13-0562 (MECH)P.O. BOX 1504
78-495 CALLE TAMPICO"
LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT .
Application Number:
Property Address:
APN:
Application description
Property Zoning:
Application valuation:
Applicant:
lip
13-00000562
55301 WINGED FOOT
775: -182 -043 -
MECHANICAL
LOW DENSITY RESIDENTIAL'
7075
Architect or Engineer:
VOICE (760) 777-7012
-f` FAX (760) 777-7011
-- J INSPECTIONS (760) 777-7153
�� Date: 5/01/13
Owner:
GAYLE EVANS
55301 WINGED FOOT
LA QUINTA; CA 92253 "
(
Contractor:
PREFERRED PLUMBING HTG A/C D
P.O. BOX 5120
-PALM SPRINGS, CA 9226.3 I
(760)322-3173
LiC. No.: 457554,
MAY 011013 ID
LQPERMIT
CITY OF U1 QUIM AI
FINANCE DEpy
' LICENSED CONTRACTOR'S DECLARATION -
WORKER'S COMPENSATION DECLARATION
hereby affirm under penalty of perjury that licensed under provisions of Chapter 9 (commencing with
I hereby affirm under penalty of perjury one of the following declarations:
Section 7000) of Division 3 of the Busine d Profes ' s od d m License is in full force and effect.
I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided
License Class: C10 C16 C2 Li n 57554-
by Section 3700 of.the Labor Code, for the performance of the work for which this permit is.
Date: o610 77Contractor: _
,for
issued.
ave and willmaintainworkers' 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
JWNER-UILDER DECLARATION
insurance carrier and policy number are:
I hereby affirm under penalty of perjury that I amfrom the Contractor's State License Law for the
Carrier EVEREST NATL Policy Number 7600006445131
following reason (Sec. 7031.5, Business and Professions Code: Any city or county that requires a permit to
- _ I certify that, in the performance of the work for which this permit is issued, I shall not employ any
construct, alter, improve, demolish, or repair any structure, prior'to its issuance, also requires the applicant for the
person in any manner so as to be me subject to the workers' compensation laws of California,
permit to file a signed statement that he or she is licensed pursuant to the provisions of the.Contractor's State
and agree that, if I should becc subject to the, ers' c pensation provisions of Section
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or
Labor Code, I sh forthwith cgmply h o � pr visions.
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 ofInot more than five hundred dollars ($500).:
)[/3[7%.00y2o�fothe
Date: � / plicant:�i
�C' `7T
K.., ..
(_) 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
WARNING: FAILURE TO SECURE W RKERS' COM ENSATI
N COVERAGE IS UNLAWFUL, AND SHALL
.'Contractors' State License Law does not apply to an owner of property who builds or improves thereon,
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES A
IL FINES UP TO ONE HUNDRED THOUSAND
and who does the work himself or herself through his or her own -employees, provided that the -
DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
improvements are not intended or offered for sale. If, however, the building or improvement is sold within
SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY',S FEES.
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.).
APPLICANT ACKNOWLEDGEMENT
1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.
IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the
7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of
conditions and restrictions set forth on this application. -
property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed
1 . Each person upon whose behalf this application is made, each person at whose request and for
pursuant Yo the Contractors' State License Law.). -
whose benefit work is performed under or pursuant to any permit issued as a result of this application,
1_) I am exempt under Sec. , B.&P.C. for this reason, _
the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City ,
. -
ofLaQuinta, its officers, agents and employees for any act or omission related to the work being
- - _ -
.,performed under or following issuance of this permit. ,
Date: Owner. - -
.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
- CONSTRUCTION LENDING AGENCY
permit to cancellation.
I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the - -
ormation is correct. I a e to comply with all -
I certify that I have read this application and stateAp�roper
work for which this permit is issued (Sec. 3097,. Civ. C.). -
city and county ordinances and state laws relatinguction, an y t rize representatives
_
of this county to enter upon the above-mentionedc ' n pposes.Lender's
Name:
Lender's Address: f \ -
/ppgDate: ture (A Iicant or Ar'
-
LQPERMIT
Application Number 13-00000562
Permit MECHANICAL
Additional desc .
Permit Fee 40..50 Plan.Check Fee '.
10.13
Issue Date . . . Valuation
0
Expiration Date 10/28/13:
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 REPLACE (1) UNIT
13SEER/80AFUE, CONDENSING UNIT AND (1)
EVAPORATOR COIL [2008 ENERGY] CARBON
MONOXIDE ALARM(S) TO BE INSTALLED PRIOR
TO FINAL INSPECTION.,2"010-CALIFORNIA
BUILDING 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
,• LQPERMIT -
"
Bin #
City of La QUA= --
Building U Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
; r:.. a._:,....•.,_ ;Building Permit Application and Tracking Sheet
--
Permit
,.4
Project Address,! ¢ili �� OOT
Owner's Name: g! V
Address: .SS�3�/ L -J /NaC13 A6tO
Legal Desci]goon::>;'`. _ r:,.:
City, ST, Zip:II�R CA a s3
Preferred A'r, Condition'ing dbii
Contractor preferred:; P.1liiilbin Hearin &Ai
Telephone:��
Project Description:
City; ST,m,A9.2263P9p
%
Telephone ( 7 6 01
4 City Lic. #:
.State Lic: # :; .::...::...::..... ..:. ..
Arch.; Engr. Designer:
Address:.:,
Telephone;.. - :`; :-;:::;'::. ;::; .
State .Lip #;:'.'.:'•'::;'< =. *i .';';°= _`::
IQame of;Coritact:PeFso`.' •..:
Construction Type: Occupancy:
Prajecttype (circle one): New Add'n Alter Repair Demo
Sq. Ft: #Stories: #Units:
Telephone # of,Cotitact Pe(son
Estimated Value of Project: % 7
5. APPLICANT: DO NOT WRITE BELOW THIS LINE
# .
Snb►iifttal; -s`.' '.. ., .
Reg'd Recd
TPACMG.i
PERMYT FEES
PIan,Sets:: , .° •:
Plan Check geDmitted
Iten
Amount
..Stnictursl.Calea..:.:
Reviewed, ready for corrections
Flat .Check Deposit
:
Trags Calcs., .:.:.=. • .
Called Contact Person
Plar Check Balance
E4eigy Calcs. ` !
Plans Dicked op
Con truction
Flood plain plaq . !.
;.
Plans.resubmitted
Me and •cal
Grading,pisi - ,
tad Review, ready foi'correctionsrssue
Ele rlcal
.
Subcontactor.List .
-
Called Contact Perqon
Plumbing
Grant Deed . ..
Plans picked up
S.M I.
H.O.A.. Approyal
Plans resubmitted
Gra ing
114 AOUSE:=
''" Review, ready for corrections/issue
Dev loper Impact Fee
Planning Apprbyal.
Called Contact Person
A.I. -P.
.
.,Pub. Wks. Appr '
Date of permit issue
School Fees '
Tots I Permit Fees
Simplified Prescriptive Certificate of Com fiance: 2008 Residential HVACAlteradons CF -IR -ALT -HVAC
Climate Zones 10 to 15
2008.Residential Compliance Forms ne„> h 7010
Site Address: Enforcement Agency:
5301 W(AVeb Fo t ' L & �q
Date:
1
-V11W_13_
Permit #:
Equipment T e'
List Minimum EfficienCY2Duct insulation requirement
Condi oned Floor
Area
Thermostat
❑ Packaged Unit
ornate
�AFUESO
Over 40 ft of ducts added or
❑ COP
etback
door Coil
Jl3SEER�
laced in unconditioned space
13 HSPF re _ p p
❑ R 6 10-13)
Served b system
Y
(If not already
94ondensing Unit
❑ EER
(CZ
❑ Resistance
❑ R 8 14-15)
sf
present, must be
❑ Other
(CZ
installed)
1. Equipment Type: Choose the equipment being installed; if more than one system, use another CF -IR -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 CF4R forms (no hand filled CF-4Rs allowed) are filled out and
si QLBeginning October 1, 2010, a registered copy of the CF -1R and CF -6R shall also be on site for final inspection.
1. HVAC Changeout
Required Forms:
• All HVAC Equipment replaced
CF -6R forms: MECH-04, MECH-2I-HERS and (for split systems) MECH- 25 -HERS
CF -4R forms: MECH- 21 and fors lits stems MECH-25
Condenser Coil and /or
• Indoor Coil and/or
CF -6R forms: MECH-2I-HERS and (for split systems) MECH- 25 -HERS
• Furnace
CF -4R 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
For Packaged Units: Duct leakage < 15 percent
Exempted from duct leakage testing if:
❑ 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. Existing ducts stems areconstructed, insulated or sealed with asbestos
❑ 2. New HVAC System Required Forms:
• Cut in or Changeout with new CF -6R forms: MECH-04, MECH-20-HERS,and (for split systems) MECH-22-HERS, and MECH-25-HERS
ducts: (all new ducting and all CH -
new equipment) CF -4R forms: MECH 20-, and (for split systems)MECH-22, and MECH 25
For Split Systems: Duct leakage < 6 percent; RC, CCA _> 350 CFNVton, FWD, TMAH, STMS, and either HSPP or PSPP.
For Packaged Units: Duct leakage < 6 percent
113. New Ducts with Replacement Required Forms:
Includes replacing or installing all new ducting CF -6R forms: MECH-04, MECH-20-HERS,and (for split systems) MECH-25-HERS
and/or outdoor condensing unit and/or indoor CF -4R forms: MECH-20 and (for split systems) MECH-25
coil and/or furnace. Not all equipment changed.
For Split Systems: Duct leakage < 6 percent, RC, CCA >_ 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
linear feet of duct in unconditioned space. CF -6R farms: MECH-04, MECH-ZI-HERS CF -4R forms; MECH-21
For split system or packaged units: Duct leakage < 15 percent
❑ EXCEPTION: Existing ducts stems constructed, insulated or sealed with asbestos.
Contractor (Documentation Author's /Responsible Designer's Declaration Statement)
• 1 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 Cfrtificate of Compliance con rm to the requirements of Title 24,
Parts I and 6 of the California Code of Regulations.
• The design features identified on this Certificate of Compliance are consistent with the inform on documented on other plica le compliance forms, w s eels,
calculations plans ands ecifications submitted to the enforcement agenEX for a2proval with PW PermiLfiA*ftti9n,
Name: "'1"' ��- ; I F M 5
i1
Signature:11
Company:
Date:
Address:® �� 5c s a zo
License'
.7 ��-�-
City/State/Zip:' 0G S /► // �
L/3, "A- Z (0 -3
_-
�/
Phone: f� w �5 2.Z — 3 7 -31
2008.Residential Compliance Forms ne„> h 7010
HVAC Permit Checklist
Comfort Consultant (RSP):
Service Order #: I D /
Owner's Name:
Jobsite Address:
55 30.1 U) f W3C
LA
Permit Application Declaration Page:
O Commercial residential
O Single family residence ❑ Multi -family residence
ndominium 0 Other:
_ Name of Community: .
Location of new unit on/in structure: G 1?00� ,
Plot plan required?:
Line of sight — screened / parapet /distance from lot line:
Components to be: O installed /r placed: "like for li or _upgrade? (circle one)
X'Con/denser Size (tannage):,:
FAU / Air Handler XSEER: 1
Evaporative Coil 0 EER:
0 Package unit - PGE or HP
0 Other:
CF -1R -A Form:
Project valuation: D
r ! 5
Date Permit Needed at Jobsite:
other. nformation: