10-0704 (MECH)P.O. BOX 1504 .
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT '
BUILDING PERMIT
Application Number: ('10='00000704 Owner:
Property Address: 52961 AVENIDA VALLEJO SHAUL MEZRAHI
APN: 773-323-029-12 -000000- 52961 AVENIDA VALLEJO
Application description: MECHANICAL LA QUINTA, CA 92253
Property Zoning: " COVE RESIDENTIAL
Application valuation: 3000
_ Contractor:_ _...
Applicant: Architect or Engineer: COMFORT AIR
4803 E. SUNNY DUNES ROAD
f PALM SPRINGS, CA 92264
(760)320-5800
Lic. No.: 763937
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 Licens No.: 7639937
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Date: 1\'w�`� Contractor: �lC';kA3� h
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: Any 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
License Law (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 1$500).:
(_) 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
,. 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
improvements 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, 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 apply to 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.).
( 1 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:
LQPER ITT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 7/30/10
JUL 3 0 2010
OF
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 willmaintain 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 STAR INS Policy Number WCMSTRO570214
I 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
3700 of the Labor Code, I shall forthwith comply with those provisions.
�7.� c
Date: DUtW ' Applicant:
WARNING: FAILURE TO SECURE W KERS' 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 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. 7
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 cunty to enter upon the above-mentioned property for inspection purposes.
Date: ,�� Signature (Applicant or. Agentl:
LQPERMIT
Application Number 10-00000704
Permit MECHANICAL
_Additional desc-:
Permit..Fee 33.00
Plan Check Fee
8.25
Issue -Date . . .
Valuation . .
. 0.
Expiration Date 1/26/11
Qty Unit Charge Per
Extension
BASE
FEE
15.00
1.0"0 9.0000 EA MECH
FURNACE <=100K
9.00
1.'00 ..9.000.0 EA MECH
B/C <=3HP/100K BTU
9.00
----------------------------------------------------------------------------
Special Notes and Comments
--1- .: INSTALL NEW-HVAC-PACKAGED-UNIT---2-1/2-TON
___.___......_.._....._....-•.-.......-...._._...---_......-----....__....
...
/HEAT PUMP ROOFTOP UNIT SAME FOR
SAME.
WILL REPLACE SCREENING PRIOR TO
FINAL.•
e
- ----------------------------------------------------------------------------
Other.Fees . . BLDG STDS ADMIN (SB1473)
1.00
Fee summary Charged
Paid Credited
Due
-------------------------------------
` Permit•Fee Total 33.00
--------------------
.00 .00
33.00 j
r Plan .Check Total 8.25
00 .00
8.25
Other.Fee Total. 1.00
.00 .00
1.00
Grand Total 42.25
.00 .00
42.25
LQPERMIT
Simplified Prescriptive Certificate of Compliance: 2008 Residential HVAC Alterations CF -IR -ALT -HVAC
Climate Zones 10 to 1S
Site Address: Enforcement Agency:
Date:
Permit #.
/il
Equipment T t
List Minimum Efficiency' Duct insulation requirement
Conditioned Floor
Area
The
-8 Packaged Unit
tat
etback
O Furnace
O AFUE O COP Over 40 ft of ducts added or
O Indoor Coil
❑SEER_ ❑ H replaced in unconditioned space
Served by system
pJnot already
❑ Condensing Unit
❑ EEResistance ❑ R 6 (CZ 10-13)
�p sf
present. must be
❑ Other
O R 8 (CZ 14-15)
installed)
1. Equipment Type: Choose the equipment being installed: if more than one system, use another CF -1 R -ALT -HVAC for each system.
2. Minimum Equipment Efficiencies: 13 SEER. 78.9 AFUE, 7.7HSPF jor 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 fad the work completed by the
installer. The inspector also verifies that each appropriate CF -611 and registered CF4R forms hand
(no filled CF4Rs allowed) are filled out and
signed.jBirginning October 1 2010 areghteredco of the CF -1R and CF -6R shall also be on site for final inspection.
HVAC Changeout
Required Forms:
• All HVAC Equipment replaced
CF-61(forms: MECH-04, MECH-2I-HERS and (for split systems) MECH- 25 -HERS
CF -4R forms: MECH- 21 and fors lit systems). MECH-25
• Condenser Coil and /or
• Indoor Coil and /or
CF -6R forms: 14ECH-2I-HERS and (for split systems) MECH- 25 -HERS
• Furnace
CF4R forms: MECH- 21 and (for split systems) MECH-25
For Split Systems: Duct leakage < 15 percent; RC, CCA > 300 CFMhon(Minimum Air Flow Requirement), TMAH
For Packaged Units: Duct leakage < 15 percent
lixempted from duif:�ct leakage testing i
�W° -t system was documented to have been previously sealed and confirmed through HERS verification, or
t systems with less than 40 linear feet in
unconditioned space, or
O 3. Existing ducts sterns are constructed,insulated or sealed with asbestos
❑ 2. New HVAC System
Required Forms:
• Cut in or Changeout with new
ducts: (all new ducting and all
CF -6R forms: MECH-04, MECH-20-HERS,and (for split systems) MECH-22-HERS, and MECH
-25-HERS
new equipment)
CF -4R fours: MECH 20-, and (for split systems)MECH-22, and MECH 25
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
❑ 3. New Ducts with Replacement— ' - '
RegUired-fte rs:
• Includes replacing or installing all new ducting
CF -6I1 forms: MECH-04, MECH-20-HERS,and (for split systems) MECH-25-HERS
and/or outdoor condensing unit and/or indoor
CF411 fortes: 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 > 300 CFM/ton, TMAH
For Packaged Units: Duct leakage < 6 percent
O 4. New Ductin 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
O EXCEPTION: Existing 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 ceniN 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.
• I he design features identified on this Certificate of Compliance are consistent with the information documented on other applicable compliance forms, worksheets,
calculations, and specifications
plans submitted to the enforcement a e f approval with the kation.
Name:
l��j r2 V
Signature:
Company: ��
Date:
loop f
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Address:
V 1,2License:
City/Statclzip:
Phone: /� �
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zvvo neatuettttut L.Umptiance corms March 2010
Bin #
Qty of La Quints
Buildingff Safety Dh*lon
P.O. Box 1504,, 78-495 Calle Tampico
La Qulnta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #; j
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Project Address:Q� le
Owner's Name: 77
A. P. Number:
Legal Description:City,
Contractor:::.',%..
Address: 3 _ s
ST, Zip. Q��e.� f
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Telephone: ,.{:�:�'� ,,c �• ;:9%•}:.4a«.>�;t:
Project Description: C�
City, ST, Zip: cS t
r 1 e
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Telephone: �.��
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}. FSF �rYa°'YS:co
State Lie. # : �� 7 3 City Lie. #;
Arch., Engr., Designer:
Address:
City., ST, Zip:
Telephone: •>ik n�:CR\
�' `}c: °a. ,..�`<•'': :?i:icac�
, •teas.
State Lie. #: ' ' L""""' %�
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•};A .fY
Name of Contact Person: ��, S'ex� of -S
Constmetion. Type: QCCUpanCy'
Project type (circle one): New Add'n Alter Repair Demo
Sq. FL:#Stories:
#Units:
Telephone # of Contact Person: (-z 3 azj pS
Estimasted Value of Proje .
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.
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
Plans resubmitted
Mechanical
Grading plan
2" Review, ready for corrections tissue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
H.O A Approval
Plans resubmitted
Grading
IN HOUSE:-
'"' Review, ready for correctionsfissue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees
-o #A4 -m L��c.Lcj
11 ON
010
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