BMCH2014-111478-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
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COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING PERMIT
Application Number:
BMCH2O14-1114
Property Address:
57540 INTERLACHEN
APN:
762180021
Application Description:
REPLACE (1) FURNACE, COIL, AND CONDENSING UNIT
Property Zoning:
Application Valuation:
$11,832.00
Applicant:
EFFICIENT AIR CONDITIONING INC
P.O. BOX 1043
THOUSAND PALMS, CA 92276
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 Professions Code,
and my License is in full force and effect. I
License Class: _ License No.: :LIC -0005383
L !
Date:b " 6' LcF Contractor: �� I�C�(1
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).:
(_) 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
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
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
WORKER'S COMPENSATION DECLARATION
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
Dfe w rk for which this permit is issued.
=ave 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: _ Policy Number: _
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 subject to the
workers' compensation provisions of Section 00 of the Labor Code, I shall forthwith
comply with those provisions.
Date: V, Applican
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 Building Official 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 of this city to enter upon the above-
mentioned property for inspection purposes.
Date:i /b — Ilo, Signature (Applicant or Agent):
Date: 10/16/2014
Owner:
JOSEPHINE NEWELL
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Contractor:
SS
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EFFICIENT AIR CONDITIONING
INC A, o
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P.O. BOX 1043
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THOUSAND PALMS, CA 92276
3
(760)343-5340
I
Llc. No.: :LIC -0005383
WORKER'S COMPENSATION DECLARATION
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
Dfe w rk for which this permit is issued.
=ave 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: _ Policy Number: _
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 subject to the
workers' compensation provisions of Section 00 of the Labor Code, I shall forthwith
comply with those provisions.
Date: V, Applican
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 Building Official 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 of this city to enter upon the above-
mentioned property for inspection purposes.
Date:i /b — Ilo, Signature (Applicant or Agent):
DESCRIPTION
ACCOUNT CITY
PAID
PermitTRAK '
$153.28
BMCH2O14-1114' Address: 575401NTERLACHEN
Apn:762180021
$153.28
BUILDING STANDARDS ADMINISTRATION BSA
$1.00
BSAS SB1473 FEE
101-0000-20306 0
$1.00
CHANGEOUT
$60.43
HVAC CHANGEOUT - PACKAGED UNIT PC
101-0000-42600 0
$24.17
HVAC CHANGEOUT - PACKAGED UNIT
101-0000-42402 0
$36.26
PERMIT ISSUANCE
$91.85
PERMIT ISSUANCE
101-0000-42404 0
$91.85TOTAL
FEES PAID BY RECEIPT:R2107
$153.28
Date Paid: Thursday, October 16, 2014
Paid By: EFFICIENT AIR CONDITIONING INC
Cashier: MFA
Pay Method: CHECK 1306
Printed: Thursday, November 06, 2014 10:44 AM 1 of 1 Cg?Wt 1TFAAC
Description: REPLACE (1) FURNACE, COIL, AND CONDENSING UNIT
Type: MECHANICAL Subtype: Status: SUBMITTED
Applied: 10/16/2014 SKH
Approved:
Parcel No: 762180021 Site Address: 57540 INTERLACHEN LA QUINTA,CA 92253
Subdivision: TR 27332 SEE ASSESSOR MAP 761 PG 47 Block: Lot: 3
Issued:
& 48
Lot Sq Ft: 0 Building Sq Ft: 0 Zoning:
Finaled:
Valuation: $11,832.00 Occupancy Type: Construction Type:
Expired:
No. Buildings: 0 No. Stories: 0 No. Unites: 0
Details: HVAC CHANGE OUT - 15SEER/80AFUE SPLIT SYSTEM [2013 ENERGY) CARBON MONOXIDE ALARM(S) TO BE INSTALLED PRIOR TO
FINAL INSPECTION. 2013 CALIFORNIA BUILDING CODES.
ADDITIONAL SITES
CHRONOLOGY
CONDITIONS
FINANCIAL
FINANCIAL INFORMATION
Printed: Thursday, October 16, 2014 10:45:29 AM 1 of 2 CB?—W—
INSPECTIONS
SEQID INSPECTION TYPE INSPECTOR SCHEDULED COMPLETED RESULT REMARKS NOTES
DATE DATE
MECHANICAL FINAL**
PARENT PROJECTS
REVIEWS
REVIEW TYPE REVIEWER SENT DATE DUE DATE RETURNED STATUS__T REMARKS NOTES
DATE
BOND INFORMATION
ATTACHMENTS
Printed: Thursday, October 16, 2014 10:45:29 AM 2 of 2 CRWYSTEMS
- -
'CHECK
V
-CLTD
DESCRIPTION7
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
RECEIPT #
#
METHOD
PAID BY—
BY
BSAS SB1473 FEE
101-0000-20306
0
$1.00
$0.00
Total Paid forBUILDING STANDARDS ADMINISTRATION $1.00 $0.00
BSA:
HVAC CHANGEOUT -
101-0000-42402
0
$72.52
$0.00
SPLIT -SYSTEM
HVAC CHANGEOUT -
101-0000-42600
0
$36.26
$0.00
SPLIT -SYSTEM PC
Total Paid forCHANGEOUT: $108.78 $0.00
PERMIT ISSUANCE
101-0000-42404
0
$91.85
$0.00
Total Paid forPERMIT ISSUANCE: $91.85 $0.00
TOTALS:00
INSPECTIONS
SEQID INSPECTION TYPE INSPECTOR SCHEDULED COMPLETED RESULT REMARKS NOTES
DATE DATE
MECHANICAL FINAL**
PARENT PROJECTS
REVIEWS
REVIEW TYPE REVIEWER SENT DATE DUE DATE RETURNED STATUS__T REMARKS NOTES
DATE
BOND INFORMATION
ATTACHMENTS
Printed: Thursday, October 16, 2014 10:45:29 AM 2 of 2 CRWYSTEMS
Simplified Prescriptive Certificate of Compliance: 2008 Residential HVACAlterations CF -IR -ALT -HVAC
Climate Zones 10 to 15
Site,40ress:
5-7 - � 4U
L4 win1 _ I Enforcement Agency: I Date: ,UIl�I i j l Permit #:
Equipment Type' List MinimuConditioned Floor
m Eflicienc Z Duct insulation requirement
❑ Packaged Unit Area Thermostat
V Furnace bg AFUE $0% ❑ COP Over 40 ft of ducts added or `g Setback
X` Indoor Coil g'SEER 15 ❑ HSPF replaced in unconditioned space Served by system (7f not already
A Condensing Unit A EER f Z- ❑ Resistance ❑ R 6 (CZ 10-13) sf present, must be
❑ Other ❑ R 8 (CZ 14-15) installed)
1. Equipment Type: Choose the equipment being installed; if more than one system, use another CF -1 R -ALT -HVAC for each system.
2. Minimum Equipment Efficiencies: 13 SEER, 78%AFU& 7.7HSPFfor 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
signed. Beginning October 1, 2010, a registered copy of the CF -1R and CF -6R shall also be on site for final inspection
k I. HVAC Changeout I Required Forms.
• All HVAC Equipment replaced CF -6R forms: MECH-04, MECH-2I-HERS and (for split systems) MECH- 25 -HERS
CF -4R forms: MECH- 21 and fors lit stems MECH-25
• Condenser Coil and /or
• Indoor Coil and/or CF -6R forms: 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
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
❑ 2. New HVAC
Required Forms:
• Cut in or Changeout with new CF -6R forms: MECH-04, MECH-20-HERS,and (for split systems) MECH-22-HERS, and MECH-25-HERS
ducts: (all new ducting and all
new equipment) CF4R 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
❑ 3. New Ducts with
uired Forms:
• Includes replacing or installing 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 CF4R 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 Packaged Units: Duct leakage < 6 percent
❑ 4. New Ducting over 40 feet Required Forms:
• Includes adding or replacing more 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 duct systems constructed, insulated or sealed with asbestos
Contractor (Documentation Author'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�feiitures and performance specifications for the design identified on this Certificate of Compliance conform to the requirements of Title 24,
Parts I and 6 of the California Code of Regulations.
• The design features identified on this Certificate of Compliance are consistent with the in f ion documented on other applicable compliance forms, worksheets,
calculations, plans and specifications submitted to the enforcement apencv fnr anal — 6 n{:..........:.......t:.....:.._
Name: _19M es j`a - Sign
STI
Address: .730rj2 n „AMAA
[�'IUYYtY�G Date: 1 S�1t�
License: O 0
i- ��p Phone: O I 34� 673
Bill #
Qty. 'f %c7 QUtnta
Building ar Safety DivIsion
P.O. Box 1504,78-495 Calle Tampico
� •Qdnta. CA 92253 - (760) 777-7012
Building Permit Application* and Tracking Sheet
Permit #
Znl �P - l
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Project Address:— 1 NOW.F.Address:
ner's Name:
A. P. Number.
.)Legal
Description:
, ST, Zip; CJ± C
Telephone a >•
Contractor
Address: P . � 3.
Project Description: 1
ii
1 S_fp
City, ST, Zip f i%li C Gj li�� lX 3
DY� l I 5: -e-e r,/s^ i ty)
7 �
Telephon ;_�j�C� :� �lVs.
State Lie. # :— 525! City Lic #
0
Arch., Engr., Designer
y ofE� � 15 L1
Address:
City, ST, Zip:
..•'.,fie,..
Telephone: Construction Type: Y AC Occupancy:
State Lie. Project type (circle one): New Add'n Alter Repair Demo
Name of Conlan Person " " Sq, Ft ; # Stories: # Units:
Telephone # of Contact Persanl -- -
Estimated Value of Project U�
APPLICANT: DO NOT WRITE BELOW THIS LINE
N
Submittal
P q'd
Recd
TRACKING
PERMIT FEES
Plan Sets
Pian Cheek submitted
Item Amount
Structural Cafes.
Reviewed, ready for corrections
Plan Check Deposit, .
Truss Calcs.
Called Contact Person
Plan Check Balance
Title 24 Cafes.
Plans picked up
Construction
Flood plain plan
Plans resubmitted • .
Mechanical
Grading plan
Zad Review, ready for corrections!'issue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plana picked up
S.M.L
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
'^' Review; ready for correetlonsftut
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees