11-0890 (MECH)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number —_
11-_00000890--
Property Address: C=Z 47910"VIA'NICE
APN:
643-130-027-27 -26152 -
Application description:
MECHANICAL
Property Zoning:
LOW DENSITY RESIDENTIAL
Application valuation:
6000
Applicant:
r
I hereby affirm under penalty of perjury
Section 7000) of Division 3 of tf a Busi
T419� 4 .fwQ"
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT.
Architect or Engineer: ..
W
------------------ --- -----
:ENSED CONTRACTOR'S DECLARATION//
I am licensed underprovisions of Ch ter 9 (commencing with '
and Professi nals Code, and my Lic (ase is in full force and effect.
License No.: 77 94
I-
0 NER- UILD ECLARATION
I hereby affirm under penalty of perjur hat I am exempt from the Contractor's State License Law for the
following reason ISec. 7031.5, Busin s 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, as owner of the property, or my employees with wages as their sole compensation, will do the work, and 111
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.l•
( ) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project ISec.
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 contractors) licensed
pursuant to the Contractors' State License Law.).
I—) 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:
FRIMTZIS STEVEN R
47910 VIA NICE
LA QUINTA, CA 92253
VOICE (760) 777-7012
FAX. (760) 777-7011
INSPECTIONS (760) 777-7153
Contractor:
J ANTHONY PLUMBING HEAT/AIR
72216 NORTH SHORE STREET, #1141
THOUSAND PALMS, CA 92276
(760)343-2121
Lic. • No.: 777794
WORKER'S COMPENSATION DECLARATION
Date: 8/18/11
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.
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 STATE FUND Policy Number 1932451-201A--
certify that, in the performance of the work for which this permi ' issued, I shall not employ any
person.in any manner a's to become subject to the work compensation laws of California,
and agree that, if I sh Id become subject to the work compensation provisions of Section
3700 of the LabWRKERS'COMP'ENSATI'ON
hwith comply those provisions.
te: /%ems' ant:
WARNING: FAI RCU E TO SECURCOVERAGE 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 La Quinta, its officers, agents and employees for any act or omission related to the work being
performed under or following issuance of is permit.
2. Any permit issued as a result of this appli ation becomes null and void if work is not commenced
within 180 days from date of issuance f such permit, or cessation of work for 180 days will subject
permit to cancellation.
I certify that I have read this application a state at the above informatio i correct. I agree to comply with all
city and county ordinances and state laws relatin o building constructio , an hereby'authorize representatives
;a4te
ty t enter upon the above-ioned rty for inspect purpos
IS' ature (Applicant or Ag tl:
LQPERMIT
Application Number 11-00000890
Permit . . . MECHANICAL
Additional desc .
Permit Fee . . . . 40.50 Plan Check Fee
10.13
Issue Date . . . . Valuation
0
Expiration Date 2/14/12
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
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Special Notes and Comments
HVAC CHANGE OUT, FURNACE,INDOOR COIL &
CONDENSER, 14 SEER. 2010 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
Simplified Prescriptive Certificate of Compliance: 2008 Residential HVAC Alterations CF -IR -ALT -HVAC
Climate Zones 10 - 15
Site Address:
Enforcement Agency:
Date:
Permit #:
47910 VIA NICE La Quinta, CA 92253
City of La Quinta
Aug 13, 2011
Duct insulation
Conditioned Floor
Equipment Type1
List Minimum Efficiency2
requirement
Area
Thermostat
❑ Package Unit
p Furnace
p Indoor Coil
0 AFUE 78%
p SEER 14.0
❑ COP
❑ HSPF
❑ R 6 (cz 10-13)
Served by system
0 Setback
If not already present, must be
• Condensing Unit
[]EER_
❑ Resistance
❑ R 8 (CZ 14-15)
1600 sf
installed)
ElOther'
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 Efflciencies: 13 SEER, 78010 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 -611 and registered CF -411
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 -6111 shall also be on site for final inspection.
9 1. HVAC Changeout
Required Forms:
• All HVAC Equipment
CF -611 forms: MECH-04, MECH-2I-HERS and (for split systems) MECH-25-HERS
replaced
CF -411 forms: MECH-21 and (for split systems) MECH-25
• Condenser Coil and /or
• Indoor Coil and /or
CF -611 forms: MECH-04, MECH-2I-HERS and (for split systems) MECH-25-HERS
• Furnace
CF -4R forms: MECH-21 and (for split systems) MECH-25
t ;,
For Split Systems: Duct leakage 15 percent; RC, CCA <_ 300 CFM/ton (Minimum Air Flow Requirement), TMAH
Fe Paskage.d Units- n...-4 le- k-ag . i 1 e R -
F Rt
Exempted from duct leakage testing if.:
1p 1:"Ductsystem'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
El 3. Existing duct systems are constructed, insulated or sealed with asbestos
4. Themes stemgwill not be Ducted ie: -Ductless Mrni-S lit S stem r
❑ . y a ( l p .yr )Y("Also-Exempt fr r -Q . efrigerrant Charge)
61
❑ 2. New HVAC System
Required Forms:, i`
. Cut inJor'Changeout with'','
jf I I 1 � � �,;.�� t •% � j.'- '� � o w�a .,-,..
new ducts: (all new
CF 6R,forms MECH-04, MECH-20-HERS, and (for split systmH'
es) MEC22-HERS, and;MECH-25=HERS
nd
ducting aall new
CF-4R'forms..MECH 20, and (for split systems) ME CH -22' and'MECH 25
equipment) ..
1� Eke: `. 1�
For Split Systems: Duct leakage <,6 percent; RC,`CCA:>_ 350 CFM/ton, FWD`, TMAH, SIMS, and -either HSPP'or-PSPP.
For Packaged Units: Duct leakage ,< 6; percent
❑ 3..- New Ducts with/or without -
Required Forms:
Replacement
. Includes replacing or installing all new ducting
and/or outdoor condensing unit and/or indoor
CF -611 forms: MECH-04, MECH-20-HERS, and (for split systems) MECH-25-HERS
coil and/or furnace. No or some equipment
CF -411 forms: MECH-20 and (for split systems) MECH-25
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
CF -611 forms: MECH-04, MECH-2I-HERS
linear feet of duct in unconditioned space.
CF -4R forms: MECH-21
For split system or packaged units: Duct leakage < 15 percent
❑ EXCEPTION: Existing duct systems 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 agency for approval with the permit application.
Name: Kevin Robinson Signature: Kevin Robinson
Company: J ANTHONY PLUMBING HEATING & AIR CONDITIONING Date: Aug 13, 2011
Address: 72216 NORTH SHORE ST #101 License: 777794
City/State/Zip: THOUSAND PALMS / CA / 92276. Phone: 760-343-2121
Reg: 211-A0041556A-00000000-0000 Registration Date/Time: 2011/08/13.16:14:22 HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms July 2010
Bin #
Cit/ of La Quinta
Building & Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit # "
Project Address:� (O
Owner's Name: t 771K+72 '`
A. P. Number:
Address:
Legal Description: 7
Contractor:
City, ST, Zip:
Telephone:—/
project Description:
Address: J ANTHONY SERVICES
City, ST, Zip: THOUSAND PALMS, CA 92276
RV AL
Telephone. ?66. 343
State Lic. # :'� 77 —7 11"I' City Lic. #; i 0
Arch., Engr., Designer.
Address:
City., ST, Zip:
Telephone:.
State Lic. #:
Name of Contact Person:
Construction Type:. Occupancy
Project -type (circle one): New Add'n Alter Repair Demo
Sq. Ft:
# Stories:�r
# Units:
Telephone # of Contact Person:
Estimated Value of Project:. 0C> J
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Cales•
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 correctionsAssue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
Review, ready for corrections/issue "
Developer Impact Fee
Planning Approval
Called Contact Person
A.LP.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees