09-0468 (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: 5/13/09
Application Number:. 09-00000468 # Owner:
Property Address: 51395 AVENIDA VALLEJOREDEVELOPMENT AGENCY CITY OF L
APN: - 773-083-021'-9 000000- 78495 CALLE TAMPICO
Application description: MECHANICAL LA' QUINTA, CA 92253
Property Zoning: COVE RESIDENTIAL
Application valuation: 2600 j
Contractor:X).
t U
Applicant: iJ Architect or Engineer: PRIORITY ONE A/ AEATI,G
P . O : BOX I `�
-PALM DESERT,' 9 261'''' f. '
(760)773-081
Lic. No. - :75'180
Alvy
• 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 70001 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 License No.- 752180 for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
issued. -
Dat(; `� G �` 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
O INER-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 ROWC013690.
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 should become subjecttothe 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 COdA Cod,shall forthwith 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).: Dater =� Applicant: -
(_ 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 WORKE '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 PE LTIES 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.). - - r APPLICANT ACKNOWLEDGEMENT
(_ 1 I, as owner of the property, am exclusively contracting with licensedcontractorsto 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 issuedasa 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 building construction, and hereby authorize representatives
' of this county to enter upon the above-mentioned propy for inn ion purposes. `
Lender's Name: h✓ •- -
Date: 1 I_�-_-)Nignature (Applicant or Agent):.
• Lender's Address:
LQPERMIT - '
Application Number 09-000004681,
Permit MECHANICAL
Additional desc°.
Permit Fee.. 33 00, Plan Check Fee
8.25
.Issue Date. -c. Valuation . . .
0
Expiration Date 11/09/09
Qty Unit Charge Per
Extension
BASE FEE
15.00.
1.00 9.0000 EA. MECH FURNACE <=100K
9.00
1..00 9.0000 EA_ MECH B/C <=3HP/100K BTU
9.00
---------------------------------------------------------------------
Special Notes and Comments
REPLACE HEAT PUMP FAN - COIL 13 SEER .
(INDOOR ONLY)-
Other Fees BLDG STDs"ADMIN (SB1473)
1=.00
Fee summary Charged Paid Credited
Due
Permit Fee Total- 33..00 .00 .00
33.00 .
Plan Check Total 8.25 .00 .00
8.25.
Other Fee Total 1.00 .00 .00
1.00.
Grand Total 42.25. 0'0 .00
42.25
LQPERMIT
L E(
CERTIFICATE:OF,COM'PLIANCE RESIDENTgAL ; Pa e 1".14-4)","; ;CF -IRA
Project Tale°- � :.� ; `
Date • "
Heating Equipment Type ` , . , Minimum` • Distribution Type ' Configuiation
l
Duct"systems;that are:docurriented to have been previously sealed as confirmed through field
verification and di nostic testin in'accordance.with`' rocedures..in,the Residential.'ACM Manual;.
2
: ❑-
"Existin • ductus stems that: are extended;W'hich are:constructed, insulated or.seal'ed' with asbestos
3'r
Project Address
Q ..; %: {nom
f
Refrigerant Charge
Plan Check/Date�
Y.
p
EERY. ���:�-
CF-6Rpage8of 12 ;,;i,;_•' _CF-4R"pagea"5
Documentation Author f a = '
Telephone '
Freld70ftececkI Date gam` g
Compliance Method, (Prescriptive: HVAC and/ or Duct •
- Climate Zone ;".
nforcement Agency Use�Only
System Alteration:§ 152,(b) 1�C, D and�.E)
e
��
R -Value
(attic, etc)
TherniostaCType (split or ;
De
r. •
Y
EXCEPTIONS f _ '
If an • of the' followin three exce tions are ✓; the .duct s stem is exempt from sealed`ducts
HVAC SYSTEMS
Compliance Requirements°
`EX ce tions > - *-" . I � • ..
Heating Equipment Type ` , . , Minimum` • Distribution Type ' Configuiation
0
Duct"systems;that are:docurriented to have been previously sealed as confirmed through field
verification and di nostic testin in'accordance.with`' rocedures..in,the Residential.'ACM Manual;.
2
: ❑-
"Existin • ductus stems that: are extended;W'hich are:constructed, insulated or.seal'ed' with asbestos
3'r
0
Ductsystem s with;less than`401inear feet of ducts in unconditioned s ace; ".
HVAC SYSTEMS
Compliance Requirements°
E], `'
Heating Equipment Type ` , . , Minimum` • Distribution Type ' Configuiation
.
TXV-(Climate zones 2 and 8=15 only)'([nstaller,testingand certification and HERS Rater'field;verificatioo required.)
and Ca aci furnace, heat El i ienc ; ` and:Location: ducts" Duct;or Pim s lit or
p ' tY ( >
t g rThetinostat Type (p
'
`
-
"pump; boiler; etc.) , (AFUE.or-HSPF _ attic;,eto R -Val e
) .". )' package)
CF=6R-pages 5.andf6 of 12.:.
