10-0767 (MECH)"1
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 10-00000767
Property Address: 80560 WEISKOPF
APN: 762-100-012- - -
Application description: MECHANICAL
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 6800
Tiht
"
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Applicant- / Architect or or E
A44__
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 Professio Is Code, and my License is in full force and effect.
Licensee CCllao: C 0-1236 /Licee o�77794
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).:
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.).
I _ 1 1, 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:
LQPERMIT
Owner:
EMMONS CAROL
80560 WESKOPF
LA QUINTA, CA 92253
(
Contractor:
J ANTHONY PLUMBING
72216 NORTH SHORE
THOUSAND PALMS, CA
(760)343-2121
Lic. No.: 777794
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 8/16/10
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 STATE FUND Policy Number 1932451
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 work s' compensation la sof California,
and agree that, if I should become subject to the work compensation isions of Section
�0 of the Labor Co , I s forth comp) those
Date: r+ 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 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 information is correct. I agree to c ly with all
city and county ordinances and state laws relating to building construction, and hereby authori resentatives
of this count ooa ter upon the above-mentioned property f ns n pur S.
Date: ' Signature (Applicant or Agent):
- 'It
LQPERMIT
Application Number . . . . . 10-00000767
Permit . . . MECHANICAL
Additional desc . .
Permit Fee . . . . 40.50
Plan Check Fee
10.13
Issue Date . . . .
Valuation . . . .
0
Expiration Date 2/12/11
Qty Unit Charge Per
Extension
BASE
FEE
15.00
1.00 9.0000 EA MECH
FURNACE <=100K
9.00
1.00 16.5000 EA MECH
B/C >3-15HP/>100K-500KBTU
16.50
----------------------------------------------------------------------------
Special Notes and Comments
HVAC CHANGE OUT 5 TON 16 SEER UPLFLOW
SPLITSYSTEM 2007 CODES.
----------------------------------------------------------------------------
Other Fees . . . . . . . . . BLDG STDS ADMIN (SB1473)
1.00
Fee summary Charged
-------------------------------------
Paid Credited
--------------------
Due
Permit Fee Total 40.50
.00 .00
40.50
Plan Check Total 10.13
.00 .00
10.13
Other Fee Total 1.00
.00 .00
1.00
Grand Total 51.63
.00 .00
51.63
Climate Zones 10
Certificate of
5 l<® P
equipment l e- List Minir
O Packaged Unit r
t�4�GVFumace M'0
WrIndoor Coil INS ER
eCondensing Unit ❑ EER
O Other
2008 Residential HVAC
Enforcement Agency:
CF -IR -ALT -HVAC
'16A6 I Perm&!.
Area
❑ COP Over 40 ft of ducts added oroYYSck
❑ HSPF replaced m unconditioned space Served by system 17fnot already
❑ Resistance ,❑ R 6 (CZ 10.13) sf present, must be
❑ R 8 (CZ 14-15) installed)
!. Equipment Type: Choose the equipment being installed, if more than one system, use another CF -I R -ALT -HVAC for each system.
2. Minimum Equfpment Afj'icienctes. 13 SEER, 7856 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 ITERS measures that must be conducted. A Dopy of the forms
inspection and a copy given to the homeowner. shall be left onsite for final
At final, the inspector verifies that the work listed on this form was in fact the work completed by the
Beginning installer. The inspector also verifies that each At
CF-6R and registered CF -4R forms (no hand filled CF-4Rs allowed) are filled out and
si October 1 2010 a tered co2z of the CF -111 and CF -6R shag also be on site for final inspection.
1 HVar Required Forms:
• All HVAC Equipment replaced I Lt• -ax torms: MECH-04,1
CF -4R forms• MH21 n
• Con en
split systems)
• Indoor Coil and/or CF-6R'forms: MECH-2I-HERS and (for split systems) MECH- 25 -HERS•
• Furnace CF4R forts: MECH- 21 and (for split systems) MECH-25
For Split Systems: Duct leakage < 15 percent; RC, CCA > 300 CFMhon
For Packaged Units: Duct leakage < IS percent (Minimum Air Flow Requirement), TMAH
Exempted from duct leakage testing if -
0
f❑ 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. Existin 'duct systems are constructed, insulated or sealed with asbestos
❑ 2. New HVAC System Required Forms:
• Cut s: al Chang outducting
with new CF -6R forms: MECH-04 TECH -20 -HERS and for Int stems MECH-22-HERS, and MECH-25-HERS
ducts: (all new ducting and all � ( split systems)
new
equipment) CF -4R forms: MECH 20-, and (for split systems)M ECH-22, and MECH 25
For Split Systems: Duct leakage < 6 percent; RC, CCA 2:350 CFMhon, FWD, TMAH, SIMS, 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 forts: MECH-04, MECH-20-HERS,and (for split systems) INCH -25 -HERS
and/or outdoor condensing unit andlor indoor CF -4R forms: MECH-20 and (for split systems) MECH-25
coil and/or furaoe. Not all equipment changed.
For Split Systems: Duct leakage < 6 percent, RC, CCA >_ 300 CFMhon, 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. I CF -611 forts: MECH-04, MECH-2I-HERS CF -4R forms: MECH-21
For split system or packaged units: Duct leakage < 15 percent
❑ EXE ON: Existing duct systems constructed,insulated or sealed with asbestos.
Contractor ( t1lentation Author's /Responsiblb Designer's Declaration Statement)
• 1 certify that Oils 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 cenify that the energy features and performance specifications for the design identified on this Certificate of Compliance conform to the requirements of Title 24,
Pans I and 6 of the California Code of Regulations.
• The design feawres identified on this Certificate of Compliance aro consistent with the information documented on other appli oo licence forms, worksheets,
lquIAtions,'lams and st ifications submitted to the enforcement agency for approval withthe p�alit cep lication a
K� U t)1 -j RIO t rJ ,� AK Srgr,a
N
Company: Date: a I6110
/ r-CJl
J ANTHONY SERVICES
Address: 72216 NORTH SHORE ST. UE1W
THOUSAND PALMS, CA 92276P
:---77-7-7
-77 N
7 !
City/Statc/Zip: f
hone760 3 Q3 -Z!
2008 Residential Compliance Forms March 2010
Bin #
City of La Quinta
Building & Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Qulnta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
Project Address: ?01560
Owner'sName:CARo� o ')'
A. P. Number:
Address:
Legal Description:
Contractor:p
City, ST, Zip:
: 4...,:...
Tele hone•
Address: J ANTHONY SERVICES
Project Description: A UAL L K kw e oco�
City, ST, Zip: THOUSAND PALMS, CA 92276
Telephone: • , �:
State Lie. # : City Lie. #, I OS
'PLC t7 M
Arch., Engr., Designer.
Address:
City., ST, Zip:
Telephone:
State Lie. #: "
Name of Contact Person:
Construction Type: Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
Sq. FL:
#Stories:
#Units:
Telephone # of Contact Pe n:
Estimated Value of Projec : S- V
.APPLICANT: DO NOT WRITE BELOW THIS LINE
H
Submittal
Req'd
Recd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Cala.
Called Contact Person
Plan Check Balance
Title 24 Cafes.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanlcal
Grading plan
2i° Review, ready for correctionstissue
Electrical
Subcontactor Iast
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
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees