10-0552 (MECH)is
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 10-00000552
Property Address: 60562 WHITE SAGE DR
APN: 764-270-999-109 -300231-
Application description: MECHANICAL
Property Zoning: MEDIUM HIGH DENSITY RES
Application valuation: 4262 -
------ Applicant:
x�
I�e
T4ht 4 4 Q"
Architect or Engineer:
IA—
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.
LicenseCllass: C20 / License No.: 878533
Date: Z—; -2-1V Contractor: 0/4-1 / Ya P fi' ! e /`
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.).
1 _ I 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:
LQPERMIT
Owner:
ROZLS RICHARD
60562 WHITE SAGE -DRIVE
LA QUINTA, CA 92253
Contractor: .
DIAL ONE'S ONE HOUR A/C &
2712 E. LA CADENA DRIVE
RIVERSIDE, CA 92507
(951)276-9744
Lic. No.: 878533
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 6/22/10
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.
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 INS CO OF WEST Policy Number WSD500334900
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 I should become ubject to the workers' compensation provisions of Section
3700 of the Labor Code, I shall hwith Qom { with those provisions.
Date: &-: 2��applicant: i
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 L6 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 c ruction, an hereby authorize representatives
of this county to enter upon the above-mentioned property fo i pectin pur se
i
Dater �y Signature (Applicant or Agent):
Application Number . . . . . 10-00000552
Permit . . .
MECHANICAL
Additional desc .
Permit Fee . . . .
24.00
Plan Check Fee
6.00
Issue Date . . . .
Valuation . . .
. 0
Expiration Date . .
12/19/10
Qty Unit Charge
Per
Extension
BASE
FEE
15.00
1.00 9.0000
EA MECH
B/C <=3HP/100K BTU
9.00
----------------------------------------------------------------------------
Special Notes and Comments
REPLACE 5 TON CHANGE
OUT 13 SEER
A/C
-UNIT WITH -DISCONNECT"
BOX:--
----------------------------------------------------------------------------
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 Prescritstive Certificate of Compliance: 2008 Residential RVACAlleualions C&I R-ALT-HifAC
Climate Zones 10 to 15
T
Me Addnas: I ^r, ., t i '1 C ^ _ -,\ —I Enf4mL _ Dates 1 .. _ _ Pani! fl:
r
E Type,
List Minimum Efficiencyl
Dud insulation requirement
Ams
Thermo"
Unit
❑ NckaFurnace
O indoor
IR AfUE
Q COP
Over 4011 o(ducts added or
0 Setback
D Indoor Coil
tiiiSEER
O HSPF
ftplactd in unconditiamed space
system
tuna alb
O'Condensing Unit
❑ EER
O Resistance
O R 6 (CZ 1x13)
�sf
purara4 araotiir
n nt.�
O R 8 (CZ 14-15)
i+mrm
I. Equlpmavt rye: (kw- the equrp rent being iasioW ifmwr thmr one s3wem, use anahar CF 1 R ALT -HV 4C far Each r}sren.
2 itfbdnrum Bgsfptrrlet Lrf jklendes-13 SEER 78%A1U$ 7.7HSPFJ6r typical rrsMi wW s)3tena
HERS VERIFICATION SUMMARY Listed below am four HVAC alteration Options. 'the Insudlerdecides what work is being dntte and
picks one of the appropriate- Optioos. E86 Option lists the HERS measures that must be conducted. A cap+ of theG»rns "I be left an site for final
4 spectiun and a copy given to the homeowner. At final, the inspector verifics that the work listed on this tum was in fact the work completed by the
installer. The inspector also verifies that each appropriate CF -6R and registered CF4R Corms Join hand filled CF4Rs allowed) ars filled out and
signed. Beginning October 1, 2010�a registered copy of the CF -IR and CF -6R shall also be on elle fir final iammetien.
