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13-1081 (MECH)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: 13-00001081 Property Address: 47875 VIA NICE APN: 643-130-020-20 -26152 - Application description: MECHANICAL Property Zoning: LOW DENSITY RESIDENTIAL Application valuation: 3632 Applicant: - Architect or Engineer: 44QVOICE (760) 777-7012 FAX (760) 777-7011 r BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153 BUILDING PERMIT In LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I 1 licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business rt'Profess' als Co nd my License is in full force and effect. License Class: CIO �C16 C2 Lic se o:: 457554 Date 1 � 2.a//,¢ontractolo ' O``�R UILDER DECLARATION I hereby affirm under penalty of perjury that I am e7t t 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 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.). (. 1 I am exempt under Sec. I , 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 Date: 8/28/13 Owner: BERTEIG LAURENCE 2892 160TH PL.NE BELLEVUE, WA 98008 AUG(425)556-1230 U2i 2013 Contractor: CITY OF LA QUINTA PREFERRED PLUMBING HTG A FINANCE DEPT. P.O. BOX 5120 PALM SPRINGS, CA 92263 (760)322-3173 Lic. No.: 457554 ------------------------------------ WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: 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. �I 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 EVEREST NATL Policy Number 7600006445131 _ 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 o become subject to the workers' compensation laws of California, and agree that, if" 1 should ome subject t thes' compensation provisions of Section 3700 of the Labor Code hall f rthwit com hos provisions. gotAppl nt:— — - WARNING: FAILURE TO SECURE WORKEQITIES SATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PD CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000). INADDITION TO 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 ab information is correct agree to comply with all city and county ordinances and state laws relating to he onstructio , an here a hori representatives of this county to enter upon the above-mentioned ��piropert f insp cti purp es Datr� Signature (Applicant or Agent): ' Application Number 13-00001081 - Permit . . . MECHANICAL 2013 Additional desc - Permit Fee 35.75 Plan Check•Fee .00. Issue Date Valuation 0 Expiration Date 2/24/14 ' y. Qty Unit Charge Per 'Extension. 1.00 35.7500 EA MECH CONDENSER/COMP 35.75 • Special Notes and Comments , HVAC CHANGE OUT - 3.5 TON/13SEER CONDENSOR [2008 ENERGY] CARBON MONOXIDE ► - ALARM(S) TO BE INSTALLED PRIOR TO FINAL r z - INSPECTION. 2010 CALIFORNIA BUILDING CODES. ---------------_------------------------------------------------------------- Other Fees PERMIT ISSUANCE M/P/E 90.57 PLAN CHECK; MECHANICAL 23.83 - Fee summary Charged Paid .- Credited --------- --------------------_-------= Due ------------- Permit Fee Total 35.,75 .00 00 35.75 ' Plan Check Total .00 .00 .00 .00 - Other Fee Total 114.40 .00 00 114.40 Grand Total- 150.15 ..00 00 150.15 LQPERMIT Bin # inta City ®f La 1%., U Building U Safety DllVISIon -P.O. Box 1504, 78-495 Calle Tampico Permit* La Quints, CA 92253 - (760) 777-7012 Y, -.-BU'11d1n'g Permit Application and Tracking Sheet Owner's Naind: Project /C 7-2. A/ 6 A. P. Mrnbii:. Address: N9.a 40 Mew Legal ;e9a City, ST, Zip:135r11esaLf, {/1%W WOO Vjo3jn� dba: Telephone: Con 'o of: AdcIteg., PO Project Description: c 'eity";Zip pa<jn CA".92'263 ity.. S.T. Tlev 78 �-h YOE . StateLic:.#:: City Lic. M. Arc Agn 4. Addri!.§S:,� - - ee e S tAt9 J_ .41M AGF Construction Type: Occupancy: Project - type (circle one): New A:d&n Alter Repair Demo Name Sq. Ft.: # St�ries: # Uniti: T e f —Of qtR0*Ur:,: ep�pl7e 00 Estimated Value of Project s16 3R APPLICANT: M NOT WRITE BELOW THIS LINE :. .7 1-7-7- R- Id' Rec�d' TRACKING.i. PERM� FEESOft Ylan. rIRn Check itted Iterif Amount Reviewed, ready for corrections Flail Check Deposit Called Contact Person Pla q Check Balance EnergyC2". Plans Dicked up Con traction Flood Ji in P . plan_ Plans.resubmitted Mee innical 2'd Review, ready fb�'correctiovslissue Elec seal coftlacto $ U-6 r1isu� -7-77777 Called Contact Pergon Plui ibing 7 Grant Deed .* Plans picked up S.M L H.O.A. Approysl Plans resubmitted Graing Review, ready for corrections/issue Dev toper Impact Fee rI.in!djqj Appr'bynl. Called Contact Person pr 'rub. Wks. Appr Date of permit Issue Bqhool Fc.c.7 Tot g I Permit Fees I Simplified Prescriptive Certificate of Com liance: 2008 Residential HVA C Alterations CF -IR -ALT -HVAC Climate Zones 10 to 15 1"W's KeSit7pnti/11' (:mmnlrn",rp Hnr S' 4 Ad �-7 no cmentA ZdA/ Permit #_ L Equipment T er List Minimum Efficiencyz Duct insulation requirement onditione Floor Area Thermostat ❑ Packaged Unit ❑ Furnace ❑ AFUE_ ❑ COP Over 40 ft of ducts added or Setback ❑ Indo r Coil R ❑ HSPF replaced in unconditioned space etv b system (If not already ensing Unit ❑ EER ❑ Resistance ❑ R 6 (CZ 10-13) sf present, must be Other ❑ R 8 (CZ 14-15) 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, 7.7HSPFfor 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 -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 MNton(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 duct systems are constructed, insulated or sealed with asbestos ❑ 2. New HVAC System Required Forms: • Cut in or Changeout with new ducts: (all new ducting and all CF -6R forms: MECH-04, MECH-20-HERS,and (for split systems) MECH-22-HERS, and MECH-25-HERS 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 CFM/ton, FWD, TMAH, STMS, and either HSPP or PSPP. For Packaged Units: Duct leakage < 6 percent ❑ 3. 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 CF4R 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 forms: MECH-04, MECH-2I-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) • 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 age fora roval with the peanit aprk4tion. Name: Jt`_P-9:7 Signature: Company r r— 1. -T ' Date: q Address .To W^ Sao License: 4S 7'<'4 City/State/Zip: ' CA63 Phone: 1"W's KeSit7pnti/11' (:mmnlrn",rp Hnr