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11-1043 (MECH)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: 11-00001043 Property Address: 56685 JACK NICKLAUS APN: 762-070-013- - Application description: MECHANICAL Property Zoning: LOW DENSITY RESIDENTIAL Application valuation: 7400 T4ht 4 4 Q" - 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 Pro ssionals Code, and my License is in full force and effect. License ss: C20 C36 Lily No.: 906115 Date: ontractor: OWNER -8 ILDER 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—) 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: I- Lender's Address: IR LQPERMIT VOICE (760) 777-7012 ._..SAX (760) 777-7011 Owner: �� 1 "�' 2 BUCK TERRY A 56685 JACK NICKLAUS CITYOFLgQUINiA LA QUINTA, CA 92253 1H4!VCEncar Contractor: HYDES 42949 MADIO STREET INDIO, CA 92201 (760)360-2202. Lic. No.: 906115 ----------------------------------------------- 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 NORGUARD INS Policy Number CEWC243358 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 37.Q0 of the Labor Code, all h mply with those provisions. /Date: I/ pplicant: WARNING: FAILURE TO SECURE WORKERS' COM ENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,0001. 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 a-ct 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 inform ion is correct. I agree to comply with all city and county ordinances and state laws relating to building construc n, hereby authorize representatives of this county to en er up o the above-mentioned property fo 'nsp on pur os s. "Date: Zq�� f gnature (Applicant or Agenth r - cy LQPERMIT Application Number . . . . .. 11-00001043 Permit . . . MECHANICAL Additional desc . Permit Fee . . . . 40.50 Plan Check Fee 10.13 Issue Date . . . . Valuation . . . . 0 Expiration Date 3/26/12 Qty Unit Charge Per Extension BASE FEE 15.00 1.00 9.0000 EA MECH FURNACE <=100K 9.00 1.00 16.5000 EA MECH B/C >3-15HP/>100K-500KBTU 16.50 ---------------------------------------------------------------------------- Special Notes and Comments INSTALL NEW HVAC SYSTEM, FURNACE, INDOOR COIL & CONDENSER (4 TON 16 SEER). 2010 CODES. ---------------------------------------------------------------------------- Other Fees . . . . . . . . BLDG STDS ADMIN (SB1473) 1.00 Fee summary Charged -------------------- Paid Credited -------------------- Due ----------------- Permit Fee Total 40.50 .00 .00 40'.50- 0'.50Plan PlanCheck Total 10.13 .00 .00 10.13 Other Fee Total 1.00 .00 .00 1.00 Grand Total 51.6.3 .00 .00 51.63 f Simplified Prescriptive Certificate of Compliance: 2008 Residential HVAC Alterations CF-lR-ALT-HVAC Climate Zones 10 - 15 Site Address: Enforcement Agency: Date: Permit #: 56-685 Jack Nicklaus La Quinta, CA 92253 City of La Quinta Sep 22, 2011 Equipment Typel List Minimum Efficiency2 Duct insulation requirement Conditioned Floor Area Thermostat ❑ Package Unit 0 Furnace © Indoor Coil p AFUE 78% d SEER 13.0 ❑ COP ❑ HSPF [I R 6 (CZ 10-13) Served by system p Setback If not already present, must be CEJ Condensing Unit ❑ EER ❑ Resistance ❑ R g( ) CZ 14-15 1600 sf installed) ❑ Other 1. Equipment Type: Choose the equipment being installed; if more than one system, use another CFSR-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: 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 ❑A. The system.will not be Ducted,(ie,�Ductless,Mini-Split System) . (Also -Exempt from; Refrigerant Charge) _: ❑ 2. New HVAC System Required Forms: ) . Cut inlor Changeout with'; new ducts: (all new 20 H CF-61kforms: MECH-04, MECH-ERS and (for split sy tems) MECW22-HERS, a d MECH-25-HERS ducting and all newif( / CF -4R` forms: MECH 20, and (for split systems) MECH-22, and MECH 25 equipment) For Split Systems: Duct leakage < 6 percent; RC, CCA >_ 350 CFM/tan, FWD, TMAH, SIMS, and either HSPP or PSPP. For Packaged Units: Duct leakage < 6 percent ❑ 3. New Ducts with/or without Required Forms: Replacement r . Includes replacing or installing all new ducting and/or outdoor condensing.unitand/or indoor CF -6R forms: MECH-04, MECH-20-HERS, and (for split systems) MECH-25-HERS coil and/or furnace. No or some equipment CF -4R forms: MECH-20 and (for split systems) MECH-25 changed. v 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 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: Mark Hyde Signature: Mark Hyde Company: CERTIFIED COMFORT SYSTEMS INC Date: Sep 22, 2011 Address: 42-949 MADIO STREET License: 906115 City/State/Zip: INDIO / CA / 92201 Phone: (760) 360-2202 Keg: 111-Ao049313A-00000000-0000 Registration Date/Time: 2011/09/22 14:34:16 HERS Provider: Ca10ERTS, Inc. 2008 Residential Compliance Forms July 2010 Bin # Permit `Cj,� � i Project Address: A. P. Number: Legal De Contractor: l �5 Address: City, ST, Zip: ' Telephone: State Lic. #: q061 Asch., Engr., Designer: Address: City, ST, Zip: Telephone: State Lic. #: Name of Contact Person-------------: Telephone # of Contact Person: # Submittal Plan Sets Structural Calcs. Truss Calcs. Energy Calcs. Flood plain plan Grading, plan' Subcontactor List Grant Deed MO.A. Approval IN HOUSE: - Planning Approval Pub. Wks. Aper School Fees City of La Quinta Building & Safety Division P.O. Box 1504, 78-495 Calle Tampito La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet ao ( q, I t Owner's Name: Address: .��� City, S. Zip: l �/ .i Lic. #: Project Description: k__ N Construction Type: Occupancy: Project type (cucle one): New Add'n Alter Repair Demo Sq. FL: # St 'es: # Units: Estimated Value of Project: APPLICANT: DO NOT WRITE BELOW THIS LINE Recd TRACKIIYG PERMIT FEES Plan Check submitted Reviewed, ready for corrections Item Amount Plan Check Deposit Called Contact Person Plan Check Balance Plans picked up Construction Plans resubmitted Mechanical correctiossue 2"d Review, EPerson Electrical Called Con Pinmbing Plans picked up S.M.I. .w, TPIansubmittedGrading ready for corrections issueDeveloper Impact Feeontact Person A.I.P.P. Date of permit issue Total Permit Fees