13-0412 (MECH)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253 '
Application Number:
Property Address:
APN:
Application description:
Property Zoning:
Application valuation:
-Applicant:
1E 7:� VOICE (760) 777-7012
FAX (760) 777-7011
BUILDING & SAFETY DEPARTMENT INSPECTIONS (760)'777-7153.
BUILDING PERMIT
13,-0'0000412
55387 WINGED FOOT,
775 -182 -030 -
MECHANICAL
LOW DENSITY RESIDENTIAL
_ 7000
Architect or Engineer
'Opt,' //V
Owner:
ANDREW BOROWSKY.
55387 "WINGED -FOOT
LA QUINTA, CA 92253
(
Contractor:
GENERAL AIR CONDITIONING
31170 RESERVE DRIVE
THOUSAND PALMS, CA 92276
(760) 343-7488
Lic. No.: 686310
DF APR 04 2013 D
-
-------- - - - - - - - - -- ------------------------------
LICENSED CONTRACTOR'S DECLARATION
NS
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury that I am 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 Business and Professionals Code, and my 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: C20 License No.: 686310 -
for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
� '"'
issued.
"Date: 4 (3 Contractor. : _'
'd+� 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
OWNER -BUILDER DECLARATION -
insurance carrier and policy number are: '
• I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the
Carrier ZENITH INS CO Policy Number Z071741502` ,
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 beuuirie subject to the workers' compensation lows of Colifornia, -
-
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 become subject to the workers' compensation provisions of Section
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or
3700.of'the Labor Code, I shall forthwith comply with those provisions.'
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).:
Date:1{ Applicant:
- ( ) 1, 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 WORKERS' COMPENSATION 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 AND CIVIL 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 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
Each person upon whose behalf this application is made, each person at whose request and for
pursuant to the Contractors' State License 'Law.).
.1.
whose benefit work is performed under, or pursuant to any permit issued as a result of this application,
' ( 1 1 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
of La Ouinta, 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
j
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
I certify that I have read this application and state that the above information is correct. I agree to comply with all
work for which this permit is issued (Sec. 3097, Civ. C.).
city and county ordinances and state laws relating to building construction, and hereby authorize representatives
of this county to enter upon the above-mentioned property for inspection purposes.
Lender's Name:
• -
_
Date: Signature (Applicant or Agent):
Lender's Address:
--
LQPERMIT
Application Number 13-00000412
Permit MECHANICAL
Additional desc .
Permit Fee 33.00 Plan Check Fee
8.25
Issue Date Valuation.
0
Expiration Date 10/01/13
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
Special Notes and Comments
HVAC CHANGE -OUT - 13.50 SEER/AFUE 78,
(1) 4 TON AIR CONDITIONER. [2008 ENERGY]
CARBON MONOXIDE-ALARM(S) TO BE INSTALLED
PRIOR TO FINAL INSPECTION. -2010
CALIFORNIA BUILDING CODES.
-"------------------_-----------------------------------------
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
-. .
04/04/2013 01:42PM 8187353575 IPERMIT ERATERS PAGE 08/11
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, ANDREW
OOT
ACA 92253
OUT (1) 4TON AIC, 13.60 SEED;
e0,00Cs BTUS-
City. of, La Quihta
?.'OL box 1504,78-495 Cie ran*
�""{� u-gwmt, CA 92253 -x(760) 7717-10
117 Bullding Pffn* Application and Trac
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Addmw, 31170 Reserve Drive pc�aaDasa on CHAN
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04/04/2013 01:42PM 8187353575 z ,IPERMIT"ERATERS - PAGE.09111
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Simplified Prescriptive Certificate of Compliance. 2008 Residential HVAC AI erations: CF-1R-AILT-HVAC
Climate Zones 10 - 15
Site Address. Enforcement Agency: Date: Permit #:,
55387 WINGED FOOT La Qulnta, CA 92253. City of.La Quinta Apr 4,:2013 ,
Duct Insulation . Conditioned F or
Equipment Typel List Minimum Efficiency2 requirement i Area Thermostat '
p Package unit e
® Furnace 10 AFUE 78Me [3 COP R 6 CZ 10-13 Served by sys em ® Setback • 1
® Indoor Coil ® SEER 13.0 93 HSPF ( ) III sf Irhot .g/ready present; must be
®Condensing Unit 0 EER ❑Resistance R 8 (CZ Iii-15) �� InstaU2d) v '
.„ .
E3 Other -
1. Equipment Type. Choose the equipment beffig installed; if more than one system, use another CF-IR- LT-HVAC for each system.
2. Minimum Equipment Elillciem es: 13 S7 ER, 78% AFVF- 7.7HSPF for typiral residential Systems,
HERS VERIFICATION SUMMARY Listed below are FOUR HVAC alteration Options. The insta ler decides what work is being done
and picks one of the appropriate Options. Each Option lists the HERS measures that must be onducted. A copy of the forms shall
be left on site for final Inspection and a copy given to the homeowner. At final, the inspector i erifies that the work listed on this
form was in fact the work completed by the Installer. The Inspector also verifies that each apf ropriate CF-611 and registered CF-4R
forms (no hand filled CF-4Rs allowed) are filled out and signedAeginning October 1, 2010, a registered copy of the CF-1111-
and
F-1Rand CF-6R 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) ECH-254HERS ,
replaced CF-4R forms: MECH-71 and (for split systems) MECH-25
. Condenser Coil and /or CF-6R forms: MECH-04, MECH-21-HERS and (for split systems) ECH-25-HERS J k
' 0 Indoor Coll and /or CF-4R forms: MECH-21 and (for split systems)' MECH-25 �
. Furnace
For. Spilt Systems: Duct Ieakag :1:S: percent; RC, CCA 5 300 CFM/ton (Minimum Air Flow equlrement), TMAHper Panksged 1111-1
I'
Exein ;t6dXrom duct.leel
d i:C3rlchsYaCei7l:was docuttii2 d to have been previously sealed and confirmed throug HERS verification, or
2., boat Systems vrlth
leis':
thloi ACHlnear feet in unconditioned space, or
EXisbhg.dYct systems bi t:structed,.lnsulated or sealed with asbestos
'llfnotherD (Ips L I N to xe a 9e)-
Q 2. iY i1i1 Requi
Cut f p'jeout:w CH-04' QRS t 11t sy 3 MEC RS, ..h
new :(all new .,.:_:....,.,>:
. ducN elf n
ECH- 0, r s
an' o
PSNK, .11
For
.' • For;Rackag�d•."• nl!s'`.45utt leakag.. r, ,. • .> •; , r'- .
❑:3' `� o;:fiulRl?o Required Forms: _
«.•:4 .. a
•.Inaudesrepl;i'dng�•oriris>~aihngailnew Y ' • '
ducting and/or outdoor c6bden4"g unit CF-6R forms: MECH-04, MECH-ZO-HERS, a d (for spilt systems) MECW-25-HERS • ; r
and/or indoor coil and/or• fu naG ..No:.or some CF-4R forms: MECH-20 and (for split syste s) MECK-25 .'
equipmegt changed.
For Split Systema: Duct leakage <.fi percent; RC, CCA z 300 CFM/ton, TMAH =
For Packaged Units. Dud leakage < 6 percent 4
❑ 4. New Ducting over 40 feet Required Forms: -
. Includes adding or replacing more than 40 CF-6R forms: MECH-04, MECW-2I-HERS ,
linear feet of duct in unconditioned space, CF-4R forms: MECH-al
For split system or packaged units: Duct leakage < 15 percent
E3 EXCEPTION: Existing duct systems constructed, insulated or sealed with asbestos..
Contractor (Documentatlon Author's /Responsible Designer's Declaration Stateme t) ,
' . I cettlfy that this Certificate of Compliance documentation is accurate and complete. r.
. I am eligible under Division 3 of the California Business and Professions Code to accept responsibility fo r the design identified on this Certificate of.
_ Complianea.
• I certify that the energy features and performance specifications for the design identified on this Certifi ate of Compliance_ conform to the -
requirements of ntle 24, Parts 1 and 6 of the California Code of Regulations-
. Thdesign features Identified on this Certificate of Compliance are consistent with the information doct mented or other applicable compllarice
forms, worksheets, calculations, plans and specifications submitted to the enforcement agency for appy oval with tie permit application.
Name: Danielle Garcia Signature: Dnnlelle Garcia
r ,
Company: HARRISON ENTERPRISES INC Date: Apr 4, 2013
Address: 31-170 RESERVE DRIVE STE A License: 686310 -
City/State/2ip: THOUSAND PALMS / CA / 92276 Phone: (760) 343-7488
Reg! 213-A0019961A-000006000-0000 Registration. Mite/Time: 2013/04/09 02:37,49 'HERS Provider: Ca10ERTS, TIIc.
200B Residential Compliance Forms r]uly 2010