10-0448 (MECH)P.O. BOX 1504
78-4.95 CALLE TAMPICO
LA. QUINTA, CALIFORNIA 92253 ,
Application Number: 10-00.00-0-448
- — --�
Property Address: 48507. VIA AMISTAD
APN: 646-122-031- -
Application description: MECHANICAL
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 1000
Applicant: Architect or Engineer:
al a
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LICENSED CONTRACTOR'S DECLARATION
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
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 Busines and Professionals Code, and my License is in full force and effect.
License Class: C20 ff License No.: 794315
fJ Z r to /C� o tor:
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 ($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 shedid not build or
improve for the purpose of sale.).
(_) 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.).
(_) 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.I. '
Lender's Name:
Lender's Address:
LQPERMIT
Owner:
BRYAN WILLIAM
48507 VIA AMISTAD
LA QUINTA, CA 92253
(760)777-1766
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 5/25/10
Contractor: `' _....._ __...
DOVE AIR.INC.
69749 RISUENO ROAD
A� '2,
2014
CATHEDRAL CITY, CA 92234
(760) 327-1890 �U111i�`
Lic. No.: 794315 ^R-41?f_9M
WORKER'S COMPENSATION DECLARATION
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 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
insurance carrier and policy number are: '
Carrier EXEMPT Policy Number EXEMPT
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 be me sub' t to the workers' compensation provisions of Section
r+q 3700 of the Labor Code all forth h comply with those provisions.
ate:
"D..0 • L • \ gpplf.�cant: I
WARNING: FAILURE TO SECURE WORKERS' 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.
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 inspec ' n purposes.
—Date:
Signat pplicant or Agentl r
LQPERMIT
Application Number
10700000448
- Permit . . .
MECHANICAL
Additional.desc .
Permit -Fee;..
24.00
Plan Check
Fee
6.00
Issue Date
Valuation
. . .
. 0
- Expiration Date
11/21/10
Qty Unit Charge
Per
Extension
BASE
FEE
15.00
1.00' 9.0000
EA MECH-APPL-REP/ALT/ADD
9.00
-------------------_---------------------------------------------------------
Special Notes and Comments
REPLACE LIKE FOR LIKE
5 TON EVAPORATION
_._—__COIL-..-. __........._---_________._._..._.___
_....—_. _:--...- -•----._..__
" Other Fees•-. .
-----------------------------
. . . . BLDG SIDS ADMIN (SB1473)
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1.00
Fee summary Charged
Paid Credited
Due
Permit Fee Total.
---- ----------
24.00.
----------
.00
----------
.00
24.00
Plan Check Total.
6.00
.00
.00
6.00
Other Fee Total
1.00
.00
.00.
1.00
Grand Total
31.00
.00
.00
31.00
LQPERMIT
Simplified Prescriptive,Certifrate:,of,Compliance: 2008 Residential HV.ACAlt mations :CF 1R -ALT HVAC
Comate. Zones ;LO: to 15. , ..
._._
Site Address:
- S01 U Cf /�r��s .
Enforcement Agency:
er L4
Date:
Permit #r
v s
ZS" nolo
—Equipment T et
List Minimum EffieiOc
Duct insulation reuirement .
Conditioned Floor
Area
Thermostat
❑ Packaged Unit
❑' Furnace
❑
❑;COP' :
Over 40 ft.of ducts added or
❑ .Setback
tglndoorCoil
SEER
EER
❑:I-ISPF
replaced 'in unconditioned space
p p
Served b . system
Y Y
(If not already
❑ Condensing Unit
❑ EER
❑Resistance
❑ R 6 (CZ 10-13)
sf
present, must be
0-0ther
❑ R 8 (CZ 14-15)
installed)
1. Equipment Type: Choose the equipment being installed • if more than one.systeni; use another CF -I R -AL T -HVA Cfor each system.
2. Minimum Equipment Efficiencies: 13 SEER, 78% AFUE, 7.7HSPF for.typical residential systems.
HERS VERIFICATIOMSUMMARY'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 shalbbe 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 appro.priate'CF-6R.and registered CF -4R forms (no hand filled CF-4Rs allowed) are filled out and
signed: je innin October.l, 2010,.,a re istered co .:of the.CF-IR and CF76R shall also be on site for final. inspection.
1. HVAC thangeout
Required: lF.orms:
• All HVAC Equipment replaced
CF -`6R forms:MECH-04, MECH-2I-HERS and (for split systems) MECH- 25 -HERS
CF4R.forms:.MECH=21 and fors lits stems MECH-25
Condenser Coil and /or
• Indoor Coil and /or
CF -611 forms: :MECH-2I-HERS and (for split systems) MECH- 25 -HERS
CF -411 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 r 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. Existin 'ducts stems 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-2044ERS;and.(for.split systems) MECH-22-HERS, and MECH=25=HERS•
.
new equipment)
CF4R forms:. MECH 20-, and (for split systems)MECH-22, and MECH 25
For SpotSystems: Duct leakage < 6.percent; RC,:CCA >.350 CFM/ton,.FWD TMAH; STMS, atid:either HSPP or PSPP.
For Packaged :Units: Duct leakage < 6 percent;
❑ 3. New Ducts with Replacement
Required Forms:
• Includes replacing or installing all.new ducting
CF-.611.forms: MECH-04, MECH.:wZO-HERS,and (for split systems) MECH-25-HERS
and/or outdoor condensing unit and/or indoor
CF-4114onns: 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, TVIAH
For:Packa ed Units: Duct 'leakage < 6 ercent
M .4...New Ductin .over 40 feetm.
Re. uired Forms:
• Includes adding or replacing more. than 4t)
linear feet of duct in unconditioned.s ace.
CF=6R forms: MECH-04, MECH-2I-HERS CF -4R forms: MECH-21
For split system or packaged units: Duct -leakage < 15 percent
❑. EXCEPTION:. Existin .duct systems constructed; insulated or sealed with.asbestos.. _
Contractor, (Documentation�Author's7Responsibte Designer's Declaration'Statement).
• 1 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 designidentified,on this Certificate of Compliance.
• I. certify that the energy featuresand 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 andspecifications submitted to the enforcement .agency for approval with the p/mg(applicatio.
Name: / Y a r Y
V`
Signature:
Company:
o V lit . L rlC'e
Date:
/t(� a Z 010
Address:
License:
7? I% 3/f
City/State/Zip: . C � 4 C
Phone: 6
2008 Residential Compliance Forms March 2010
1Li V0 In Vr o: 11 a'HA La j(ul[lLa Du11C11 t1c�(�al �.y IkJV V1!.0 V
................
Bits !f
City of is Quinn
Building at Safety Division
P.O. Box 1$04,'78-495 Calle Tampico
La Quina, CA 92253--1-760).777-7012
Building Permit Application and Tracking Sheet .
Permit 1,!
S.
'Project Address: \I -c.., A , S G
Owner's Name: i � is
A. P. Number:Address:
S7 'ALegal
Description:
� , ��� -
;7-5-
City, ST, Zip: E v s ,l, 3Cunttactor:OQ
—
Telcphouz: 6D. 77? 04 b
Adress; n�''rl 1 ; _
sr, Zip: G410 Jo) e- C 9 t23 Y
Telephone: 7o_ 3
"citva
Project Description: yJ L� Ct`'City,
-'0 ►� L - ,�
y A4 'C o X—L.
State [Ac. : '7 3 I �. #: 03
A xch., Fatgr., Designer:
Address:
City, 9r, Zip:
Telephone:
;laze Lic. #:
Constriction Type: Occupancy.
Project type (circla one): New Add'n Alter Repair Demo
Name. of Contact Person:
Sq. Ft.:
#Stories:
=9 Units:
Telephone # of Contact Person:
Estimated Value of Project: Lo 0 0, 00
APPUCANT: DO. NOT WRITE BELOW THIS UNE
to
Submittal
Plan Sets
Req1d
Recd
TRACKING.
Plao ('heck submitted
PERMTr FEES
ttew Amount
Structural Cates..
Reviewed, ready for corrections
Plan Check Deposit
Trass Calm.
Called Contac Person
Plan Cheek Batatce
Energy C'al&
-Plans bieked up
Construction .
Flood plain plan
Plam reanbmitted
Mechanical
Grading.Plan'
V Review, ready for eorrections/issut
Electrical
Sabcoutictor List
Called Contact Person
Ptambing
Grant Deed
Plans picked up
$ Iyt I
ICO.A. Approval
Plans resubmitted
Gradtdg
IN HOUSE:-
Review, ready for correctiosWissue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.t.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees