14-0647 (MECH)PCO:: BOX 1504 _ VOICE (760) 777-7012
78-495 CALLE TAMPICO FAX (760) 777•:7011
LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153
= BUILDING PERMIT - - -
_ Date: 5/16/14
Application Number: 14-00000647 Owner.
Property Address: 55572 SOUTHERN HILLS GARY NOTENBOMER
APN: 775-181-05.9 - - 55572 SOUTHERN HILLS
Application description: MECHANICAL LA QUINTA, CA -92253
Property Zoning: LOW DENSITY RESIDENTIAL (760)_771-0304
Application valuation: 5986 _ p
Contractor: t
Applic w Architect or Engineer: DESERT AIR CONDITIONI IN(��
590 WILLIAMS ROAD . >
i T PALM SPRINGS, CA 9226
(760)323-3383 4MCEU��t
F►N.
Lic. No.: 27.6586 -
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 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: C20 -C43 Li se No.: 276586 for by Section3700of the Labor Code, for the performance of the, work for which this permit is
� — issued. r
Date: Contractor: 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: ,
1 hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the _ - Carrier CYPRESS INS CO Policy Number 3300065410131 -
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 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 become 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 shall forthwith mply with those provisions.
that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by S ` �.� - -
• any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).: _Date:- b '1 Applicant:
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: FAILURETOSECURE WORKERS' 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 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 ($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
(_) 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 contractors) 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 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 penaltyofperjury 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 co struction, an hereby authorize representatives
of this county to enter upon the above-mentioned property f i spe tion uses.
! Lender's Name: /
. Signature (Applicant or Agentl:
Lender's Address: -
LQPERMIT -
Application Number 14-00000647
Permit MECHANICAL 2013
Additional desc
_
Permit "Fee '83.42 Plan Check Fee
.00
Issue Date Valuation
0
Expiration Date.. 11/12/14
Qty. Unit Charge Per
Exten6ion
1.00 35.7500 EA MECH FURNACE
35.75
1.00 11.9200 EA MECH APPL REP/ALT
11.92
1.00'" 35:7500 EA MECH-CONDENSER/COMP
35.75
------------------------------------=-----=---------------------------------
', Special Notes and Comments
AC CHANGE OUT FURNACE INDOOR COIL &
CONENSING UNIT 3.5 TON SPLIT SYSTEM 78
AFUE 13 SEER PER 2013 MECHANICAL CODES.
CARBON MONOXIDE ALARM(S) TO BE INSTALLED
PRIOR TO FINAL INSPECTION.
-----------------_-_----------------------•-------- - ---------
Other Fees . . BLDG STDS ADMIN-(SB1473)
1.00
PERMIT ISSUANCE M/P/E
90.57
PLAN CHECK, MECHANICAL
52.43
Fee summary Charged PaidCredited
Due,
Permit Fee Total. 83.42 .00 .00
83.42
Plan Check Total .00 .00 .00
.00-
00-Other
Fee Total 144.00 00 ..00
Other-Fee
144.00
Grand Total 227.42 .00 .00
227.42
i
Bln.#
CIS}/ O Lc7 QuInta
Building at Safety Division
P.O. Box 1504,78-495 Calle Tampico
Ia.Quinta, CA 92253 -:(760) 777-7012
Building Permit Application* and Tracking Sheet :
Pemdt #
55-572 SOUTHERN HILLSOwner's
Name:. GARY NOTENBOMER
rPrqiectA4dr==-:
Address: 55-572 SOUTHERN HILLS
n:
City, ST, Zip: LA QUINTA, CA 92253
contractor. DESERT AIR CONDITIONING, ING.
•
Telephone: 760-771-0304 w
Project Description: replace 3.5 ton split system on
Address: 590 WILLIAMS RD.
City, ST, zip: PALM SPRINGS, CA 92264
ground like for like
Telephone: 760-323-3383
State Lic. 4:276586. City Lia#; 363
Arch., EW-, Designer. N/A
Address:
City., ST, Zip:
Telephone: Construction Type:. Occupancy:
State Lie. M Project type (circle one): New Add'n Alter . Repair Demo
Name of Contact Person: K E R I S KOV Sq. Ft.: # Stories: # Univ:
Telephone # of Contact Person: 760-323-3383 Estimated Value of project: $5,986.00
APPLICANT: DO NOT WRITE BELOW THUS UNE
#
Submittal
Req'd
Reed
TRACMG
PERbW FEES
Plan Sets
Plan Cheek submitted
Item Amount
Structural Cafes.
