10-1068 (MECH)i
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
10-00001068
Property Address:
57611 INTERLACHEN
APN:
762-180-016- - -
Application description:
MECHANICAL
Property Zoning:
LOW DENSITY RESIDENTIAL
Application valuation:
8175
Tit!t44Q"
Applicant: Architect or Engineer:
LICENSED CONTRACTOR'S DECLARATION
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
I hereby affirm under penalty of perjury that I am licensed under pr visions of Chapter 9 (commencing with
Section 7000) of Division 3 of the Business and ofessionals C e, and my License is in full force and effect.
License Class: C20 C36 L' nse No.: 906115
Date: .ntractol:
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that 1 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 (5500).:
( 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
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 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 _ 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
Owner:
MCFARLAND JAMES R
57611 INTERLACHEN
LA QUINTA, CA 92253
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 10/15/10
Contractor: D A
HYDES
77825 WILDCAT STREET
PALM DESERT, CA 92211 OLT 15 2010
(760)360-2202
Lic. No.: 906115 CITYOF
C.`. -. L- QUINTA
-----------------------------------------------
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 issucd. My workers' compensation
insurance carrier and policy number are:
Carrier NORGUARD INS Policy Number CEWC133676
I certify that, in the performance of the work for which this permit is issu shall not employ any
person in any manner so as to become su ject to the workers' co nsatian laws of California,
and aree that, if I should become subje to the workers' sation provisions of Section
�77
Labor Code, I shall forth h comply wiisions.
Date: Lnt:
WARNING: FAILURE TO SECURE WORKERS' tOMPENSATION 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 appliciQn 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 i all
city and county ordinances and state laws relating to building construction, and hereby aut 'ze prese tives
of is county t e er yponthe above-mentioned property for ins �tses.
/ Da je+gnature (Applicant or Agent):
J
LQPERMIT
Application Number . . . . . 10-00001068
Permit . . MECHANICAL
Additional desc .
Permit Fee . . . . 33.00
Plan Check Fee
8.25
Issue Date . . . .
Valuation
0
Expiration Date 4/13/11
Qty Unit Charge Per
Extension
BASE
FEE
15.00
1.00. 9.0000 EA MECH
FURNACE <=100K
9.00
1.00 9.0000 EA MECH
B/C <=3HP/100K BTU
9.00
----------------------------------------------------------------------------
Special Notes and Comments
CHANGE OUT HVAC COMPLETE SYSTEM,
4 TON
14 SEER. 2007 CODES.
----------------------------------------------- ----------------------------
Other Fees . . . . . . . . . BLDG STDS ADMIN (SB1473)
1.00
Fee summary Charged
---------- ----------
Paid Credited
----- - ---- ----------
Due
-----------------
Permit Fee Total. 33.00
.00 .00
33.00
Plan Check Total 8.25
.00 .00
8.25
Other Fee Total 1.00
.00 .00
1.00
Grand Total 42.25
.00 .00
42.25
J
LQPERMIT
Simplified Prescriptive Certificate of Compliance: 2008 Residential HVAC CF-lR-ALT-HVAC
Alterations
Climate Zones 10 - 15
Site Address:
Enforcement Agency:
Date:
Permit #:
57-611 Interachin La Quinta, CA 92253
City of La Quinta
Oct 14, 2010
Duct insulation
Conditioned Floor
Equipment Typel
List Minimum Efficiency2
requirement
Area
Thermostat
❑ Package Unit
❑ Furnace
❑AFUE
❑ COP
CZ ❑ R 6
(
0 Setback
JZ Indoor Coil
p SEER 14.0
❑ HSPF
10-13)
❑ R 8 (CZ
Served by system
1600 sf
If not already
present, must be
p Condensing Unit
p Other Furn Heat Exch
❑ EER
❑ Resistance
14-15)
installed)
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 Efrciencies: 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-4R forms (no hand filled CF-4Rs allowed) are filled out and Sig ned.Beginning
October 1, 2010, a registered copy of the CF-111 and CF-611 shall also be on site for final inspection.
D 1. HVAC Changeout
Required Forms:
. All HVAC Equipment
CF-6R 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-6R 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 <_ 300 CFM/ton (Minimum Air Flow Requirement), TMAH
For Packaged Units: Duct leakage < 15 percent
Exempti-d'from duct leagage 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
1713. Existingrduct,systems are onstru{cte_d;
Bin # City Of LaQ Uinta
Building & Safety Division
Permit iff P.O. Box 1504, 78-495 CaIIe Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application .and Tracidng Sheet
Pmject Address: * -7� h eraain eraOwnees Name: h7e S /L
qr r7 h
A P. Number: Address: 5-7
Legal Description: Cny, S', ZiF 4— G?
Address: y5 I rI ✓40-1 I ProjectDescription:7—
City, ST, Zip: LC, 1 r/A 1/1
Telephone: °77 6C,-3: o r-Z;70'Z—
State Lia # : �� I �. city Lic. #:
Arch Fjr-, Designer:
Address:
City, ST, Zip:
Telephone: Construction Type: Occupancy: .
State Lia #: Projecttype (circle one): New Add'n Alter Repair Demo
Name of Contact Person: Sq. Ft: # 'es: # Units:
Telephone # of Contact Person: Fzfimaied Value of Project��
APPLICANT- nn NAT warrc am ^IAI ru.c• I ■—
#
Submittal
Req'd
Rec'd
TRACKING •
PERhM FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calm.
Reviewed, ready for corrections
Play Check Deposit
Truss Cales.
Caned Contact Person
Plan Check Balance
Energy Cates.
Plans picked up
Construction
Flood plaim! plan
Plans resubmitted
Mechanical '
Grading plan
2id Review, ready for corrections/issue
Electrical'
Subeontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.ML
SOA Approval
Plans resubmitted
Grading
IN HOUSE-
'"' Review, ready for correctionsrume
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees
M