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12-0801 (MECH)- 1 ------------------------------------------------ WORKER'S COMPENSATION DECLARATION P.O. BOX 1504 I hereby affirm under penalty of perjuryoneof the following declarations: " 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253, ' Application Number: 12-0000080-1 Property Address: - 54711 SOUTHERN HILLS_. APN: 775 -101 -070 - Application description: MECHANICAL Property Zoning: LOW DENSITY RESIDENTIAL Application valuation: 8000 VOICE (760) 777-7012 FAX (760) 777-7011 • BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153 BUILDING PERMIT Date: 7/19/12 Owner: DANIEL WALKER 54711 SOUTHERN HILLS - BERMUDA DUNES, CA 92203 Contractor: Applicant: Architect or Engineer: PERFECT WEATHER ; P.O.'BOX 13308 PALM DESERT, CA 92255 (760) 770-0404 �I►i`- Lic. No.: 897743 ------------------------------------------------- - - LICENSED CONTRACTOR'S DECLARATION r - ------------------------------------------------ WORKER'S COMPENSATION DECLARATION hereby affirm under penalty of perjury thatam licensed under provisions of Chapter 9 (commencing -with - I hereby affirm under penalty of perjuryoneof the following declarations: _I Section 7000) of Division 3 of the Bus' 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 Cla 0 ices No.: 897743 • _ for by Section 3700�of,the Labor Code, for.the performance of the work for which this permit is 7 /Date: ! 4? [dontractor: ' • ' _ issued. '1' ' �•'F 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 , 1 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 HARTFORD CASUAL Policy Number 72WECDQ8041 - 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' 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 ld become subject 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 oft Lab, C d I shall fort- y 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).:. ate:7 Applicant: 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, 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 underorpursuant 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 - of La Quinta, its officers, agents and employees for any act or omission related to the work being _ - - - performed under ori 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 all ' work for which this permit is issued (Sec. 3097, Civ. C.). city and county ordinances and state laws relating to b ' n construction, nd h by authorize representatives - of thi cou ty to ter upon a above-mentioned pro e f mspectio p Lender's Name: ate: nature (Applicant or Agent): Lender's Address: LQPERMIT - • - Application Number . . . . . 12-00000801. Permit. . . MECHANICAL • Additional desc . Permit Fee- -. 40:50 Plan Check Fee ;. 10-.13. - Issue Date . . .valuation �. Expiration Date 1/15/13 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/>100K7500KBTU.. 16.50'` Special Notes and Comments . HVAC CHANGE -.OUT; REPLACE GAS/ELECTRIC UNIT ON ROOF WITH.I6.SEER GAS/ELECTRIC - UNIT. 2010 CODES -----------------_-_------------ ------------ ----------------- Other Fees . . ... . BLDG STDS ADMIN-(SB1473) 1.00 Fee summary Charged Paid Credited Due Permit Fee Total 401.50 .00' .00 40.50 Plan Check Total.10.13 .00 00 10.13 Other Fee Total 1.00 .00 00 1.00 - Grand Total 51.63 .00. 00= 51.63_ LQPERMIT Simplified Prescriptive Certificate of Compliance: 2008 Residential HVAC Alterations CF -IR -ALT -HVAC Climate Zones 10 -IS Site Address: - Enforcement Agency: Date: Permit #: 54711 So6thern Hills Dr. La Quinta, CA 92253- City of La Quinta Jul 13, 2012 Duct insulation Conditioned Floor Equipment Typel, List Minimum CMciency2 requirement Area Thermostat * Package Unit . * Furnace 0 AFUE 78% ❑[1 COP [I R 6.(CZ 10-13) Served I rved by syst�m 0 Setback, [] Indoor Coil 0 SEER 13,0 [] HSPF [I R 8 (CZ 14-15) ❑0 sf If not alri0i"present,must be 0 Condensing Unit EER 0 Resistance instafled),, [I 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'Tgjri� #Iftidecides what work is being done and picks one of the appropriate Options.'Each Option lists the HERS measures that mus't'b'e"cond'u-'c;ted..Altboy,of the.f6rms shall be left on site for final inspection and a copy given to the homeowner. At final, the inspector verifies1.ffi6t'th­e wo-rki'list6d on this form was in fact the work completed by the installer. The inspector also verifies that each appropriate CF -611 registered forms (no hand filled CF-4Rs allowed) are filled out and