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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 ------------------------------------------------------------------------------------------------- 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