1 01. HVAC Chang Bout I Reauired Forms:
• All HVAC E t replaced CF -6R forms: MECH-04. MECH-21-HERS and (for split system:.) MECH- 25 -HERS
4d p CF4R ftam: MECH- 21 Aral (for soffit systemsl MFLH.25
•
Condenser Coil and /or
• Condor Carl and/or CF -6R forms: MECH-2 t -HERS and (for split systems) MECH- 25 -HERS
•
CF -4R %: MECH- 21 and (for split systems) MECH-25
Furnace
For Split Systems: Duct leakage < 15 percent; RC, CCA ? 300 CFM/ton(I4linitmttit Air Ftow F.equirwnent} T M
For Packaged Units. Duct leakage < 15 percent
Exempted from duct leakage testing iP
O I. Duct system was documented to have been previously healed and confirmed duough HERSverificatiati or
O 2 Duct systens with less than 40 Ilacar foci in unconditioned spscc. or
17 3. Existhkg duct systems ane oagstructed, Insulated or seated with asbestos
112. New HVAC System I Reasired Fortes: if
• Cut in or Changrout with acw CF -611 forms: MEC", MECH-20-IMSimd (for si 4 sysuna) MECH-22-11ERS, and MECH-25-HERS
ducts: (alp new dueling and rip CF4R fmmx MECH 20-, and (for split systeas)MEC1�22, and MECH 25
new end
For Split Systems: Duct l i tage <6 lucent; RC, CCA _> 350 CFM/ton, FWD, TMAH, STMS, and either HSPP or PSPP.
For Packaged Units: Duct leaime < 6 Percent
L Q 3. New Ducts with Replacement I Required Forums
I• Includes replacing or installing alp new ducting I CF -M forms. MECH-04, MECH-20-HERS Bad (f+rsplit sysiems) MECH-25-HERS
and/or outdoor condensing unit and/or indoor CF -4R !dines: MECH-20 and (for split systems) MECH-25
coil andkr furnace. Not all edukxnent chance
For Split Systems: Duct leakage < 6 percent, RC, CCA >_ 300 CFM/ton, TMAH
For Packaged Units: Duct leatmrte < 6 Der=
O 4. Nen Ducting over 40 feet
• lunatics adding or replacing more than
Ilntint feet of dud in uocaadiUtmed e
ce. CF 6R fowls: MECH-04, MECH-2I-IIERS CF4R forms: MECH-21
For split system or packaged units: Duct leakage < 15 percent
17 EXCEFIION: Existi duct nems constructed, insulated or settled with asbestos
Contractor (Doenmentotion Author's /Responsible Designer's Declaration Statement)
• I certiN that this eatifkate of Cownance docvmenwion it wcurata and eomplete.
• I am eligible coda Division 3 olthe California 13usirtesa and 1'mfeasiotss Code to accept respeusibillty for the &34p Wad lied on this Certificate of Cm0imm
1 certify that the energy features end pafbnnonca apapf icatlone tier the design *nti6ai an this Catifi ate of tbnpuanee cmfaru to the mquitearmts of Title Z1,
PaAa i cern! ti of the California Cuda of Aeguldicim
• The duiprp features identified on this CaWknle of Cumplk= are consistent with the infunnatim doconv ed on qu � Atiaace fo teabte tom
T rot; walkShttts,
KiiW� TOMfff I12.9 7. ;
2008 Residential Compliance Forms March 2010
Bin #
Qty of LQ Quinta
Building &r Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
. o f --
i V
Project Address:—Owner's
Name: ZL6
A. P. Number:
Address:
Legal Description:
City, ST, Zip: 4f ►
r
Contractor: /&/ e( ir
Telephone:
Address: �Z � ��
Project Description: e
City, ST, Zip:
STeer
Y ..: - f z •.: •
Telephone:''>>::•:?>. 3 ,x c;,y r:••
State Lic. # : `?j 1 City Lic.
Arch., Engr., Designer-
esignerAddress:
_13
Address:
City., ST, Zip:
Telephone: >� q' % `: ::?
P 2%;�T '�`+ • iy' ' �FF
State Lic. #: sy;.rf , say
Ji\K;.. �% NI.vC,h'VI:<7%i'l%K..�%{i:i•.
Name of Contact Person:
Construction Type: Occupancy:,��
Project -JY �' a (circle one): N. -.w Add'n Alter Repair Demo
Sq. Ft.:
# S;ories:
#Units:
Telephone # of Contact Person:
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Rec'd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Cales.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance
Title 24 Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
god Review, ready for corrections/issue
Electrical
Subcontactor List
Called Contact Person
5 Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
'"' Review, ready for correctionstissue
Developer Impact Fee
Planning Approval
Called Contact Person
A,LP,P,
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees