12-1172 (MECH)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 12-00001172
Property Address: 79835 HORSESHOE RD
APN: 649-062-002-35 -2180 -
Application description: MECHANICAL -
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 4700
4
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
JEAN LYLE
79835 HORSESHOE ROAD
LA QUINTA, CA 92253
Contractor:
VOICE (760) 77-7
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
C 4
Date: 10/04/12
Applicant: Architect or Engineer:
PP 9
J ANTHONY PLUMBING HEATS/AIR CiTYtjF�-�j
LA QUINTA
72216 NORTH SHORE STREET,—#1.01=11VAV_CFnr'T
THOUSAND PALMS, CA 92276
(760)343-2121
1
LiC. No.: 777794
------------------------------------------
• 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 Busi ss and Professionals Code, and my License' 'w-Wilf -force and effect.
_ I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided
Lice a Class:
C20–C36 License N
for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
ate: b
Contractor:
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:
1 hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the
Carrier GRANITE STATE Policy Number WC065255599
following reason (Sec. 7031.5, Business and Professions Code: Any city or county that requires a permit to
_ I certify that, in the perform ce 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 s 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 Labor C rthwith comply with those provision
that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by
`
O
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).:
ate: plicant:
(_ 1 1, 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
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.).
(_ 1 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.).
(_ 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 Quints, 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 issuanc 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 t at the above information is correct. I agree to comply with all
city and county ordinances and state laws rel Ing building construction, and hereby authorize representatives
of this co nt to a/nter upon the above -menti p open q
n purposes.
Dgte f Q Y 'nature (Applicant or gent)
LQPERMIT
Application Number . . . . . 12-00001172
Permit . . . MECHANICAL
Additional desc .
Permit Fee . . . . 31.50 Plan Check Fee
7.88
Issue Date . . . . Valuation . . . .
0
Expiration Date . . 4/02/13
Qty Unit Charge Per
Extension
BASE FEE
15.00
1.00 16.5000 EA MECH B/C >3-15HP/>100K-500KBTU
16.50
----------------------------------------------------------------------------
Special Notes and Comments
HVAC CHANGE -OUT: INSTALL NEW CONDENSING
UNIT, INDOOR COIL. 2010 CODES.
-------------------------------7--------------------------------------------
Other Fees . . . . . . . . . BLDG STDS ADMIN (SB1473)
1.00
Fee summary Charged Paid Credited
--------------------
Due
-------------------------------------
Permit Fee Total 31.50 .00 .00
31.50
Plan Check Total 7.88 .00 .00
7.88
Other Fee Total 1.00 .00 .00
1.00
Grand Total 40.38 .00 .00
40.38
r
Simplified Prescriptive Certificate of Compliance: 2008 Residential HVAC Alterations CF-lR-ALT-HVAC
Climate Zones 10 - 15
Site Address:
Enforcement Agency:
Date:
Permit #:
79835 HORSE SHOE RD La Quinta, CA 92253
City of La Quinta
Oct 4, 2012
Duct insulation
Conditioned Floor
Equipment Typel
List Minimum Efficiency2
requirement
Area
Thermostat
❑ Package Unit
❑ Furnace
® Indoor Coil
❑AFUE
® SEER 13.0
❑ COP
❑ HSPF
❑ R 6 (CZ 10-13)
Served by system
® Setback
If not already present, must be
® Condensing Unit
❑ EER
❑ Resistance
❑ R 8 (CZ 14-15)
3820 sf
installed)
❑ Other
1. Equipment Type: Choose the equipment being installed; if more than one system, use another CF-1R-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 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. The inspector also verifies that each appropriate CF-6R and registered CF-411
forms (no hand filled CF-411s allowed) are filled out and signed.Beginning October 1, 2010, a registered copy of the CF-111
and CF-611 shall also be on site for final inspection.
