09-0755 (MECH)V?.
P.O. BOX 1504,
78-495 CALLE TAMPICO
LA_ QUINTA; .CALIFORNIA 92253
Application Number: OA=A.OA_ C: t5T 5�
Property Address: 78865 ZENITH WY
APN: 609-560-011-11 -23773 -
Application description: MECHANICAL
Property Zoning: LOW DENSITY RESIDENTIAL
Appljootjon v'oluotion: 5000
'BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Applicant: Architect or Engineer: ,
Owner:
RYSDEN DORMAN L
78865 ZENITH WAY
LA QUINTA, CA 92
Contractor:
TELFORDJONES, IN
25920 IRIS AVE,
MORENO VALLEY, C
(951)486-0337
Lib. No.: 856936
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 7/13/09
LQPERMIT
" - LICENSED CONTRACTOR'S DECLARATION -
- WORKER'S COMPENSATION DECLARATION
I herebyaffirm 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 Pro ssio rials 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 CI s: -1210-C20- License No 856936
_
for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
Date: Contractor:
issued.
I have and will maintain workers' compensation insurance, as required by Section 3.700 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 I am exempt from the Contractor's State License Law for the
Carrier STATE FUND Policy Number 238-0005911
_ 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, 1 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 become 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 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
Code, I wit with rhos provisions.
that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by ,
�EE
any applicant for a permit subjects the applicant to a civil penalty -of not more than five hundred dollars ($500).:ate:
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: FAILURTOSCURE WORKER O PENSATION 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. arenot 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 I, 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
T. Each person upon whose behalf this application is made,each person at whose iequest and for .
pursuant to the Contractors' State License Law.).
whose benefit work is performed under or pursuant to any permit issued as a'result of this application,
(_) .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
_
- 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.
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 .
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.L.
city and county ordinances and slate laws relating to building c nstruction, a hereby authorize representatives
-
of thi cou//��__tty to enter upon he above-mentioned pro rty �pspec ' n ur . ses.
����____[[[[
Lender's Name: -
,�y�}/�� /1
ate: ISi ature (Applicant or Agent):
Lender's Address:
-
LQPERMIT
Application Number 09-00000755
Permit MECHANICAL
Additional desc .
Permit.Fee 48.50. Plan Check Fee`:'.
12.13.
Issue Date Valuation
0
Expiration Date 1/09/10
Qty Unit Charge Per
Extension
BASE*FEE
15.00
-1.00 11.0000 EA MECH FURNACE >100K
11.00
1.44 33:5000 EA MC D/C,>15 3wir/1500IC-im DTU
22.50
------------------------------------------------------------------------
Special Notes and Comments
CHANGE OUT HVAC TO 17 SEER, 4 TON
SYSTEM. 2007 CODES
---------------------------------
Other. Fees _ BLDG STDS ADMIN.(SB1473)
1.00
Fee summary Charged Paid Credited
Due
Permit Fee Total 48.50 '.00 00
48.50
Plan Check Total 12.13 .00 .00
12.13.
Other Fee Total 1.00 .00 .00
1.00
Grand Total 61.63 .00 .00
61.63
LQPERMIT
06/26/2009 08:56 FAX 18585860863 SEARS_HOME_IMPROVEMENT ; JONES
i
I
@001/002
Certl of Compliance_ Pr �scriptive Method - HVAC -only AIL -ration CF -IR -ALT
Project Title: �j Dater
lj' S O%� �,� ®Ca, CERTS 2005
Project Address: F-6, B''-' , ment A e 'Use Ont •, 1
,r t,;., Climate Zone, l3uld! Fermtt •
tYtn iii �/� L ,.I't, ..• JS i•` la' �If•.'�4'i � .:d�. .. a•
::. 1 "•a i . int., .,,,:, .�..
Documentati or, Telepho C
� � �> Plan'Cher:k Gale: ,•' �
Company Name
F1eld,•Check Data•: k -
IMPORTANT, This lR-ALT f
orm'i. only for usejwhen an HVA Ny alteration is rnadenba an existing horse
Use one form for each s stem baht altered. Thislis s stem # of
Check all fin c th�t 9onh+ Gh k I stems altwed In thls house.
Scope of Alterations: Qa;ltnes that aetiiv,
1 C3Alr Handlar is to be Installed or reDI Iced. Duet sawing to be determined. Continue to na4 rrle,
2 Furnace Heet exchen er Is to be Intltalled or re laced. Duet
4 sealing to bedetermined Continue tonaud Ilea
3 outdoor Condensing unit rs to be 6 rstalled.ar rilaced, ] Duct Sealing ardor TXV RCA) to be determined CarNnue to next flrre,
sociis er hoettn coins fo be Installed a mad, Duct Sealln and/or TXV RCA to be dee 1-d. Coll to nerd line
5 O ore than 40 feet of new, or repiacemen duct are to be installed In
❑ Chu* Well k the Duct s�firtg to ba del:rminm.
entire d� rot system Is also to.IDe new or replaced,
ti Centlnun to next Ilse_
d If none Mines; 1S are checked nalthar Duct searing nor TXV CA
. Go to Section S.
Seotlon 1 - Duct Sealln Onl if an of ! lnes 1 2 3 4 & 5 are checked. Ski D if Llne 6 Is Cht tea
70 is is in Climate Zone 1 3 4 ;, 6 7 or B. No duct sealing is MWIll Go to Section 2
8 ❑ . la em has lees than 40 feet of duct_ In unconditioned =Il No duct eal Is ragulred. Go to Seaton 2
9 ❑ ttgt system was previously saalad and 1s:ted, and was cardflad by a HERS talar,
Ne duel saeA Is tired. AtLech rev ous CF -4R fomt. Go to Section 2.
110 ❑ Is dud stem is sealed insulated r dth asbestos. No duct wall Isfired, Go to Section 2.
Note: If the tire duct s slam is tote new or replaced, Lines 11-14 do not a I .
11 CO) In Climate Zonas 2 12 and 16: An 0.92
Clate 4F'UE firmace win be installed In Ilan of duct seep and MIN, K fire ale
12 In CliZonae 1D, 13 end 15: An SEIA 14 MID EER 12 condenser will bs Installed with 7XV(RCA)
D added duct insulation R� vvreon existin ducts, R-8 n6w ducts in lieu of duct aealln _ Go to Section 2
_
13 ❑ In Climate Zones B, 10,11, 13, 14, ori; : An SEER 14 A, EER 12 condenser will be Instelleci with T7mV(Ft
ND a Cl AFUE furnace will be instalbal in lieu ofdud sealing. Go to Section 2
14 ❑ In Cllmme Zones 2, 9, 11. 12,14 or 16! All SEER 14 sdA. EER 12 cond
an 0.62 AFUE fuenser will be Installed with 1XV(ACA)
furnace will be insta iao with Increased duct insulation in lieu orduct seal i -Got
75INOns of Ilnes 7-14 above ore checkad_ tact Seal a Retinua o Section 2.qulrsd. Con
Section 2 - TXV RGA ON if Lines 3 or 4 are checked otherwise of to Section 3
16 ❑ s stem bel Altered Is a acts a unit: No TXV(RCA Is require& Go to Sal 3.
17 ❑ s system is in Climate Zone 8 sod a 14 SEER air conditioner or 0,82 All hrmare Is being installed,
No RCA) is required. Go 10 Sactic,n S,
18 ❑ is a is in Cllmma Zone 1 3 4 $ B 'or 7. No TXV R
19 ❑ Is s frim is In Cltmete ZcSection 3.
ns 18 and If r le 14 is not checked. No TXV RCA ►� oulred Sob Sedlon 3,
20 O r is is in Climate Zone 16 and lir a 14 Is chAcked and riot tins 1t9. TXV C,q is re o b SuIred. Go 3. Section g,
e This system Is in Gilman Zone 2 or 8-15 ane line 11, 18 or 17 Is not checked. TXV(RCA) Is required. Go to Sec&n 3.
Sect�io HERS Rater verification
22 0 It Une 15 Is chedmd, HERS verification s requlred for Duct S, 11 .
23 If line 12, 13, 14, 20 or. 21 are checked ar>d n6t Ilne 16 or 17, HERS varlFlcaSon ie required for TXV(R
24 ❑ It line 12, 13 er 14 am Checked, HERS w!=Ecadon 18 required for 12 EER
Section 4 - E "lull Dment Efficiencies e
25 ❑ If Ilnea 11, 13,.13, 14 or 17 are checked, upgraded equtpment:etficlenclesere required. List In Sacdori lx
Section 5- Dud R -Valu a26 _
r
❑ If mora than 40 feet of dl Is belnp Inslailed•orr Paui
faced, dud R -value must meet or ed ne a i? ram
EC Q If rens mhan 40 that of duct is bpatie me
els installed laced, duct R -value must meal or a meed R-4.2
Section 8 - Sea n®d
Version 03-10-06 .
This form can only be used on projects biting 1. `verified by CaICERTS certified raters_ 'age 1 of 2
I
www. calci: rts.com
0
-i &wrcavo vo.ao r,nA IdOdOdbV863 SEARS_HOME_IMPROVEMENT JONESl 002/002
Certificate of Compliance Prescriptive Method - HVAC -only Alteration CF -ZR -ALT
Project Title- /7 J Date:
4C810ERTS2005
IMPORTANT; ThisF-1R-ALT {off is only for use when an HVAC- is made to En exleting home
i alteratlo
Use one fort for each systen1_40ing altered, This is stem of
Section 6 - Minimum Requirements for Equl �ment to be Installed/Altered. Stems afterec in thig house.
InstePed equipment mual match lypar/Ioc *n and maul a 61x660 eflktenc{eslR.vehes
28 wHandler
anCQrTff0rt73p3swom ❑ Padt,toeUnit
29 d Nr Handllerer u a Inece, AFU
30 U Heat E er UHemPt+n+P FAU t7HYdmnfe FAI,r CIOLhar
31 Outdoe Co denaln Um gHa�13j,
32 Coolrngorh® cap EMd 58 R/HSPF:
❑Haolt E'ER re d:
33 0 Ducts Ilan;
Compliance Statement:
All mandato me. sures a to an a tared tom onenL See MF -TR -ALT form�YWue: ' x
. .
This certificate of compliance lists the building: featur6s and specifications needed to.pom
Title 24
California Code Of Regulations, and the adm nistrdttve regulations to implemonf dem, Thjg Ifl hss been signed by the
Individual with overall project re¢ponsibllity. 'rhe undersigned recognizes that Compliance using duct st3aling, verifiptiori �rsfAgt rant
Charge, and TXV require installer testing and cartification and verification by an approved HERS rater.
Home Owner Authorized an
Name: / — Documentation Author
,,,
n
Address:
p/ r� Company Name: A
O 6J �iVj.K
ZZZ,
�j /' Ad:a& /r C. ��'?. S 7 S -e ?�
CirylSte ip•
/J t!� ' �� / Z
J� iC o
Phone: hrrt;' �
Signature- — y T `4-r J ( D f 5e
Signature:
Enforcaman A en ull no Depar e
Name: Notea Comments:
TIut:
Department:
Phone 0 r'
Fax
Signature or Stamp;
Required fortes:
CF -IR -ALT: by anyona.
CF -6R -ALT: by [metalling Contractor, RequiredtolOs ppermit, Copies stoohome ehome r, en{n Ment agency, HERE tater.
agency, HER,3 rater.
CF -4R -ALT: by HERS rater. Required to close :)emtit Copies to home owner, en(p
I'll all 16811rnent agency, Installer, The CFVR forme for a
sa le roue shell nol be released ulg End verlflcatlon Is tom feted and assed for the entire roup.
Version p
This form 3-10.08 can only be used on projects being Ve ified by CeICERTS certified raters.
Page 2 of 2
www,®lee
'
rts.com
,r
Bin #
Qty of La Quin a
Building 8z Safety Division
P.O. Box 1504, 78-495 Calle Tampico
la Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
�Q
Project Address: T K 7 ';�eA)11'7/ Ava y
Owner's Name: �DD�lrlarU �d
A. P. Number:
Address: ��� FL/ /W ltv y
Legal Description:
City, ST, Zip: la RVIA)Ta ea 91253
Contractor: /L mDI`woNff Ice.
Telephone• * 3172 - ?W111
Project Description
Address: 2592 v 10S Rile. 4 134 -14
City, ST, Zip: M10AN O
Telephone:'1/0&:17
— 033:
s:,v}
JW
State Lic. # :(,Q 9,3 % City Lie.
Arch., Engr., Designer:
Address:
City,, ST, Zip:
Telephone: nig
f2C�f7"•y ,::.: v;rr.?Gr:,.Q�c
State Lic. #: c»:?,: �dy.,, ::s?»x ,r.:fx %4.
>:k •:w.,;;.y::.•r,:saysF; "�.�#
Construction Type: Occupancy:
,
Project type (circle one): New Add'n Alter Repair Demo
Name of Contact Person: A) Te112
Sq. Ft:
# Stories:
#Units:
Telephone # of Contact Person: W 4A —Q,2
Estimated Value of Project: .A 3 �
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calks.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calks.
Called Contact Person
Plan Check Balance
Title 24 Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2*' Review, ready for corrections/issue
ElecMcal
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
'n° Review, ready for correctionsfissue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees
x