10-0774 (MECH)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application description:
Property Zoning:
Application valuation:
Applicant:
10=00000774 w
48503 VIA AMISTAD
646-122-033- -
MECHANICAL
LOW DENSITY RESIDENTIAL
10000
Tii(f 4.4 0. "
Architect or Engineer:
0k
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
FERNALD ROBERT L
48-503 VIA AMISTAD
.LA QUINTA, CA 92253
Contractor:
GENERAL AIR CONDITIONING
31170 RESERVE DRIVE
THOUSAND PALMS, CA 92276
(760)343-7488
Lic. No.: 686310
VOICE (760).777-7012
FAX (760) 777-7011
INSPECTIONS (760).777-7153
Date: 8/18/10
M
-------------------------------------------------------------------------------------------------
LICENSED CONTRACTOR'S DECLARATION
WORKER'S COMPENSATION DECLARATION
I 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 a certificate of consent to self -insure for workers' compensation, as provided
Licen Ia s: C20 Li nse No.: 686310
for by Section 3700 of the Labor Code, for the performance of the work for which this permit is -
1
-Date. ntractor: U'I r/ -
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
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 PREFERRED EMPL Policy Number WKN1295355.
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 Lab ode, I s all forthwith c m y with those provisions.
that. he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by
'//�� n �/•� "
S A
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).: -
ate: �./ icant:
I ) 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 Coder The
WARNING: FAILU E TO SECURE WO KERS' 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
improvementsare 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.
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 ofthe 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:
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.
1 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 building construction, and hereby authorize representatives
of/th/iss c my to enter upon the above-mentioned ro y for i pe tion pyrposes �/
a� te' Sig ure (Applicant or Agent • ??, `•
LQPERMIT' -
Application Number . . . . . 10-00000774
Permit . . . MECHANICAL
Additional desc .
Permit Fee 33.00
Plan Check Fee
8.25
Issue Date
Valuation . . .
. 0
Expiration Date 2/14/11
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
HVAC CHANGE -OUT - 5 TON COMPLETE
SYSTEM,
13 SEER. 2007 -CODES.
---------------------------------------------------
Other Fees . . . . . . . BLDG STDS ADMIN (SB1473)
1.00
Fee summary Charged
----------
Paid- Credited
Due
-----------------
Permit Fee Total 33.00
.00 .00
33.00
Plan'Check Total 8.25
.00 .0.0
8.25
Other Fee Total 1.00
.00 .00
1.00
Grand Total 42.25
.00 .00
...42.25
LQPERMIT' -
Sim lified Prescriptive Certificate of Compliance: 2008 Residential HVACAlterations CF -IR -ALT -HVAC
Climate Zones 10 to 15
.. . , _-. . .---_./t 1./ 1 1711 a fl;- ITI'vi?
Site Address:
nforce t Agency
Da
NJ(v-
Permit q:.
-7 -741
Con itioned Floor
Equipment T e' List Minimum Efficienc 2
Duct insulation requirement
Area
Thennostat
❑ Pa kaged Unit
or Coil
FCondensing
❑ AF
❑SEER
❑ COP
❑ HSPF
Over 40 ft of ducts added or
replaced in unconditioned space
Served by system
9..4eiba�—
(If not already
Unit
❑EER
❑Resistance
❑R 6 (CZ 10-13)
❑ R 8 (CZ 14-15)
sf
present, must be
installed)
❑ Other
I. 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 SUAUV[ARY 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. a inspector also verifies that each appropriate CF -6R and registered CF -4R forms (no hand filled CF-4Rs allowed) are filled out and
si Beginning October 1 2010, a registered copy of the CF -1R and CF -6R shall also be on site for fmal inspection.
1. HVAC Changeout
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-611forms: MECH-21-HERS and (for split systems) MECH- 25 -HERS
• Indoor Coil and/or
CF -4R forms: MECH- 21 and (for split systems) MECH-25
• Furnace
For Split Systems: Duct leakage < 15 percent; RC, CCA >_ 300 CFM/ton(Minimum Air Flow Requirement), TMAH
For Packaged Units: Duct leakage < 15 percent
Exempted from duct leakage testing if:
❑ 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
❑ 2. New HVAC System Required Forms:
• Cut in or Changeout with new CF -6R forms: MECH-04, MECH-20-HERS,and (for split systems) MECH-22-HERS, and MECH-25-HERS i
ducts: (all new ducting and all CF -411 forms: MECH 20-, and (for split systems)MECH-22, and MECH 25
new equipment)
For Split Systems: Duct leakage < 6 percent; RC, CCA > 350 CFM/tori, FWD, TMAH, STMS, and either HSPP or PSPP.
For Packaged Units: Duct leakage < 6 percent a
❑ 3. New 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-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
❑ 4. New Ducting over 40 feet
Required Forms:
• Includes adding or replacing more than 40
CF -6R forms: MECH-04, MECH-2I-HERS CF -4R forms: MECH-21
linear feet of duct in unconditioned space.
For split system or packaged units: Duct leakage < 15 percent
❑ 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.
• 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 docume d on other applicable compliance forms, worksheets,
calculations, plans and specifications submitted to the enforcement agency for approval with the permit ap is tion.
Name: cm ks
Signature:
Company: � C'
Dater
Address: � ` 1 � O � U n � �
License:
.. . , _-. . .---_./t 1./ 1 1711 a fl;- ITI'vi?
GENERAL,
Air Conditioning & Heating
31-170 Reserve Drive • Thousand Palms, CA 92276
(760) 343-7488 • Fax (760) 343-7494
vvww.callthegeneral.com
Residential Comfort
Survey
':Eni
INSTALL DATE JOB# CUSTOMER# I
Y�
NAME
BILLING ADDRESS
CITY.
TATE
ZIP CODE
PHONE �`�'� L O �ICELL FAX
JOB ADD S
CITY
�l 5
`q al'53
� %�, STATE CA -ZIP CODE
MAP PAGE.
NEW EQUIPMENT
CONDENSER vP(��.�)
COIL
FURNACE ✓ �%U �� U C�
THERMOSTAT
FILTRATION C-_\Jd�J l rSi
PLATFORM SIZE
EXISTING EQUIPMENT
CONDENSER MODEL #
CONDENSERS AL # _
PERMIT YES ❑ NO
WARRANTY.
MISC
I ❑ FINANCING DAYS ❑ CREDIT CARD Cl C.O.D. I
Dill it
City of La QuInt'a
Buitdtng &I Safety DMston
P.O. Box 1504, 78-495 bite Tampico
La Quinta, CA 92253 - (760) 777-7012
Bullding Permit Application and Tracking Sheet
Permit #
10
Project Address:
Owner's Name: _
A. P. Number:
Address: S S
Legal Description:
City, ST, Zip:
Contractor:<;r.:
Q L
<•,..:•...
Telephone:
Address: J eGcro f Zr,
Project Description:
City, ST, Zip:
_,:�a Y\A
Telephone:Z ?'J},;:
li?,trm
�v!Ntiv+f� �':n?<`i'r,:i;.;i%r l\i•.}•ivi: ii:
n•.. •..: •: .; •.:.%•. vn. .: 4.:%^'>l:!
T/f7�)
State Lic. # :
City Lie. #;
Arch., Engr., Designer:
Address:
City., ST, Zip:
Telephone:.
Construction Type: Occupancy::
State Lic. #::%'s:r/'pi.'':?:��r?n:
>;;:::::;;<."s---- . „>a F ;<
Project type (circle one): New Add'n Alter Repair
Demo
Name of Contact Person:
Sq. Ft.:
# Stories:
# Units:
Telephone # of Contact Person:
• �j 3'
Estimated Value of Project:
APPLICANT: DO NOT WRITE. BELOW THIS LINE
#
Submittal
Plan Sets
Req Id
Recd
TRACKING
Plan Check submitted
PERMIT FEES
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
Pians resubmitted
Mechanical
Grading plan
2.4 Review, ready for correctionsflssueElectrical
Subcontactor List
Called Contact Person
Plumbing .
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
'" Review, ready for correctionsrissue
Developer Impact Fee
Planning Approval
Called Contact Person
A,I.P,P,
Pub. Wks. Appr
Date of permit issue
School Fees
"
Total Permit Fees