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10-0717 (MECH)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA; CALIFORNIA 92253 Application Number: 10X,00000717 Property Address: 51880 AVENIDA VALLEJO APN: 773-172-007-18 —000000-. Application description: MECHANICAL ` Property Zoning: COVE RESIDENTIAL ' Application valuation: 4500 BUILDING & SAFETY DEPARTMENT: BUILDING PERMIT Applicant: Architect or Engineer: r - - w•. -I LICENSED CONTRACTOR'S DECLARATION - - • • • --- < 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 License No.: 743185 <D�'at e: JJ!3 Contractor: CN, • 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: A(iy 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 LicenseLaw(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).: • (_) 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 _. _ . ... _.. .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 - - - Jmprovements 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.). - - 1 _ 1 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 applyto 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.). - - (_7 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 Owner: CUSHNER MICHEAL 51880 AVENIDA VALLEJO . LA QUINTA, CA 92253 (760)000-0000 OLALDE, ALBERT 81891 SANDY COURT INDIO, CA.92201 (760)342-0100 Lic. No.: 743.185 VOICE (760) 777-7012 FAX (160) 777-7011 INSPECTIONS (760) 777-7153 Date: 8/03/10 I" /Q 032010 GSTt!}e..r�4.��,rEVT,4 E ------------------ 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 EXEMPT Policy Number EXEMPT 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 the workers' compensation provisions of Section 2 3700 of the Labor Code, I shall forthwith comply with those provisions. Date:.�e�� Applicant:��_�^1��/ 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 EES.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 hereby authorize representatives of,this county j to enter upon the above-mentioned property for ins(\ges urposes. Date: 3�1'(OSignature (Applicant or Agent):` .Application•Number . . . 10-00000717 Permit . . . MECHANICAL Additional'desc " ' Permi"t.Fee 33.00 Plan Check Fee 8..25 - Issue. Date Valuation 0 Expiration Date 1./30/11 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-HVAC-PP;CKAGE-UNIT-T3-SEER-` ---_...__......._.__,._..-.._.-.__...------..-._-_..____._...-...-._.._... ------------------------------------------------------------------------ Other Fees . . . . . .. . . . BLDG STDS ADMIN (SB1473) 1.00 Fee summary Charged Paid Credited -----------.-----------'----- Due T. Permit Fee Total 33:00 .00' .00 33.00 i - ?G J Plan .Check Total 8.25 00. 00 :8.25 Other Fee Total., 1.00 .00 .00 1.00 I "" _ Grand Total 42.25 .00 .00 42.25 _ LQPERMIT ' , Simplified Prescriptive Certificate of Compliance: 2008 Residential HVA C Alterations CF 1R ALT HVAC ,s, Climate Zones 10 to 15 Sitezr- AdQ ess: Enforcement Agency: Daie: Permit M Equipment T 'Conditioned Floor List Minimum Efficient Duct insulation requirement Area Thermostat ackaged Unit O Furnace ❑ AFUE� ❑ COP Over 40 ft of ducts added or Setback O Indoor Coil ❑SEER_ ❑ HSPF replaced m unconditioned space Served by system (/foot already O Condensing Unit O EER ❑ Resistance O R 6 (CL 10-13) f present, must be O Other ❑ R 8 (CZ 14-15) insmlted) I. Equipment Type: Choose the equipment being installed; ijmore than one system, use another CF -I R -ALT -HVAC jor each system. 2. Minimum Equipment Efficiencies: 13 SEER, 78.0 AFUE, 7.7HSPFjortypical 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 be left shall 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 fad the work completed by the installer. The inspector also verifies that each appropriate CF -611 and registered CF4R forms (no hand filled CF4Rs allowed) are filled out and sied. Beginning October 1 2010 a registered copy of the CF -111 and CF -6R shall also be on site for final Inspection. HVAC Changeout . Required Forms: • All HVAC Equipment replaced CF -6R forms: MECH-04, MECH-2I-HERS and (for split systems) MECH- 25 -HERS 'MECH- CF -4R forms: 21 and for s litsystems),MECH-25 • Condenser Coil and /or • Indoor Coil and /or CF -6R forms: 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 leakage < 15 percent; RC, CCA > 300 CFM/ton(Minimum Air Flow Requirement), TMAH For Packaged Units: Duct leakage < 15 percent Exempled tom duct leakage testing if: ❑ 1. Duct system was documented to have been previously sealed and confirmed through HERS verification; or 0 2. Duct systems with less than 40 linear feet in unconditioned space, or O 3. Existing ducts stems are constructed, insulated or sealed with asbestos 0 2. New HVAC System Required Forms: • Cut in or Chang ucti with new ducts: (all new dulling i� all CF -6R forms: MECH-04, MECH-20-HERS,and for lit ( Split systems) MECH-22-HERS, and MECH-25-HERS new equipment) CF -4R forms: MECH 20-, and (for split systerns)MECH-22, and MECH 25 For Split Systems: Duct leakage < 6 percent; RC, CCA > 350 CF Wton, FWD,.TMAH, STMS, and either HSPP or PSPP. For Packaged Units: Duct leakage <6 percent O 3. New Ducts with Replacement'' 4t-FprMs: • Includes replacing or installing all new ducting CF -611 forms: MECH-04, MECH-20-HERS,and (for split systems) MECH-25-HERS and/or outdoor condensing unit and/or indoor CF -4R 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 2:300 CFMhon, TMAH For Packaged Units: Duct leakage < 6 percent 0 4. New Ducting over 40 feet Required Forms: • Include; adding or replacing more than linear feet of duct in unconditioned space. e CF-6R forms: MECH-04, MECH-2I-HERS CF -4R forms: MECH-21 For split system or packaged units: Duct leakage < 15 percent ❑ EXCEPTION: Existinj 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. • 1 certiN, 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 ale>ign features identifiied on this Certificate of Compliance are consistent with the inforrriation documented on other applicable compliance fortes, worksheets. calculations, tans ands ifications submitted to the enforcement en fora royal wi tmit on. Name: Signature Comp Date)�03v Address t , Lioensi;-, V City/Statc2ip: N.Phone: 2008 Residential Compliance Forms March 2010 Bin # City Of La QuIlata Building 82'.' Safety Division P.O. Box 1504, 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Permit # p l Project Address: Owner's Name: NN.. A. P. Number: Address: ^ AD Legal Description: 0 L City, ST, Zip: ContractorTelephone:WHOM > : `` "� `. Address: Project Description: City, ST, Zip: �.� q CC 41? .. f '.' Telephone: Q- .-C)k 0" "T `s State Lie. #: City Lic. #; Arch.;Engr., Designer Address: City., ST, Zip: Telephone:Construction :: Type:. Occupancy: State Lie. #: Project type (circle one): New Add'n Alter Repair Demo Name of Contact Person: Sq. Ft : #Stories: #Units: Telephone # of Contact Person: Estimated Value of Project: APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Req'd Recd TRACIGNG PERMIT FEES Plan Sets Plan Check submitted Item Amount Structural Calcs. Reviewed, ready for corrections Plan Check Deposit Truss Calcs. Caned Contact Person Plan Check Balance Tide 24 Calcs. Plans picked up Construction Flood plain plan Plans resubmitted Mechanical Grading plan 2a° Review, ready for correctioWissue Electrical Subcontactor List Called Contact Person Plumbing Grant Deed Plans picked up S.M.I. H.O.A. Approval Plans resubmitted Grading IN HOUSE:- 3" Review, ready for correction&4nue Developer Impact Fee Planning Approval Called Contact Person A.I.P.P. Pub. Wks. Appr Date of permit issue School Fees Total Permit Fees v/ Simplified Prescriptive Certificate of Compliance: 2008 Residential HVAC Alterations CF -IR -ALT -HVAC Climate Zones 10 to 15 Site Add ess: r �i Enforcement Agency: Dare: Permit #: Equipment Type' List Minimum Efficienc ` Duct insulation requirement Conditioned Floor Area Thermostat ackaged Unit ❑ Furnace ❑ AFUE❑ COP � Over 40 ft of ducts added or etback ❑ Indoor Coil _O ❑SEER ❑ HSPF replaced in unconditioned space Served by system (7f not ❑ Condensing Unit ❑EER ❑Resistance ❑ R G (CZ /0-/3)f present, must be ❑ Other ❑ R F. (CZ 14-15) installed) I. Equipment Type: Choose the equipment being installed: if more than one system, use another CF- I R-ALT-HVACforeach system. 2. Minimum Equipment Efficiencies: 13 SEER, 78.0 AFUE, 7.7HSPF 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 CF4R forms (no hand filled CF-4Rs allowed) are filled out and signed. Beginning October 1, 2010 a registered copy of the CF -1R and .CF -6R shall also be on site for final Inspection. HVAC Changeout . Required Forms: • All HVAC Equipment replaced CF -6R forms: MECH-04, MECH-2I-HERS and (for split systems) MECH- 25 -HERS CF -411 forms: MECH- 21 and fors litsystems). MECH-25 • Condenser Coil and/or • Indoor Coil and /or CF -6R forms: MECH-2I-HERS and (for split systems) MECH- 25 -HERS CF -4R forms: MECH- 21 and (for tsplit systems) MECH-25 • Furnace For Split Systems: Duct leakage < 15 percent; RC, CCA > 300 CFiM/tdn(Minimum Air Flow Requirement), TMAH For Packaged Units: Duct leakage < 15 percent hxempled from duct leakage testing if: O 1. Duct system was documented to have been previously sealed and confirmed through HERS verification; or ❑ 2. Duct systems with less than 40 linear feet in unconditioned space, or ❑ 3. Existing ducts stems are constructed, insulated or sealed with asbestos 0 2. New HVAC System Required Forms: • Cut in or Changeout with new E CF -6R forms: MECH-04, MECH-20-HERS,and (for split systems) MECH-22-HERS, ducts: (all new ducting and all and MECH-25-HERS CF -411 forms: MECH 20-, and (for split systems)MECH-22, and MECH 25 new equipment) r 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 0 3. New Ducts with Replacement— RizgtTired'F`orms: }, • 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 CF411forms: MECH720 and (for split systems) MECH-25 coil and/or furnace. Not all equipment changed. For Split Systems: Duct leakage < 6 percent, RC, CCA > 300 CFWton, TMAH For Packaged Units: Duct leakage < 6 percent 0 4. New Ducting over 40 feet Required Forms: • Includes adding or replacing more than linear feet of duct in unconditioned space. CF-611 forms: MECH-04, MECH-2I-HERS CF4R forms: MECH-21 For split system or packaged units: Duct leakage < 15 percent ❑ EXCEPTION: Existing ducts stems constricted, insulated or sealed with asbestos. Contractor (Documentation Author's /Responsible Designer's Declaration Statement) • 1 certify that this Certificate of Compliance documentation is accurate and compl` te. • 1 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 cenify 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 apeE2!2jwittift permit app Name: i Signature Comp \ Date CA Address t �^ ^ t� t Licens -Z v �1 i� City/State/Zip: r Phone: [UUlf Kestaenttal Compliance Forms March 2010 Certificate of Field Verification Prescriptive Method - and Diagnostic Testing HVAC -Only Alteration CF -4R -ALT Pr oje Title: LA 5 pe,e—`^�!J C�� Date: $1 r3 A5 © 2005 CaICERTS Enforcement Agency Use Only' Project Address:ff 6-/ $�� /� V�� LQ Climate Zone: Building Permit # Installing Contractor: Telephone: 'Woo Plan Check Date CaICERTS Rater Name- Telephone:r4,0 Field check Date Rater's Company Name: CAC CaICERTS Rater ID #: IMPORTANT: This CF -4R -ALT form is only for use when an HVAC- my alt ation is made to, an existing home . Use one form for each system being altered. This is system #� of.77 systems altered in this house. . Do not release CF-4Rs for a sample group until all verification and testing in the group is completed and passed. Copies to: Homeowner, Installer, and Building Department Hers Rater Compliance Statement: As the HERS rater providing diagnostic testing and field verification, I certify that the house identified on this form complies with the diagnos esting compliance re uire nts as checked ✓ ori this form. I also certify that I have followed all proto s Vrd. p cedur ulred by the CaICERTS Rater Agreement. Signed: Samplingirst t t ❑ Re-tepprfattach previous CF -4R -ALT) his house is T part of a sample group. is house passes all necessary tests. (Rater to sign HERS rater compliance statement above). ❑ This house did NOT pass the necessary tests. Retest required. See notes below and next page. ❑ This hcfuse is part of a sample group Other houses in the group include (max 6): Home owner's last name/Street address/City 1) 3) 4) 5) 6) ❑ This house passes all necessary tests. (Rater to sign HERS rater compliance statement above). All homes in sample group will be issued CF -4R certificates from CalCERTS registry. ❑ This house did NOT pass the necessary tests. Retest required. See notes below and next page. 11 This is the first house to fail in this group. (Select one of the above homes for second test). ❑ 'This is the second house to fail in this group. All homes in group must be tested. Notes: Version 03-10-06 This form can only be used on projects being verified by CaICERTS certified raters. Page 1 of 2 www.calcerts.com .b , "' Certificate of Field Verification Prescriptive Method - and Diagnostic Testing HVAC -only Alteration CF -4R -ALT Project itle: Date: ((n 2005 CaICERTS IMPORTANT: This CF -4R -ALT form is only for use when an HVAC -only alteration is made to an existing home Use one form for each system being altered. This is system # I of I systems altered in this house. Copies to: Homeowner, Installer, and Building Department Rater to verify only results of test that passed on CF -6R -ALT form. See lines 26 to 29 of CF -6R -ALT form. Results must be uploaded to CaICERTS Registry for issuance of final certificate per Title 20. Step 1 - Protest: Leakage of the system before any alterations.(Only if line 27 is checked on the CF -6R -ALT form. 1 Protest leakage I ICFM25 From Line 1 of CF -6R -ALT form. 2 1 Line 1 x 0.4 = I Jarget for 60% reduction Step 2 - Determine Total System Fan Flow: Use any of these methods.(Only if lines 26, 27 or 28 are checked on CF -6R -ALT m 3 Cooling: Condenser tonnage: tons x 400 CFM/ton = QAC r21CC> CFM 4 Heating: Furnace output: Btuh x.0217 CFM/Btuh = CFM 5 6 Measured: (refer to ACM Manual Appendix RE, section 4.1) = CFM Measurement method: ❑ flow hood ❑ plenum pressure matching ❑ flow grid 7 Total system fan flow value to be used: FM may use highest of lines 3, 4, or 5 Step 3 - Determine Targets: (Only if lines 26 or 28 are checked on CF6R-ALT form) 8a Total System fan flow (line 7 from aboveLO.O6 FM25 = 6% leakage target 8b Total S stem fan flow line 7 from above FM25 = 15% leakage target9 Total S stem fan flow line 7 from above FM25 = 10% leakage to outside target Step 4 - Alterations: Must be consistent with the CF -1R form. 10 ❑ IVerifv that all new connections are sealed with approved materials. 11 ❑ lNo newly constructed portions of the system can have unducted building cavities to convey system air. 12 IDuct insulation to be checked by local code enforcement agency. Step 5 - Total Leakage (Only if line 26 or 27 are checked on CF -6R -ALT form) 13 leakage = I I 2M ICFM25 refer to 2005 ACM appendix RC, Sections RC 4.3.1 14a ❑ 14bline If line 13 is less than line 8a, house passes the 6% leakage requirement. Go to Step 9 13 is less than line 8b house passes the 15% leakage requirement. Go to Step 9 ❑ K1 If line 13 is less than line 2 house asses the 60% reduction requirement after line 17 is checked. 6 ❑ This house does not yet pass the necessary tests. Retest required. Attach new CF -4R -ALT. See notes, bel 17 ❑ If line 15 is checked, but not 14a or 14b, Smoke Test and Visual Inspection of Accessible Duct Sealing is required. Go to Step 8 Step 6 - Leakage to Outside:(Only if line 28 is checked on CF -6R -ALT form) 18 leakage = CFM25 refer to 2005 ACM appendix RC, Sections RC 4.3.3 19 ❑ lif line 18 is less than fine 9, house passes the 10% leakage to outside requirement. 20 ❑ IThis house does not yet pass the necessary tests. Retest required. Attach new CF -4R -ALT. See notes, below. Step 7 - (If line 29 is checked on the CF -6R -ALT form. 21 ❑ 22 ❑ 23 ❑ Smoke Test and Visual Inspection of Accessible Duct Sealing are required. Install required label per ACM Appendix RC, Sections RC.4.3.5. House can NOT be part of a sample. ❑ This house does not yet pass the necessary tests. Retest required. Attach new CF -4R -ALT. See not s el w. Step 8 - S—nifte Test and Visual Verification(Only if lines 27 or 29 are checked on CF -6R -ALT form 24 erform smoke test per ACM Appendix RC, Sections RC 4.3.6. 25 erform Visual Inspection and verify repair of excessively damaged ducts per ACM Appendix R i 7. 26 erify that register boots are sealed to surrounding material per ACM Appendix RC, Sections SteI19 - V(RCA) 27a TXV is required by the CF -1 R form (line 23 on CF -1 R -ALT form), it has been i ss as been rovided for visual verification b HERS rater. 27b I "Refrigerant Charge and Airlfow" (see ACM appendix RD) was done in lieu of X pleted a es 3 of 8 and 4 of 8 from the CEC's CF -4R form. Step 10 raded Equipment Efficiencies 28 If grade equipment efficiencies are required (line 24 of CF -1 R -ALT) Hers rater to verify c sa ake and model number of equipment. Installing contractor to provide rater adequ tion to veri efficiencies. 'Rotes: refer to line numbers above Version 03-10-06 Page 2 of 2 This form can only be used on projects being verified by CaICERTS certified raters. www.calcerts.com