10-0312 (MECH)P.O. BOX 1504
78-495 CALLE TAMPICO .
LA QUINTA, CALIFORNIA 92253
Application Number:
10-00000312
Property Address:
r: w55395 SOUTHERN HILLS
APN:
775-181-024- - -
Application description:,
MECHANICAL
Property Zoning:
LOW DENSITY RESIDENTIAL
,Application valuation:
4900
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
VOICE (760) 777-7012
. FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 4/13/10
Owner:
JEFF BURDA
55395 SOUTHERN HILL
LA QUINTA, CA 92253
' - Contractor: + .-
Applicant: Architect or Engineer: BROTHER'S AIR COND/HE TI 1t,—�
Cfi l�; -
PO BOX' 279 ,> t�, 1 �A1( rJ
CABAZON, CA 92230 ;%
~ r^!.,r
(951) 922-2404
Lic.. No.: C20
11
---------------------------------
LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION
hereby affirm under penalty of perjury that I am licensed under 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 and Professionals 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
License Class: 937766 License No.: C20 for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
issued.
Date: . ntractor: � � _ 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 the Carrier EXPEPT Policy Number EXMEPT
following reason (Sec. 7031 .5, Business and Professions Code: Any city or county that requires a permit to IX, 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 becom subject to the workers' compensation provisions of Section
License Law (Chapter 9.(commencing with Section 7000)of Division 3 of the Business and Professions Code) or 3700 of the Labor Code, I sh dithw' comply with those provisions.
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).: e: /^ ��G. pplicant:,
(_ 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 COVERAGEISUNLAWFUL, 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 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. - - 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 contractor(s) 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 and void if work is not commenced
- - _ within 160 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 above information is correct. I agree to comply with all
work for which this permit is issued (Sec. 3097, Civ. C.)• city and county ordinances and state laws relating to building construction, and hereby authorize representatives
of this county to enter upon the above-mentioned property for in on/pyrposes.
Lender's Name:
te: ^110 S' ature (Applicant or Agent):
Lender's Address:
LQPERMIT
Application Number 10-00000312
Permit MECHANICAL
Additional desc
Permit Fee - -31..50
Plan Check Fee
7.88
Issue Date . . . .
Valuation.
0
Expiration Date 10/10/10
Qty Unit Charge -Per
Extension
.'BASE
FEE
15.00
1:00 16.5000 EA MECH
B/C >3-15HP/>100K-500KBTU
- .16.50
-----------------------------------------------------
Special Notes and Comments
INSTALL -NEW 13 SEER CONDENSER 3.5
TON.
2007 CODES.
----------------------------
.. � SB1473
Other Fees BLDG STDS ADMIN )
- 1.00_
Fee. summary Charged -
- ----
Paid Credited
- - - - - -
Due .
----------- - --------- - - -
Permit Fee Total 31.50
00� .00
31:50`
Plan Check Total 7.88
.00 .00
7.88.
Other Fee Total. 1.00
.00 .00
1.00
Grand Total 40.38
.00 .00
40..38
r
LQPERMIT
- .
Simplified Prescriptive Certificate of Compliance: 2008 Residential HVAC Alterations CF -IR -ALT -HVAC
Climate Zones 10 to 15
0
Site Address:
SS3 e /�b tit`
Enforcement Agency:
Date:
Permit #:
Equipment T
List Minimum Efficienc 2
Duct insulation requirement
Conditioned Floor
Area
Thermostat
Packaged Unit
Furnace
O AFUE_ O COP
Over 40 ft of ducts added or
O Setback
O Indoor Coil
IRSEER 13 O HSPF
replaced in unconditioned space
Served by system
(If not already
O Condensing Unit
O EER O Resistance
O R 6 (CZ /0-13)
sf
present. must be .
O Other
OR 8 (CZ 14-15)
installed)
-+�-- - --- •••`-Y•••r••••^ -.5 wu,aa, q murr mun unesystem. use anornert,l'-IK-AL1-NYACJOreach system.
