12-0731 (MECH)f
•f 4
BUILDING &.SAFETY DEPARTMENT
BUILDING PERMIT
Owner:'
DEBORAH ROLPH
78835 VIA AVANTE
LA QUINTA, CA 92253
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 7/12/12
Contractor: e
P.O. BOX 1504
PALOMA AIR CONDITIONING -
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA
92253
Application Number:
C -S1:2=0:00007.31. -
Property Address:
78835 VIA AVANTE
APN:
643-160-006-132 -26152 -
Application description:
MECHANICAL
Property Zoning:
LOW DENSITY RESIDENTIAL
Application valuation:
600
f
•f 4
BUILDING &.SAFETY DEPARTMENT
BUILDING PERMIT
Owner:'
DEBORAH ROLPH
78835 VIA AVANTE
LA QUINTA, CA 92253
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 7/12/12
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
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 nd state laws relating to building construction, and hereby authorize representatives .
o rs county to enter u n rty f the above-mentioned prope'nspection purposes. -
Date:� ��Z ignature (Applicant or Agentl: CiO
Contractor: e
Applicant: - Architect or Engineer:
PALOMA AIR CONDITIONING -
P.O. BOX 3501
PALM DESERT, CA 92261 D
(760)347-1212
Lic. No.. 619091
JUL 12 2012,
' LICENSED CONTRACTOR'S DECLARATION
CITY OF LA QUINTA
WORKER'S COMPENSATION AW -16 MAST
. 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
License Class: C20 License No.: 619091
for by Section 3700 of the Labor Code, for the performance of. the work for which this permit is
/Date�—/Z ontractor.. � 0 -
/.' /
issued. t +
have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor
I h
/
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 COMPANION PROPT Policy Number CPCA15666
following reason (Sec. 7031.5, Businessand 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 Professionss-Code) or3700
of the Labor Co 1 shall forthwith cor9gy with those provisions.
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).:
Date"'y� icant:
1 _) I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and
10
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. -
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.)- -
- APPLICANT ACKNOWLEDGEMENT "
(_ 1 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.
IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the
7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of
conditions and restrictions set forth on this application. ,.
property who builds or improvesthereon, and who contracts for the projects with a contractor(s) licensed
1. Eachpersonupon whose behalf this application is made, each person at whose request and for
pursuant to the Contractors' State License Law.).
' whose benefit work is performed under or pursuant to any permit issued as a result of this application,
(_ ) I am' exempt under Sec. , B.&P.C. for this reason
the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City
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
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 nd state laws relating to building construction, and hereby authorize representatives .
o rs county to enter u n rty f the above-mentioned prope'nspection purposes. -
Date:� ��Z ignature (Applicant or Agentl: CiO
Application Number. . . . . . 12=00000731
Permit . . MECHANICAL
Additional desc .
Permit Fee 24:00
Plan Check Fee...
6.00
Issue Date
Valuation . . .
. 0 -
Expiration Date 1/08/13
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
INSTALL NEW INDOOR COIL. 2010 CODES.
---------------------------------------------------
• Other.Fees . . . . . BLDG STDS ADMIN (SB1473)'
1.00
Fee summary • Charged
Paid, Credited
•. Due
Permit Fee Total 24.0.0
.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 ..
4�, ;
-
D�; ci1P.
17'
Simplified Prescriptive Certificate of Compliance: 2008 Residetitial HVAC Affiellrations CF -1R -ALT -HVAC
Climate Zones 10 - 15
Site Address:
Enforcern'ent Agency:
Date:
Permit #:
78-835 VIA AVANTlE'La Q6i9'ta,,CA 92253-.'-,,..
I City,otLa. QuiritA
'
May Si -2012
_
Duct insulation
Conditioned Floor
.Equipment Typel
List MinirhurhEfficiencyZ
requirement .
A . rea
Thermostat
❑ Package Unit.
0 Furnace
* Indoor Coil
[I AFUE
0 SEER
Ej cop
[I HSOF�_�:,
0 R 6 (CZ 10-13)
[1R8(CZ14-15)'_
Served by system
1200 sf
0 Setback
If ricit.alreadypresent; must be
* Condensing Unit
[3 EER
[3 Resistance
insizdled) .
D 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 tfi ' e appropriate Options. Each Option, lists the HERS measures that rhiust'bd conducted. A copy of-tfie forms shall
be left on site for final
al inspectionand a* copy given to homeowner: homeowh. At final, 't.he''Jirispector verifies that the work listed on this
form was in fact the work completed by the installer. The insoectolir.'alsoVerifies that each aip_0r6pri6te_CF-6R registered CF -4k
forms (no hand filled CF-4Rs allowed) are filled out and signed.Bieginining October 1; 2010, a registered copy of the CF -1111
and CF -6R shall also be on site for final inspection.
1'. HVAC Changeout
Required Forms:
All HVAC Equipment
CF -6R forms: MECH-04, MECH-21-HERS and (for, split systems) MECH-25-HERS
replaced
CF -4R forms: MECH-21 and (for split systems) MECH-25
Condenser Coil and /or
Indoor Coil and /or
CF -6R f6rms: MECH-04, MECH-21-HERS and (foe split systems) MECH-25-HEkS
-split 'systems)
Furnace
CF4.11.4orms'. MECH-21 and (for MECH-25
For Split Systems: Duct)"X4§'j' U "..
