11-0358 (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
t : - _BUILDING PERMIT
Date:. 4/11/11
Application Number:.11-00000358 Owner:
- Property Address:. 52154 AVENIDA VALLEJO HAKANSSON HENRY
APN:, 773-223-007-16 -000000- P -O BOX .1082 4ZJ
Application description: MECHANICAL F LA QUI,NTA, CA 92253 •
Property Zoning: COVE RESIDENTIAL �� 1 •� �O
Application.valuation: 9750 ' 1 ,9
C1,p /
Applicant: Architect or Engineer: PREFERRED,- PLUMBING HTG A/C
i P.O. BOX 5120
PALM SPRINGS., -CA92,263
(760)322=3173
Lic.. No.: 457554
fv
- 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 r4Professionals C e, 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 '
Lice .Class: C10 C16 Li n No.: 457554 for by Section 3700 of the Labor Code; forthe performance of the work'for which this permit is
issued.
Date: ontractor: - d 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
OWN -BUILDER DECLARATION insurance carrier and policy number are: _ -
Ihereby affirmunderpenalty of perjury tha m ex pt from the Contractor's State'License Law for the Carrier EVEREST NAIL Policy -Number 7600006445111
following reason (Sec. .70131..51 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, 1 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 ecome subject to the workers' compensation laws of California,,
permit to file a signed statement that he or she is licensed pursuant to the provisions ofLthe Contractor's State and agree that, if.1 should b me 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 of the Labor Code, I all forthwith comply with t se rov' ions.
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 1S500).: Date: f I' ppli'c t:
• 1 ) I, as owner of the property, or my employees with wages as their sale 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' (OMPEN N 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 PENAL 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 ASPROVIDED"FOR IN -
- improvements are notintendedor offered for sale. -If; -however, the building or improvement is soldwithin' SECTION 370.6 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 _ 1 I am exempt under Sec. BAP.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. - -
D_ ate: - 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 underpenaltyof 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 c struction, and hereby a rize representatives.
of this county to enter upon the above-mentioned property inspect n pur -
Lender's Name:
..\ ., r t Date: ' �I �r Signature (Applicant or Agent):,/ - - -
Lender's Address: N • •.
LQPERMIT
Application Number ll -0.0000358
Permit MECHANICAL
Additional' desc .
Permit Fee 40:5.0 Plan Check Fee
10.13
Issue Date' Valuation
0 .
Expiration Date 10/08/11'
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-5.00KBTU'
16.50
Special.Notes and Comments
REPLACE EXISTING HEAT PUMP SYSTEM WITH
LIKE FOR.LIKE, GROUND.UNIT 15 SEER. 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 Total 51:63 .00 00 `
51:63
LQPERMIT - •. ;. - ..
Simplified Prescriptive Certificate of Compliance: 2008 Residential HVACAlterations CF -IR -ALT -HVAC
Climate Zones 10•to 15
Site -Address:
Sa/s AVWIPA VAuE�o
Enforcement Agency:
LA- d OW T�2
Date-
917<61
2 j
Permit #:
Conditioned Floor
E ui ment T �'
List Minimum Efficient z
Duct insulation requirement
Area
Thermostat
❑ Packaged Unit
Over fi. of ducts added or
❑Setback
mace .9W
❑ AFUE
❑ COP
replaced in unconditioned space
a
S/e�rv`e//d/Aby system
(If not already
❑ Indoor Coil .
P
BgEER <'
la'EER
EMSPF �
❑ Resistance
❑ R 6 (CZ 10-13)
! / 7�V sf
YYi ----
present, nn�sr be
installed)
. ondensing Unit
�,
❑ R 8 (CZ 14-15)
❑ Other
1. Equipment Type.• Choose the equipment being installed; if more than one system, use another CF -I R -ALT -HVAC for each system.
2. Minimum EquipMent Efficiencies; 13 SEER, 78%AFUE, 7.7HSPFfor typical residential systems.
HERS* VERIFICATION SUMMARY Listed below are four HVAC alter4tion 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! CF -4R forms (no hand filled CF-4Rs allowed) are filled out and
signed. a inning October 1, 20101 a registered co y of the CF -1R and CF -6R shall also be on site for final inspection.