2. Minimum EquipmeniEfficiencies: 13 SEER. 78%AFUE. 7.7HSPFjortypical residential systems.
HERS VERIFICATION SUMMARY Listed below are four HVAC alteration Options. The installer decides what wort 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 fad the work completed by the
installer. The inspector also verifies that each appropriate CF -6R and registered CF4R forts (no hand filled CF4Rs allowed) are filled out and
sied. BeVnning October 1 2010 a registered cpjpy of the CF -1R and CF -6R shall also be on site for final inspection.
F1Required Forms:
• All HVAC Equipment replaced CF -6R fors: MECH-04, MECH-21-HERS and (for split systems) MECH- 25 -HERS
CF -4R forms: MECH- 21 and for split 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 CF4R forms: MECH- 21 and (for split systems) MECH-25
For Split Systems: Duct leakage < 15 percent; RC, CCA -e 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
O 2. Duct systems with less than 40 linear feet in unconditioned spade, or
❑ 3. Existing ducts stems are constructed, insulated or sealed with asbestos
O 2. New HVAC System Required Forms:
• Cut in ( Chang with new
(all aCF-6R forms: MECH-04, MECH-20-HERS,and (for split systems) MECH-22-HERS, and MECH-25-HERS
ll new ducting
ng rg_td all
new equipment) CF -4R forms: MECH 20-, and (for split systetms)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
O 3. New Ducts with Replacement Required Forms.
. • Includes replacing or installing an 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 2:300 CFM/ton, TMAH .
For Packs ed' Units: Duct leakage < 6' percent
O 4. New Ducting 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 space. .
For split system or packaged units: Duct leakage < 15 percent
O EXCEPTION: Existing duct systems constructed, insulated or sealed with asbestos.
Contractor (Documentation Author's /Responsible Designer's Declaration Statement)
• I certifv 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.
• 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,
Pans 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 enforcementenc .for approval with the permWapplication.
Name: Si attire:
Company:
DT t < < �ie�+ Date: /—
Address: R 3 --lo
A 0 t3 0 -2 y License: ? ? 6 6
City/Statc/Z.ip: Gh Ccc 12-130 Phone: J
- qsl—f22 -2 yuy
2008 Residential Compliance Forms March 2010
Bin #
City of La Quinta
Building 8r Safety Division _
P.O. Box 1504, 78-495 Calle Tampico
La Quint a, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit # 2.
O 3�
Project Address: L-1 Is jJ L•,,-
Owner's Name: , V
A. P. Number:
Address: SS S' S
Legal Description:
City, ST, Zip:
4 2 2
Contractor: 1 1%.12 S L
Telephone: 209- o s- 1902-
902Address:
Address:
x9'
Project Description:
City, ST, Zip: CGa4tiZcM C4)
We, C4 4-g, k., he a114-0141 c
Telephone: 5 SI J�2 - 2 y0
.:(SY.v..\J{�;.v:{i:::.}'F.v..i:: 11.41: '^Yi.. rii:iir
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......................
IQC-c
1 i
3 /2 �v �. h (r � ` �-
State Lic. # : .3 % 7 fj b
City Lic. #;
Arch., Engr., Designer:
Address:
City., ST, Zip:
Telephone:
'>fi{•...x;>•:;.t:>" . �<;::::;<v�<w�:;
�k;:'{gig<ck.?,pk•>;4..;ti:;:;�� �::.;f: so.
'1,.%:3 y{4`•2/.•CF�(•"{T: r••<'%i �G `;r�
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``>` "'"' "''i'''1t' "'
Ai'k{S::vrxir,{.:,;.,vu: ii iiifl::{•ii}i: ii?i n4i�i
Construction Type: Occupancy:
�a .
.
State Lic. #:
Project type (circle one): New Add'n Alter Repair Demo
Ft.: 2 6()p # Stories: # Units:
Name of Contact Person:Sq.
Telephone # of Contact Person:
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
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance
Title 24 Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
21" Review, ready for correctionstissue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. ApprovalPlans
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
M