12-0840 (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:
12-00000840
53235 AVENIDA VILLA
774-063-024-12 -00001
MECHANICAL
COVE RESIDENTIAL
12437
Architect (
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
VOICE (760) 777-7012
FAX (760) 777-7011
•INSPECTIONS (760) 777-7153
Date: 7/36/12
Owner:
MILLER IKUKO
53235 AVENIDA VILLA .
LA QUINTA, CA 92253
Contractor:
GENERAL AIR CONDITIONING
31170 RESERVE DRIVE
THOUSAND PALMS, CA 92276
(760)343-7488
Lic. No.:'686310
LICENSED CONTRACTOR'S DECLARATION
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury that I am I sed 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 Pr ssionals 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
' •
Da, _ te: '760 .Coni t`%i -
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.•
O NER-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 Z071741501
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 r 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 su ct 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 sub je o 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 forth wit compl 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: 'Appli6ent:_
(_ ) I, as owner of the property, or my employees with wages as their sole compensation, will do the .work, and
_J
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
(_) 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 Protesslons Code: The Cunuactws' 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
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,
(_) 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
Date:. Owner:
V .
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:
r
LQPERMIT
of La Qwnta, its officers, agents and employees for any act or omission related to the work Deng
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 per it, 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. I agree to comply with all -
city and county ordinances and state laws relating to buildin nstruction, and hereby authorize representatives
of this county to enter upon the above-mentioned property inspection purposes.
t
App lication.Number 12-00000840
Permit . . MECHANICAL
Additional desc .
Permit Fee 40.50 Plan Check Fee
10.13
' Issue'Date Valuation...
0
Expiration Date 1/26/13
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-50,0KBTU
16.50..
--------------------------------------------------------------------------
Special Notes and Comments
HVAC CONDENSER & FURNACE INDOOR COIL
UNIT 13 SEER 4 TON CHANGE OUT 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
" LQMRMIT '. -
Simplified Prescriptive Certificate of Compliance: 2008 Residential HVAC Alterations CF -IR -ALT -HVAC
Climate Zones 10 - 15
Site Address:
Enforcement Agency:
Date:
Permit #:
53235 AVENIDA VILLA La Quinta, CA 92253
City of La Quinta
Jul 27, 2012
Equipment Typel
List Minimum Efficient 2
Duct insulation
reguirgment
Conditioned Floor
Area
JbPrrnnct-;%j*
❑ Package Unit
® Furnace
® Indoor Coil
® AFUE 78%
® SEER 13.0
❑ COP®Setback
[1HSPF
❑ R 6'(CZ 10-13)
Served by system
not already present, must be
® Condensing Unit
❑ EER —
Resistance—
❑ R 8 CZ 14 -IS
( )
�.� sf
in
installed)
❑ Other
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, 7.7HSPF for typical residential systems.
HERS VERIFICATION SUMMARY Listed below are FOUR HVAC alteration Options. The installer decrdes 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 -IR
and CF -6R shall also be on site for final inspection.
® 1. HVAC Changeout
Required Forms:
. All HVAC Equipment
CF -611 forms: MECH-04, MECH-2I-HERS and (for split systems) MECH-25-HERS
replaced
CF411 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
For Split Systems: Dud leakage" X15 percent; RC, CCA <_ 300 CFM/ton (Minimum Air Flow Requirement), TMAH
Exempted from dud leaksa testinif:
P 9 9�; .
❑ L—Duct system -Was docume`n�fed to have been previously sealed and confirmed through HERS verification, or
2. Duct systems with less than!.40 linear feet in unconditioned space, or
p 3. Existing dud systems are constructed, insulated or sealed with asbestos
❑"4. The systemill not be Dui (ie,,Ductless Mi niYSplit�System)a(Also-Exempt from 2fri Brant Charge)
❑ 2. NeoVAC`System
Required1Eorms "" �r Y.kl
".
e Cut Irtfot;Changeout with'
new du`ct5 ,(all new
CF 6 forms CH-04MCH 2 HERS ancf' fors lits tems� MECH �2 HERS end
.. , A y )
MECHhf25HERS
dude g all new
equipment) t
CF 4R forms MECH 20, nd Cfor tors Its stem) MECH 2 , and MECH=2� a
al
For Split Systems. Duct leakage < 6`pe ent,kRC; CCAIz 350 CFM/ton; FWD; TMAIi, STMS, and-`eltiertJ_ISPP or`PSW
For.Packaged Units Duct leakage <?6 percent'
❑ 3 New Ducts with/or withod .:
Required Forms:
Replace eat m,.,•
.Includes replacing or installing.Alghew
ducting and/or outdoor conden$ing--unit
and/or indoor coil and/or furnaceNo or some
CF -6R forms: MECH-04, MECH-20-HERS, and (for split systems) MECH-25-HERS
CF -4R forms: MECH-20 and (for split systems) MECH-25
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
CF -6R 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. -
and performance specifications for the design identified on this Certificate of Czmpliance 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: Danielle Garcia -_.Signature:-Danielle-Garcia— - ---• ----- -
Company: HARRISON ENTERPRISES INC Date: Jul 27, 2012. -
Address: 31-170 RESERVE DRIVE STE A L.cense: 686310
City/State/Zip: THOUSAND PALMS/ CA / 92276 — - Pnone: (760) 343-7488—
Reg: 212-A0040481A-00000000-0000 Registration-Date/Time: 2012/07/27 20:06:26 HERS Provider:-Ca10ERTS; Inc.
I^^Q Resid 1 C 1'
en t'
is omp lance Forms July 2010
Bln. #
.. .
Cray. Of La Qutnta
Building 8L Safety Division
P.O. Box 1504,78-495 Calle Tampico
Lo.Quinta, CA 92253 -:(760) 777-7012
Building Permit ApplicationSheet' and Tracking
Permit # .
p
-L D�o
Project Address: 5313 . •/ p lv'eW a `
Owner's Name:.. KV b M ►'�/1
A- P. Number. 3 2.
Address:
Legal Description:
City, ST, Zip:
Contractor. ��x�`
Telephone:
Address: _ 10 F \ r.
Pmject Description
W 1a
--
-City,
City, ST, Zip: •—f
Z
E,
Telephone:( -7601,-34
State Lic. # : b a ' 3 City Lia #:
Arch, Engr., Designer
Address:
City, ST; Zip:
Telephone:.
State Lic. #: '`'
Name of Contact Person:
Construction Type:. 'Occupancy:
Project type (circle one): New AdTn Alter Repair Demo
Sq. Ft.:'
# Stories: ,�
#Units:
Telephone # of Contact Person:
Estimated Value of Project: 2
APPLICANT: DO NOT WRITE BELOW THIS UNE
# Submittal Req'd Recd TRACMG PERMIT FEES
Plan sets
Plan Check submitted
Item Amount
Strgcturat Cales.
Reviewed, ready for corrections
Plan Ch.ck Deposit, .
Truss C21cs.
Called Contact Person
Plan Chtck Balance •
Title 24 Calcs.
Pians picked up
Contra -don
Flood plain plan
Plans resubmitted.' ,
Mechati�eal . .
Grading plan
2'! Review, ready for corrections/issue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
SALL
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
'^` Review, ready for corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees