12-1230 (MECH)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 12_0.00.01230P.r
Property Address: 55341 SOUTHERN HILLS
APN: .775 -181 -021 -
Application description: MECHANICAL
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 8845
Applicant: .
Architect or Engineer:
,plv
4 4 I. P,
W .
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
BARTHOLOMEW KENNETH K,
55341 SOUTHERN HILLS
LA QUINTA, CA 92253
Contractor:
HYDES
42949 MADIO STREET
INDIO, CA 92201
(760)360-2202
LiC. No.: 906115
VOA -1606) 7 -7012
FriX ( 777-7011
INSPECTIONS (760) 777-7153
Date:. 10/15/12
PF- ocr 1;27012
-
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-- LICENSED CONTRACTOR'S DECLARATION
- WORKER'S COMPENSATION DECLARATION
. I 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 Professional ode, 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
a C{lass: C20 C36 ense No.: 906115
for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
-
issued. _
�lU5
0 /Y
Oate: ontractor:
v�\I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor .
I
1 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 NORGUARD INS Policy Number CEWC356415
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 mannersoas 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 thew rs' comrns'ation provisions of Section
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or
7D0 of the Labor Code, I sha I forthwith comp ' h rhos rowsions.
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)•:
at Appli t:
(_ 1 I, as owner.of the property, or my employees with wages as their sole compensation, will do the work, and'
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the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The
WARNING: FAILURE SECURE WORKS 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 NLTIES 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 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—) 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
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within 180 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 certifythat 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.).
and county ordinances and state laws relating to building construc ' n, and hereby authoriz epresentatives
.hisZ��Si
Lender's Name:
pon a above-mentioned property for ins rposes.
/Date::
G1
ature (Applicant or Agent):
Lender's Address: 1
LQPERMIT
Application Number . . . . 12-00001230
Permit . . . MECHANICAL
Additional desc .
Permit Fee 40.50 Plan Check Fee
10.13
Issue Date . . . Valuation
0
Expiration Date.. 4/13/13
Qty Unit Charge Per
Extension
BASE FEE
15.00:
1.00 9.0000 EA MECH FURNACE <=100K
9.00
1.00 16.5000 EA MECH B/C >3-15HP/>100K-500KBTU
16.50
---------------------- ------------------------------------------------
Special Notes and Comments
HVAC CHANGE -OUT: 5 TON 14 SEER PACKAGE
UNIT.- 2010 CODES.
-----------------------------------------------------------------------
Other Fees . . . . . . . . . BLDG STDS ADMIN (SB1473)
-----
1.00•
Fee summary Charged Paid Credited
Due
Permit Fee Total 40.50 .00 .00
40.50
Plan Check Total 10.13 .00 .00
10.13
Other Fee Total 1.00 .00 .00
1.00
Grand Total 51.63 .00 .001,
51.63
' LQPERMIT
Simplified Prescriptive Certificate of Compliance: 2008 Residential HVAC Alterations CF-lR-ALT-HVAC
Climate Zones 10 - 15
Site Address:
Enforcement Agency:
Date:
Permit #:
55-341 Southern Hills La Quinta, CA 92253
City of La Quinta
Oct 15, 2012
Duct insulation
Conditioned Floor
Equipment Typel
List Minimum Efficiency2
requirement
Area
Thermostat
® Package Unit
❑ Furnace
® AFUE 78%
❑ COP
❑ R 6 (CZ 10-13)
Served by system
® Setback
❑ Indoor Coil
® SEER 13.0
❑ HSPF
❑ R 8 (CZ 14-15)
2000 sf
If not already present, must be
[I Condensing Unit
[3 EER'
[3 Resistance
installed)
❑ Other
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 onsite 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 -IR
and CF -611 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 (fee split ......t.,ms) P49GH-25 HERS
replaced
CF -4R forms: MECH-21'and (f..F Split systems) MECH 2
. Condenser Coil and /or
CF -6R forms: MECH-04, MECH-2I-HERS aF;d (f8F Split ...,,.«,.ms) MEG14 ,c HERS y
. Indoor Coil and /or
M�H ,5
CF'4R forms + MECH-21 �� (f Split ,-
,•.
. Fumace
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 systerns.with less'then'40 linear feet in unconditioned space, or
p 3. Existing duct systems are constructed, insulated or sealed with asbestos
❑ 4. The#systeriiIwill,not be Ducted (ie 4Ductlessj,,y it System)"'(Algd`*Exernpt from_lR_efngerant ChaNrge)
❑ 2. New HVAC System Required Formsy°y:°� ;���iF
. Cut inlor Changeout with; ": .: ....�, .
CF 6R forms MECH 04; MECH 20 HERS, and (for split systems) MECH=22i HERS, and ---Y
new ducts. (all new'* MECHI251HER5;, fir, rt f `
a;;
ducting and all new CF 4R forms 'MECH 20` and (for split systems) MECW and MECH 25 i '`
equipment) ` t c-i� ?� .' fes, .. >:a .?_- <ts '- '.
For.Split Systems:;Duct leakage <16'percent; RCnCCA°>_ 350,CFM/ton*FWD;;TMAH STMS, anc1either1HSPP or'.PSPP
For Packaged.Units'Duct leakage !c 6' ercent , `"i' .:A
❑..3.-New?Ducts with/or without ":iv
Required Forms:
Replacement
. Includes replacing or installing aWnew
ducting and/or outdoor condensing unit
CF -6R forms: MECH-04, MECH-20-HERS, and (for split systems) MECH-25-HERS
and/or indoor coil and/or furnace:;.No.or some
CF -4R forms: MECH-20 and (for split systems) MECH-25
equipment changed. - ,r
For Split Systems: Duct leakage <.6:.percent; RC, CCA >_ 300 CFM/ton, TMAH
For Packaged Units: Duct leakage < 6 percent
❑ 4. New Ducting over 40 feet
Required Forms:
. Includes adding or replacing more than 40
CF -6R forms: MECH-04, MECH-2I-HERS
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.
. 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: Mark Hyde Signature: Mark Hyde
Company: CERTIFIED COMFORT SYSTEMS INC Date: Oct 15, 2012
Address: 42-949 MADIO STREET License: 906115
City/State/Zip: INDIO / CA'/ 92201 Phone: (760) 360-2202
M
Reg: 212-A0057379A-000000000-0000 Registration Date/Time: 2012/10/15 13:33:11 HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms July 2010
Bin #
Permit .#
Project Address:
A. P. Number:
ci -3 '-f 1 -
Contractor:
Address: ` c
City, HE
Zip: Lc
TI h
e ep one. 7.� GG — ZZ e,Z
i
State Lic. # : q 06�
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone:
State Lic. #:
Name of Contact Person:
-------------
Telephone # of Contact Person:
# Submittal
Plan Sets
Structural Calcs.
Truss Calcs.
Energy Calcs.
Flood plain plan
Grading, plan
SubContactor List
Grant Deed
ILOA- Approval
IN HOUSE: -
Planning Approval
Pub. Wks. APpr
School Fees
City of La Quinta
Building .& Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and -Tracking Sheet
Q✓n 5 Owner's Name: en -7
Address:
City, ST, Zip: r G d
Project Description:
A •cl Z -" d I
Lic. #: �`i x Z
Zz S3
Construction Type:
Occupancy:
P cY=
Project type (circle one):
New Add'n Alter Repair Demo
Sq. Ft.:
# Stories: # Units:
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW
THIS LINE
Recd TRACI�YG
PERMIT FEES
Plan Check submitted
Item Amount
. Reviewed, ready for corrections
Plan Check Deposit
Called Contact Person
Plan Check Balance
Plans picked up
Construction
Plans resubmitted
Mechanical
2°d Review, ready for correctio�ssue
Electrical
Called Contact Person
Plumbing
Plans picked up
]Called
S M L
Plans resubmitted
Grading
3rd Review, ready for corrections/issue
Developer Impact Fee
Contact Person
A.LP.P.
Date of permit issue
Total Permit Fees