10-1074 (MECH)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:X10=00`001074,
Property Address:
56240 JACK NICKLAUS
APN:
762 -070 -030 -
Application description:
MECHANICAL
Property Zoning:
LOW DENSITY RESIDENTIAL
Application valuation:
14000
Tiht 4 4v Q"
Architect or Engineer..
aim
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 70001 of Division 3 of the Business and Professionals Code, and my License is in full force and effect.
License Class: C20 -C36 LicenseNo.: 777794
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 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. , BAP.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
`!
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-71.53
'
t
Owner: A uat
DON REYNOLDS
56240 JACK NICKLAUS
LA QUINTA,.CA 92253 ;CI 1 201 J
CITY CF i.A Q
Contractor:
J ANTHONY PLUMBING HEAT/AIR
72216 NORTH SHORE STREET, #101
THOUSAND PALMS, CA 92276
(760)343-2121
Lic. No.: 777794
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.
V_ 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 STATE FUND Policy Number 1932451
_ 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 Se tion
'a )Gsv 700 oft Labor Code, I shall for with co with=thosepr ns.
Dat/V •/a I /� Applicant:
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
o is county to enter up o the above-mentioned property inspection purpos
Date! & , nature (Applicant or Agent):��-
Application Number . . . . . 10-00001074
Permit . . . MECHANICAL
Additional desc .
Permit Fee 66.00
Plan Check Fee
16.50
Issue Date . . . .
Valuation . . . .
0.
Expiration Date 4/17/11
Qty Unit Charge Per
Extension'
BASE
FEE
15.00
2.00 9.0000 EA MECH
FURNACE <=100K
18.00
2.00 16.5000 EA MECH
B/C >3-15HP/>100K7500KBTU
33.00
-----------------------7----------------------------------------------------
Special Notes and Comments
CHANGE OUT HVAC, SYSTEMS - 1, 3 TON & 1,
5 TON SPLIT SYSTEM. 2007 CODES.
-----------------_-_-------------------------------
Other Fees . . . . . BLDG STDS ADMIN (SB1473)-
1.00
Fee summary Charged'
----------
Paid Credited
--------------------
Due
---------------------------
Permit Fee Total 66.00•
.00 .00
66.00
Plan Check Total 16.50
.00 .00
16.50
Other Fee Total 1.00
.00 .00
1.00
Grand Total 83.50
.00 .00
83.50
LQPERMIT
Simplified Prescriptive Certificate of Compliance: 2008 Residential RVACAlterations CF -IR -ALT -HVAC
Climate Zones 10 to 15
ite dress:Enforcement
ti0 5( Ll� ��
r�,� 6Iv
Agency:
C.� L) �
Date:
1C) G�
Permit #: .
Conditioned Floor
Equipment T e'
List Minimum Efficiency,
Duct insulation requirement
Area
Thermostat
ackaged Unit
v
e UE�,
COP
Over 40 ft of ducts added or
E] Setback
1purnace
door Coil
ondensing Unit
ROther
EERY
EER
HSPF
ResistanceR
replaced in unconditioned space
R 6 (CZ 10-13)
Served by system
sf
(If not already
present, musbe
8 (CZ 14-1S)
installed)
1. Equipment Type: Choose the equipment being installed; if more than one system, use another CF -/R -ALT -HVAC for each system.
2. Minimum Equipment Efficiencies: 13 SEER, 78% AFUE, 7.7HSPF for typical residential systems.
HERS VERIFICATION SUNEWARY 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
si ed. Beginning October 1, 2010, a registered copy of the CF -1R and CF -6R shall also be on site for final inspection.
El 1. HVAC Changeout
Required Forms:
• All HVAC Equipment replaced
CF -611 forms: MECH-04, MECH-2I-HERS and (for split systems) MECH-25-HERS
CF -4R forms: MECH-21 and fors lits stems MECH-25
• Condenser Coil and/or
• Indoor Coil and/or
CF -6R forms: MF -CH -21 -HERS and (for split systems) MECH-25-HERS
CF -4R forms: MECH-21 and (for split systems) MECH-25
• Furnace
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.
B1. Duct system was documented to have been previously sealed and confumed through HERS verification, or
2. Duct systems with less than 40 linear feet in unconditioned space, or
M 3. Existing ducts stems are constructed, insulated or sealed with asbestos
2. New HVAC System 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
CF -4R forms: MECH-20, and (for split systems) MECH-22, and MECH-25
new equipment)
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 Replacement
Required 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
CF -4R 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
M. 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 CF4R forms: MECH-21
For split s stem 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 andspecifications submitted to the enforcement agency for approval with the permit application.
Name:Kevin Robinson
signature:
Company: J Anthony Plumbing Heating and Air
Date: 10/1 /2010
Address: 2216 North Shore St. # 101
License: 777794
City/state/Zip:Thousand Palms, CA 92276
Phone:760-343-2121
2008 Residential Compliance Forms July 2010
Simplified Prescriptive Certificate of Compliance: 2008 Residential HVACAlteratlons CF -IR -ALT -HVAC.,
Climate Zones 10 to 15
ite dress:
J5�L1� WIC
a� 6Iv
Enforcement Agency.
C:� U
Date:
io/�GL a6
Permit #:
Conditioned Floor
Equipment T
List Minimum Efficiency,
Duct insulation requirement
Area
Thermostat
PackagedumacUnit
�j%
® COP
Over 40 ft of ducts added or
[a Setback
door Coil
Condensing Unit
EERL�
EER
8Other
HSPF _
Resistance
laced in unconditioned space
6 (CZ 10-13)
911R,
Served by system
sf
(If not already
present, must be
8 (CZ 14-15)
installed)
I. 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% 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 CF4R forms (no hand filled CF4Rs allowed) are filled out and
si ed Beginning October 1, 2010, a registered copy of the CF -1R and CF -6R shall also be on site for final inspection.
El 1. HVAC Changeout
Required Forms:
• All HVAC Equipment replaced
CF -6R forms: MECH-04, MECH-2I-HERS and (for split systems) MECH-25-HERS
CF4R forms: MECH-21 and for split 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
M. New HVAC System
Required Forms:
• Cut in or Changeout with new
ducts: (all new ducting and all
CF -6R forms: MECH-04, MECH-20-HERS,and (for split systems) MECH-22-HERS, and MECH-25-HERS,
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, SIMS, and either HSPP or PSPP.
For Packaged Units: Duct leakage < 6 percent
®3. New Ducts with Replacement
Required 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 fwnace. Not all equipment changed.
For Split Systems: Duct leakage < 6 percent, RC, CCA > 300 CFM/ton, TMAH
For Packaged Units: Duct leakage < 6 percent
M. 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 CF4R forms: MECH-21
For splits stem 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 Tide 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:
I
Company: J Anthony Plumbing Heating and Air
Date:
10/17/2010
Address72216 North Shore St. # 101
License: 777794
city/state/zip:Thousand Palms, CA 92276
Phone:760-343-2121
-IUU6 Restarential (;ompliance Forms July 2010
Bin # =°
City of La Quinta
Building & Safety Mblon
Permit # I 1 P.O. Box 1504, 78-495 Calle Tamplco
to Quinta, CA 92253 - (760) 7777012
Building Permit Application and Tracking Sheet
Project Address: nil G 0W,5 Owner's Name: � f () Lo
A. P. Number. Address:
Legal Description: City, ST, Zip-
Contractor.
ip:
Con_ Uad°r' c_S
Address: -7Z -7s 4 , n hj L P --T
City, ST, Zip`�W6 us mjio
Telephone?&)
State Lie. --I `I L4
Arch., Engr., Designer.
Address:
City., ST, Zip:
Telephone:
State Lic. #:
Name of Contact Person4
Telephone # of Contact Person:
# Submittal Rey
Plan Sets
Structural Calcs.
Truss Calcs,
Title 24 Calcs.
Flood plain plan
Grading plan
Subcontactor List
Grant Deed
H.O.A. Approval
IN HOUSE --
Planning Approval
Pub. Wks. Appr
School Fees
Is
C14,& -w
Construction Type: Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
Sq. Ft: #Stories: #Units:
Estimated Value of Project: Lf (� 0 0 `�-
APPLICANT:
Recd
DO NOT WRITE BELOW THIS LINE
TRACMG PERMIT FEES
Plan Check submitted
Item
Amount
Reviewed, ready for corrections
Plan Check Deposit
--Called Contact Person •
Plan Check Balance
Plans picked up
Construction
Plans resubmitted
Mechanical
2•' Review, ready for correctionvissue
Electrical
Called Contact Person
Plumbing
ML
Plans picked up
Plans resubmitted .
Grading
Review, ready for correctionvinue
Developer Impact Fee
A.LP.P.
Called Contact Person
Date of permit Issue
Total Permit Fees