11-0233 (MECH)P.O. 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: 3/09/11
Application Number: �11-000002331 Owner:
Property Address: 54394 SOUTHERN HILLS SHI•PTON JOHN
APN: 775-110-034- - - 54394 SOUTHERN HILLS
Application description: MECHANICAL LA QUINTA, CA 92253
Property Zoning: LOW DENSITY RESIDENTIAL (760) 289-6556 - �!
Application valuation: f 7985 D d
� r
'Contractor: '
Applicant: Archjt ct gjneer: 4. GENERAL. AIR CONDITI• I G V � Z��
" 31170 RESER20 11
DRIVE f
THOUSAND PALMS,. CA 92276GITY0FL4 UINTq
(760) 343-7488 Fff�lii�J.�,��FRT .
- Lic. No.: 686310
' 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 Arofessionals 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 r
License Class: C20 License.No.:. 686310 for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
issued. - • ° .
CDate: 3/4 1 t 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: -
hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the Carrier EVEREST NAT). Policy Number 7600006147101--
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 ' s� 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 becom ubject 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 hwith 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 _ '•
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).: i ._. Date: S/961 .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: 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 -
. (_ 1 1, 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,
(_ 1 I am exempt under Sec. 6'.&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 of 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.
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 informs ion is correct. I agree to comply with all*
work for which this permit iszissued (Sec. 3097, Civ. C.). city and county ordinances and state laws relating to building constructs and hereby authorize representatives
- - of this county to enter upon the above-mentioned property for inspectio rposes. -
Lender's Name: - - _
r • Date: 3`� `t,t —Signature -(Applicant or_ Agent): "
Lender's Address:
LQPERMIT
LQPERMIT
Application Number 11-00000233
Permit MECHANICAL
Additional-"dese
Permit Fee 24.00
Plan Check Fee
6.00
Issue Date . . ..
Valuation .
. 0
Expiration Date 9/05/11
Qty Unit Charge Per
Extension
BASE,FEE
15.00
1.00 9.0000 EA MECH
B/C <=3HP/100K BTU
9.00
Special Notes and.Comments.
HVAC CONDENSING UNIT CHANGE OUT 13
SEER,.
2007 CODES.
--_---------------------------------------------------------
Other Fees. . . . . . . . . BLDG STDS ADMIN (SB1473)
1.00
Fee summary Charged
Paid Credited
Due
Permit Fee Total 24.00
.00 .00
24.00`
Plan Check Total 6.00
.00 00
6`.00
Other Fee Total 1.00
.00 .00
1.00
Grand Total 31.00
.00 .00
31.00
LQPERMIT
Sim lifted Prescriptive Certificate of Compliance:- 2008 Residential HVAC.Alterations CF -IR -ALT -HVAC
Climate Zones 10 to 15
Site Address: _J71l39V So u-�n.n tom!/S
Enforcement�ency:
Date: -
Permit #:
—Equipment T et
List Minimum Efficiency 2
Duct insulation requirement
Conditioned Floor
Area
Thermostat
❑ Packaged Unit
❑ Furnace
❑ AFUE 80%
❑ COP
Over 40 ft of ducts added or
wSetback
Indoor Coil
❑SEER ! 3
❑ HSPF
replaced in unconditioned space
Served by system
(if not already
Condensing Unit
❑ EER 1 J
_
❑ Resistance
❑ R 6 (CZ 1043)
sf
present, must be
❑ Other
❑ R 3 (CZ 14-15)
installed)
1. Equipment Type: Choose the equipment being installed; if more than one system, use another CF -1 R -ALT -HVAC jor each system.
2. Minimum Equipment Efficiencies: 13 SEER, 78%AFUE, 7.7HSPFfor 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 treasures 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 -611 and registered CF -4R forms (no hand filled CF-4Rs allowed) are filled out and
ed. Beginning October 1, 2010, a registered co of the CF -1111 and CF -6R shall also be on site for final inspection.
e1 - HVAC Changeout
l
Required Forms:
• All HVAC Equipment replaced
CF -6R forms: MECH-04, MECH-2I-HERS and (for split systems) MECH- 25 -HERS
CF -4R forms: MECH- 21 and fors lits stems) MECH-25
• Condenser Coil and /or
• Indoor Coil and/or
CF -6R forms: MECH-21-HERS and (for split systems) MECH- 25 -HERS
• Furnace
CF -4R forms: MECH- 21 and (for split systems) MECH-25
For Split Systems: Duct leakage < 15 percent; RC, CCA > 300 CFM/ton(Minimum Air Flow Requirement), TMAH
For Packaged Units: Duct leakage < 15 percent
Exempted from duct leakage testing if:
❑ 1. Duct system was documented to have been previously scaled and confirmed through HERS verification, or
❑ 2. Duct systems with less than 40 linear feet in unconditioned space, or
❑ 3. Existing duct systems are constructed, insulated or sealed with asbestos
112. New HVAC System Required Forms:
• Cut in or Changeout with new CF -6R forms: MECH-04, MECH-20-HEItS,and (for split systems) MECH-22-HERS, and MECH-25-HERS
ducts: (all nese ducting and all
CF -4R forms: MECH 20-, and (for split systems)MECH-22, and MECH 25
new equipment)
For Split Systems: Duct leakage < 6 percent; RC, CCA > 350 CFM/ton, FWD, TMAH, STMS, and either HSPP or PSPP.
For Packaged Units: Duct leakage < 6 percent
❑ 3. New Ducts with Replacement Required Forms:
• Includes replacing or installing all new ducting CF -6R forms: MECH-04, MECH-20-HERS,and (for split systems) MECH-25-HERS
and/or outdoor condensing unit and/or indoor CF4R forms: MECH-20 and (for split systems) MECH-25
coil and/or furnace. Not all 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
linear feet of duct in unconditioned space.
CF -6R forms: MECH-04, MECH-2I-HERS CF -4R forms: MECH-21
For split system or packaged units: Duct leakage < 15 percent
❑ EXCEPTION: Existing ducts stems 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 ' orrn tion documented on other pplic ornpliance forms, worksheets,
calculations, plans and specifications submitted to the enforcement age fora ro al with t e permit aDPlication.
Name:(20 1leen Uj0_*66YI
Sig tures
Company: , ,
G�n,er�( t4tr Cond;f,oH,
Date:
Address:
Pesertln_tt✓�
License:.
108.31 v
City/State/Zip:��D��L f�ty4s� GA 9,��7�
T'
Phone:
76 o -3 43- 74k8
2UUtf Residential Compliance Forms March 2010
Ca10ERTS - CF -1R Registration
Page 1 of 1
Home Danielle Garcia logged in [LogoartJ
II•
[Home]
ihnlrc tis CONGRATULATIONS
Training - Your CF -I R -ALT -HVAC Registration is complete!
You may want to print this page for your records.
Rater Directory #
Forms Site Address: 54394 SOUTHERN HILLS
La Quinta, CA 92253
ALm�orc6iP tse:cfvc CEC Registration: 211-AOO 12527A-00000000-0000 r .
Y E�cuts CF -IR -ALT -HVAC: CLICK HERE TO DOWNLOAD F-
tedustg Pu;nas .'Assigned Company: HARRISON ENTERPRISES INC
\ew. Do y6u know your HERS Rater?
To register for our u If you'do, you may want to send.this CF -1 R to them.
monthly j
newsletter, please CaICERTS Rater ID:
,
• click here. , OR
My Rater Quick Select: The Energuy CA LLC
.r I
Every CaICERTS rater'has a license number.
• If you need to find the rater by name [Click HERE] to search our directory.
`SEND CF 1 R TO HERS RATER'r
[CLICK HERE] to do another
Copyright :�• 2010 CalC:ER:1-S, Inc. All ri_his reserved. Revised: ,lanuary 1 1.2010
[Terms and Conditions] [Privacy Statement] [Class Cancellation Policy]
CalCERTS, Inc., 31 Natoma St Suite 120; Folsom, CA 95630
' Office: 916-985-3400,Toll Free: 877-HERS-R8R, (877437-7787)
Fax: 916-985-3402 Contact Us
• F + I • � - .-f�j;/Arm' � f .. ♦ I ' ' ri •
lowR
R�R .
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https://www.calcerts.com/public—CfIR.cfin?project—id=103112 3/8/2011
Bin #
City of La Quinta
Building &r Safety Division
P.O. Box 1504, 78-495 Calle Tamplco
La Quinta, CA "92253 - (760). 777-7012
Building Permit -Application and. Tracking Sheet
Permit #
ProjectAddress, ,-6,11 • c i4G a6 JA4,1 S -f-oto
cJOu�.Qit.n " Owner's Name: �
A. P. Number: ".
Address:
Legal Description; City, ST, Zip:
Contractor:
Telephone: 77 (oQ g 9 �S y,..: - M sz;r:,N
�;•�0
Address: 3 Project Description:
City, ST, Zip: 7 V V)Lwv—
Telep"hone:
y;^.rtt,.;s;>
State Lic. # : 3
City Lic. #;
Arch., Engr., Designer:
Address:
City., ST, Zip:
-Telephonerfy
State Lic.
.... k Construction Type: Occupancy.
J}`:IJ,":+} �:n'�S✓!Y.\:vi.S:i::iJJiiYiii�n'i�C" a circle one): New Add'n
Project tJ'P � Repair Demo
Name of Contact • Person: Sq. Ft.:
/ "Alter
#.Stories:
#Units:
Telephone # of Contact Person: Estimated Value of Project: 7 , 8S," 0
APPLICANT: DO. NOT WRITE. BELOW THIS LINE
#
Submittal
Req'd:
Rec'•d
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Cafes.
Reviewed, ready for corrections
Plan Check Deposit
Truss Cafes.
Called Contact Person
Plan Check Balance
Title 24 Calcs.-
Plans picked up
Construction "
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2"a Review, ready for corrections/Issue
Electrical
Subcontacfor List
Called Contact Person
Plumb"ing " "
Grant Deed
Plans picked up"
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN"HOUSE:-
'rd Review,.ready for corrections/issue
Developer Impact Fee
Planning "Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School. Fees
Total Permit Fees