09-1189 (MECH)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
09-00001189
Property Address:
53745 AVENIDA DIAZ
APN:
774-111-024-12 -000000-
Application description:
MECHANICAL
Property Zoning:
COVE RESIDENTIAL
Application valuation:
5700
At: Architect or E/n in
Tiiit 4 4 Q"
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 Professionals Code, and my License is in full force and effect.
License Class: C20 License No.: 619091
Date: �Contractor:
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.).
(_ 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: 11/17/09
Owner:
COUCH GERALD C
53745 AVENIDA DIAZ
LA QUINTA, CA 922 G O
(
N "r 1
Contractor:
PALOMA AIR COND TIONIRO'VoF
P.O. BOX 3501 34,r1L11Vp,�
PALM DESERT, CA 92261 '-�!^'j'
(760)347-1212
Lic. No.: 619091
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
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.
1 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 SOUTHERN INS CO Policy Number WSIO02303401
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, f lsftouId become subject to the workers' compensation provisions of Section
37�f the Pi ode, 1 shall forthwith comply with those provisions.
Date: /TApplicant:
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 building construction, and hereby authorize representatives
of this fcoun^y (o gpteLuV�e above-mentioned property for inspection purposes.
Date: 1 I / �•• Signature (Applicant or Agent):
Application Number . . . . . 09-00001189
Permit . . . MECHANICAL
Additional desc .
Permit Fee . . . . 33.00
Plan Check Fee
8.25
Issue Date " . . .
Valuation . . .
. 0
Expiration Date 5/16/10
Qty Unit Charge Per
Extension
BASE
FEE
15.00
1.00 9.0000 EA MECH
FURNACE <=100K
9.00
1.00 9.0000 EA MECH
B/C <=3HP/100K BTU
9.00
------------------------------------7----------------------------------------
Special Notes and Comments
REPLACE HVAC SYSTEM 15 SEER LIKE
FOR
LIKE.
--------------------------------------------------------------------=-------
.Other Fees . . . . . . . . . BLDG STDS ADMIN (SB1473)
1.00
Fee summary Charged
---------------------------
Paid Credited
----------
Due
----------
Permit Fee Total 33.00
----------
.00 .00
33.00
Plan Check Total 8.25
.00 .00
8.25
Other Fee Total 1.00
.00 .00
1.00
Grand Total 42.25
.00 .00
42.25
LQPERMIT
CERTIFICATE OF COMPLIANCE: RESIDENTIAL (Page 2 of 4) CF -IR
0 11
Project Title Date
FENESTRATION PRODUCTS— U -FACTOR AN'D SHGC
✓ ❑ FENESTRATION \MAXIMUM ALLOWED AREA WORKSHEET WS -4R —must be included for New Construction.
Additions and Alterations.
Fenesu•ation
Thermostat Configuration
Type (split or pack -age)
t
,r/l-vpe/Pos.
Exterior
(Front. Left. Orien- I
Shading °'
/Overhangs'
Rear. Right. tation. Area U -factor
SFIGC ✓ box if WS -3R is
Skylight) N,_S. E, W' (ft') U -factor- Source' SHGC"
Source' included
❑
❑
I 1 Ski lights are now included in \Vest facing fenestration area if the skylights are tilted to the west or tilted in any direction
when the pitch is less than 1:12. See § 151(f)3C and in Section 3.2.3 of the Residential Manual
Enter Values in this column are either NFRC Rated value or from Standards default Table 116A.
3) Indicate source either from NFRC or Table 116A.
4) Enter Values in this column from NFRC or from Standards Default Table 1168 or adjusted SHGC from WS -3R.
it Indicate source either from NFRC or Table 116B.
6) Shadinu Devices are defined in Table 3 in the Residential Manual and see WS -3R to calculate Exterior Shading devices.
7) See Section 3.2.4 in the Residential Manual.
HVAC SYSTEMS
Heating Equipment klininttnn Distribution
T\ pe and Capacity Efficiencv Type and Location Duct or Piping
OMWICe. t,cat �t t»,. honer. etc.) (AFU1- or 1-1SPF) (ducts. attic. etc.) R -Value
Thermostat Configuration
Type (split or pack -age)
i�cLt�C C
-Cj c.
1 -.r 'T d L4
q
j Cooling Equipment \Minimum
Type and Capacitv Efficiency
tA'�'. hcat ,um - C\ap, coati»,) (SEL=F, or L F k)
Duct Location Duct Thermostat
(attic. etc.) R -Value Type
Configuration
( tit or package)
j .`.. ,
C t 71
Residential Compliance Forms March 200
Bin #
City of La Quinta
Building &r Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-701 ' 2
Building Permit Application and Tracking Sheet
Permit #
Project Address: d 64-0
Owner's Name: 0 6?
A. P. Number:
Address: 7j ^ -7 V (ie k4l a, J
Legal Description:
City, ST, Zip:
Contractor:
Telephone: -
Address:
Project Description:
City, ST, Zip:
P C
Telephone: -76--D V-712, ......... .........
t
State Lic. #: City Lic.
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone:
X.- ........... .....
. . . ....... . . . . . . . . . . . . . . -
.......... ..........
.. .........
Construction Type: Occupancy:
State Lic. #:
Alter Repair
Project type (circle one): New Add'n Demo
Name of Contact Person:
Sq. Ft.:
# stories:
# Units:
Telephone # of Contact Person:
Estimated Value of Project: '1� -7. 069t
APPLICANT:- DO NOT WRITE BELOW THIS LINE
Submittal
Req'd
Rec1d
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item Amount
Structural CaIcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Cales.
Called Contact Person
Plan Check Balance.
Title 24 CaIcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
21' 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.-
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