® 1. HVAC Changeout
Required Forms:
• All HVAC Equipment
CF-611 forms: MECH-04, MECH-2I-HERS and (for split systems) MECH-25-HERS
replaced
CF-411 forms: MECH-21 and (for split systems) MECH-25
• Condenser Coil and /or
• Indoor Coil and /or
CF-611 forms: MECH-04, MECH-2I-HERS and (for split systems) MECH-25-HERS
. Furnace
CF: 4R forms: MECH-21 and (for split systems) MECH-25
For Split Systems: Duct leakage < 15 percent; RC, CCA 5 300 CFM/ton (Minimum Air Flow Requirement), TMAH
Pep Paelia9ed URitse Duet leakage -; 16
peFeeRt
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 duct systems are constructed, insulated or sealed with asbestos
❑ 4. The system will not be Ducted (ie. Ductless Mini-Split System) (Also Exempt from Refrigerant Charge)
❑ 2. New HVAC System
Required Forms:
. Cut in or Changeout with'
CF-6R forms: MECH-04, MECH-20-HERS land (for split systems) MECH-22-HERS, and
new ducts: (all new
ducting and all new
MECH-25-HERS
J '
equipment)
CF-4R forms: MECH-20, and (for split systems) MECH-22, and MECH-25
�!^ ,f/
4
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
❑ 3. New Ducts with/or without
Required Forms:
Replacement
. Includes replacing or installing all new
ducting and/or outdoor condensing unit
CF-611 forms: MECH-04, MECH-20-HERS, and (for split systems) MECH-25-HERS
and/or indoor coil and/or furnace. No or some
CF-4R forms: MECH-20 and (for split systems) MECH-25
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-611 forms: MECH-04, MECH-2I-HERS
linear feet of duct in unconditioned space.
CF-4R forms: MECH-21
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 documented on other applicable compliance
forms, worksheets, calculations, plans and specifications submitted to the enforcement agency for approval with the permit application.
Name: Kevin Robinson Signature: Kevin Robinson
Company: J ANTHONY PLUMBING HEATING & AIR CONDITIONING Date: Oct 4, 2012
Address: 72216 NORTH SHORE ST #101 License: 777794
City/State/Zip: THOUSAND PALMS / CA / 92276 Phone: (760) 343-2121
Reg: 212-A0055418A-00000000-0000 Registration Date/Time: 2012/10/04 12:12:05 HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms July 2010
Bin. #
r
Cit ofla ,(.a Qui -b,
Building gr Safety Ai ion l
Permit #:
P.O. Box .1504,-78-495 Calle Tampico
'a.Quin"' CA 92253 -:(760) 177-7012
Building Permit
Application and Tracking Sheet
Project AddRss: / ��
/LSA ��Or" O vnees Name:. J t�w (,
A. P. Niuinbcr:
Address:
Legal Description:
City, ST, Zip:
Contractor.
Telephone:
Address: J ANTHONY SERVICES
c TE 101.
Project Description:
City, ST, Zip: TIOUSAND PALMS, CA 92275
77
Telephone:
State Lic. # :.7 77 15
City Lia #: b o S
Arch., Bagr., Designer.
Address:
City. ST. Zip:
Telephone:
Construction Type:. Occupancy:
State Lia #:
Project
J type (circle one): New Add'a Alter Repair Demo
Name of Contact Person: �� /!. e
�� .� Sq. FL: #Stories #Units
Telephone # of Contact Person: %10U 3 !{3 27 "Zi Estimated Value of Project � e Q
APPLICANT: DO NOT WRITE BELOW THIS UNE
0 Submittal ReVd
Recd TRACIMG PBRhII'r FEES
Plan Sets
Plan Check submitted Item Amount
�4dand Cales.
Reviewed, ready for corrections Pian Cluck Deposit. .
Truss tics.
Called Contact Person Plan Check Balance
11de 24 tales.
Plans picked up Construction
"Flood plain plan
Pians resubmitted.. Meeharikal
Ginding plan
V Review, ready for correcdowkrmu.e Electrical
Subeostactor List
Called Contact Person Plumbing
Grant Deed.
Plans picked up SA,t,
H.O.A. Approval
Plans resubmitted Grading
IN HOUSE:-
2" Review; ready for correetionslissae Developer Impact Fee
Planning Approval
Called Contact Person A".P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees