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11-0684 (MECH)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: 11-0 0 -66 0684 Property Address: 55076 SOUTHERN HILLS APN: 775 -190 -033 - Application description: MECHANICAL Property Zoning: LOW DENSITY RESIDENTIAL Application valuation: 3071 Tay/ 4 4 Q" Applicant: Architect or Engineer: ------------------ LICENSED CONTRACTOR'S DECLARATION BUILDING '& SAFETY DEPARTMENT BUILDING PERMIT I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect. License Class: C20 icenseNo.: 374937 ate: y J / tracicr OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the following reason (Sec. 7031.5, Business and Professions Code: Any city or county that requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the 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 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).: I—) 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 Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who does the work himself or herself through his or her own employees, provided that the improvements are not intended or offered for sale. If, however, the building or improvement is sold within 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.). (_) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed pursuant to the Contractors' State License Law.). 1 _ 1 I am exempt under Sec. , B.&P.C. for this reason Date: Owner: CONSTRUCTION LENDING AGENCY I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.). Lender's Name: Lender's Address: LQPERMIT VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 6/23/11 Owner: ALICE ABBOTT 55076 SOUTHERN HILLS LA QUINTA, CA 92253 n Contractor: J`' l" 23 ?9t•l� PALM DESERT AIR CONP CO 42081 BEACON HILL (idC �,UIN PALM DESERT, CA 92211 • v„� ?- � (760)346-0677 Lic. No.: 374937 -------------------------'--------------------- WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: _ I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided for by Section 3700'of the Labor Code, for the performance of the work for which this permit is 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 insurance carrier and policy number are: Carrier FIRST COMP INS Policy Number 010111WC I certify that, in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree that, if I should become subject to t e workers' compensation provisions of Section 3700 of the bor Code, I shall forthwit ply with those provisions. Da r� plicant: WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. APPLICANT ACKNOWLEDGEMENT IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on this application. 1. Each person upon whose behalf this application is made, each person at whose request and for whose benefit work is performed under or pursuant to any permit issued as a result of this application, 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.' 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 permit to cancellation. _ I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and by authorize representatives of this county_ to /eenter upon the above-mentioned property for inspection purp - te: � Si ture (Applicant or Ag Permit ^. ' ' ' ' ' MocHxNzcxL Additional deac ' ' . Permit Fee ' ' �� ' 31'50 ` Plan Check Fee ' ' 7'88 Issue Date ' - ' ' Valuation ' ' ' ' o Expiration Date ' ' 12/20/11 ' Qty Unit Charge Per Extension BASE FEE' 15'00 z'oO 18'5000 oa xms�o'o/c �s-zs�e/��oVK-sVOno�Tn � 16'50 ' ---------------------------------------------------_ Special moteo and Comments -____--------_-_- RoezAuCo 1 coxoDomGzmo UNIT,z� SEER.2o1n ^ � cmooS' - . __--__-_-_-_-___-_-_----_____-_-_-__--__-__-------__- Otber Fees ` ' ' ' ' ' ' ' . oLo8 oToS aoMzm (Go1473) 1'00 ' - Fee oonunary Charged. Paid _ Credited Due ----------------- Permit Fee Total ---------- _---_----_---__ 31'50 _-___-- '00'OO 31'50 Plan Check Total 7'88 '00 'OO 7�88 Other nee Total ` ' z'oO `00 .00 1'00 � Grand Total *o'sa 'nO .on 40'38 \� LQPERMI` Simplified Prescriptive Certificate of Compliance: 2008 Residential HVAC` Alterations CF-IR-ALT-HVAC Climate Zones 10 - 15 + Site Address:Enforcement Agency: Date: - Permit #: 55-076 SOUTHERN HILLS La Quinta, CA 92253 [City of La Quinta • Jun 23, 2011 Equipment Type1 List Minimum Efficiency2_. Duct insulation requirement Conditioned Floor Area Thermostat ❑ Package Unit ❑ Furnace E] Indoor Coil i] AFUE p SEER 13.0' . ❑ COP ❑ HSPF ❑ R 6 (CZ 10-13) Served by system p Setback not already present, must be 0 Condensing Unit ❑ EER .. ❑Resistance ❑ R 8 (CZ 14-15) 1600 sf in instal/ed) ❑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, Z7HSPF 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 CF74Rs allowed) are filled out and signed.Beginning October 1, 2010, a registered copy of the CF-111 and CF-6R shall also be on site for final inspection. 2 1. HVAC Changeout Required Forms: I• . • 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 (for split systems) MECH-25 • Condenser Coil and /or • Indoor Coil and /or CF-6R forms: MECH-04, MECH-2I-HERS and (for split systems) MECH-25-HERS • Furnace CF-4R'forms: MECH-21 and (for split systems) MECH-25 ;,•. For Split Systems: Duct leakagei<e15 percent; RC, CCA <_ 300 CFM/ton (Minimum Air Flow Requirement),.TMAH For- Parileaged I Wits- 1-1— 4 -'15; igiarrIARt Exempted from duct leakage',testing if:;.. { :11. Duct system•was documented to have been previously sealed and confirmed through HERS verification, or i❑ 2:1Duct systems with less than 40 linear feet in unconditioned space, or :❑ 3.`Existing duct systems are constructed; insulated or sealed with asbestos 04. Th%system=will not be Du ted (ie'DuctlessiMini-Split-+System)i(Also=Exempt�from Refrigerant_Charge) E]2. New HVAC System RequiredGForms �..�Y 'rkd �Y, irr4 . Cut in,lor Changeout with;" new ducts`r(all new j CF 6R;for4is MECH 04, MECH=20-HERS, and for split systems) MECH-22 HERS and•MECH 25 HERS' ducting and all new, �" equipment) CF� 4R,forms MECH 20 and (for split s `stems('MECH 22 and•MECH 25 -; �+ For Split Bystems.;Duct leakage 6-oercent,'RC, CCA z 350 CFM/ton, FWD, TMAH, STMS, and either4HSPP o`r=PSPP'`�,};`, = - For:packeged Units Duct leakage'<6 percent 4.> -;�.r,••;�.": _ „�.�• ���.,�+::�,� �`� '.'.'"" ,,,., ❑ 3.,New•Ducts with/or without t} Required Forms: Replacement, : a•� y }1". • Includes replacing or,installing all new ducting and/or outdoor condensing;unit'and/or indoor CF-6R forms: MECH-04, MECH-20=HERS, and (for split systems) MECH-25-HERS coil and/or.furnace. No or some equipment CF-411 forms: MECH-20 and (for split systems) MECH-25 changed. For Split Systems: Duct leakage <�6 percent; RC, CCA >: 300 CFM/ton, TMAH For Packaged 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 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: Karl Brown Signature; Karl Brown - Company: PALM DESERT AIR CONDITIONING CO INC Date: Jun 23, 2011 Address: 42-081 BEACON HILL License: 374937 City/State/Zip: PALM DESERT/ CA/ 92211 Phone: (760) 346-0677 Reg: 211-A0030387AO� 0000 0-0000 Registration Date/Time: 2011/06/23 10:46:00 HERS Provider CalCERTS, Incl 2008 Residential Compliance Forms July 2010 P:O: Box 1504 78=495::.Calle Tampico, La Quinta, California 92211; � ,1 � ` �' Tel (760):777=7012 •Fax (76Q) 777 7112. Wetslte -www Laulnta Or ';• EmaBWldtn. 9 ,ding' @La=Quetta Org Bin # Permit #1.1�_b Building Perini# Application &,Tra'cking Sheet: Project•Addr'ess: 55-076 SOUTHERN HILLS Owners: Name:' ABBOTT, ALICE P. -..'Number: Address: 55-076 SOUTHERN HILLS Legal Descnpfion: _ ._„ CityStat0 Zip: LA QUINTA, CA 92253 CcntraCtor. Palm Desert Air Conditioning,& Heating, Company. - Telephone: ( _ Address: 42-081 Beacon Hill > Orojed Description:: City, State;Zip;= Palm Desert, CA 92211 REPLACE (1) AIR CONDITIONING CONDENSER. Telephone. No - (760) 346-0677 :State: Lic.;* 374937• 'City:Lic::#: 100886 aArch:lEh i lDesigries .Andress: 'City,.State; Zip:, Telephone. No:: ., Construction:Type: Occupancy; Statea'Lic::#'.; Project Type: ❑ Neuv;-'®Add.n .©'Altera 0 Repair - Demo FNamebf Contact Person; KARL BROWN'. Sq°Fta '# Stogies: #"Units: Contact;TelepKone:Noa (760) 346-0677: Egtimatdd!Value;of'Pfoject,' $3,071.00 APPLICANT:' DO.NOT,WRITE. BELOW TNIS':LINE # Su.bmittal Reg'd.: Recd: Track."ing Fermif:Fee's Plan Sets ' Plan'Check.SU&itted Item Amount" Sfa6ctural Calcs.-- Reviewed; Ready f& Corrections` >PIan.Che'ck.0e0osit• .Truss Gatcs: ;Called,Contact'Por.son Plaii Check Balance; Title 24 Calcs. Plans Picked'.Up - Construction Piood Plain Plan :Plans Resomitie' ; Mechanical Grading Plan_ '2nd Revietiy, Ready for`Gorrections • Electrical Suticontractor'Llst Called:Contact Person Plumbing Grant'Deiii `Plans Picked;llp S :M.l M. ,AOprdvbl Plans::Resubmitted ;Grading: IN HOUSE: " '� Review; Ready;` Corrections Developer, Impact Fee ' Planning Approval -,Called: Contact Person: Pul:.lNorks Appr'I Date of Permit Issue, School. Fees. . Total; Permit: Fee's