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P.O. BOX 1504^� VOICE (760) 777-7012
78-495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 3/06/13
Application Number: 13-00000239 Owner:
Property Address:-5&15t"� GRAND TRAVERSE AVE SCHRIEBLE
APN: - LA QUINTA, CA 92253
Application description: MECHANICAL —np-32,0 0 C (
Property Zoning: MEDIUM DENSITY RES
Application valuation: 12216
Contractor: 1 .
Applicant: 'Architect or Engineer: ONE HOUR A/C & HTG W
3030 MYERS STREET
RIVERSIDE, CA 92503
(951)276-9744
` Lic. No.: 878533,-
C�N
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with
Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect.
License Class: C20 LicenseNo.; 878533
Date: ?2 ontractor:
WNER-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 dr 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, 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 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.I.
Lender's Name:
Lender's Address: 1_
e
LQPERDIIT
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 INS CO OF WEST Policy Number WVE502266100
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 become subject to the workers' compensation laws of California,
and agree that, if I should become subject to the workers' compensation provisions of Section
3700 of the Labor Code, I shall forthwith comply with those provisions.
Date: Applicant: -
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS 1$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,
z 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 above information is correct. I agree to comply with all
city and county ordinances and state laws relating to building construction, and hereby authorize representatives
of this county to
to enter upon the above-mentioned property for inspe urposes.
Date: 7"1TtIbP Signature (Applicant or Agent):
Application Number . . . . . 13-00000239
Permit . . . MECHANICAL
Additional desc . .
Permit Fee . . . . 64.00
Plan Check Fee
16.00
Issue Date
Valuation . . .
. 0
Expiration Date 9/02/13
Qty Unit Charge Per
Extension
BASE
FEE
15.00
2.00 9.0000 EA MECH
FURNACE <=100K
18.00
2.00 9.0000 EA MECH
B/C <=3HP/100K BTU
18.00
2.00 6.5000 EA MECH
OTHER MECH EQUIPMENT
13.00
----------------------------------------------------------------------------
Special Notes and Comments
REPLACE 2 COMPLETE SYSTEMS 2-60,000 BTU
FURNACES, 2-3 TON COILS, 2 -3 -TON
A/C
UNITS, SAME LOCATION. 2010 CODES.
-------=--------------------------------------------------------------------
Other Fees . . . ... . . . . BLDG STDS ADMIN (SB1473)
1.00
Fee summary Charged
-------------------------------------
Paid Credited
--------------------
Due
Permit.Fee Total 64.00
.00 .00
64.00
Plan Check Total 16.00
.00 .00
16.00.
Other Fee Total 1.00
.00 .00
1.00
Grand Total 81.00
.00 .00
81.00
LQFEIIAIIT
Bin .#
City. of U. Qulhta
Building & Safety Division
P.O. Box 1SO4,"78-495 Calle Tampico
La.Quinta, CA 92233 -:(760) 777-7012
Building Permit Application" and Tracking Sheet
Permit #
(�
Project Address:! ��
Owner's Name:. jn
A. P. Number. '1116_ 0'3D
Address:
Legal Description:
City, ST, Zip, -CA Ol�S3
Contractor.
�a �v
Telephone:
Address:
Project Description:y� a�
City, ST, Zip-., NI
Telephanea>=j� = l
t#N
i�i� C �State
Lic. # : [
a } l
Arch., Engr., Designer
Address:
City., ST, Zip:
Telephone:
y
State Lie. #:���> _ "f
�:�..., q..• _. _�; � " ,r
Name of Contact Person:
Construction Type;.Occupancy:
Project.type (circle one): New Add'n Alter Repair Demo •
Sq. Ft.: #• Stories: J # U dtp:
Telephone # of Contact Person:
Estimated Value of Project: l a
APPLICANT: DO NOT WRITE BELOW THIS UNE
H
Submittal
Req'd
Recd
TRACKING
PERMIT FEES"
Plan Sets
Plan Cheek submitted
Item Amount
Structural Cates.
Reviewed, ready for corrections
Plan Check Deposit. .
Truss Cates.
Called Contact Person
Plan Check Balance
Title 24 Cates. '
Plans picked up
Construction "
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2`! Review, ready for correctionsfissue
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 correetionsAssue
Developer Impact Fee
Planning Approval
Called Contact Person
Pub. Wks. Appr '
Date of penult issue
School Fees
Total Permit Fees
Simplified Prescriptive Certificate of Compliance: 2008 Residential HVA C Alterations CF -IR -ALT -HVAC
Climate Zones 10 to 15
Site Address: 50685 Grand Traverse Ave
Enforcement Agency:e,o�OvInm
Date: 3-6-2013
Permit#:
Conditioned Floor
Equipment T e'
List Minimum Efficiency 2
Duct insulation requirement
Area
Thermostat
x
Packaged Unit
Furnace
El AFUE 80%
® COP
Over 40 ft of ducts added or
E] Setback
Indoor Coil
BEERta
HSPF
®
laced in unconditioned space
R 6 (CZ 10-13)
ffj
Served by system
zaoo sf
1 nor already
present, must he
x
Condensing Unit
[]EER
Resistance
_
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, 7.7HSPF 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 -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.
E] 1. HVAC Changeout
Required Forms:
• All HVAC Equipment replaced
CF-611forms: 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
CF -6R forms: MECH-2I-HERS and (for split systems) MECH- 25 -HERS
• Indoor Coil and/or
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:
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 ducts stems 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
Ej 3. New Ducts with/or without 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 coil
CF -4R forms: MECH-20 and (for split systems) MECH-25
and/or furnace. No or some equipment changed.
For Split Systems: Duct leakage < 6 percent, RC, CCA > 300 CFM/ton, TMAH
For Packaged Units: Duct leakage < 6 percent
'ff4. New Ducting 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 s stem or packaged units: Duct leakage < 15 percent
Fj 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.
• 1 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.
• The design features identified on this Certificate of Compliance are consistent with the information documented on other applicable compliance forms, worksheets,
calculations, plans andspecifications submitted to the enforcement a ency for approval with the permit application.
Name:Jane Recktenwald
Signature:
Company: Dial One's One Hour
Date: 3-6-2013
Address: 3030 Myers Street
License: 878533
City/State/Zip: Riverside, CA 92503
Phone: 951-276-9744
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