12-0704 (MECH)v
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: V=12-00000704'.'
Property Address: 5_4768-0—A 1iIbA1iALLEJO
APN: 774-2827009-16 -000000-
Application description: MECHANICAL
Property Zoning: COVE RESIDENTIAL
Application valuation: 3500
Applicant:
Architect or Engineer:
�I a
4
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
VOICE (760) 777-7012
FAX (760) 777-7011
.INSPECTIONS (760) 777-7153
Owner:
THOMAS ANN '
54680 AVENIDA VALLEJO fn
LA QUINTA, CA 92253 �fr
Contractor:
PALM DESERT AIR COND
42081 BEACON HILL
PALM DESERT, CA 92211
(760)346-0677
Lic. No.: 374937
Date: 6/26/12
JCJ Ai n ^ q^
CO INC
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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 and Professionals Code, and my License is in full force and effect.
_ I have and will maintain acertificate of consent to self -insure for workers' compensation, as provided
license Class: C20 ,_ Q ^ense No.: 3 74 93 7 -
for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
issued.
ate: G 2G tractor•�.�i .7r ��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
• OWNER 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 CHARTIS CASUALT Policy Number WC001605716
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 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 shall forthwith com ' h those provisions.
that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by
//
4 �
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).:
Date: pplicant
1 ) 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. w-
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 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 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:` pC
LQPERMIT
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 to enter upon the above-mentioned property for inspection purposes.
Date: 47 gnature (Applicant or Agent):
LQPERMIT
Application Number 12-00000704
Permit MECHANICAL
Additional desc .
Permit Fee . . 31.50
Plan Check Fee
7.88
Issue Date
Valuation . . . .
0
Expiration Date 12/23/12
_. Qty Unit Charge Per
Extension
BASE
FEE
15.00
1.00 16.5000 EA, MECH
B/C >3-15HP/>100K-500KBTU
16.50
-------------------------------------------
Special Notes and Comments
---------------------------------
REPLACE (1) HEAT PUMP CONDENSER.
2010
' CODES . -
----------------------------------------------------------------------------
Other Fees . . . . . . . BLDG STDS ADMIN (SB1473)
1.00
Fee summary Charged
----------
Paid, Credited
---------- ----------
Due
l----------------- -----------
Permit Fee Total 31.50
.00 .00
.31.50
Plan Check Total 7.88
.00 .00
7.88
Other Fee Total 1.00
.00 :00
1.00
Grand Total 40.38
.00 .00
40.38
LQPERMIT
Simplified Prescriptive Certificate of Compliance: 2008 Residential HVAC Alterations CF -IR -ALT -HVAC
Climate Zones 30 - 15
Site Address:
Enforcement Agency:
Date:
Permit #:
54-680 ADA. VALLEJO-La Quinta, CA 92253
City of La Quinta
Jun 25, 2012
Duct insulation
Conditioned Floor
Equipment Type1
List Minimum Efficiency2
requirement
Area,
Thermostat
[]Package Unit
❑ Furnace
❑ Indoor Coil
❑ AFUE
p SEER 13.0
❑ COP
❑ HSPF
❑ R 6 (CZ 10-13) .
Served by system
p Setback '
If not already present, must be
D Condensing Unit
C1 EER
❑Resistance,
❑ R 8 CZ 14-15)
(
1600 sf
installed) -
❑ 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. 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. Aco of the fo s shall
be left on site for final inspection and a copy given to the homeowner. At final, the inspector verifies that th work listed 0 this
form was in fact the work completed by the installer. The inspector also verifies that each appropriate CF -6 an e: 'tered F-411.
forms (no hand filled CF-4Rs allowed) are filled out and signed.Beginning October 1, 2010, a registered copy'zo the -iR
and CF -6111 shall also be on site for final inspection.
D 1. HVAC Changeout
Required Forms:
. All HVAC Equipment
CF -6R forms: MECH-04, MECH-2I-HERS and (for split systems) MECH-25" E
replaced
CF -4R forms: MECH-21 and (for split systems) MECH-25
. Condenser Coil and /or
. Indoor Coil and /or
CF -6R forms: MECH-04, M -25 -2I -HERS and (for split syste- MECH-25-H "
. Furnace
CF;4R forms: MECH-21 and (for split systems) MECH-25
. , •
For Split Systems: Duct leakage< 15 percent; RC, CCA <_ 300 CFM/ton (Minimu Air Flow Req i ee
"nt), TMAH
Eiempted from,duct leakage testing if:
I❑ 1"'Duct system was documented to have been previously sealed and c firmed thro . h HERS verification, or
❑ 2. Duct systems with less tha6.40 linear feet in unconditioned space, o`r�r
.