signed.Beginning October 1, 2010, a registered Copy "of the; and CF -611 shall also be on site for final inspection. E3 1. HVAC Changeout Required Forms: • All HVAC Equipment CF -6R forms: MECH-04, MECH-21-HERS and (fqr split systems) DAF: 14 25 14ERS replaced CF -411 forms: MECH-21 ,rid (feF Split systems) MEG14 2-5 • Condenser Coil and /or CF -6R forms-'MECH-04, MECH-21-HERS and (feF split systems) MEG14 25 WEaRS • Indoor Coil and /or CF -411 forms*: MECH-21 BRd �er- split systems) MEGN 2& ( • Furnace I %. . -Oft I FGF Split- Sy"-- 4 15 peFeeRtj RG, GGA eg 3�9 F!t"WA (MiRimum AiF We For Packaged Units: Duct leakage <`15 percent Exempted from duct leakage testing -if: [3 1. Duct system was cloLmehtecl to'have been previously sealed and confirmed through HERS verification, or [3 2. Duct systems with less than 40 linear feet in unconditioned space,or, 0 3. Existing duct systems are constructed, insulated or sealed with asbestos [34. ThesV9fe-NVw . ill not be DtLctio (ie ,DV4ss;Mini=Sp1it-System),(AIWExe Tp raMEChame) 13 2. New HVAC system Required Forms: ." V, .Cut in*or Changeout wittf. new ducts' (all new ducting ' X, lik ,AST CF 611 fo :MECH-04, MECH 207HERS,; and'(f6r split syste�nS)'MtCH"2i'z.HERS,. and ,- M�ZH,�251HERS % and all new '- 7-4"R forms: MECf -10 and (for split systems) MECH-'22, and MECH-2 equipment). J _k 0 For Split Systerns:'Duct leakage< 6 percent; RC, CCA,�! 350.CFM/ton";FWD,,,TMAH, STMS, and either HSPP oePSPP. For Packaged Units: Duct leakageA < .6 percent 13 3. New Ducts with/or without Required Forms: Replacement Includes replacing or installing all new A' 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 furnace. No or some CF -4R forms: MECH-20 and (for split systems) MECH-25 equipment changed. For Split Systems: Duct leakage 79 percent; RC, CCA �: 300 CFM/ton, TMAH For Packaged Units: Duct leakage < 6 percent 0 4. New Ducting over 40 feet Required Forms: Includes adding or replacing more than 40 CF -6R forms: MECH-04, MECH-21-HERS 1CF-4R linear feet of duct in unconditioned space. forms: MECH-21 For split system or packaged units: -Duct leakage < 15 percent 0 EXCEPTION: Existing duct systems constructed, insulated or sealed with asbestos. Contractor (Documentation Author's /Responsible Designer's Declaration Statement) • I certify t6k 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 Complianci. • Icertify that the energy features and performance specifications for the design identified on this Certificate of Compliance conform to the requirements of Title 24, Parts I 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: David Cullen bavid Cullen Company: I A S MECHANICAL INC Date: Jul 13, 2012 Address: P 0 BOX 13308 License: 897743 1Phone: City/State/Zip: PALM DESERT CA 92255 (760) 770-0404 Reg: 212-A0037187A-00000000-0000 Registration Date/Time: 2012/07/13 11:18:41 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms July 2010 3 Bin .# City. of La Quinta .Building 81 Safety Division P.O. Box 1504,'78-495 Calle Tampico La.Quinta, CA 92253- (760) 777-7012 Building Permit Application' and Tracking Sheet Permit # Project Address: 61-71 �® �` /l GS Owner's Name:. �.( C ' A P. Number. Address: Legal Description: City, ST, Zip: �ZZS 3 Contractor eepone: S—D8z =a�'+x::s Address: S p J S -r Project Description: C� �S e/ City, ST, Zip:Uox Z � � Telephone: 7 0-7�d '0�0, �,� 2 �: £\,�,,.,, „�\. ,y 16Z e C C State Lie. #: O 9 Cf3 City Lia k Arch., Engr., Designer Address: City., ST, Zip: Tele hone: �. P � State Lie. #:Project Name of Contact Person: 11 Construction Type:. Occupancy: type (circle one): New Add'n Alter Repair Demo Sq. Ft.: bt # Stories: i' # Unit;: Telephone # of Contact Petson:0—� Q ti (j Estimated Value of Project (jQ oa APPLICANT: DO NOT WRITE BELOW THIS UNE N Submittal Req'd Recd TRACKING PERMIT FEES Plan Sets Plan Check submitted Item Amount Structural Cates. Reviewed, ready for corrections Plan Check Deposit. . Truss Calcs. Called Contact Person Plan Check Balance_ Title 24 Calcs. Plans picked up Construction Flood plain plan Pians resubmitted.. aMechanical Grading plan r' Review, ready for correctionsrissue Electrical Subcontactor List Called Contact Person Plumbing Grant Deed Plans picked up S.M.L H.O.A. Approval Plans resubmitted Gradlu ' IN HOUSE:- '^' Review, ready for correctionsfissue Developer Impact Fee Planning Approval Called Contact Person Pub. Wks. Appr Date of permit Issue School Fees Total Permit Fees