11-0384 (MECH)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
c&t!t °F4Q"
Application Number: 11-00600384,
Property Address: '_44120'G6LDENROD CIR
APN: 604-081-005-97 -22982 -
Application description: MECHANICAL
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 8235
Applicant: �� Architect or Engineer:
PIA
LICENSED CONTRACTOR'S DECLARATION
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
I hereby affirm under penalty of perjury that I am licens under provisions of Chapter 9 (commencing with
Section 7000) of Division 3 of the Business and Profes nals Code, and my License is in full force and effect.
Lic a Class: C20 License No.: 686310
Date: � �1 S / t\� ntractor:
.GVN -BUILDER DECLARATION
I hereby affirm under penalty'of perjury that I am exempt 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.). -
(_) 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. 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:
LEDERMAN JEFFREY A
44120 GOLDENROD CIRCLE
LA QUINTA, CA 92253
Contractor:
GENERAL AIR CONDITIONING
31170 RESERVE DRIVE
THOUSAND PALMS, CA 92276
(760)343-7488
Lic. No.: 686310
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS.(760) 777-7153
Date: 4/15/11
_D n
APR 15 2011 E.
CITY OF LA QUINTA
F04ANCE DEPT.
------------------
WORKER'S COMPENSATION DECLARATION
I 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 EVEREST NATL Policy Number 7600006147101
_ 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 to becomubject to the workers' compensation laws of California,
and agree that, if I should becomes j ct to the workers' compensation provisions of Section
3700 of the Labor Code, I shall fort ith'comply with those provisions.
ate: IIS/ 11 Appli nt: '
WARNING: FAILUR 0 SECURE WORK S' C PENSATION COVERAGE 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 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, of cessation of work for 180 days will subject
permit to cancellation.
I certify that I have read this application and state that the above infor ion is correct. I agree to comply with all
city'?d county ordinances and state laws relating to building constru i n, and hereby authorize representatives
of is county to enter upon the above-mentioned property for inspec purposes.
Date: 4 5 nature (Applicant or Agent):
Application Number . . . . . 11-00000384
Permit MECHANICAL
Additional desc
Permit Fee . . . . 40.50
Plan Check Fee
10.13
Issue Date . . . .
Valuation . . . .
0
Expiration Date 10/12/11
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
Special Notes and.Comments
INSTALL NEW HVAC SYSTEM, FURNACE,
13
SEER CONDENSER & INDOOR COIL..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
Sim lifted Prescriptive Certificate of Compliance:- 2008 Residential'HVACAlterations CF -IR -ALT -HVAC
Climate Zones 10 to 15
Site Address:
Enjor ement etuy:
Date:
*q 4_8
Permit k:
Conditioned Floor
E ui ment Type'
List Minimum Efficiency Z
Duct insulation requirement
Area
Thermostat
❑ Packaged Unit
Pomace
❑ AFUE 80%
❑ COP
Over 40 ft of ducts added or
XSetback
indoor Coil
❑SEER 13
❑ HSPF
replaced in unconditioned space
Served by system
Ufnot already
ondensing Unit
❑EER ! /
❑Resistance
❑ R 6 (CZ 10-13)
❑ R 8 (CZ 14-! i)
s
present, must be
Installed)
❑ Other
1. Equipment Type: Choose the equipment being installed: if more than une system, use another CF-/R-ALT-HVACfor each system.
2. Minim tint Equipment Efficiencies: 13 SEER, 78%,4FUE, 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
si ed. Beginning October 1, 2010, a re istered copy of the CF -IR and CF -611 shall also be on site for final inspection.
L 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
CF -4R Forms: MECH- 21 and (for split systems) MECH-25
• Furnace
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.
❑ I. 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
CF -6R forms: MECH-04, MECH-20-HERS,and (for split systems) MECH-22-HERS, and MECH-25-HERS
ducts: (all new ducting and all
CF -4R forms: MECH 20-, and (for split systems) MECH-22, and MECH 25
new equipment)
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 leakage < 6 percent
❑ 4. New Due I ting over 40 feet
Required Forms:
• Includes adding or replacing more than 40
CF -6R forms: MECH-04, MECH-2I-HERS CF -4R forms: MECH-21
linear feet of duct in unconditioned space.
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 I and 6 of the California Code of Regulations.
• -rhe design features identified on this Certificate of Compliance are consistent with the ' orm tion documented on other ppli ompliancc forms, worksheets,
calculations, plans ands specifications submitted to the enforcement a enc fora ro al with t e permit application.
Name: Co I(eeil Uja-;(-,Sdsl
Sig ture:
Company: P y: 67&rier&J 41'r Gonda f .`0,10 t
Date: :4
Address:
License: 684,310
ty/State/Zip: r�4u�SGl�xe� �GC.LV►�S. G
LC
Phone: 760-3IV3--74911
CaICERTS - CF -1.R Registration Page 1. of 1-
***IMPORTANT NOTICE*** Server Upgrade DID NOT occur. We will be rescheduling the upgrade soon: We apologize for any'
rrmw� t,
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. . y ro '•�, � ' s � r=te a �, � _ � 'E�c �
a r ' s �f:Y 4%%#i!/} � Jdl{'.iz nlli �inC► %R zTrl -Prol ider
Home Danielle. Garcia logged in [Logout)
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ntwut us CONGRATULATIONS ,
Tnt".'tnfi Your CF -1 R -ALT -HVAC Registration is complete!
You may want to print this page for your records.
ltycer Diaeiorq
Forms 44120 GOLDENROD CIRCLE
Site Address: La Quinta, CA 92253
CEC Registration: 211-A0018616A-00000000-0000
Events CF -IR -ALT -HVAC: CLICK HERE TO DOWNLOAD
r"aut�yrz�t�n Assigned Company: HARRISON ENTERPRISES INC
rr« Do you, know your HERS Rater?
To register for our If you do, you may want to send this CF=1 R to them.
monthly
newsletter, please CaICERTS Rater ID:
click here. OR _
MY Rater Quick Select:j Energy Driven Solutions, Inc. or
Every CalCERTS.rater has a license number.
if you need to find the rater by name [Click; HERE] to search our directory.
SENDlCF 1R T,QHERSRATER
[CLICK HERE] to do another
Copyright,,O 2010 CalCERTS, Inc. All rights reserved. Revised: January 11, 2010
[Terms and Conditions] [Privacy Statement] [Class Cancellation Policy]
CaICERTS, Inc., 31 Natoma St Suite 120' Folsom, CA 95630
Office: 916-985-3400,Toll. Free: 877-HERS-R8R, (8777437-7787)
Fax: 916-985-3402 Contact Us
f
B®BFmt1 us uri Facebook®
https:Hvvww.calcer.t§.com/public_cfl R.cfm?project_id=108894 4/.14/2011
nm tt Qty of LA Quil to
Building U Safety Division
'Permit # P.O. Box 15.04, 78-495 Calle Tampico
La Quanta, CA 92253 - (760). 777-7012
\� Building, Permit Application and. Tracking Sheet
Project Address: f� L f �D. 60 ld,o jr oce Owner's Name:
A. P. Number:
Address: O �GQ�N FDG f N�P✓
Legal Description:
City, ST, Zip:
Contractor:y
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Project Description:
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City Lic. #:
Arch., Engr., Designer:
Address:
City., ST, Zip:
Telephone:'
State Lic. #:
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Yrw`%>�yki,<i:•r,��'4�'i'<•,�vli''G,y;„,Y�f�•.,vvvf%�'k'/„:^r�}:t4c�f�f,''.+onstruction
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type: occupancy:
Pro ect a circle one New AMP Alter Repair 'Demo!
:I type � )�
Name of Contact'Person:
Sq. Ft.:
#ston'e's: #Units:
Telephone # of Contact Person:
Estimated Value of Project. �s•
APPLICANT: DO. NOT WRITE. BELOW THIS LINE
#
Submittal
Req'd
Rec'•d
TRACIUNG PERMIT FEES
Plan Check submitted Item Amount
Plan Sets
Structural Cales.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance .
Title 24 Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
20' Review, ready for corrections/issue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up.
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
'rd Reyiew,.ready for corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.I?..
Pub. Wks. Appr
Date of permit issue
School. Fees
Total Permit Fees