Mor -HVAC Cha®geout
Required Forms:
CF -6R forms: MECH-04, MECH-2I-HERS and (for split systems) MECH- 25 -HERS
• All HVAC Equipment replaced
CF -4R forms: MECH- 21 and (fors lits stems) MECH-25
• Condenser Coil'and /or
CF -6R forms: MECH-2I-HERS and (for split systems) MECH- 25 HERS
• Indoor Coil and/or ,
CFAR forms: MECH- 21 and (for split systems) MECH-25
.*.Furnace.
For Split Systems: Duct leakage < 15 percent; RC, CCA _> 300 CFM/t6n(Minimum Air Flow Requirement), TMAH
For Packaged Units: Duct leakage < 15 percent
Exempted from. duct leakage testing if:
0 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
❑, 3. Existing duct systems are constructed, insulated or sealed with asbestos_
b 2. New HVAC System Required Forms:
• Cut in or.Changeoui with new CF -6R forms: MECH-04, MECH-20-HERS,and (for split systems) MECH-22-HERS, and MECH-25-HERS
ducts: (all, new ducting and all CF -4R forms: MECH 20-, and (for split systems)MECH-22, and MECH 25
new a ui ment)
For Split Systems: Duct leakage < 6 percent; RC, CCA >_ 350 CFM/ton', FWD, TMAH, STMS, and either HSPP or PSPP.
For Packnged,Units; Duct leakage < 6 percent
0 3: Ne*v 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 CF -4R forms: MECH-201:and (for split systems) MEC14-25
coil and/or furnace. Not all equipment changed.
ForSpllt Systems: Duct leakage < 6 percent, RC, CCA >_ 300 CFM/ton, TMAH
For Packa ed Units: Duct leakage <.6 ercent
4. New Ductin over 40 feet Required Forms:
• Includes adding or replacing more than 40 CF -6R forms: MECH-04, MECH-2I-HERS CFAR forms: MECH-21
linear feet of duct in unconditioned s ace.
.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.
e 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.
o 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 I and 6 of the California Code of Regulations.
v The design features identified on this Certificate of Compliance are consistent with the information documented on other applicable compliance forms, worksheets,
calculations, plans andspecifications submitted to the enforcement agency for approval with the permit application.
Name: S
Signature:
CompanyDate:
14/-,;�a`Dl/
Address:/� �• n �NlVy &�- b �I
License: 5- � �s
Ci[) /State/Zip:- 6 ip��6 0/fl- 9d_aG
Phone: Q l
2008 Residential Compliance Forins March 2010
Bin #
City of La QuAnta
Building U Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
-Building Permit Application and Tracking Sheet
Permitfl �}
Project Address: • 5 21 154 A\N N W A1 _cc To
Owner's Name: Lf s A lv a?e'l 1 4 Y A N S
A. P. Number:
Address: .s-? /,S 4 V L(LTQ
Legal Description:
City, ST, Zip: CA- a 01 io i k y 9ZZ! �
Preferred Air Conditioning ciba
Contractor: P r e f e r r e d Plumbin Heatin &Ai
Telephone: �O -139 _ 19.Z7�
Address:-P0 Box 5120
Project Description: &PJ.Ad_!r, gk1'ST/A3G.
City,ST,Zip:Pa•lm Springs, CA•92263
100"•P SNSIYA-�_ 01174-
Telephone: 7 6 0) 3 2 2 = 317 3
(
L ( �� ICQ {Q, �� jC� • � 612—obt !) O1� i T�.
State Lic. # : 457554 City Lic: #:
Arch., Engr., Designer:
X29 tz—
Address:
City, ST, Zip:
Telephone:
State Lic. #:
Construction Type: Occupancy:
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
TRACKING.:
PERMq FEES
Plan Sets
Plan Check submitted
Iten
Amount
Structural Calcs.
Reviewed, ready for corrections 1
Pla Check Deposit
Truss Calcs.
Called Contact Person
ria, Check Balance
Energy Calcs.
Plans Dicked up
Con truction
Flood plain plan
Plans. resubmitted
Mec anical
Grading. plan'
2"' Review, ready for'correctionsrissue
E14 rlcal
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M I.
H.O.A. Approval
Plans resubmitted
Gra ling
IN HOUSE -
Review, ready for corrections/issue
Dev toper Impact Fee
Planning Approval
Called Contact Person
A.I..P.
Pub. Wks. Appr
Date of permit issue
School Fees '
TotA I Permit Fees
V