11-0780 (MECH)P.O. BOX 1504• E VOICE (760) 777-7012
78-495 CALLE TAMPICO 1 FAX (760) 777-7011
LA, QUINTA, CALIFORNIA 92253.^ BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153 "
BUILDING PERMIT'
Tit Date: 7/,19/11
N de
Application Number: t= -x,11="00"0 0 0 780 ---;3, W Owner.
Property Address: .''•�,'53305-AVENIDA VILLA ey.{ MARLENE BRIDGES r
APN: 774-093-015-3 -0 000- Q 53305 AVENIDA VILLA
Application description:, MECHANICAL = �� ' . k' LA QUINTA, CA 92253 w
Property Zoning: COVE RESIDENTIAL
Application valuation: 3800
Contractor:
Applicant: Archi or Engineer, M B AIR CONDITIONING/HEATING I.
2323 MARY STREET
RIVERSIDE, CA 92506
(951)789-3020
Al 1 :l Lic. No.: 713817 .
-
---------------------------------------------
LICENSED CONTRACTOR'S DECLARATION _ 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 -C36 Lice a No.: 713817 for by Section 3700 of the Labor Code, for the performance of the work for which this permit is -
issued.
ate: �--% /. ntractor: V 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
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 SOUTHERN INS - Policy Number WS1003115902
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 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 3700 of the Labor Code I;Zi�oZse; provisions:
that he'or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by/Q ..
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).: ate: _ —/pplicant: -
(_) 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 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 ($100,0001. 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 -
I _ 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 tp an PWner gf rnnditinns and restrit•finns set fnrth nn thip r,pproation. • - ' - f' -
pfupei ty wnu uunus or lglproves trior,%66, Arid -who contracis for the projects with a contractorls) licensed 1 . Each person upon whose behalf this application is made; each person at.whose request 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,
(_ 1 I am exempt under Sec. , B.&P.C. for this reason - .the owner, and the applicant, each agrees to, and shall defend, indemnity 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.). - 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 f nspectio purposes.
Lender's Name: - �
1 - _ ate nature (Applicant or Agent): /�
• L'ender's Address: -
. LQPERMIT _ • '.
Application Number 11=00000780
Permit MECHANICAL .
.Additional desc .'.
Permit Fee 31.50
Plan Check Fee
7..88
Issue Date
Valuation
0
Expiration Date 1/15/12
Qty. Unit Charge Per
Extension
BASE
FEE:
15.00
1.00 16.5000 EA MECH
B/C >3-15HP/>100K-500KBTU
16.50
Special Notes and Comments
REPLACE OUTDOOR HEAT PUMP UNIT,
13 SEER.
2010 CODES.
--------------------------------- ----------------------------------------------
Other Fees . • BLDG STDS ADMIN (SB1473)
1.`00
Fee summary Charged
---------- ----
Paid Credited'
Due
-----------------
Permit Fee Total 31:50
.00 .00
31.50
Plan Check Total 7.88
.00 .00
7.88
Other Fee Total 1.00
.00 .00
1.00
Grand Total 40.38
.00 ....00
40.38
LQPERMIT
Simp lifted Prescri tive Certificate of Com licence: 2008 Residential HVAC Alterations CF -IR -ALT -HVAC
Climate Zones 10 to 15
Site Address: L� V,,a jj
'Enforcement Agency:
Date:
Permit tl:
ui rent ni u
List Minimum Efficienc '
Duct insulation requirement
Conditioned Floor
Area
thermostat
❑ Packaged Unit
❑ Furnace
❑ AFUE_ ❑ COP
Over 40 ft of ducts added or
Wetback
❑.Indoor Coil
W3SEER4-a_ ❑ HSPF
replaced in unconditioned space
Sery by system
(7fnor already
I'Condensing Unit
❑ EER 13Resistance
13R 6 (0210-13)
/Cy, zo sf
present must be
❑ Other
I a
❑ R 8 (CZ 14-15)
installed)
I. Equipment Type: Choose the equipment being installed: if more than one system, use another CF -1 R -ALT -HVAC for each system.
2. Minimum Equipment Effrciencles: 13 SEER 78°x6 AFUE, 7.71fSPFfor 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 -411 forms (no hand filled CF4Rs allowed) are filled out and
Beginning
si ed. October 1 2010,2 registered rn of the CF -1R and CF -6R shall also be on site for final ection.
1. HVAC Changeout
Required Forms:
• All. H VAC Equipment replaced
CF -6R forms: MECH-04, MECH-2I-HERS and (for split systems) MECH- 25 -HERS
CF -4R forms: MECH- 21 and fors lit systems) MECH-25
ndense oil and /or
• Indoor Coil and/or
CF -6R forms: MECH-2I-HERS and (for split systems) MECH- 25 -HERS "
• Furnace '
CF -41K 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:
0:1 - 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. Existingducts tems are constricted, insulated or sealed with asbestos
❑ 2. New HVAC System Required Forms:
• Cut in or Changeout with new CF -6R forms: MECH-04, MECH-20-20for lit
ducts: (all new ducting and all ( 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
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 leak e < 6 percent
❑ 4. New Du cting over 40 feet
Required Forms:
• Includes adding or replacing more than 40
linear feet of duct in uinconditioned s ace.
CF -6R forms: MECH-04, MECH-21-HERS CF4R 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)
• 1 certify that this Certificate of Compliance documentation is accurate and complete.
• 1 am eligible under Division 3 ofthe California Business and Professions Code to accept responsibility for the design identified on this Certificate of Compliance.
• . 1 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.
• iha design features identified on this Certificate of Compliance are consistent with the information 4owmmented on other applicable compliance forms, worksheets,
calculations laps ands ifications submitted to the enforcement age2a for &Eproval with the perrnits lice ' n
Name: Q ^) Signaturo:
Company:
Date:
7-1
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Address:C
2 -3r
citylStetclLip: J
License:/
lea-�
I C`2 2�
Phone:
S -�
LUUS Kesidential Compliance Forms March 2010
Bin #
City 0f Quinl.Q
Building 8t Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
1`
Project Address:XP
Owner's Name:
A. P. Number:
Address: kf I la
Legal Description:
Contractor: C
City, ST, Zip:
Telephone: _ '`"'` """ ><::':#•
Address: 12 f
Project Description:
City, ST, Zip:19 f (�a�JO r
Telephone:
State Lie. _#L
City Lie. #c
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone:
n}...v
State Lie. #: isz;::::::!•:.}F::»»;<::::>::<:>i:> >s :>::}>;:..::.
Name of Contact Person:
Construction Type: Occupancy:
'
Pro'
Ject type (circle one): New Add'n Alter Repair Demo
Sq. Ft.: So � # Stories: # Units:
Telephone # of Contact Person:
Estimated Value of Project: O
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 Cneck Deposit
Truss Calcs.
Called Contact Person .
Plan Check Balance
Title 24 Calcs.
Plans picked up
Constmction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
tad Review, ready for corrections/issue
Electra -cal
Subcontactor List
Called Contact Person
Piumting
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-'
Ud Review, ready for correctionslssue .
Develbper Impact Fee
Planning Approval
Called Contact Person
A.I.PP.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees