12-0836 (MECH)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
12-00000836
Property Address:
50825 GRAND TRAVERSE AVE
APN:
770-320-023-23 -25389 -
Application description:
MECHANICAL
Property Zoning:
MEDIUM DENSITY RES
Application valuation:
1200
"`&t�v 4 XP Q"
Applicant: Architect or Engineer:
------------------
LICENSED CONTRACTOR'S DECLARATION
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
I hereby affirm under penalty of perjury th I m 1' nsed under provisions of Chapter 9 (commencing with
Section 7000) of Division 3 of the B ess an rofessionals Code, an my License is in full force and effect.
License Class: C36 C License 'T
896899
Date:O ".S7 Contractor: (/
OWNER -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 itsissuance, 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 ($5001.:
(_ 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 owrier-builder will have the burden of proving that he or she did not build or
improve for the purpose of sale.).
(_ 1 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 Law3.
(_ 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'sName:
Lender's Address:
LQPERMIT
Owner:
ROBERT TICE
50825 GRAND TRAVERSE
LA QUINTA, CA 92253
(
Contractor:
COMPLETE WATER SERVICE
77980 WILDCAT DRIVE, STE #2
PALM DESERT,'CA 92211
(760)972-8068
Lic. No.: 896899
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 7/27/12
3 0 2012 L
M!
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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 oftheLabor
Code, for the performance of the work for which this permit is issued. My workers' compensation
insurance carrier and policy number are:
Carrier UNITED SPC INS Policy Number MW00032824-01
_ 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 a come subject to the workers' compensation laws of California,
and agree that, if I u d bec a subject to the workers' compensation provisions of Section
t 3700 of the Lab Code, I all forthwith comply with th se provisions.
Date:G —Z —t 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 ($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, 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 buil nction, and hereby authorize representatives
of this county to enter upon the above-mentioned pro rty for ' spection purposes.
Date: B%4:signature (Applicant or Agent):
Application Number . . . . . 12-00000836
Permit MECHANICAL
Additional desc .
Permit Fee . . . . 40.50 Plan Check Fee 10.13
Issue Date . . . . Valuation . . . . 0
Expiration Date 1/23/13
Qty Unit Charge Per Extension
BASE FEE 15.00
1.00 9.0000 EA MECH APPL REP/ALT/ADD 9.00
1.00 16.5000 EA MECH B/C >3-15HP/>100K-500KBTU 16..50
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Special Notes and Comments
REPLACE EVAP COIL & CONDENSER PER 2010
CODES.
------------------------------------------------------------------=---------
Other Fees . . . . . . . . . BLDG STDS ADMIN (SB1473) 1.00
Fee summary Charged
Permit Fee Total 40.50
Plan Check Total 10.13
Other Fee Total 1.00
Grand Total 51.63
LQPERMIT
Paid Credited Due
.00 .00 40.50
.00 .00 10.13
.00 .00 1.00
.00 .00 51.63
Simplified Prescriptive Certificate of Compliance: 2008 Residential HVACAlterations CF -IR -ALT -HVAC
Climate Zones 10 to 15
Site ddress: - -
Enforcement Agency:
Date:
Permit #:
J_,
-
c�lwt- 2
7 ' 2 7, -
Conditioned Floor
Eq ui ment Type'
List Minimum Efficiency 2
Duct insulation requirement
Area
Thermostat
❑ Packaged Unit
❑ Furnace
❑ AFUE
❑ COP
Over 40 ft of ducts added or
❑Setback
Indoor Coil
❑SEER_3
❑ HSPF
replaced in unconditioned space
Served by system
(If not already
Condensing Unit
c9r❑
❑ EER
_
❑ Resistance
❑ R 6 (CZ 10-13)
sf
present, must be
Other
❑ R 8 (CZ I4 -I5)
installed)
1. 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 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.
[11. 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
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
❑ 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 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 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)
• 1 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 1 and 6 of the California Code of Regulations.
• The design features identified on this Certificate of Compliance are consistent with the inf ation cumented on oth applicable compliance forms, worksheets,
calcul 'ons, plans ands specifications submitted to the enforcement agency forapproval w th the mitapplication.
Name: l
Signature: 44/
mpany: U ,
Date: -7 Z? ' 7—
8
Address: - 2
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License: n r
9 (p
City/State/Zi t 2I
Phone: 772 -^
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--. l-1 --7-
Bill
BJn. #
of Lel Quin
BuikUng 8T Safety Division
P.O. Box 1504,79-495 Calle Tampico
i.a.Quints, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Pen # ` ,,
N-
Project Address:
Owner's Name:.
A. P. Number
Address:
Legal Description:
City, ST, Zip:
Contractor.Telephone:
(�
Project Description:
Address:
City, ST, Zip:
Telephone:
State Lir. # : V' qAq
Arch., Engr., Designer.
City Lia #; Q I �Q�} 41
Address.
City., ST, Zip:
Telephone:
State Lia #:
Name of Contact Person:
Construction Type:. Occupancy:
Project type (circle one): New Add'n Alter Repair
Sq. Ft.: # Stories: # Unity:
Demo
Telephone # of Contact Person:
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THUS UNE
#
Submittal
Req'd
Recd
TRACMG
PERWTFEES-
Plan Sets
Pian Cheek submitted
Item
Amount
S"Ctum CaIes.
Reviewed, ready for corrections
Plan Check Deposit. .
Truss Cake.
Called Contact Prion
Plan Check Balance
Title 24 CaW6
Plans picked up
Construction
Flood plain plan
Plans resubmitted.'.
Mecharilcal
r 00
Grading plan
2'! Review, ready for corrections/issue
Electrical
Subeontaetor List
Called Contact Person
Plumbing
Grant Deed
Plana #idred up
S.M.I.
H.O.A. Approval
Plaus resubmitted
Grading
IN HOUSE:-
''" Review; ready for eorreetions/issoe .
Developer Impact Fee
Planning Approval.
Called Contact Person
A.%P.P.
Pub. Wks. Appr
Date of permit issue
School Pees
Total Permit Fees
h-