11-1232 (MECH)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
s'1
Application Number: _ 11-00001232`
Property Address: 56780 JACK NICKLAUS
APN: 762-070-044- - -
Application description: MECHANICAL
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 16500
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BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
PETERSEN PATRICIA
56780 JACK NICKLAUS
LA QUINTA, CA 92253
Contractor:
Applicant: Architect or Engineer: GENERAL AIR CONDITIONI
31170 RESERVE DRIVE
THOUSAND PALMS, CA 922
(760)343-7488
\�P, Lic. No.: 686310
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 11/15/11
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LICENSED CONTRACTOR'S DECLARATION
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with
I hereby affirm under penalty of perjury one of the following declarations:
Section 7000) of Division 3 of the Business and Pr ssionals Code, and my License is in full force and effect.
_ I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided
License Class: C20 License No.: 686310
for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
ate: (�
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
NER-BUILDER DECLARATION
insurance carrier and policy number are:
I hereby affirm under penalty of perjury tha I am exempt from the Contractor's State License Law for the
Carrier ZENITH INS CO Policy Number Z071741501
following reason (Sec. 7031 .5, Business and Professions Code: Any city or county that requires a permit to
_ I certify that, in the performance ofthe work or which this permit is issued, I shall not employ any
construct, alter, improve, demolish, or repair any'structure, prior to its issuance, also requires the applicant for the
person in any manner so as to become su j ct to the workers' compensation laws of California,
permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State
and agree that, if I should become subjec
the workers' compensation provisions of Section
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or
3700 of the Labor Code, I shall forthwit
omply with those provisions.
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).:
Date: tt ( plicant:
(_ 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
WARNING: FAILURE TO SECURE WORKERS-150191PEOSATION COVERAGE IS UNLAWFUL, AND SHALL
Contractors' State License Law does not apply to an owner of property who builds or improves thereon,
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
. and who does the work himself or herself through his or her own employees, provided that the
DOLLARS ($100,000)• IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
improvements are not intended or offered for sale. If, however, the building or improvement is sold within
SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
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.).
APPLICANT ACKNOWLEDGEMENT
1 _ 1 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.
IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the
7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of
conditions and restrictions set forth on this application.
property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed
1. Each person upon whose behalf this application is made, each person at whose request and for
pursuant to the Contractors' State License Law.).
whose benefit work is performed under or pursuant to any permit issued as a result of this application,
(_) I am exempt under Sec. , B.&P.C. for this reason
the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City
k
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
of La Quinta, its officers, agents and employees for any act or omission related to the wor 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. .
1 certify that I have read this application and state that the above i o mation is correct. I agree to comply with all
city and county ordinances and state laws relating to building con ction, and hereby authorize representatives
of this county to enter upon the above-mentioned property for in tion purposes.
ate: t S' nature (Applicant or Agent):
LQPERM[T
Application Number. 11-00001232
Permit . . . MECHANICAL
Additional desc .
Permit Fee . . . . 66.00 Plan Check Fee
16.50
Issue -Date . . . . Valuation . . . .
0
Expiration Date 5/13/12
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/>1.00K75A0KBTU
33.00
Special Notes and Comments
INSTALL 2 NEW 4 TON SYSTEMS AT GROUND
LEVEL: CONDENSERS, COILS & FURNACES.
2010 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
LQPERM[T
Sim lifted Prescriptive Certificate of Compliance: 2008 Residential HVACAIterations CF -IR -ALT -HVAC
Climate Zones 10 to 15
Site Address:Enforcement
so ✓1 ��c�Gf
Agency:
Date •
JI4/
Permit #:
Conditioned Floor
Equipment T e
List Minimum Efficiency'
Duct insulation requirement
Area
Thermostat
Packaged Unit
urnace
DAFUE
COP
Over 40 ft of ducts added or
D Setback
door Coil
EER
HSPF
re laced in unconditioned space
R 6 (CZ 10-13)
Served by system
sf
(If not already
present, must be
MCC,ndensing Unit
EER
Resistance
Other
R 8 (CZ 14-15)
installed)
1. Equipment Type: Choose the equipment being installed; ifmore than one system, use another CF-IR-ALT-HVACfor 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 -1R and CF -6R shall also be on site for final inspection.
1. HVAC Changeout
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 lits stems MECH-25
• Condenser Coil and /or
an
• Indoor Coil and
CF -6R forms: MECH-21-14ERS 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
Exemptf d fibm duct leakage testing if:
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 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)
CF -4R 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/or without 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 coil CF -4R forms: MECH-20 and (for split systems) MECH-25
and/or furnace. No or some 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 s stem or packaged units: Duct leakage < 15 percent
EXCEPTION: Existing ducts stems 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 Califomia Code of Regulations.
documented on othe pplicable compliance forms, worksheets,
• The sign features identified on this Certificate of Compliance are consistent with the innthe
cal ul ions plans and s ecificatio submitted to the enforcement agency forapproval wrrnit a lication.
Name:
Signatur .
Company:
Date:
Address: (311-70
rD
License:
l!� V
City/State/Z' •
Phone:zn
2008 Residential Compliance Forms March 2010
Simplified Prescriptive Certificate of Compliance: 2008 Residential HVA C Alterations CF -1R ALT HVAC
Climate Zones 10 to 15
Site Address:Enf
����o Jam. Y � C.tCil-
rceme gency:
Date:
_•� �-� 1
Permit #:
Equipment T e�
List Minimum Efficient 2
Duct insolation requirement
Conditioned Floor.
Area
Thermostat
ackaged Unit
urnace
tF
❑ AFUE SD O ❑ COP
Over 40 ft of ducts added or
Setback
door Coil
❑SEER 13 ❑ HSPF
replaced in unconditioned space
Served by system
(1./'not already
Oil densing Unit
El EER / / ❑ Resistance
❑ R 6 (CZ 10-13)
sf
present, must be
❑Other ❑ R 8 (CZ 14-15) installed)
1. Equipment Type: Choose t1.e 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, 7.7HSPFfor 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 fours 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
tsi ed. Beginning October I, 2010, a registered co of the CF -IR and CF -6R shall also be on site for final inspection.
1- HVAC Changeout Required Forms:
• All HVAC replaced Equipment CF -6R forms: MECH-04, MECH-2I-HERS and (for split systems) MECH- 25 -HERS
CF -4R rams: IMECH 21 and (Fors lits 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
Exempttm duct leakage testing if:
I 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 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
113. 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) r4ECH-25
coil and/or fumace. 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
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 ducts stems 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 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 ' onn tion documented on other pplic ompliance forms, worksheets,
calculations, plans andspecifications submitted to the enforcement agency fora ro al with t e ennit a lication.
Name: lfeerl W,�cSB� Si lure: f _
Company:
�Q
Date: 4ir
/'/- "—
I/-
/
Address:3ir7o Peserue License: &00&310o3�v
City/State/Zip: � Ph, "3-74
SgPa,(—T—S, Phone: 760-3"5-
2008
Residential Compliance Forms AW --1, In to
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CONGRATULATIONS
Your CF -IR -ALT -HVAC Registration is complete!
You may want to print this page for your records.
Site Address: 56780 JACK NICKLAUS BLVD
La Quinta, CA 92253
CEC Registration: 211-A0059247A-00000000-0000
CF-IR-ALT-HVAC:ICLICK HERE TO DOWNLOAD
Assigned Company_IHARRISON ENTERPRISES INC
----Do you know -your. HERS Ratern - -• _ - - -- -- _ -- - ._
If you do, you may want to send this CF -1 R to them.
CaICERTS Rater ID:
OR_
My Rater Quick Select:: Energy Driven Solutions, Inc.
Every CaICERTS rater. has a license number.
Ifyou need to find the rater by narae [Click HERE] to search our directory.
Imo: x!^stSEND CF.1R;TC) HERS RATER ,I
[CLICK HERE] to do another
Copyright (0 2010 CaICERTS. Inc. All rights reserved. Revised: January 11, 2010
[Terms and Conditions) [Privacy Statement) [Class Cancellation Policy]
CaICERTS, Inc., 31 Natoma St Suite 120, Folsom, CA 95630
Office: 916-985-3400,Toll Free: 877-HERS-R8R, (877-437-7787)
Fax: 916-985-3402 Contact Us
BBB ,Find us anFaaebook:Q'.j
CaICERTS - CF -1R Registration
Page 1 of 1
Public Home
Secure Home
About Us
Training
Rater Directory
Forms
Membership Benefits
Events
Industry Partners
News
To register for our
monthly
newsletter, please
click here.
Danielle Garcia logged in [Logout]
[Home]
CONGRATULATIONS
Your CF -IR -ALT -HVAC Registration is complete!
You may want to print this page for your records.
Site Address: 56780 JACK NICKLAUS BLVD
La Quinta, CA 92253
CEC Registration: 211-A0059248A-00000000-0000
CF-IR-ALT-HVACdCLICK HERE TO DOWNLOAD
Assigned Com pany:11 HARRISON ENTERPRISES INC
Do you know youF HERS-Ratert *'--
If
'— -If you do, you may want to send this CF -1 R to them.
CaICERTS Rater ID:
OR
My Rater Quick Select:: Energy Driven Solutions, Inc.
Every CalCERTS rater has a license number.
If you need to find the rater by name [Click HERE) to search our directory.
.E CF JR TO HERS. RATER
[CLICK HERE] to do another
Copyright (02010 Ca10ER•1-S, Inc. All rights reserved. Reviscd:.lanuary 11. 2010
[Terms and Conditions] [Privacy Statement] [Class Cancellation Policy]
CalCERTS, Inc., 31 Natoma St Suite 120, Folsom, CA 95630
Office: 916-965-3400,Toll Free: 877-14ERS-R8R, (877-437-7787)
Fax: 916-985-3402 Contact Us
f�
,fes
T
BBB • Find us on Facsbootcp,)
1 .I -.1--...'-. --.--/.___1.1:- -!`1T-C.--CI._------I - 1 1 AnP71c 11 /1 A//1/%11
Kin #.
-
0 y of La Quinta
Building a Safety Division
Box 1504, 78-495 Calle Tampico
La Qulnta, CA 92253 - (760). 777-7012
Building Permit -Application and. Tracking Sheet
Permit # �2P.O.
Project Address:
�✓
.. wners Name:
O ' �cGG u- Se
n
Address: J&ck
City, ST, Zip:_
A. P. Number:
Legal Description:
Contractor:
:<a•• ` " ,
Telephone: ,' `�''`
Address:
City, ST, Zip:'
Project Description.
Telephone:
i4
LJ
State Lic. # : 3 L City Lic. C lot 42
Arch., Engr., Designer:
Address:
City., ST, Zip:
Telephone: �'r <rc:
State Lic. #: �4'` .n.r . rxry`s. <;;;:r��`•:�ta� :: .
�cFw,.::
Construction Type: Occupancy:
Project type (circle one): New' Add'n Alter Repair Demo
Name of Contact-Person:p (,(c �✓t �` ec%t` 0YU
Sq. Ft.:
# Stories:
#Units:
Telephone # of Contact Person: -7& O 3 AL3 %
Estimated Value of Project: Ao S&j•
APPLICANT: DO. NOT WRITE. BELOW THIS LINE
#
Submittal .
Plan Sets •
Req'd
Recd
TRACMG
Plan Check submitted
PERMIT FEES
Item Amount
Structural Cafes.
Reviewed, ready for corre.cdons
Plan Check Deposit
Truss Calcs.
i
Called Contact Person
Plan Check Balance.
Title 24 Calcs.
Plans picked no
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2°d 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 HOUSE:-
'•d Review, ready for corrections/issue
Developer Impact Fee
Planning Approval
4,
Called Contact Person
A.I.P.P.
Pub. Wks. A r
PP
s
Date of permit issue
Schodl. Fees ,
Total Permit Fees