13-0403 (MECH)49
P.O. BOX 1504 -' r VOICE (760) 777-7012
7&495 CALLE TAMPICO ^ FAX (760) 777-7011.
LA QUINTA, CALIFORNIA 92253.. BUILDING & SAFETY DEPARTMENTINSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 4/03/13
' Application Number: 13-00000403 Owner:
Property Address: 55143 SOUTHERN HILLS SHELBY
APN: 775-181-013- - LA QUINTA, CA 92253
Application description: _ MECHANICAL (61S)589-5095 '
q. Property Zoning: LOW -DENSITY RESIDENTIAL
Application valuation: 15945 y
Contractor:
Applicant: Architect or Engineer: HYDES D
` 42949 MADIO $TREE [r'�1
INDIO, 9220'1
APR 03.2 13
(760)360- 02
Lic. Nb..::9 906T15
"plJyV V CITY of LA QUINTA
l/ FINANCE DEPT.
s
„ - LICENSED CONTRACTOR'S DECLARATIONWORKER'S
COMPENSATION DECLARATION
1 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 C36 Li No.: 9061.15
for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
�-
l� y
�/ issued.
–/'hhave maintain insurance, as required by. Section 3700 of the Labor
Dater ontractor:
and will workers' compensation
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 manner so as to become subject to the workers' compens 'on 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' compens i n 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 forthov' comply with e p sions.
' that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by
�./ ? ✓,i
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).:
/Appynt:�
(_ 1 I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and
;D=te.✓"7—•J�
-
the structure is not intended or offered for sale (Sec.'7044, Business and Professions Code: The
WARNING: FAILURE TO SECURE 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 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 .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 certify that I have read this application -and state that the above information is correct. I agree to comply with IIS
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 represent as
-
of this county to enter on the above-mentioned property for inspection purposes.
Lender's Name: -
- ,
Date: � gnature (Applicant or'Agentl� '
T
Lender's Address: L_
LQPERA1IT `
e
:-Appl••cation Number 13-00000403
Permit . . MECHANICAL
- Additional desc .
" Permit. Feer. 66.0.0• Plan Check Fee
16.50
Issue•Date Valuation• . .
0
Expiration Date 9/30/13,
Qty Unit Charge Per
Extension
BASE -FEE
15.00
2.00 9.0000 EA MECH FURNACE <=100K
18.00'. .
:2.00' 16.5000 EA MECH,B/C >3-15HP/>100K-500KBTU
33.-00
Special Notes and Comments
HVAC CHANGE OUT (2) 4 TON 4SEER/AFUE78
2010 CALIFORNIA BUILDING CODES.
Other Fees . . . . . . . . . BLDG STDS ADMIN '(SB1473)
1.00
Fee summary Charged Paid Credited
Due >
Permit Fee Total, 66.00 .00 .00
66.00
Plan Check Total 16.50 .00 00
16.50
Other Fee Total, 1.00 .00 .00
1.00
Grand Total 83.50 00 .00
83.50
I.QPERD4IT-
Bin #
City of La Quinta
Building 8l; Safety Division
Permit #
P.O. Box 1504, 78-495 Calle Tampico
003La
Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Project Address: - �� — �' (3 rr
S o t � Owner's
A. P.
u e rn � 5 Name:
Number:
_
Address: �
ription:
�_City,
v el, t/ f,,J
ST, Zip:��
L. fo ��.yZZ53$rtS
N, /� Telephone:(
rAdd
�^/ lt'�.Project
Description: 2) IDci
p:
6a _
: q (f(,
�. City Lic. #:
Arch., Engr., Designer:
Address:
City, ST, Zip.-
ip:Telephone:
Telephone:
State Lic. #:
Construction Type: Occupancy:
p �'�
Name of Contact Person:
Project type (circle one): New Add'n Alter Repair. Demo
Telephone # of Contact Person:
Sq. Ft.: # Stories: # Units:
Estimated Value of project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
# Submittal Req'd
Recd
TRACKING
Flan Sets
. PERMIT FEES
Plan Check submitted
Structural Calcs.
Item Amount
Reviewed, ready for corrections
Truss Calcs.
Plan Check Deposit
Called Contact Person
Plan Check Balance
Energy Cities.
Plans picked up
Flood plain plan
Construction
Plans resubmitted
Grading• plan'
Mechanical
god Review, ready for correciionsrissue
Subcontactor List
Electrical
Called Contact Person
Grant Deed
Plumbing
Plans picked up
H O.A. Approval
S.M.I.
Plans resubmitted
IN ROUSE:
Grading
'"' Review,
ready for corrections/issue Developerlmpact Fee
Planning Approval
Called Contact Person
Pub. Wks. Appr
A.LP.P.
Date of permit issue
School Fees
Total Permit Fees
Simplified Prescriptive Certificate of Compliance: 2008 Residential HVAC Alterations CF-lR-ALT-HVAC
Climate Zones 10 - 15
Site Address:
Enforcement Agency:
Date:
Permit #:
55-143 Southern Hills(2) La Quinta, CA 92253
City of La Quinta
Apr 1, 2013
Duct insulation
Conditioned Floor
Equipment Typel
List Minimum Efficiency2
requirement
Area
Thermostat "
® Package Unit
❑ Furnace
❑ Indoor Coil
® AFUE 78%
® SEER 13.0
❑ COP
❑ HSP F
❑ R 6 (CZ 10-13)
Served by system
1600 sf
® Setback
If not already present, must be
[3 Condensing Unit
[3 EER
❑ Resistance
❑ R 8( CZ 14-15)
installed)
❑ 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 (f9F split systems) P49GI4 -25 HERS
replaced
CF -4R forms: MECH-21
. Condenser Coil and /or
CF -6R forms: MECH-04, MECH-2I-HERS and (f9 Sp it ` ysteF Q MGC14 25 HERS'
. Indoor Coil and /or
CF -4R forms: MECH-21 and (feF split systems) MEGM—`
• Furnace
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 systems with less than 40 linear feet in unconditioned space, or
[13. Existing duct systems are constructed, insulated or sealed with asbestos
❑ 4. The system i will not be Ducted '( ie. •Ductless Mini=Split System) -(Also Exempt from' Refrigerant Charge)
❑ 2. New HVAC System
Required Forms:
. Cut in'or Changeout with
new ducts: (all new ,/)'
- ` ? f
CF -6R forms: MECH-04, MECH-20-HERS, and (for split systems) MECH-22-HERS, and
MECH-25-HERS 1 j s"
ducting and all new r
CF -4R forms: MECH-20, and (for split systems) MECH-22, and MECH-25
J .J
equipment). %f I -'
1 .. r - 1
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'
❑ 3. New Ducts with/or without
Required Forms:
Replacement '
. Includes replacing or installing all new
ducting and/or outdoor condensing unit
CF -611 forms: MECH-04, MECH-20-HERS, and (for split systems) MECH-25-HERS
and/or indoor coil and/or furnace. No or some
CF -411 forms: MECH-20 and (for split systems) MECH-25
equipment changed.
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: Apr 1, 2013
Address: 42-949 MADIO STREET License: 906115
City/State/Zip: INDIO / CA / 92201 Phone: (760) 360-2202 ,
Reg: 213-A0019319A-000000000-0000 Registration Date/Time: 2013/04/01 17:47:19
2008 Residential Compliance Forms,
T
HERS Provider: CalCERTS, inc.
July 2010