12-1050 (MECH)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: -12-00001650
Property Address: 44631 LIBERTY AVE
APN: 604-513-014-49 -24197 -
Application description: MECHANICAL -
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 3700
Ta�/ 4 4 Q"
Applicant:: Architect or Engineer:
------------------
LICENSED CONTRACTOR'S DECLARATION
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
I hereby affirm under penalty of perjury at I am licensed under provisions of Chapter 9 (commencing with
Section 7000) of Division 3 of the Busi ss and Professionals Code, and my License is in full force and effect.
Licen ee, lass • `C200 -C36 Licen o.: 777794
-IltDat • `� � mractor:
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).:
(_) 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. , 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:
LOPERMIT
,dca.,NL.e,d. io/3
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 9/13/12
Owner:
ARREDONDO JUAN n
44631 LIBERTY AVENUE no
LA QUINTA, CA 92253
( u�p �'� ��12 J
Contractor: I CITY OF lA QUINTA
J ANTHONY PLUMBING HEAT/AI-.FINANCE DEPT.
72216 NORTH SHORE STREET, #101
THOUSAND PALMS, CA 92276
(760)328-8096
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.
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 GRANITE STATE Policy Number WC065255599
_ I certify that, in the perfor ance of the work for which this permit is issued, I shall no mploy any
person in any manner as to become subject to the workers' compensation sof California,
and agree that, if I s o Id ecome subject t workers' compensatio visions of Section
t//^.� { 3700 of the Labor , I forthwit ompl with those prov' ' s.
Date: 1 / 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 uch permit, or cessation of work for 180 days will subject
permit to cancellation.
I certify t at I have read this application and state thatthe above information ' orrect. I agree to co y with all
city
I ya�nd oun ordinances and state laws rela in to uildin construction, nd ereby authorize resent ativa
�of t t o ente pon the above -menti roe r inspectio urpo s.
Date: Signature (Applicant or
Application Number . . . . . 12-00001050
Permit . . . MECHANICAL
Additional desc . .
Permit Fee . . . . 24.00
Plan Check Fee
6.00
Issue Date . . . .
Valuation . . .
0
Expiration Date 3/12/13
Qty Unit Charge Per
Extension
BASE
FEE
15.00
1.00 9.0000 EA MECH
FURNACE <=100K
9.00
----------------------------------------------------------------------------
Special Notes and Comments
REPLACE 5 TON FURNACE / COIL &
CONDENSER 2010 CODES.
----------------------------------------------------------------------------
Other Fees . . . . . . . . . BLDG STDS ADMIN (SB1473)
1.00
Fee summary Charged
----------
Paid Credited
--------------------
Due
---------------------------
Permit Fee Total 24.00
.00 .00
24.00
Plan Check Total 6.00
.00 .00
6.00
Other Fee Total 1.00
.00 .00
1.00
Grand Total 31.00
.00 .00
31.00
- - LQPERMIT
Simplified Prescriptive Certificate of Compliance: 2008 Residential HVAC Alterations CF -1R -ALT -HVAC
Climate Zones 10 - 15
Site Address:
Enforcement Agency:
Date:Permit
#:
44631 LIBERTY AVE La Quinta, CA 92253
City of La Quinta
Sep 13, 2012
Equipment Typel
List Minimum Efficiency2
Dud insulation
requirement .
Conditioned Floor
Area
Thermostat
❑ Package Unit
® Furnace
® Indoor Coil
® AFUE 78%
❑ SEER
❑ COP
❑ HSPF
❑ R 6 (CZ i0-13)
Served by system
® Setback
If not alread Y Present, must be
❑ Condensing Unit
C1EER
❑Resistance
❑ R 8 (CZ 14-15)
1800 sf
installed)
[3 Other
1. Equipment Type: Choose the equipment being installed; if more than one system, use another CF -1R -ALT -HVAC for each system.
2. Minimum Equipment Efficiendes: 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 -411
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 -611 shall also be on site for final inspection.
® 1. HVAC Changeout
Required Forms:
. All HVAC Equipment
CF -611 forms: MECH-04, MECH-2I-HERS and (for split systems) MECH-25-HERS
replaced
CF -411 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
❑ 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 duds: (all new
CF -611 forms: MECH-041 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 -611 forms: MECH-04, MECH-20-HERS, and (for split systems) MECH-25-HERS
and/or indoor coil and/or furnace. No or some
CF -411 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 -611 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 Trtle 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: Kevin Robinson
Company: 3 ANTHONY PLUMBING HEATING & AIR CONDITIONING Date: Sep 13, 2012
Address: 72216 NORTH SHORE ST #101 License: 777794
City/State/Zip: THOUSAND PALMS / CA 192276 Phone: (760) 343-2121
Reg: 212=A0050906A-00000000-0000 Registration Date/Time: 2012/09/13 12:34:54 HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms July 2010
I
Bin. #
, .. .
city.Of. i,a Q[!Ih'.. }�
BWk tng a Safety DivEslon
P.O. Box. 1504,78-495 Calle Tampla)
I.a.Quinta, CA 92253 -:(760) 177-7012
Building Permit Application and Tracking Sheet
Permit # :
Pt oject Address: i 6� �/�
Owner's Name: Vf D/V D
A P. Number
Address:
Legal Description:
Contractor
City, ST, Zip:
Telephone:
Address: J ANTHONY SERVICES
PmjeetDescription:
City, ST, Zip: 'THOUSAND PALMS, CA 9227601
5 TO A) 6
Telephone:
State Lie. #: �'% % 4 {Sty Lic, #; /D
BW, Designer. - ..
Address:
City, ST, Zap:
Telephone:
Construction Type: _ Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
State Lia #:
Name of Contact Person
Sq. FL:
# Stories: #Unit$
Telephone # of Contact Person: Ewmatnd Value of Pmjmt ?760.
APPLICANT: DO NOT WWTE BELOW THIS UNE
# Submittal Req'd 'Ree'd TRACING PBRM[F FEES
Plan Sete Plan Creek submitted Item Amount
Stmduml Calm
Reviewed, ready for con)K tons Plan Clink Deposit. .
Titus Calm
Called Contact Person Plan Check Balance.
Title 24 Calls.
Plans picked up Construction
Flood plain plan
Plans resubmttted.. Mechanical
Giading plan
2'! Review, ready for correctionsrasue Electrical
Subeoataetor List
Called Contact Person Plumbing
Grant Deed.
Pians picked up S,�y
H.O.A. Approval
Plans resubmitted Grading
IN HOUSE:-
''' Review; ready for correedonsfissue Developer Impact Fee
Planalug Approval-
Called Contact Person A.I.P-P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees