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13-0536 (MECH)P.O. BOX 1504 ��• I J � �1 � rr . 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: Property Address: APN: Application description Property Zoning: Application valuation: Applicant: 13-00000536 55440 LAUREL VALLEY 775-181-036- - MECHANICAL LOW DENSITY RESIDENTIAL 8100 Architect or Engineer: BUILDING & SAFETY DEPARTMENT BUILDING PERMIT LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7 00) of Division 3 of the Business and Professionals Code, and my License is in full force and effect. License Cl ss: ,20-C36 LicenseNo.: 481393 Date: r) Contractor 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).: 1 _ 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 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 she did 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 1 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: LQPERAI IT Owner: JAN LANG 55440 LAUREL VALLEY LA QUINTA, CA 92253 ( Contractor: MAPLE LEAF PLBG HEAT/A P.O. BOX 3653 PALM DESERT, CA 92261 (760)346-6758 Lic. No.: 481393 VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 4/26/13 WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: _ 1 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. 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 BBSI Policy Number 2246 _ 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 become sub'ect to the workers' compensation provisions of Section I 700 of the LLaab`or e I 2rt ith comply with those provisions. Date Applicsn 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 ofthis court y to ter upon the above-mentioned proper o 'nsp do r .s. Date/' �gnature (Applicant or Agentt-�7 ! �� LQPFRAI IT ' Application Number . . . . . 13-00000536 Permit . . . . . . MECHANICAL Additional desc . Permit Fee . . . . 40.50 Plan Check Fee 10.13 Issue Date . . . . Valuation 0 Expiration Date'. 10/23/13 Qty Unit Charge Per Extension BASE FEE 15.00 1.00 9.0000 EA MECH FURNACE <=100K 9.00 1.00 16.-5000 EA MECH B/C >3-15HP/>100K"-500KBTU 16.50 ----------------------------------------------------------------------------- Special Notes and Comments HVAC CHANGE OUT REPLACE (1) 13SEER/80 AFUE SPLIT SYSTEM [2008 ENERGY] CARBON MONOXIDE ALARM(S) TO BE INSTALLED PRIOR TO FINAL INSPECTION. 2010 CALIFORNIA BUILDING CODES. ---------------------------------------------------------------------------- Other Fees . . . . . . . . . BLDG STDS ADMIN (SB1473) 1.00 Fee summary Charged Paid Credited ---------------------------------------- Due ----------------- Permit Fee Total 40.50 .00 .00 40.50 Plan Check Total 10.13 .00 _00 10.13 Other Fee Total' 1.00 .00 .00 1.00 Grand Total. 51.63 .00 .00 51.63 LQPFRAI IT Bin # City of La Quinta BuUding & Safety Division Permit # P.O. Box 1504,78-495 Calle Tampico l�J 4 Quints, CA 92253 - (760) 777-7012 Building Pennit Application and Tracking Sheet Project Address:w-e ` C. t: Owner's Name:. A. P. Number. ' Address: y410e. � 04#12- 4#RLegal LegalDcsaippon: City, ST. Zip: La 4:�U,�, C� Contractor. Telephone: / /- Address: .Q O� 3 S3 Project Description: City, ST, Zip: (��1��'L(,p Telephone: e v) J S State Lie, # : 1-3 9 3 City Lie, 0, Arch, Eng., Designer: Address: City., ST, Zip: Telephone: Construction Type:. Occupancy: State Lie, d: Project type (circle one): New Add' Altrx Repair Derno Name of Contact Person: �✓� P.� -� Sq. Ft :J� ig Stories: p Units: a Telephone # of Contact person: (o ��. S , p 2�/ L Estimated Value of Project APPLICANT: DO NOT WRITE BELOW THIS UNE N Submittal Req'd Recd TRAQQNG PERb= FEES - Plan Sell Ptaa Check sabmitted Item Amount Structural Cates Reviewed, ready for corrections Plan Check Deposit. Truss Gla. Called Contact Partoa Plan Check Balance. Title 21 Gla Pian picked up Construction Flood plain plan Plans resubmitted Grading plan T.EEeCtFIC&I 2`! Review, ready for correclioasfasueSubeontactor list Called Contact Person Grant Deed Plans picked up &NLL Ii O A Approval Plan reabmitted Gndtog IN !;OUSE: -3" Review; ready for carrectionslissue Developer Impact Fee Planolug Approval Called Contact Person A.LP.P, Pub. Wks. Appr Date of permit Issue School Feu Total Permit Fees I Prescriptive Certificate of Compliance: Residential CF -1R -ALT. I , Residential Alterations Page 1 of 1 - Project Name: I Climate Zone I # of Stories .I General Information: Site Address: Z/ 1/16 /:e -r ate Enforcement Agency: �3 Building Type: Single Family ❑ Multi Family Front Orientation: ❑ N ❑ E,B W ❑ S Project Type:Alteration HVAC Replacement ❑ Duct Replacement ❑ Conditioned Floor Space (CFS): NOTE: This form is not to be used for new construction or additions. HVAC Systems - Heatin : Duct Insulation Thermostat Configuration (Split Equipment Type" Capacity AFUE HSPF R -Value Type or Package) a GQ a $n. ,,,1 HVAC Systems - Coolin : - Pipe Insulation Thermostat Configuration (Split Equipment Type Capacity SEER EER R -Value Type or Package) /J HERS Verification Summary: Duct Sealing & Testing - HERS verification is required for this measure. ❑ Yes ❑ No In Climate Zones 2 and 9-16, if more than 40 linear feet of new or replacement ducts are installed in unconditioned space, the ducts are to be sealed per §152(b)1 Dii and the newly installed ducts are to be insulated per §151(f)10. O Exception: Existing duct systems that are extended, which are constructed, insulated or sealed with asbestos. L3 Yes ❑ No In Climate Zones 2 and 9-16, if the existing space -conditioning system (HVAC equipment and ducting) is replaced, the ducts are to be sealed per §152(b)1 Di. ; Yes ❑ No In Climate Zones 2 and 9-16, if the existing HVAC equipment is replaced (including the replacement of the air handler, outdoor condensing unit of a split system, cooling or heating coil, or the furnace heat exchanger) the ducts are to be sealed per §152(b)1 E. Exception: Duct systems that are documented to have been previously sealed confirmed through HERS verification in accordance with procedures in the Reference Residential Appendix RA3. ❑ Exception: Duct systems with less than 40 linear feet in unconditioned space. ❑ Exception: Existing duct systems are constructed, insulated or sealed with asbestos. — R frigerant Charge — Split System — HERS verification is required for this measure. Yes ❑ No In Climate Zones 2 and 8-15, when the existing HVAC equipment is replaced (including the replacement of the air handler, outdoor condensing unit of a split system A/C or heat pump, cooling or heating coil, or the furnace heat exchanger) a refrigerant charge measurement shall be verified per §152 b 1 F. Central Fan Integrated (CFI) Ventilation System and Fan Watt Draw The ventilation requirements of §150 o do not apply to existing residential homes. Dilcted Split Systems — Air Conditioners and Heat Pumps: Airflow — HERS verification is required for this measure. ji Yes ❑ No In Climate Zones 10 through 15, when the existing space -conditioning system (HVAC equipment and ducting) is replaced, the airflow and fan watt draw shall be verified er 152 b 1Ci to meet the requirements of §151(D713. Documentation Author's Declaration Statement I certify that this Certificate of Compliance documentation is accurate and complete. Name: Signature: ` Company: �1v �� Date: Address: City, State, Zip Code: Ph M�� Registration Number: Registration Date & Time: HERS Provider: 2008 Residential Compliance Forms PDAC January 2010