12-0441 (MECH)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA,'CALIFORNIA 92253.
Application.Number: 12 - 0000044__l�
Property Address: 54999 SOUTHERN HILLS
APN: 775-181-005- - -.
Application description: MECHANICAL
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
SOO ROH
54999 SOUTHERN HILLS
LA QUINTA, CA 92253.
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 7245 I�D
VOICE (760)777-7012
FAX (760) 777-7011
.INSPECTIONS (760) 777-7153
Date: 4/23/12
Contractor: APR
Applicant: Architect or Engineer: HYDES APR 2 0 1012
42949 MADIO STREET
INDIO, CA 92201 C1
(760) 360-2202 FANC QUIPdT,q
1 !1, Lic. No:. 906115 ���PT,
LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION
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,a d 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
Licens Class: C20 C36 icens o.: 906115 - - for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
_ issued:
ate: • _ tractor: 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: -
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 CEWC243358
following reason (Sec. 7031.5, Business and Professions Code: Any city or county that requires a permit to I certify that, 1n 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' coppensation provisions of Section
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or, 3700 the Labor Code, I shall fo hw' 1 o y wi so1'e provisions. t -
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 thamfive hundred dollars ($500).: ate: �� plicant: ,
1 _) .1, 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 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,,
1 ) 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
Date: Owner:
CONSTRUCTION LENDING AGENCY
-
I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the
wort for which this permit is issued (Sec. 3097, Civ. C.).
Lender's Name: '
Lender's Address:
LQPERMIT
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.
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 hereby authorize representatives
of this unty-tto enter pon the above-mentioned property for inspectio wwosedhs.
�S1 ture.(Appticant or Agent):
-Application Number. 12-00000441
Permit MECHANICAL
Additional desc_.
Permit Fee 40.50 Plan Check Fee
10,13
Issue Date Valuation
0
Expiration Date 10/20/12
Qty Unit Charge Per
Extension
BASE FEE
15.00
.1.00. 9.0000 EA MECH FURNACE <=100K
9.00
1.00 16.5000 EA MECH B/C.>3-15HP/>100K-500KBTU
16.50
• Special Notes and Comments
;
HVAC. CHANGE -OUT 4 TON, 14 .SEER PACKAGE
UNIT LOCATED,ON ROOF. 2010 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 :-1.00 00 .00
1.00
Grand Total51.63 00 :00
51.63
LQPERMIT �.
Simplified Prescriptive,Celrtificate of Compliance:. 2008:Residentia/ HVA. CAlterations" : `CF-1R=ALT-HVAC_
Climate Zones 10 -.15 i
Site Address
Enforcement Agency:
Date:
Permit #:
54-999. Southern Hllls'La',Quinta, CA 92253
City of La' Quints
Apr 23, _2012 -•
Duct insulation • :.
Conditioned Floor
Equ pment Typei
List Minimurn Efficiency2;,•
requirement "
Area
Thermostat
0< ackage Unit
❑Furnace
Indoor Coil
® AFUE 78%;
® SEER; 13.Oi
[],COP
❑ HSPF.
-
[1,116 (CZ 10-13)
Served.by system
p Setback
If not-altdady present; must be
,0
❑ Condensing Unit
❑EER i
❑Resistance :
❑R8 CZ 1415
!' ), ,�
0 sf
installed).
❑Other
�'
il
11
1. Equipment Type: Choose the equipment being installed;"'if more than one system, use anotherCF=1 R-ALT=HVAC for each system.
2. Minimum Equipment Efficiencies: i13 SEER, .78.010 AFUE, 7.7HSPF for typical residential, systems.
HERS VERIFICATIONSUMMARY. Listed below are FOUR HVAC alteration'Options. The installer decides.whatwork°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 finalinspection 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;py the installer: The inspector also _yer'ifies that each appropriate CF -6R and registered CF -4R
forms (no hand filled CF-4Rs:allowed) are filled out andaigned.Beginning October:1,,2010, a.registered copy.of•the CF=3111:
and CF -6111 shall also be on site final =inspection:
m 1.,HVAC Changeout
Required Forms
All HVAC Equipment
CF-6Rjform's: MECH-04,_MECH-21-HERSR's, HERS
re.placed:...
CF 4RCforms 'MKH-2,1 .
C /or,
CF 6R forms MECH 04, MECH=21 HERS
.:IndoornGoil"anldand
/or
CF 4Rforms MECH 21:
. Furnace:�'s.:...
_ .
For ..P"ackaged Units Duct leakage 015 pereent F
Exemptedfrom:ductaeakage'testing`if'
;pal Duct,sysytem was documented to hare:been previously sealed and confirmed through' MS verlficatlon,:or
p 2 Duet systems with less than;40„linear feet lin uncontlitlonedspace; or
33 E Existingduct systems aeconstructed insylated orsealed with asbestos
Q 4 The system will not be Ducted (ie DuctleMMlm'°Splljt System) (iAlso Exempt from RefngerantrCharge)
2.: NewHVACaSystem
ur-0
r
Required Foams ” r WO:'m� a
.:Cut m oe Changeout wlth�
:new ducts' (all new
CFl6R fo ms MECH 09 MECH 20 HER5�a d splits st s MECH-22¢H
( P Y ) �? r-
T. Wo
MECH 25-2HfiR5�����
ductllinv
gi all new
equipment)
CF 4R forms MECH 2Oand (forsphtsystems)MEGH22 and3M C 25 �r
,-
4{�_
For Split Systems D�uctvleakage
:,.. •:i.,y.: .�. s,{'" <�eh: aX" S:S,..6!"'
"—'Du
percent;±11C CCA > 350 CFM/ton; FWD TMAH SIMS, and either HSPP orPSPP. ='
fj Ei"Ci�-
For:iPacka ed Units
....<...r9 a
leaka ex< 5' ercent?
f
❑3NeKDucts with/or without' °
Required Forms:
Replacement�
. Includes replacmg'or mstailing�all, new
ducting and/or.outdoor cond�ens ng unit
CF' -6R forms MECH 04, MECH 2O=HERS, and (for spilt systems):MECH 25, HERS
and/or indoor coil;and/or fumaeeNo oraome.
CF -4R forms MECH 2O;and (for'spht systems) MECH 25 .
equipment changed` �.
For.Split:Systems: IDU ctaeakage <'-6 peecent; RC; CCA 2:':300 CFM/ton; TMAH
For Packaged Units:;Duct leakage < percent a. E
❑ 4: New Ducting over 40 feet i.,
Required Forms:
. Includes adding'orreplacing more-than40 .
CF -6R forms: MECH704; MECH-2.I-HERS
linear feet of duct in unconditioned.space.
CF-4R-forms:,MECH-21
For split system or -packaged Ju nits: Duct leakage.< 15 percent ;
❑ EXCEPTION:,,Existing.duct"sysEems constructed, insulated or sealed"with asbestos
Contractor (DOCumentation Author's /Responsible Designer's Declaration -Statement)
• I certify,that this Certificate of.Compliance documentation is accuiate 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 ihugy features andiperformance specifications for the design identified on this Certificate of Corripliance-conform to the
requirements of Title 24, Parts'.1 and'6 of the California Code of Regulation`s:.-,
• 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' ° Signatures Mdrk Hyde
Company: CERTIFIED COMFORT SYSTEMS:INC. Date:,Apr 23; 2012
Address: 42-949 MADIO STREET i License: 906115
City/State/Zip: INDIO/ CA /,9220T,:Phone: (760) 360-2202
Bin #
Permit #
1
1 rolect Address: — CI 'I 7 /,1
A. P. Nurnber:
Legal Description:
Contractor:
Address:
City, ST, Zip: h
Telephone: zle7 -�
State Lic. # : `166
Arch., End., Designer.
Address:
City, S'1', Zip:
Telephone:
Stale Lic. #:
Name of Contact Person:
1'elephone # of Contact Person:
# Submittal
Plan Sets
Structural Cafes.
Truss Cafes.
Energy Cafes.
Flood plain plait
Grading, plan
Subcuntactor List
Graaf Deed
II.O.A. Approval
IN HOUSE: -
Planning Approval
Pub. Wks. Appr
School Fees
City of La'
Qu►nta
Building & Safety Division
P,O: Box 1504, 78-495 Calle Tampico
La: Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Owner's Name:
Address: 4�
City, S -T, Zip: /
Telephone: �—
Project Descripkion: A`
City.L ic. #: LJf `LZ
J—T?
Construction Type:
Occupancy:
Project type (circle one):
New Add", Alter Repair' llemo
Sq. Ft.:
#Stories:
# Units:
Estimated Value of I'rojeet:
APPLICANT: DO NOT WRITE BELOW THIS LINE
d Rec'd TRACKING
Plan Check submitted
PERMIT FEES
Reviewed, ready for corrections
Item Amount
Plan Check Deposit
Called Contact Person
,
P1311 -Check Valance
Plans picked up
Construction
Plans resubmitted
Mechanical
2" Review, ready for corrections'issue
Electrical
Called Contact Person
Plumbing
Plans picked up
S.M.I.
Plans resubmitted
--�_
Grading
7id Review, ready for correctionsfissue
Developer Impact Fee
Called Contact Person
A-I.P.P.
Date of permit issue
Total Permit Fees