12-0631 (MECH)N
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 4Z:�12-0.0000631'�
-Property Address: 55599 SOUTHERN HILLS
APN: 775-200-014- - -
Application description: MECHANICAL
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 11517
Applicant: Architect or Engineer:
'BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
VOICE (760) 777-7012
"
FAX, (760) 777-7011
INSPECTIONS (760) 777-7153
~ Date: , 6/07/12
Owner:
GUDMUNDSON-DARRELD J & NANCY_L
55599 SOUTHERN HILLS
LA QUINTA, ,CA 92253
t
Contractor:
GENERAL AIR CONDITIONING
31170 RESERVE DRIVE
THOUSAND.PALMS, CA 92276
(760)343-7488
Lic. No.:"686310
'" - �-
JUN 0f 2,012 J
Mr :A QWNTA
t
------------------- ------- - ---------
LIC' CONTRACTOR'S DECLARATION
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury that I�am i ensed 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 Businessand fessionals 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
Lic nse Class: C20 License No.: 686310 -
for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
Date:`Contractor:
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
'WNER-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 ZENITH .INS CO Policy Number Z071741501 .
following reason (Sec. 7031.5, Business and Professions Code: Any city or county that requires apermit to
' ' _ I.certify that, in the performance of thork 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 bec a subject to the workers' compensation laws of California,
if 1 becom to the compensation of Section
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 -
and agree that, should ¢eject workers' provisions
3700 of a Labor Code, I shall f With 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
6 -
' any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).:
:
ateL A 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 WO RS�C MPENSATION 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
I - . . .
improve for the purpose of salea.-
APPLICANT ACKNOWLEDGEMENT ,--.
(_ 1 I, as owner of the property, am exclusively contracting with licensedcontractorsto 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.). T ' '
• +' whose benefit work is performed under or pursuant to any permit issued as a result of this application,
(_ 1 I am exempt under Sec. , B.&P.C: for this reason
the owner, and the applicant, each agrees to, and shall defend, indemnity 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 issuanceof 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 penalty of perjury that there is a construction lending agency for the performance of the
mation is correct. I agree to comply with all
I certify that I have read this application and state tlbuildingn'struction,
work for which this permit is.issued (Sec. 3097, Civ. C.I.
city and countyordinances and state laws relating and hereby authorize representatives
of this ounty toenter upon the above-mentioned pion purposes.
Lender's Name:
te: �ature (Applicant or Agent)
Lender's Address:
✓✓✓✓✓✓
LQPERMIT
Application Number 12-00000631.'
Permit" MECHANICAL
Additional desc .
,Permit Fee 40.50 Plan Check Fee
Issue Date Valuation . . . .
0
Expiration Date 12/04/12
Qty Unit Charge Per
Extension,
BASE FEE
15.00.,
1.00 9.0000 EA MECH FURNACE 5=100K
9.00
1.00 16.5000 EA MECH B/C >3715HP/>100K-500KBTU
16.50
Special Notes and Comments
HVAC CHANGE -OUT: INSTALL NEW 3 TON
SYSTEM FURNACE,, CONDENSER, INDOOR COIL "
AT GROUND.LEVEL. 2,010 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 1.00v .00 :00
1.00.
Grand Total 51:63 .00 .0.0
51.63
LQPERMIT
•
Simplified Prescriptive Certificate of Compliance: 2008•Residentia/ HVAC Alterations CF=11R-ALT-HVAC
Climate Zones 10 - 15
Site Address: ,
Enforcement Agency:
Date:
Permit #:
'55599 SOUTHERN HILLS.La Quinta,'CA 92253
City of La Quinta _
Jun 4, 2012 -
`
Equipment Typel
List'Minimum Efficiency2•'
Duct insulation
requirement '
Conditioned -Floor
, Area, '•_
-
Thermostat,;•
❑ Package Unit
® Furnace
Iridoor Coil; N
® AFUE 78%
❑ COP '-
t
❑ R 6 (CZ 10-13)
Served by•system
® Setback "
®
® SEER 13.0
❑ HSPF.
❑ R 8 (CZ 14=15)
1253 sf'
If not already present;`must be
'
® Condensing,Unit
[3 EER"
❑Resistance
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 rrieasures,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 -111
and CF -611 shall also be on site for final inspection.
® 1. HVAC Changeout
Required Forms:
• All HVAC Equipment ;
CF -611 forms: MECH-04, MECH-21-HERS and (for split systems) MECH-25-HERS .:
replaced
CF -4R forms: MECH-21 and (for split systems) MECH-25
.Condenser Coil and /or
CF -611 forms: MECH-04, MECH-2I-HERS and (for split systems) MECH-25-HER_ Si
• Indoor Coil and /or
CF -4R forms: MECH-21 and (for split systems) MECH-25 t; '"
•Furnace -
.� - ••
ForSplit Systems: Dud leakageft5k.15 percent; RC, CCA <_ 300 CFM/ton (Minimum Air Flow, Requirement), TMAH
Exempted from dud leakage testin'�g'
.❑ 1.`Duct system was.documented.to have been previously sealed•and confirmed through HERS verification, or •, '
[12. Dud systems with less then'S40 linear feet in unconditioned space, or.
y
3: Existing dud systems are constructed, insulated or sealed with asbestos '"
04. The systemwill not be Ducted' (ieDucElessMinf-•Sp�ht System)(AlsoExempfro[nRef�iger�anrCha;rge)
_
❑ 2. New N$f" System
_ a.
Re uired Foims
q � .. _ a _
'>.
• Cut in`or'Ch'an eout with.
9
i� r .— ,�. ' pm x ,
CF;�6RAformsMECH-04, MECH. 20 HERS rand( of rsplit systems) MECH 22 HERS, and
new duets ;(all new.•.
��
dudirliganci all neve
MECH 25 HERS ,
r �j q �...
CF 4R forms 0 2 25
��..
equipment)
MECH , and.for splitsystems)MECH, , andMECii• �:
'
For Split Systems„Duet leakage
<16 per�cent,RCY CCAz 350 CFM/ton, FWD;TMAli,SIMS, and"either HSPP ofPSPP _
For Packa ed Units. Dud
leaka e < 6 ercent
13.3 New DutWO th/or without `i,
Required Forms:' '
Replacements -;•.
- s '
. 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 furnaceNo 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: r
. Includes adding or replacing more than 40
CF -611 forms: MECH-04, MECH-2I-HERS B
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 constructedl'insulated or sealed with asbestos.'
Contractor (Documentation Author's /Responsible Designer's Declaration Statement) r'
I certify that this Certificate of Compliance documentation is accurate and complete.. i
•• 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.' - -'' S I I,
• 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: Danielle Garcia „ '. Signature: Danielle Garcia
Company: HARRISON ENTERPRISES INC- Date: Jun 4, 2012;'
Address: 31-170 RESERVE DRIVE STE A License: 686310
City/State/Zip: THOUSAND PALMS /,CA/ 92276 Phone: (760) 343-7488 '
Reg: 212-A0028645A-00000000-0000 Registration Date/Time:,2012/0.6/04 20:29:40 HERS Provider: Ca10ERTS, Inc.
2008 Residential Compliance Forms July 2010
Bin #
City of La Quinta
Building 8f Safety Division
P.O. Box 1504,78-495 Calle Tampico
LOLdrita, CA 92253::(760) 777V012
Building Permit Application and Tracking Sheet
Permit #
07
Project Address:
Owner's Name: V ` , C U wi v ,!�0 n . .
A. P. Number..
Addrem: JAM
Legal Description:
City, ST; zip: LQ lam/ ` Z L.YJ 3
Contractor: C �[ � (_
• r 3:s...:.,,.. ..�.
Telephone: -1w' �0 ' i 1 ' �J . °
Address:
PtrojectDescciption: ion
City, ST, Zip:
d
Telephone: _ c•.-11 trz -,y
State Lic. # : City Lia #:
Arcfi., Engr., Designer
�
e
Address:
_
City., ST, Zip:
Telephone:
1
Construction Type:. Occupancy:
State Lic. #:
Name of Contact Person:
ProjectWe (circle one): New Add'n Alter Repair Demo
Sq. Ft: MIrj?j # Stories: #Unit$: °
Telephone # of Contact Person:
Estimated Value of Project rT
APPLICANT: DO NOT WRITE BELOW THIS UNE
#
Submittal
Req'd
Rcc'd
TRACK NG
PERMIT FEES'
Plan Sets
Plan Check submitted
item Amount
Structural Cales.
Reviewed, ready for corrections
Plan Check Deposit, '
Truss Cates.
Called Contact Person
Plan Check Balance
Title 24 Cates.
Plans picked up
Constractlon
Flood plain plan
Pians resubmitted
Mechanleal
Grading plan
2'' Review, ready for correctionsrmue
Electrical
Subeoutactor List
Called Contact Person'
Plumbing
Grant Deed
Plans picked up
S.M°L
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. Wks. Appr
Date of permit Issue
School Fees '
Tota! Permit Fees