10-0389 (MECH)C
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: X10,-00000389
Property Address: 79885 HORSESHOE RD
APN: 649-062-005-32 -2180 -
Application description: MECHANICAL
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 6925
Applicant: _ 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 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect.
LicenseClass: C20 License No.: 878533
fDate:.. Contractor:
tC __�� 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 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.).
(_) 1, 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 ISec. 3097, Civ. C.).
Lender's Name: _
Lender's Address:
LQPERMIT
Owner:
CLOSE MARTIN LES
79885 HORSE SHOE
LA QUINTA, CA 92
( /
Contractor: ...
DIAL ONE'S ONE HOUR A/C
2712'E. LA CADENA DRIVE
RIVERSIDE, CA 92507
(951)276-9744
Lic. No.: 878533
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 5/03/10
CJ
21 A,
------------------------------------------------
WORKER'S COMPENSATION DECLARATION
I 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 GOLDEN ENGLE Policy Number WSD500334900
I certify that, in the performance of the work for which this permit is issued, 1 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 a subject to the workers' compensation provisions of Section
3700 of the Labor Code, I I forthwith with those provisions.
G Date: Q `Applicant:
a
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 1$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 nstruction, and hereby authorize representatives
of this county to enter upon the above-mentioned property /r ' tspe tion urposes. �_— V
Date:—_T-3 ao Signature -(Applicant or Agent): l/!/ �i�J �
LQPERMIT
Application Number . . . . . 10-00000389
Permit . . . MECHANICAL
Additional desc .
Permit Fee 31.50
Plan Check Fee
7.88
Issue Date . . . .
Valuation . . . .
0
.Expiration Date 10/30/10
Qty Unit Charge Per
Extension
BASE
FEE
15.00
1:00 16.5000 EA MECH
B/C >3-15HP/>100K-500K13TU
16.50
----------------------- ----------------------------------------------------
Special Notes and Comments
REPLACE / CHANGE OUT 90,000 BTH
FURNACE
-----_-_- --- --- -----" - 5 'TON 14 SEER -A/C WITH COIL PER -2007
CODES.
----------------------------------------------------------------------------
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
LQPERMIT
Sim lifted Prescriptive Certificate of Com ance: 2008 A%i&n fal BVACAIfertrtims CF 1 R -ALT -HVAC
Climate 2aaes to to 15
Site Addmas:
A
Dole:
W
PesEqeti! dI:
ui and ni '
List Kwhourn Effi '
Dud kn !Won t
Con ' nor
Area
Themasm
❑ Packaged Unit
�umace
1$tondr Coil
D AFUE
❑SEER
El COP
O HSPF
O 40 ft dddd
Over of added or
rte i11 mcandi6"d
2'Sretback
(Y -1
�sOK
Unit
DEER
D Resisttrtsce
❑ R b (CZ 1 f1-13)
sf
P nmol br
13'Candensing
0 outer
p R 8 (CZ 14-15)
lnno/le�
1. E4ufpniew I)pe Chow the egwipmem being Inualkd; If MOM dM arra 4wear, ase anodter C1v1 R-ALT-I1YAC far each system.
Z Mhrlmam Elul mkw AWdardex 13 SWA 78% AFUE: 7 MPFfor typkd nuldsuW sysstests.
HERS VERMCATION SU(4IALARY Listed below we four HVAC alteration Options, The installer decides what work is being done and
picks 0119 of the appropriate Options. Each Option lista the HERS men== that must be condudal. A Copy of the forms shall be left an sift for final
inspcctW and a copy given to the homeowner. At Gnat, the mspectar verifies dW the work listed on this form was in tack the work oampleted by the
installer. The inspector also verifies that each eppropriase CF -GR and registered CF -4R fm m (no hand filled CF-41ts alimved) are filled out and
signed- October t 1010 s registered COPY of the CIF -IR and C74R"abe be an tate for rust
I. HVAC Changeoat
Required Fortes:
• All IfVAC Equipmrat replaced
CF -6R fame: MECH-04, MECH-21-HERS nod (forspilt systems) MECH-25-HERS
CF4R forms; MECH- 21 and for s MECH-z5
• Condenser Coit and /or
Indoor
• Indoor Carl and
m
CF -6R fame: MECH-214MRS and (for split systems) MECH- 25 -HERS
•
Funu=For
CF -4R forma; MECH- 21 and (for split systems) MECH-25
Split Systems: Duct leakage < 15 percent; RC, CCA 2:301 CFM/ton(Mhtimum Air Flow Requirement), TMAH
For Packaged Units: Duct leakage < 15 percent
Exempted Grmi dud leakage testing W
❑ 1. Duct system was domancated to have been pmkxssly Sealed and coaftwd dmigh HERS verification, or
132. Duct systems with k ss than 40 Ham feet in unconditioned spnerw or
O 3. Existing duck systems are coostnreied, insulated or sealed with ashman
O 2. New HVAC System
Requtred Forma:
• Cut in or Changeout with new
duds: (all new dutlingAW all
CI'�R forms MECH-M, MEC14-204BUL W (for split systems) MECH-22-HERS, and MECH-25-HERS
new ens)
CF4R farms: MECH 20•, and (for split system)Y W14-22, and MECH 25
For SPIN Systems: Duct k mge < 6 percent; RC, CCA >_ 350 CFMAon, FWD, TMAH, SIMS, and either HSPP or PSPp.
For Packaged Units: Duct < 6 percent
0 3. New Ducts with Replacement
Required Forms:
• Includes replacing or installing all new dulling
CF -611 farms: MECH-04, MEC I-204iERSjmd (far split sysums) MECt•1-25-HERS
and/or outdoor condensing unit and/or Wdow
CF4R forms: MECH-20 and (for split system) MEM25
coil and/or fumace. Not all equipment changed.
For Split Systems: Dud leakage < 6 peroeu4 RC, CCA >_ 300 CFMIton, TMA H
For Packaged Units: Dud leakage < G Lwmcnt
0 4. New Ducting over 40 fat
Required Forma;
• Includes adding or replackg mora than 40
linear feet of dud in unconditioned space. I
CF -6R forms: MECHA MECH-2I-HERS CF -4R fame MECH-21
For spit "em or packaged oaks: Duct leakage < 15 pacotrt
❑ EXCEPTION: Ensting dud system cunstructcd, insulated or sealed with mbcstos.
Contractor (Documentation Author's /ResponslWe Designer's DeclaraMm Sbtemeut)
• 1 certify that this certifima of Cmnpfiam documpuation is acmwe and compkim
• 1 am eligible under Division 3 ortlm CaNternin Buaim. and pmkniow Cade to amcpt tapOObiNty row the design idcatiftod as rho Catifiarta orComptim m
• 1 cert ify" the enery feohm and perfmmen= *vcWrauorta for rho design Wentifmd on the Cu fieare of Compiiaum conform to the requirement: of Title 24,
Pons 1 and 6 of the California Code of Resulntiow
• The diniga Rntums ideval ied on Wts Cadficale of Comptiggrm arc comigent wish the iaformatfos donmrron(ow otdxx sppiiar6dc cotnplmrme fonm, warkshcm
calculedum view mel specirrAflons nbolued to the rnforament agmy for With the ion
Name:
5virW MINISign�tu+C
Company: _ .
n111e
Addtrsx .
LOr
Urease: �r
City/3tate!/Ap:
Phone
oliva nruuernrLUt.onrpnarnce parmr March 2010
Bin #
City of La Quinta
Building 8i Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
,
Permit #
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Project Address: '�
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Owner's Name: •� � � � ,�
A. P. Number:
Legal Description:
Address:O� u
City, ST, Zip:
Contractor:
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Telephone: `/ Vis.: ,. ;;:.>, .r .,•:.::
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Address:
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Project Description:
City, ST, Zip: P-Kvr tt1e--
Telephone: > ::>;:::•:>:<:;:;::;{:<::::<:.......:.:h>:::; < »y
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State Lic. # :
Arch., Engr., Designer:.
City Lic. #;
LlJA10 edl
Address:
City., ST, Zip -
Telephone:
State Lic. #:
Name of Contact Person:
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�•;r>.;;<.,�;:•i;;>v::;;;::;:>.::>::::>:•i::>i•:.:•.;;<;�;
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'z>f^-`'::>> ::: ;;:•<cl;>rc:
Construction T e:
YP Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
Sq. Ft.: 7T# stories: #Units:
Telephone # of Contact Person:
Estimated Value of Project: , OV
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance
Title 24 Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2"a Review, ready for corrections/issue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
1N HOUSE:-
3 4 Review, ready for corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person
,+,I_p p
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees