07-1339 (MECH)4 P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Application Number: 07-00001339 Owner:
Property Address: 51860 AVENIDA DIAZ BILL HOLIDAY
APN: 773-161-005-19 -000000- 51860 AVENIDA
Application description: MECHANICAL LA QUINTA, CA
Property Zoning: COVE RESIDENTIAL
Application valuation: 2000
Contractor:
Applicant: Architect or Engineer: PERFECT WEATHE
P.O. BOX 2359
PALM DESERT, CA
(888)522-4897
/5,- Lic. No.: 835820
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm underpenalty of perjury that I am licensed under provisions of Chapter 9 (commencing with
Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect.
License Class: C20 Li c No.: 835820
ate: Z _ -joentractor: ae
11-1-1
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 ($5001.:
(_ 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 _ 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.).
( 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
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153 ,
Date: 5/02/07
�Z&
T
3 3
MAY o 2007
CITY OF LA QUINTA
FINANCE DEPT.
92261
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.
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 ENDURANCE REINS Policy Number WEN001920001
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 I1,41d become subject to the workers' compensation provisions of Section
3 00 of the Labo C e I shall forthyvitpf (nply with those provisions.
n I/ llr/�/0 .
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 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 information is correct. I agree to comply with all
city and county ordinances and state laws relating to l di construction, and hereby authorize representatives
of this tty to enter upon Sq2 above-mentioned pro er[ f inspectio
tB5 e: � 0gnat ture (Applicant or Agent):
Application Number 07-00001339
Permit MECHANICAL
Additional desc . .
Permit Fee . . . . 24.00
Plan Check Fee
6.00
Issue Date
Valuation . . .
.
0
Expiration Date 10/29/07
Qty Unit Charge Per
Extension
BASE
FEE
15.00
1.00 9.0000 EA MECH
APPL REP/ALT/ADD
9.00•
--------------------'-----------------.---------------------------------------
Special Notes and Comments
REPLACE EXISTING.DUCTS IN ATTIC WITH
R-8 DUCTING
Fee summary Charged
Paid Credited
Due
----------------- ---------- ----
Permit Fee Total 24.00
----- ---------- -----------
.00 .00
24.00
Plan Check Total 6.00
.00 .00
6.00
Grand.Total 30.00
.00 .00
30.00
LQPERMIT
Bin #
City of La Quinta
Building U Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building .Permit Application and Tracking Sheet
Permit #
i �Q)
/
Project Address: S %g vetilv�4 h A -Z
Owner's Name: 1 Z
A. P. Number:
Address:
Legal Description:
Contractor: .�,e�?-- W kev-
City, ST, Zip: v A4774 CA 727 S 3
Telephone:
Address: D , Vo S
Project Description: teL e--,f—1S77,-J(2,
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City, ST, Zip: �Q P`T- C•4 7 2� 2
C� Q`J C- i�•� —GJ
Telephone: — fi q2�
v MD
State Lie. # :93592-0 City Lic. #:
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone:
Construction Type: Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
State Lic. #:
Name of Contact Person:
Sq. Ft.: / 3 S
# Stories:
# Units:
Telephone # of Contact Person:
Estimated Value of Project: Z0009•II'
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Rec'd
TRACKING.
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance
Energy Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading. plan'
2°" Review, ready for correctionslssue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I. .
H O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
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
Total Permit Fees
CERTIFICATE OF FIELD VERIFICATION & DIAGNO IC TESTING (Page 1 of 8) CF4R
Project Address
L
�\
C� JJ1
Measured
Values
Builder Name
Ider ontachone
Enter Tested Leakage Flow in CFM:Ir
'-1T T
Plan Number
H r
'1..
Telgphone
Sample GroupNumber
3
Co li ce th
tiv ,
D Pass ❑ Fail
Climate Zone
Certs i
'1A 2
Date
Sample House Number
Fim7F
ZI
5
Enter Tested Leakage Flow in CFM: Final Test of New Duct System or Altered Duct System
for Duct System Alteration and/or Equipment Change -Out.
HERS Provider
c, AA
S A fres
l
Cir
Copies to: BUILDER,1WRS PROVIDER AND BUILDING DEPAWMENT
HERS RATER MPLIANCE STA'Y'EMENT v
The house was: ✓ Tested ✓ ❑ Approved as part of sample testing, but was not tested
As the HERS rater viding diagnostic testing and field verification, l certify that the house identified on this form complies with
the diagnostic tested compliance requirements as checked ✓ on this form The HERS rater must check and verify that the new
distribution system is fully ducted and correct tape is used before a CF -4R may be released on every t ed buildt'ng. The HERS
rater must not release the CF -4R until a properly completed and signed CF -6R has been received for the sample and tested
buildings.
❑ The installer has provided a copy of CF -6R (Installation Certificate).
XNew Distribution system is fully ducted (i.e., does not use building cavities as plenums or platform returns in lieu of ducts).
O New systems where cloth backed, rubber adhesive duct tape is installed, mastic and draw bands are used in
combination with cloth backed, rubber adhesive duct tape to seal leaks at duct connections.
✓ O MINIMUM REQUIREMENTS FOR DUCT LEAKAGE REDUCTION COMPLIANCE CREDIT
Procedures for field verification and diagnostic testing of air distribution systems are available in RA CM, Appendix RC4.3
Duct Diagnostic Leakage Testing Results
NEW CONSTRUCTION:
Duct Pressurization Test Results (CFM @ 25 Pa)
Measured
Values
[']
Enter Tested Leakage Flow in CFM:Ir
Fan Flow: Calculated (Nominal: ✓ Cooling ✓ D Heating) or ✓ ❑ Measured
Enter Total Fan Flow in CFM:
l a (
✓ ✓
3
Pass if Leakage Percentage <_ 6% [ 100 x [__(Line # 1)1 (Line # 2)11
D Pass ❑ Fail
ALTERATIONS: Duct System and/or HVAC Equipment Change -Out
4
Enter Tested Leakage Flow in CFM from CF -6R: Pre -Test of Existing Duct System Prior to
Duct System Alteration and/or Equipment Change -Out.
5
Enter Tested Leakage Flow in CFM: Final Test of New Duct System or Altered Duct System
for Duct System Alteration and/or Equipment Change -Out.
`
1
6
Enter Reduction in Leakage for Altered Duct System [_(Line # 4) Minus (Line # 5)]
(Only if Applicable)
7
Enter Tested Leakage Flow in CFM to Outside (Only if Applicable)
✓ ✓
8
Entire New Duct System - Pass if Leakage Percentage <_ 6%
100 x Line # 5 / Line # 2
D Pass ❑Fail
TEST OR VERIFICATION STANDARDS: For Altered Duct System and/or HVAC Equipment Change -Out
Use one of the following four Test or Verification Standards for compliance:
9
Pass if Leakage Percentage <_ 15% (100 x r 130 (Line # 5) / )00 (Line # 2)j]
Pass ❑ Fail
10
Pass if Leakage to Outside Percentage:5 10% [ 100 x [_(Line # 7) / (Line # 2)]]
D Pass ❑ Fail
11
Pass if Leakage Reduction Percentage >_ 60% [100 x [_(Line # 6) / (Line # 4)]]
and Verification b Smoke Test and Visual Inspection
D Pass Fail
12
Pass if Sealing of all Accessible Leaks and Verification by Smoke Test and Visual Inspection
❑ Pass ❑ Fail
Pass if One of Lines # 9 through # 12 pass
Pass ❑ Fail
Residential Compliance Forms 1pri! 2005