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12-0601 (MECH)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: 12-00000601 Property Address: 80895 WEISKOPF APN: 762 -170 -004 - Application description: MECHANICAL Property Zoning: LOW DENSITY RESIDENTIAL Application valuation: 9000 Td�/ 4 4 Q" Applicant: Architect or Engineer: 1- I ------------------ LICENSED CONTRACTOR'S DECLARATION BUILDING & SAFETY DEPARTMENT BUILDING PERMIT I hereby affirm under penalty of per' ry hat.l am licensed under provisions of Chapter 9 (commencing with Section 7 00) of Division 3 of th usi ess and essionals Code, and my License is in full force and effect. Licens ss: C20 C36 'cense No.: 906115 �I /,� Date: tractor:It V O VNER-BU LDER 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.). (_ 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: 01 LQPERMIT Owner: AUDREY MADIA 80895 WEISKKOPF LA QUINTA, CA 92253 VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 5/31/12 Contractor: f� HYDES 42949 MADIO STREET MAY 3 12 012 INDIO, CA 92201 (760)360-2202 Lic. No.: 906115 ( TY OF LA QUINTA CI FINANCE DEPT. ----------------------------------------------- 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 NORGUARD INS Policy Number CEWC243358 I certify that, in the perfor n e of the work for which this permit is issued, I shall not employ any person in any manners as to become sub act to the workers' compensation laws of California, and agree that, if I sho Id ecome subject t e workers' compensa on provisions of Section 3 0 I the Labor Co I shall forthwith • ly with tho a pro io Yate: �/pp icant- /WARNING: FAILURE TO SECURE WORKE -' COMP SATIO CO RAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENH NO CIVIL S 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 ve informatiLct.' I agree to comply with all city and co my ordinances and state laws relating to bu' in construction,by authorize representatives f�his c ty t e'n�te_r/u/upon the above-mentioned prop or inspection p Date: nature (Applicant or Agent): e LQPERMIT Application Number Permit . . . Additional desc . . Permit Fee . . . . Issue Date . . Expiration Date . . 12-000006.01 MECHANICAL 40.50 Plan Check Fee . . 10.13 Valuation . . . . 0 11/27/12 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: INSTALL 4 TON.SYSTEM, FURNACE, CONDENSER, INDOOR COIL. 2010 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 Simplified Prescriptive Certificate of Compliance: 2008 Residential HVAC Alterations CF-IR-ALT-HVAC Climate Zones 10 - 15 Site Address: 80-895 weiskoff La Quinta, CA 92253 Enforcement Agency:. City of La Quinta May 29, 2012 Permit #: Equipment Type1 List Minimum Efficiency2 Duct insulation Conditioned Floorrequirement Area Thermostat ❑ Package Unit 0 Furnace IhBoo� Coil ® AFUE 78% ®SEER 13 �� ❑ COP ❑ HSPF ❑ R 6 (CZ 10-13) Served by system ®Setback . If not already present, must be �J Cbndensing Unit ❑ EER ❑ Resistance ❑ R 8 (CZ 14-15) 1600 sf installed) Other Equipment Type: Choose the equipment being installed; if more than one system, use another CF-1R-ALT-HVAC for each system. 2. Minimum Equipment Efficiencies: 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-4R 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-6R forms: MECH-04, MECH-2I-HERS and (for split systems) MECH-25-HERS replaced CF-4R 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-411 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�jf: ❑ 1. Duct system was documented to have been previously sealed and confirmed through HERS verification, or p 2. Duct systems with less than 40 linear feet in unconditioned space, or' ❑ 3. Existing dud systems are constructed, insulated or sealed with asbestos [14. The s sterq will not be Ducted (ie. , ctl ss ini-Spli S,ysteKhV,0! xerg fro . f�gi eranh rge) 132. NejjHf1AC System Requi edI [mss _y' xv .Cut in or'Ctiangeout wi C -6 0,PgECH-04, M CH-2 ERS ands or p It sy terns) MEC 2?HERS, end new ucts:- (all new MEC - 5 HERS dudi r s, . g all n w _--a equip ent) CF Rtiforms: MECH- 0, nd (for s' it s stem. MECH,-2• , and MEI-25 " _ For! lit S stems: Dud-leaka�<�6� ,)._, >: 1 ' 1i I v p y g percent RG ,CCAT�35D.CFNT/ton;.FWD TM74H-eSTMS,an either'HSPMoP 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 z 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 Title 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: Mark Hyde Signature: Mark Hyde Company: CERTIFIED COMFORT SYSTEMS INC Date: May 29, 2012 Address: 42-949 MADIO STREET License: 906115 City/State/Zip: INDIO / CA / 92201 Phone: (760) 360-2202 Reg: 212-AO02739BA-00000000-0000 Registration Date/Time: 2012/05/29 19:02:30 HERS Provider: Ca10ERTS, Inc. 2008 Residential -Compliance Forms July 2010 Invoice Certified Comfort Systems, Inc. dba Hyde's Air Conditioning 42-949 Madio St. Indio CA 92201 760-360-2202 FAX: 760-360-3350 Account# 101318 Invoice # 334962 Date: 05/15/12 Dunn H I -V I Service At: Audrey Madia Audrey Madia 80-895 Weiskopf 80-895 Weiskopf La Quinta CA 92253 La Quinta CA 92253 Service Date 05/15/12 1 PO # Job # 239942 Removed existing equipment and installed a new 4 ton 16 Seer American Standard heating and cooling system. ARI#4585977 ***5 YEAR LABOR 12 YEAR PARTS AND 20 YEAR HEAT EXCHANGER WARRANTY*** Description Of Service Quantity Unit Price IExtended Price Tx Installations 1 $10,380.00 $10,380.00 TRADE-IN 1 ($1,000.00) ($1,000.00) 4.OT 15SEER FAMILY COOLING COND 1 $0.00 $0.00 M#4A7A5049E1000AA S#11034JBH2F 1 5 TON AMER STAND VS FURNACE 1 $0.00 $0.00 M#AUD2C100B9V5VBA S#12152H9N1G 1 5 TON HORIZONTAL COIL 1 $0.00 $0.00 4XDH1365/100 S#RDE220169 1 F0CUSPR0 5-1-1 PROG TSTAT 2H/2C 1 $0.00 $0.00 FOCUSPRO 5-1-1 PROG TSTAT 2H/2C 1 Total $9,380.00 5/16/2012 Payment $9,380.00 Balance Due $0.00 Paid in Full. We appreciate your business! BIn # Permit # MID d' Project Address: A. P. Number. Legal Description: Contractor. H\) QtY Of %a Qulht'a 4, Building 8f Safety Division P.O. Box 1504,78-495 Calle Tampico La.Qtdnta, CA 92253 -:(760) 7777012 Building Pennit Application and Tracking Sheet OwncesName:. Q/eJ�� vr'.�Z.•/J,� Addttiss: ��� (�v�S12QPi . City, ST, Zip: g 'Z Z S -% / TAhnnn• ?3 Address: Project Description: City, ST, Zip: Telephone: I `z State Lia # : Arch., Engr., Designer City Lic. #; Address: City., ST. Zip: Telephone: State Lta #' Construction Type: _ Occupancy: Project type (circle one): Now Add'n Alter Repan Demo Name of Contact Person: Sq. FL: # Stories: #Univ Telephone # of Contact Person: Estimated Value of Project: APPLICANT: DO NOT WRITE BELOW THIS UNE N Submittal Req'd Recd TRACXCZrIG PERMIT FEES Plan Sets Plan Check submitted Item Amount Structural Calm Reviewed, ready for corrections Plan Check Deposit. . TrussCates. Called Contact Person Plan Check Balance. Mde 24 Calci. Plans picked up Construction Flood plain plan Plans resubmitted.. Mecharilcal Giadlag plan 2' Review, ready for corrections issue Electrical Subcoutactor List Called Contact Person Plumbing Grant Deed Plans picked up &NLL H.O.A. Approval Plans resubmitted Gradiog IN HOUSE:- 2" Review; ready for correetionsAssue Developer Impact Fee Planning Approval Called Contact Person A.LP.P. Pub. Wks. Appr - Date of permit issue - School Fees Total Permit Fees