12-0092 (MECH)P.O.. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application description
Property Zoning:
Application valuation:
Applicant:
12--00000092
_606_i_2—LACEsLE F CT
764-270-999-117 -300231-
MECHANICAL
MEDIUM HIGH DENSITY RES
5600
T414t 4 4 Q"
Architect or Engineer:
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
JOSEPH REYES
60612 LACE LEAF COURT
LA QUINTA, CA 92253
Contractor: )�D
GENERAL AIR CONDITIONING l
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 2/01/12
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 _ 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 contractors) licensed
pursuant to the Contractors' State License Law.).
(_ 1 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 .I.
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 Jabovation is correct. I agree to comply with all
city and county ordinances and state laws relating ion, and hereby authorize representatives
of this county to enter upon the above-mentioned on purposes.
Da 1 S' ature (Applicant or Agent
RESERVE31170
THOUSANDPA MS, CA 92276 tt� )L
! 201 r`
\(�
(760)343-7488 f --,
Lic. No.. 686310 C� % r, ,; �
i'�'.iJ'"a 1
/)
LICENSED CONTRACTOR'S DECLARATION
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury that I am liq nsed 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 essionals 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
Date: ZAt I. Z Contractor: -
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
OWNER -BUILDER DECLARATION
insurance carrier and policy number are: ,
I hereby affirm under penalty of perjury that 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 of the work for 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 subject 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 subje to 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 forthwi%comply 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 ($500).:
ate:' _/_(_2 plicant:
(_) I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and
T�
the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The
WARNING: FAI URE TO SECURE WORKER C15M—P NSATION 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.). '
1 _ 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 contractors) licensed
pursuant to the Contractors' State License Law.).
(_ 1 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 .I.
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 Jabovation is correct. I agree to comply with all
city and county ordinances and state laws relating ion, and hereby authorize representatives
of this county to enter upon the above-mentioned on purposes.
Da 1 S' ature (Applicant or Agent
Application Number 12-00000092
Permit . . . MECHANICAL
Additional desc . .
Permit Fee . . . . 38.00
Plan Check Fee
9.50
Issue Date
Valuation . . . .
0
Expiration.Date 7/30/12.
Qty Unit Charge Per
Extension
BASE
FEE
15.00
1.00 16.5000 EA MECH
B/C >3-15HP/>100K-500KBTU
16.50
1.00 6.5000 EA MECH
OTHER MECH EQUIPMENT
6.50
----------------------------------------------------------------------------
Special Notes and Comments
HVAC'CHANGE-OUT INSTALL 2.0 TON MINI
SPLIT SYSTEM - COOLING UNIT ONLY,
NON -DUCTED , GROUND APPLICATION.
2010
CODES.
----------------------------------------------------------------------------
Other Fees . . . . . . . . . BLDG STDS ADMIN (SB1473)
1.00
Fee summary Charged
----- - ----------- ------- --
Paid Credited
Due
- ---------=
Permit Fee Total 38.00
---------- ----------
.00 .00
38.00
Plan Check Total 9.50
.00 .00
9.50
Other Fee Total 1.00
.00 .00
1.00
Grand Total 48.50
.00 .00
48.50
LQPERMIT
mplifled Prescriptive Certificate of Compliance: 2008 Residential. HVA C Alterations CF-IR-ALT-HVAI
mate Zones 10 to 15 '
Site Address:
L�OIo 12 (-�C� L�aC C
Enforcement Agency:
fz
Date:
Permit #:
I In
!,
Equipment T et
List Minimum Efficienc z
Duct insulation requirement
Conditioned Floor.
Area
Thermostat
❑ Packaged Unit
❑ Furnace
��``FUE 80 �v
❑COP
Over 40 ft of ducts added or
Setback
EI'fndoor Coil
�ER ! 3
❑ HSPF
replaced in unconditioned space
p p
Served b system
Y Y
(if already
LY'ondensing Unit
EER / J
_
❑ Resistance
❑ R 6 (CZ 10-13J
�fm sr
present, must be
❑ Other
❑ R 8 (CZ 14-15)
installed)
1. Equipment Type: Choose the equipment being installed: if more than one system, rise another CF -1 R-ALT-HVACfor 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 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 -411 forms (no hand filled CF-4Rs allowed) are filled out and
si ed. Beginning October 1, 201.0, a re' istered copy of the CF -111 and CF -611 shall also be on site for final inspection.
1. HVAC Changeout
Required Forms:
o ? •! HVAC -Equipment replaced
CF 611 forms: MECH-04, MECH_21-HERS and (for split systems) M_ ECH- 25 -HER S .
CF41Zforms: MECH- 21 and fors lits stems MECH-25
• Condenser Coil and/or
• Indoor Coil and/or
CF-611forms: 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 ducts stems are constructed, insulated or sealed with asbestos
❑ 2. New HVAC System
Required Forms:
with new
• Cut s: al Chang outdueling
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)
s: -, anCF-4R formMECH 20d ( split fors s )MECH-22, and MECH 25
Y stems
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 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 s ace.
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)
• 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.
• 1 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 ' orm tion documented on other pplic ompliance forms, worksheets,
calculations, plans ands specifications submitted to the enforcement agency fora ro al with t e permit application.
Name: C(een
cure:
Si9+1
Company: 6 &neCaj .,41\r Coed; {'•`Or7 r
Date: :2—/ ( ([2—
rZAddress:
Address:
rt ✓�
31170 Aese(ve
License:
(08!,3/6)
�%d�^s� Gf}
kTty/State/Zip:__rk0t.1Za,4-_A G%aa-%�o
Phone: -760-3,t3--749,9'
f-17' 1 T% T% _ _
Public Home
Secure Home
About Us
Training
Rater Directory
Forms
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:, 60612 LACE LEAF COURT
ILa Quinta, CA 92253
CEC Registration• 212-A_0005438A_-00000000-0000_
CF -IR -ALT -HVAC: CLICK HERE TO DOWNLOAD - �^
Copyright,,O 2010 CaICERTS, Inc. AR riehts reserved. Revised: January 1 1.'010
[Terns 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
r-
BBg FaaettookQ
I«.,:
https://www.calcerts.com/public_cfl R.cfm?proj ect_id=165167 1/31/2012
' Assigned Company: ENTERPRISES'INC
_..--.-------._._..-_.__.____.__.
MembershipBenefits
�.._.. _. ._...._....___�__ _ _ ......_..—.-.-----.__..._._.......__....__.._.-..... ....... _........ _._.......... _
Events
Do you know your HERS Rater?
If you do,you may want to send this CF -1R to them.
Industry Partners
CaICERTS Rater ID:
News
OR
My Rater Quick Select:_Energy Driven Solutions, Inc.
Every CaICERTS rater has a license number.
To register for our
If you need to find the rater by name Click HERE to search our directory.
monthly
SEND GFJ RTO HERS RATER
newsletter, please
`
click here.
[CLICK HERE] to do another
Copyright,,O 2010 CaICERTS, Inc. AR riehts reserved. Revised: January 1 1.'010
[Terns 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
r-
BBg FaaettookQ
I«.,:
https://www.calcerts.com/public_cfl R.cfm?proj ect_id=165167 1/31/2012