0305-022 (MECH)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
12'-OOO:OQ6547—
Property Address:
79�8�53 PPcRKWP__yESPLANADE
APN:
609-600-015- -
Application .description:
MECHANICAL
Property Zoning:
LOW DENSITY RESIDENTIAL
Application valuation:
3859
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
S MARY ANN KLAUS
79853 PARKWAY
LA QUINTA, CA
ESPLANADE SOUTH
92253
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 6/12/12
• . ... Contractor:..
Applicant- Architect or Engineer: PREFERRED PLUMBING H/C
P O BOX, 512 0 !t
PALM `SPRINGS,. CA 92263 f 1. 2 �®
(760)i322=3173
Lic. No.: 457554
-+LICENSED CONTRACTOR'S DECLARATION' WORKER'S COMPENSATION DECLARATION
hereby affirm under penalty -of perjurythatd•am:licensed under provisions of Chapier'9'(commencing :with I.hereby affirm under penalty of perjury one of the following declarations.
Section 7000)'of Division 3 of the Business d,Professionals Code, and my License is in full force and effect. - 1have and will maintain acertificate of corisent,to self -insure for workers' compensation, as provided
_ License Class- C10 C16 C2 •'457554 for by.Section 3700 of the. Labor Code, for the.performance.of the work for which this permit is
•issued.
Date: �ZWContractor: _ - -' 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
�WJN-�BUILDERDECLAR.ATION insurance carrier and policy number are: - -
I hereby affirm'under penalty of perjury that I am exempt from the Co ntractor's'State License Law for the Carrier EVEREST NATL Policy Number ' 7600006445121 .
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, alw;-improve, demolish, or repair, any structure, prior to its issuance, also requires the applicant for the person. in any manner so as become subject to the workers' compensation laws of.California,
permit to file a signed statemen4.that he or. she.is licensed, pursuant'to the provisions of the Contractor's State and agree that, if I shout ecome subject to the .w rs'- compensation ptovisions`'-of'Section
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or - 3700 of the Labor-Ccd shall torthw' mpl wi th - e 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 than4ly' e -hundred dollars ($5001.: Date���— plicant:
(_ 1 1, as owner of -the ,property, or my employees withwages as'their sole compensation, will do the work, and -'
- the:structure isnotintended'or.offered for sale (Sec. 7044 :.Business and. Professions Code: The WARNING: FAILURE"TO SE RE WORKEUALTI
PENSATION COVERAGE IS UNLAWFUL, AND SHALL
Contractors' State License Law does not apply to an owner ofproperty who.builds'or'improves thereon, .SUBJECT AN EMPLOYER TO CRIMINAL'.PAND CIVIL'FINESUP TO ONE HUNDRED -THOUSAND ,
and who does the work himself or herself through his,or her own employees,zprovided that the D6LLARS'($;t00,000).- IN ADDITION TO'OF. COMPENSATION, DAMAGES AS PROVIDED FOR IN
improvements'are not intended or offered for sale. If, 'however, the buildirig or improvement is sold within SECTIOM3706.OF THE LABOR CODE, INTEREST, ANDIATTORNEY'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 I, as owner oftheproperty; 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 improves thereon, and who contracts for the projects with a contractor(s) kensed 1. Each person upon 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,
(_ 1 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
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.
Date: Owner: 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
CONSTRUCTION LENDING AGENCY permit to cancellation.
I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the I certify that I.have read this application and state that the abov i orma[ion is correct. I gree to comply with all
work for which this permit is issued (Sec. 3097, Civ. C.). city and county ordinances and state laws relating to building structiona
ereb u orize representatives
of this county to enter upon the above-mentioned property f inspe -ps.
Lender's Name:
Date497� S' ature (Applicant or Agent): \
Lender's Address:
LQPERMIT
LQPERMIT -
Application Number . . . 12-00000654
Permit . . . MECHANICAL
Additional desc .
Permit:Fee . . . . 31.50
Plan Check Fee
7.88
Issue.Date . . . .
Valuation . . . .
0
Expiration Date 12/09/12
Qty Unit Charge Per
Extension
BASE
FEE15.00
'1.00: 16,.5000 EA -MECH
B/C >3-15HP/>100K-500KBTU
16:50.
Sp.ecia-1 ;Notes.,and ment,s
,gor
.HVAC CHANGE: CONDENSER.
2010
CODES
------ ----------------------------------------------------------
Other 4Fees
Other4Fees BLDG'` STDS• `ADMIN (SB1473)
--------
-------
1.00
Fee sinmary Charged .
Paid . Credited .
D,ue
-•----- ------_-. -. -----------
---------- --
-----
Permit 4Fee Total, .31.5.0,
. 00 .00
31f:`50 i
P1an,Check`.:Tota1 7.88
.00 Q0.'
7.88
Other.- Fee -Total 1. 00
00 0'0
1.00
.'Grand. Total"': 40.38
.00 0.0
40,.38,
LQPERMIT -
Simplified Prescriptive Certificate,of Compliance:2008 Residential HVAC Alterations CF -IR -ALT -HVAC
Climate Zones 10 to 15
Site Address:En
-7 )PA 164q uJ.
orcement A ency:
A f Is'
Date:
Permit #:
Conditioned- Floor
Equipment T e'
List Minimum Efficienc
• Duct insulation requirement
Area
Thermostat
❑ Packaged Unit
❑ Furnace
❑ _
❑ COP
'Over 40 ft of ducts added or
replaced in unconditioned space
Served by system
etback
(If not already
❑ I or Coil
E ER
ER
❑ HSPF
❑ R 6 (CZ 10-13)
Z� �sf
must be
ondensing Unit
❑ EER
❑ Resistance
❑ R 8 (CZ 14-15)
present,
installed)
❑ Other
1. Equipment Type: Choose the equipment being installed; if more than one system, use another CF-IR-ALT-HVACjor 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. 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 worklisted on this form was in fact the work completed by the
installer. The inspector also verifies that each appropriate CF -6R and registered CF -4R forms (no hand filled CF-4Rs allowed) are filled out and
si ed._Beginning October 1, 2010, a registered co of the CF -1R and CF4R' shall also be on, site for final inspection.
HVAC Changeout
Required Forms:
• All HVAC Equipment replaced
CF,6R forms: MECH-04, MECH-21-HERS and (for split systems) MECH- 25 -HERS
(for
CF -4R forms: MECH- 21 and s lits stems MECH-25 _
• Condenser Coil and/or
• Indoor Coil and /or
CF -6R forms: MECH-2I-HERS and (for split systems) MECH- 25 -HERS
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:
0 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 s: Changeout with new
ducts: '
(all
l new ducting and all
CF -6R forms: MECH-04, MECH-20-HERS,and (for split systems) MECH-22=HERS, and MECH-25-HERS
new equipment)
CF -4R forms: MECH 20-, and (for split systems)MECH-22, and MECH 25
For Split Systems: Duct leakage < 6 percent; RC, CCA > 350 CFM/ton,-FWD, TMAH, STMS, and either HSPP or PSPP.
For Packaged Units: Duct leakage <6.percent
113. New Ducts with Replacement Required Forms:
• Includes replacing or iristalling 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 Packa ed'Units: Duct leakage < 6 percent .
❑ 4. New D,uctin ,over" 40 feet
Required Forms:
• Includes adding or replacing mole than 40
linear feet of duct in unconditioned space.
CF -6R forms:',MECH-04, MECH-2I-HERS CF -4R forms: MECH-21
For split system or packaged units: Duct leakage < 15 percent
❑ EXCEPTION: Existing ducts stems constructed, insulated or sealed with asbestos.
Contractor (Documentation A'uthor's /Responsible Designer's Declaration Statement)
• 1 certify that this Certificate of Compliance documentation is accurate and complete.
• 1 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 documented on other applicable compliance forms, worksheets,
calculationsplans andspecifications submitted to the enforcement a ency for approval with the permit application.
Name:Err �� ��.s/ _'.�
Signature:
Company:-R��� � /"���I� ��tT I ► � � fti � .
Date:
Address:PQ �d �� Z C
Licenser
City/State/Zip:' PAW(p S
Phone:Q ., c �.,-. -�-3
2008 Residential Compliance Forms March 2010
d7Yii
.a r
Bin # Citj of La Qu n' to
Building 8i Safety, Division
P.O. Box 1504, 78-495 Calle`Tarnplco
Permit,# La Quints, CA 92253 (760) 777-7012
1:.� Building Permit -Application and Tracking Sheet .
Project Address 7 7 rf �A �(N►S N de-.�'� Owner's Name: /y A
A. P. Number' Address: 7th g'� �� ��/ S,
Legal Degcription t City, ST, Zip: 44 (,w1•P 1A. Ch1' 3
prefrlec Asir s4onditiorii'ng dba
Contiactor pr.e.fer.re:d: P..1uinbin Heat.in &A'iTelephone:
Address P0. Bp5120j Project Description: f �QjvQ67ilS
City; M',Zip Palm,pr_ings% CA 92263
Telephone (76Or) 32-3173
StateLic:#: 4,57654 CityLic:#:
Arch,; Etigr. Desigc er
Address. '
City..ST:,ZtP
Telephone:. Construction ype: Occupancy:
State :Lit # 'Project type. (circle one): New Add'n Alter Repair Demo
Name 0f Contact Person aE LC ✓d'7V S Sq. Ft.: # Stories: # Units:
#''fC 1;3�.'Z'.VI A, Esti t .A V.1 P ��d�0a�
Telephone•.,: Q- _ •o - tac . _ ersoq ma,e ue o ro�et
c .
A ...APPLICANT: DO NOT WRITE BELOW THIS LINE
# .
Sabm(ttal
Reg'd
Reed ;
TRACKING '
Plan Check gditltted
It
Structural:.Calcs.,:.:.
Reviewed, reedy for corrections
PI
Called Contact Person
PI
Energy Celcs. °
Plans ticked up
G
Flood plain plaq,
Plans.resubmitted
M
Grading plan' :.' .
2°d Review, ready for corrections/issue
EI
..
$ubeontactorlfst-
Called Contact Person
Pi
Grant Deed .: `
Pians picked up
Sa
H,U A APProy9L
Plans resubmitted
Gi
IN;130USE:
''d Review, ready for corrections/issue
De
Plaurting Apprtryal:
Called Contact Person
A.]
.
Pub: Wks. Appr '
Date of permit issue . k
School Fees
PERMYT FEES
Amount
Check Deposit
Check Balance
truction
ianical
rical
bang
ing
oper Impact Fee .
Perrult Fees
��r