.,5percent; RC, CCA :5 300 CFM/ton (Minimum Air Flow Requirement), TMAH
Fdr. Pa&69ed Ull
Exempted .from yduct I 'k ggeteskingl
rniiw'a*s***:do*c'u'm'ente8to haiVe b66n previously sealed and confirmed through HERS viehficafion,*
.... ..... .....h,
❑ 2........u.c.. .,pint!6inear feet inunconditioned space, or. -
ms*are.:coj
constructed in�sssulat_Ie.d .or sealed asbestos
, ...... -
W�9
:sys*te *
9i1th-
, ISysf6m)W(AlswE ff46t
ri esyge=illnot be UtN&-(W6 i16 tLIS .art ha rdo)
❑ 2. New HVACSY'stem
Required oii i offfiii�i"gvmw i-�g, 1, Wi�, 51
W . ...... ....
Cult ON �geo Ut With -
new clucts:,gall new
... ..
41. ... ...
F -F.- Norril a [h]
'ECH-04:'�:::lv1E&,`E2b-H 1, ra i:s�,9ternt)!iMECHNn",HERS <and
M, R711i R .0
ducting all n.
eq
MECH 20 and pl pq tr-, H, -2,2 A n u
vst, ms M CHS ire,
VON
qip��_v
ForSplit Systems Duc
percent, �R.G...N...�.-H4(STMSt'!an'+°eit e'-eUHSP P.r6KPSPK-
C. g..: - �n—. 4...FWD;
m�--,K3::: 5 . 4..T...M.....A
..t.q..l.g..g...k.'a--ge-<t6
For4aka"edUnits Duet
:.,A..�..-,-.M...>-. .-'-:50,CF-MZC
..W...
age jperteftt.WM
wit torwithout
�'�
Required Forms:
Replacement
Includes,!ire'platin'gdt.!!iii'stellih*qill.Lfi,6w
d6cfi`n6:and/or outdoor *`...jqqd---_'- "' ji,unit
CF 611 forms: Mk'H-04, MECH-20-HEAS,-ancl (for split'syst6rns) MECH-25-HERS
and/or indoor coil and/or ':If
urnace. [Nd or some
CF -4R forms: MECH-20 and (for split systems) MECH-25
equipment changed. ....
For Split Systems: Duct leakage:`.. t: percent.: RC, CCA 300 CFM/ton, TMAH
For Packdged Units: Duct leakage < 6 percent, -
13 4. New Ducting over 40 feet
Required Forms:
Includes adding or replacing more than 40
CF -6R forms: MECH-04, MECH-21-HERS
linear feet of duct in unconditioned space.
CF -4R forms: MECH-21.
For split system or packag-6d units: Duct leakage < 15 percent
0 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 Com- pliince docurrientation is accurate and corhplete..
I am eligible under Division 3 of the California Business and Professions Code to accept msodl for the design id'entifi ed on this Certificzlte of
Compliance.
I certify that the energy features and•performance sipeiciflicatio'ns"forthe desig"n identified on this C&tificate of Compliance conform to the
requirements of Title 24, Parts I and 6 of the,California Code of Regulations.
• The design features identified on this Certificate of Compliance are consistent with the information cloculrnenfed on other applicable compliance
forms, worksheets, calculations, plans and specifications submitted to the enforcement agency for approval with the permit application.
Name: Herman Paredes ASignature: Herman Paredes,
Company: PALOMA AIR CONDITIONING ate: May 31, 2012
Address: P 0 BOX 3501 License: 619091
City/State/Zip: PALM DESERT CA 92261 Phone: (760) 347-1212
Bin ..# •• . ..
... . ;
city Of. La Qti1(1
Bund&!. -8r Safety DMdon
P.O. Box. 1504,"78-4 95 Calle Tampico
L4.Q01ta, CA 92253 , (760) M 7012
Building Pennit Application and Tracking Sheet
Permit # , � �"
1a
Project Address: 0 ��� �j, j�Jy�sti>.
Oama's Name:.6���
A. P. Number.
Address: .:,9 S -Z it �4-U•o � 7E
Legal Description:
Citi', ST. ZIP: x�, ✓.-r/�o l�� Z 3-3
Contractor.Gu ;a ��
Telephone: 5-03
Address: fr `jv ¢.S—
Project Description:
City, ST, Zip:
E?/�0�'�E�p 7v.e Ouo2. L'oi (_1/
Telephone( - -0) 3 4?f/ /Z .
State Lia # City Lir, #t
Arch, Eng., Designer.
Address:
City, ST. Zip:
Telephone: Construction Type:. Occupancy:.
State Lia M Project . ,l 4ype (eirde one): New Add'a Alter as Demo
Name of Contact Person: �C g�
��, e Ed F 1 Sq. Ft.: # Stories: # Unit$:"Telephone
;,V
# of Contact n: 9-7 fL /Z' EWmaW Value of Project d `—
APPLICANT: DO NOT WRITE BELOW THIS UNE
# Submittal RtVd Reed - TRACKDVG PBRiVIIFFEES
Plan Sib
Plan Cheek submitted Item Amoral
Sergctntal Coles
Reviewed, ready for eorrecdons Plan Check Deposit. .
Trust Cala.
Called Contact Parson Pian Check Balance
Tide 24 Caits.
Plans picked up Construction
Flood plain plan
Plans resubmitted.. Mecharilcal '
Girding plan
2" Rmlew, ready for correcdorisrrssue Electrical
Subeortaetor List
+
Called Contact Person Plumbing
Grant Deed.
Pians packed up S.M.I.
MOA. Approval
Plans resubmitted Grading
IN HOUSE:-
Review; ready for correcdonslissue Developer Impact Fee
Planning Approval
Called Contact Person A.I.P.P.
Pub. Wks. Appr
Date otpermit issue
School Fees
Total Permit Fees
AN 2 9 2012
BY: