tampico
La.Qufnta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
l
Project Address:�Ll3r-} Svh �,�kuS
Owner's Name:.,1 ' ��,y
A. P. Number.
Address:
Legal Description:.
Contractor. ro j A;r`����C�Y\ir1
City, ST, Zip: -L.ct- 01.ai1r,�A, CA C(7,2__C__]S
Telephone: 77(,0(:)---7-7-7- 1j 1'2-0 h
Address: \ 17 O . ��S�ry
Project Description:
City, ST, Zip: I..OvSco-, cl VcA'M5 CA RZZS3
_t:Z(rLCe-- S%Y, .A C �1ok STV
Telephone: '7(op_ 3 7489
State Lic. # : (03 ](�
City Lia #c
Arch., Bag., Designer.
Address:
City., ST, Zip:
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: to, y 69. UO
APPLICANT: DO NOT WRITE BELOW THIS LINE
p
Submittal
Rcq'd
Recd
TRACMG
PERMIT FEES -
an Sets
Plan Check submitted
Item Amount
Structural Cafes.
Reviewed, ready for corrections
Plan Check Deposit. .
Truss Calcs.
Called Contact Person
Plan Check Balance
Title 14 Cates.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2`! Review, ready for correctiousfissue
Electrical
Subcontactor List
galled Contact Person
Plumbing
Grant Deed
Pians picked up
S M.L
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
34 Revlew,' ready for eorrectionsfissue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr '
Date of permit issue
School Fees
Total Permit Fees
Simplified Prescriptive Certificate of Compliance: 2008 Residential RVAC Alterations CF-IR-ALT-
Climate
F-.1R A.LT-Climate Zones 10 to 15
Site Address: • -
8N 937-} �v �AU,
Eteforcmteat Age;-y:D
e:, L. Q�ch
'
L ,4 v7
Permit #:
Conditioned Floor
Equipment T t
List Minimum Efficienc Z
Duct insulation requirement
Area
Thermostat
ackaged Unit
Wumace
0 AFUE %$ Y
Q COP
Over 40 ft of ducts added or
Setback
Indoor Coil
Condensing
®SEER
8 HSPF
laced in unconditioned space
ffR 6 (CZ 10-13)
Served by system
sf
(If not already
present, must be
Unit
EER
Resistance
Other
R 8 (CZ 14-15)
installed)
1. Equontent Type: Choose the equipment being installed• if more than one system, use another CF -IR -ALT -HVAC for each system.
2. Minitt— 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 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 CF4R forms (no hand filled CF4Rs allowed) are filled out and
signed. Begoming October 1, 2010, a red copy of the CF -1R and CF -6R shall also be on site for final ins 'on.
1. HVAC Changeout
Required Forms:
• All HVAC Equipment laced
P
CF -6R forms: MECH-04, MECH-2I-HERS and (for split systems) MECH-25-HERS
CF4R forms: MECH-21 and fors lit stems) MECH-25
• Condenser Coil and/or
• Indoor Coil and /or
CF -6R forms: MECH-2I-HERS and (for split systems) MECH-25-HERS
CF4R forms: MECH-21 and (for split systems) MECH-25
'
• Furnace
For Split Systems: Dud leakage < 15 percent; RC, CCA > 300 CFM/ton(Minimum Air Flow Requirement), TMAH
For Packaged Utnits: Dud leakage < 15 petit
Exempted from duct leakage testing if:
e1. 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:
• Cutin Chang with new
ducts: (all new ducting
ting and all
CF -6R forms: MECII-04, MSCII-20-I IERS,and (for split systems) MECH-22-HERS, and MECH-25-I IERE
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: Dud 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
CF4R 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 PackaWd Units: Duct leakage < 6 percent
M. New Ductinx over 40 feet Required Forms:
• Includes adding or replacing more than 40 CF -6R forms: MECH-04, MECH-2I-HERS CF4R forms: MECH-21
linear feet of duct in unconditioned
For splits stem. or packaged units: Duct leakage < 15 percent
EXCPTION: Existin duct stems,constructed, insulated or sealed with asbestos.
Contractor (Documentation Author's /Responsible Designeeas Declaration Statement)
• 1 certify that this Certificate of Compliance documcatation 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 information documented on other applicable compliance forms, worksheets.
calculations, plans and specifications submitted to the enforcement aRencv forapproval with the permit application.
Name:SkeV e �^ _
Signatke"jrure:
Company: �rP�C'O.1 ;r C
Date: 4` 3
Address: 3W0 1`� set~�� �.v�
Lteense. (08{031D
'City/State/Zip: thouSWrya CA QZZ-7G 1
r
Phone: —7,C>- 343 -7�f8� �
2008 Residential Compliance Forms July 2010