•
f
Refrigerant Charge
CF -6R 0ages,5 and:6 of 12
CF -4R edges 3 andA of8
p
EERY. ���:�-
CF-6Rpage8of 12 ;,;i,;_•' _CF-4R"pagea"5
-of ' �..-1�
Minimum
Cooli.n Equipment"Type
Capacity ; Efficiency
Duct Location
'Duct
Configuration
and (A/C; heat
(SEER of
R -Value
(attic, etc)
TherniostaCType (split or ;
De
pump,;evap cooling)
EER
acka
P g )
iL )
_c
` l
SEALED "DUCTS; REFRIGERANT CHARGE ff-W .AND EER "
for
The prescriptive requirement either" a refrigerant charge,or a TXV does apply to packaged'uni s;;
Before the permit can be finalized, asigned -CF-4R must be,provided,to,the building department for any of
;,the follb*in ✓, com' liance re` uire'nierits
.t t�
SPECIAL=FEATURES REQUIRING HERS RATER -VERIFICATION ;.w {
-A"✓ indicates whichcompliancer6adireriients'ai•e part of this, pro ject and need _ HERS�rater.Verifcation..:
Compliance Requirements°
E], `'
Sealed Ducts (climate zones'2 and 971,6) (Installertesting and: certification -and HERS:rater fieldverificaiion required.)
.
TXV-(Climate zones 2 and 8=15 only)'([nstaller,testingand certification and HERS Rater'field;verificatioo required.)
CF=6R' page 4of 12-'
Refrigerant Char ge'(cliinate,!zones 2 and 8-15'only):(Inataller-testing and certification and HERS Rafec field ,
verification re "wired.)
❑
EER as indicated in Table g''-`3,of kesidential.Compliance Manual (climate zones 2 and'9-16 only) (Installer testing
and :certification and HERS Rater field verification required.)_ .
.t t�
SPECIAL=FEATURES REQUIRING HERS RATER -VERIFICATION ;.w {
-A"✓ indicates whichcompliancer6adireriients'ai•e part of this, pro ject and need _ HERS�rater.Verifcation..:
4 .
F.
Compliance ,Requiremenfs ..
Installer Forms (if applicable) ' '
HERSAate'r Forms (if applicable)' ,
❑
Duct Sealing
CF=6R' page 4of 12-'
CF -4R page' I of 8 . ; •', -
❑
Thermostatic Expansion Valve-(TXV).
CF=6R-pages 5.andf6 of 12.:.
CF;4R pages 3 -of 81
Q-
Refrigerant Charge
CF -6R 0ages,5 and:6 of 12
CF -4R edges 3 andA of8
p
EERY. ���:�-
CF-6Rpage8of 12 ;,;i,;_•' _CF-4R"pagea"5
-of ' �..-1�
4 .
F.
Bin #
City of La Quint'a
Building & 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:.;
Owner's Name: 0 � v
A. P. Number:
Address:
Legal Description:
City, ST, Zip: C i7' 225 3
Contractor:
D
n N•Q,� �..Qa
Telephone:
x
� n+(1� 1 n}M�Ibv:}` r}1gi:
,;::�,',.',!Zy;�'s;••s,}:;,w»:.,: ;.
Address: P_ � , ��k (061
Project Description:
City; ST, Zip: (U �Z�L(
L a V yr
Telephone• i7 �
}vi>. \.. ti}'•h;:}T',
:',;:.•.<FA i. ... .,.;»:v:•::<;::'s>'
�' — Cc)
��)1 . ► J�1. N L
State Lic. #
City Lic. #•:
Arch., Engr., Designer:
Address:
City., ST; Zip:
Telephone: �'••
f '''r`' }:':^?:'';<::.:::
State Lic. #: t^''>•",'srz<�f'w::,'....r::>w:<
'{'Project
Construction Type: Occupancy:
type (oircle one): New. Add',n Alter Repair Demo
Name of Contact Person: .
Sq. Ft.:#Stories:
# Units:
Telephone # of Contact Person:
Estimated Value of Project: l�
APPLICANT: DO NOT WRITE. BELOW THIS LINE
#
Submittal
Plan Sets
Req'd
Recd
TRACKING
Plan Check submitted
PERMIT FEES
Item Amount
Structural Cates.
Reviewed, ready for corrections
Plan Check Deposit
Truss Cates.
Called Contact Person
Plan Check Balance
Title 24 Cates.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2" Review, ready for corrections fissue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up.
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
'"' Reyiew,.ready Cor corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person
A•I•P;P•
Pub. Wks. Appr
Date of permit issue
School Fees
1
Total Permit Fees