Reviewed, ready for corrections
Plan Check Deposit. .
Truss Calcs.
Called Contact Person
Plan Check Balance
Title 24 Cates.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2'! Review, ready for correctioneLuue
Electrical
Subcoutactor List
Called Contact Person
Plumbing
Grant Deed
Pians picked up
SMI,
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
Review; ready for corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person
A.LP.P.
Pub. WU. Appr
Date of permit issue
School Fees
Total Permit Fees
Simplified Prescriptive Certificate of Compliance: 2008 Residential HVAC Alterations CF -1R -'ALT -HVAC
Climate Zones 10 - 15
Site Address:,, t
Enforcement Agency:
Date: + t
Permit#:
55-572 SOUTHERN HILLS La Quinta, CA 92253
City of La Quinta
May 8, 2014
;
Duct insulation
Conditioned Floor
Equipment TypelList
Minimum Efficiency
requirement
Area
Thermostat •;,
❑ Package Unit-
® Furnace
® Indoor Coil
H AFUE 78%
® SEER 13;0
[3COP
[1HSPF
[3 R 6 (CZ SO -13)
Served by system
® Setback • .
If not already present, must be.
®Condensing Unit
❑ EER
[IResistance
13R 8 (CZ 14-15)
1400 sf
installed)
[3 Other
'
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 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-1R
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 (for split systems) MECH-25-HERS
replaced
CF -4R forms: MECH-21 and (forsplit systems) MECH-25
. Condenser Coil and /or
CF -6R forms: MECH-04, MECH-2I-HERS and (for split systems) MECH-25-HERS
.Indoor Coil and /or ,
Furnace
CF -4R forms: MECH-21 and (for split systems) MECH-25 r
•
. ,
For Split Systems: Duct leakage < 15 percent; RC, CCA <_ 300 CFM/ton (Minimum Air Flow Requirement), TMAH `
Exempted from duct leakage testing4:
❑ 1. Duct system was -documented to have been previously sealed and confirmed through HERS verification,, or
❑ 2. Duct systems with less thah 40 linear feet in unconditioned space, or
❑�3::Existing duct. systems are constructed, insulated or sealed,with asbestos • y
❑;4:•The system will not be Ducted (ie. Ductless Mini -Split System) (Also Exempt from Refrigerant Charge) -
❑ 2:• New HVAC System
Required `Forms:
. Cut in or Ch_ angeout with
f , "" `" f "*" �•" �. ^" �.
CF 6R,; formsy MECH 04 MECH 20 HERS' and (for split m
systes) MECH 22 HERS, and r
new ducts, (all-new
MECH 25 HERS "''.; ;. ' �., n: k
ducting and all newCF=
.
4R forms: MECH-20and(fos.plit system' s');MECH2and,MCH 25
- `
equipment)
..
For Split. Systems:, Duct leakage <z6 percent RC, CCA > 350 CFM/ton; FWD, TMAH? STMS; and either HSPP or PSPP r ,
` ';
For Packaged Units: Duct`leakage4< 6 percent°, ; ' i
,,. ;;/°; , , �
❑ 3.,New Ducts witli/or.without
Required Forms:
Replacement
. Includes replacing,or installing all,new '
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
For Split Systems: Duct leakage'z,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 I
[3 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. �$ ' 1
• 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 ofthe California Code of Regulations. ,
• The design features identified on this Certificate of Compliance are consistent with the information documented on other applicable compliance
fortes, worksheets, calculations, plans and specifications submitted to the enforcement agency for approval with the permit application:
Name: Keri Skov, I ' 9 . . Signature:,Keri Skov
Company: DESERT AIR CONDITIONING INC Date: May 8, 2014
Address: 590 WILLIAMS ROAD License: 276586
City/State/Zip: PALM SPRINGS / CA / 92264 Phone: (760) 323;3383
i
Reg: 214-A0032541A-000000000-0000, Registration Date/Time: 2014/05/08 13:30:01•- HERS Provider: CalCERTS, Inc.
2008 Residential'Compliance Forms r - July 2010