❑ 3: Existing duct systems are,constructed, insulated or sealed wioasbest s
0`4, The"system+will not be Ducted (ie.- Ductless rl"Ilnl-Split Syst r),(Also;Ez mp_t - m,R_ef_rigerant�Charge)
y F
112. New HVAC System
Required Forms T . " � ry� 4
Cut in or, Chan eout with'
new ducts ,`(allnew ^'
f '—� -
CF=6R forms: MECH-04, MECH-2 -, ERS d (Yor splits stems) MECHr22 HERS and,-••
an y ""-_e
MECH-25 HERS 1 # r 111
' '
ducting and all new rf
� ,' e
-
CF 4R forms. MECH 20, and for sppllit s, stems 3MECH=22, and MECH-25 r
(_.�f,
equipment)_
.r#tr.. _ : 1 ,r� 1 :•
For Split Systems: Duct leakage �<o6'percent; RC; CCA2- S CFM/ton, FWD,tTMAH,'STMS, and: either HSPP or-PSPP.
For Packaged Units: Duct leakage-< 6:percent T
113.! New:Ducts with/or.without
R wired Forts: ,."
Replacement
. Includes replacing or installing.all.new
ducting and/or outdoor condensing um
and/or indoor coil and/or fur -nae: 0 or so e
6R��rms: MECH-04, MECH-20-HERS, and (for split systems) MECH-25-HERS
CF forms: MECH-20 and (for split systems) MECH-25
equipment changed. 4
'
For Split Systems: Duct leakage 6 percent; C, CCA >_ 300 CFM/ton, TMAH
For Packaged Units: Duct age 6 perce f
114. New Ducting over 40 fee
Required Forms:
. Includes adding or � I' bn snore han 40
CF -6R forms: MECH-04, MECH-2I-HERS ,
linear feet of ductunr� ditio e- ce. _
CF -4R forms: MECH-21
For split systemfcF'k ckag d u its: Duct leakage < 15 percent
❑ EXCEPTI�IV: Exist g duc ,YRtems constructed, insulated or sealed with asbestos. '
Contractor(F ocumenta i n Author's /Responsible Designer's Declaration Statement) .
. I certify that tKCertificate of Compliance documentation'is accurate and complete.
• I am eligible under Divisio of the California Business and Professions Code to accept responsibility for the design identified on this Certificate of
Compliance. -
• 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 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 approval with the permit application. _
Name: Karl Brown Signature: Karl Brown
Company: Date: Jun 25, 2012
Address: 42-081 Beacon Hill License: 374937
City/State/Zip: Palm Desert/ CA/ 92211 Phone: (760) 346-0677 '
VReg:_,212-A0033095A-00000000-0000Registration Date/Time: 2012/06/25 13:39:09 `HERS Provider: Ca10ERTS, Inc.
2008 Residential Compliance"Forms —July -2010
C 4W 4&'Q
r w • t Q O� .
41
P:Q. Box"115:04.78495: CaIle,Tampico,:- La•Quinta, California 92211
a " Tel.,(760) 777-7012• Fax; (766)'7717112
_4 '124
Website:,vuww.La-Quinta,Org •,Email: Building@La-Quinta.Ord rN"'for:rtt�`'..
- -
�m#-, Permit #: B- iildi.ng Permit I pp•Iication• & Tracking Sheet
Project Address: 54-680 ADA. VALLEJO `
Owner's Name:, THOMAS, ANN
A.P. Number:
Address: 54-680 ADA. VALLEJO
Legal. Description:"
City, State, Zip: LA QUINTA, CA 92253
Contractor: Palm Desert Air Conditioning & Heating Company
Telephone: (760) 564-2030
Address: 42-081 Beacon Hill
Project Description: '
City, State;,Zip: Palm Desert, CA 92211
REPLACE (1) HEAT PUMP CONDENSER.
f
,
Telephone No. (760)'346-0677
` -
'State: Lic: #: 374937
City Lid. #: 100886'
ArchaEngr./Designer.
Address:
City, State, Zip:
Telephone No::
*-'
Construction Type:
Occupancy:
State: Lic. #' .
T , .JV .` �� •;�
Project Type: 0. New • ® Add'n -13 Alter O Repair, • 0 Demo
Name of Contact Person: KARL BROWN
"Sq. Ft.:
#:Stories:
#Units:
Contact :Telephone: No. (760) 346-0677
Estimated Value of Project: $3,500.00
APPLICANT:
DO, NOT-WRITE.BELOW
THIS: LINE ,
#
Submittal
Req'd
Recd
Tracking
Permit Fee's
Plan Sets '
Plan Check Submitted
Item
Amount,
Structural Cales.
Reviewed, Ready for Corrections
Plan Check Deposit
Truss Calc..
Called Contact Person
Plan.Check•Balance,
Title'24 Cal9s-
I
Plans Picked Up
Construction
Flood Plain Plan
y
Plans. Resubmitted, •
Mechanical
Grading Plan
2nd'Review,~Ready for Corrections
Electrical
Subcontractor List
Called' Contact Person
Plumbing
Grant Deed,
Plans Picked Up
H.O.A. Approval
j
Plans Resubmitted
Grading.
IN HOUSE
3rd Review; Ready for Corrections
beveloper lmpact Fee,
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Works Appel
, ,
Date of PermitIssue
School Fees
'
F
Total Permit Fee's