12-1275 (MECH)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:` ~:.12.0000127
Property Address:— -'56290 JACK NICKLAUS
APN: 762 -070 -031 -
Application description: MECHANICAL
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 12937
Ti,ht, 4
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Applicant: Architect or Engineer:
LICENSEDC
TRACTOR'S DECLARATION _
I hereby affirm under penalty of perjury that I am licen under provisions of Chapter 9 (commencing with
Section 7000) of Division 3 of the Business and Profe nals Code, and my License is in full force and effect.
LicenseClass: �CC20— Li nse No.: 686310
C racto
Date: r.
NER-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 ($5001.:
1 _ 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.).
(_) 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:
SHEAFFER JOHN W
56290 JACK NICKLALUS
LA QUINTA, CA 92253
VOICE (760) 7-�0
FAX (760) 7 -70
INSPECTIONS (760) 777-
Date: 10/26/12
Contractor: ,
GENERAL AIR CONDITIONINGPOCT
31170 RESERVE DRIVE
THOUSAND PALMS, CA 92276
(760)343-7488Lic. No.: 686310
Irl
---"---------------"--------------=---==
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 ZENITH INS CO Polic Number Z071741501
I certify that, in the performance of the rk for which this permit is issued, I shall not employ any.
person in any manner so as to beco subject to the workers' compensation laws of California,
and agree that, if I should become u ect to the workers' compensation provisions of Section
3700 of the Labor Code, I shall for ith c ply with those provisions.
'X
Date: 26 r Z. plicant:
WARNING: F URE TO SECURE WORK PEN SATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT 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 bekio
void if work is not commenced
within 180 days from date of issuance of such ption of work for 180 days will subject
permit to cancellation.
I certify that I have read this application and state that the abois correct. I agree to comply with all
city and county ordinances a state laws relating to building .nd hereby authorize representatives'
of thi ounty to enter up the above-mentioned property for ses.
10ate: ignature (Applicant or Age nt):
[t '
Application Number 12-00001275
Permit MECHANICAL
Additional desc . .
Permit Fee . . . . 48.00 Plan Check Fee
16.50
Issue Date .'. . . Valuation . . . .
0
Expiration Date 4/24/13
Qty Unit Charge Per.
Extension
BASE FEE
15.00
.00 9.0000 EA MECH FURNACE <=.100K
.00
2.00 16.5000 EA' MECH B/C >3-15HP/>100K-500KBTU
33.00.
----------------------------------------------------------------------------
Special Notes and Comments
HVAC CHANGE -OUT: REPLACE (1) 3 TON
CONDENSER & COIL AND (1) 5 TON CONDENSER
& COIL. 2010 CODES.
-----------------_----------------------------------------------------------
Other Fees . . . . . . . BLDG STDS ADMIN (SB1473)
1.00
Fee summary Charged Paid Credited
Due
---------------- --- -- --- ------
Permit Fee Total 48.00 .00 .00
-
48.00
Plan Check Total 16.50 .00 .00•
16.50
Other Fee Total 1.00 00 .00
1.00 .
Grand Total 65.50 .00 .00
65.50
FA
LQPEPMIT
I-
Simplified Prescriptive Certificate of Compliance: 2008 Residential HVAC Alterations CF-lR-ALT-HVAC
Climate Zones 10 - 15
Site Address:
Enforcement Agency:
Date:
Permit #:
56290 ]ACK NICKLAUS (SYS 2 OF 2) La Quinta, CA 92253
City of La Quinta
Oct 25, 2012
Equipment Typel
List Minimum Efficiency2
Duct insulation
requirement
Conditioned Floor
Area
Thermostat
❑ Package Unit
❑ Furnace
® Indoor Coil
❑ AFUE
IN SEER 13.0
❑ COP
[3HSPF
[3 R 6 (CZ 10-13)
Served by system
® Setback
If not already present, must be
® Condensing Unit
❑ EER
❑ Resistance
❑ R 8 (CZ 14-15)
3441 sf
installed)
❑ Other
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 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 -4R
forms (no hand filled CF-4Rs allowed) are filled out and signed.Beginning October 1, 2010, a registered copy of the CF -1111
and CF -6111 shall also be on site for final inspection.
® 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 -4R 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
Exempted from duct leakage testing if:
[11. 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
new ducts: (all new
CF -6R forms: MECH-04, MECH-20-HERS, and (for split systems) MECH-22-HERS, and
ducting and all new
equipment)
MECH-25-HERS
CF -4R forms: MECH-20, and (for split systems) MECH-22, and MECH-25
For Split Systems: Duct leakage < 6 percent; RC, CCA Z 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 -6R 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 ober 40 feet
Required Forms:
. Includes adding or replacing more than 40
CF -6R forms: MECH-04, MECH-2I-HERS
ICF
linear feet of duct in unconditioned space.
-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: Danielle Garcia Signature: Danielle Garcia
Company: HARRISON ENTERPRISES INC Date: Oct 25, 2012
Address: 31-170 RESERVE DRIVE STE A License: 686310
City/State/Zip: THOUSAND PALMS / CA / 92276 Phone: (760) 343-7488
Reg: 212-A0059898A-000000000-0000
2008 Residential Compliance Forms
Registration Date/Time: 2012/10/25 16:58:53 HERS Provider: CalCERTS, Inc.
July 2010
Simplified Prescriptive Certificate of Compliance: 2008 Residential HVAC Alterations CF-IR-ALT-HVAC
Climate Zones 10 - 15
Site Address:
Enforcement Agency:
Date:
Permit #:
56290 JACK NICKLAUS (SYS 1 OF 2) La Quinta, CA 92253
City of La Quinta
Oct 25, 2012
Equipment Typel
List Minimum Efficiency2
Duct insulation
requirement
Conditioned Floor
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
[3R 8 (CZ 14-15)
3441 sf
installed)
(3 Other
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 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-4R
forms (no hand filled CF-4Rs 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-6R forms: MECH-04, MECH-2I-HERS and (for split systems) MECH-25-HERS
replaced
CF-4R 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
Exempted from duct leakage testing if:
p 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 iduc : (all new with:
new ducts: (all new
CF-6R forms: MECH-04, MECH-20-HERS; and (for split systems) MECH-22-HERS, and
ducting and all new
MECH-25-HERS ,
CF.-4R forms: MECH-20, and (for split systems) MECH-22, and MECH-25
equipment)
,
For Split Systems: Duct leakage < 6 percent; RC,'CCA-z 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-6R 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-6R 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 i 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: Danielle Garcia Signature: banielle Garcia
Company: HARRISON ENTERPRISES INC Date: Oct 25, 2012
Address: 31-170 RESERVE DRIVE STE A License: 686310
City/State/Zip: THOUSAND PALMS / CA / 92276 Phone: (760) 343-7488
Reg: 212-A0059893A-000000000-0000
2008 Residential Compliance Forms
Registration Date/Time: 2012/10/25 16:54:54 HERS Provider: CalCERTS, Inc.
July 2010
... City of La Quinta
Building 8r Safety Division
Permit # P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012 '
Building Permit Application and. Tracking Sheet -
Project Address: 9a • S
A. P. Number: `� dl�D�4J ,
Legal Description:
Contractor:
Address:
Y
City, ST, Zip:'_. —'`SOL �11,%
Tel hone:
'"•fir.. '\.::'1.;n�,/•j;;."^:y.i'f�f::tt,`j�':.. fN''_,
State Lic. # : 3 City Lic. #;
Arch., Engr., Designer:
Owner's Name:
Address:
City, ST, Zip:
Telephone 11aMIN
Project Description:
X�
` u 1�►
Address:
City, ST, Zip:
Telephone:
` µ'.2s \
Conshvction Type: Occupancy:
State Lic. #:
Project type (circle one): New. Add'n Alter Repair Demo
Name of Contact•Person:
Sq. Ft
q
# Stories:
# Units:
Telephone # of Contact Person: '7lo O �L :� 774 ?8' Estimated Value _
APPLICANT: DO NOT WRITE. BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACING
PERMIT FEES
Plan Sets
Plan Check 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
2°" 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
IN
7rd Review,.ready for corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School. Fees
-- I Total Permit Fees