10-0585 (MECH)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 10-00000585
Property Address: 78239 HACIENDA LA QUINTA
APN: 646-280-018- - -
Application description: MECHANICAL
Property Zoning: :LOW DENSITY RESIDENTIAL
Application valuation: 7943
BUILDING &: SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
DELISW.JEFF
7823.9 HACIENDA.LA QUINTA
LA QUINTA, CA 92253
(
--- - - - — — -- - - ---- --- - - - - - - -- - -Contractor:
Applicant: Architect or Engineer: GENERAL.. AIR-CONDITIONING
3,1170"SERVE DRIVE
THOUSAND PALMS, CA 9.2276
(760)343=7:488'
Lic. No.: 606,310
LICENSED CONTRACTOR'S DECLARATION
I hereby'affirm undef penalty of perjury that Iam licensed'under provisions of Chapter 9 (commencing with
Section 7000) of Division 3 of the siness and __Pfofessionala:Code, and my'Ucense is in full forceand.effect.
LlcenseClass: C20 1
686310
Datekir 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,ISec. 7031.5, Business and Professions Code: Any city or county that:requires:a permitto
construct, after,improve, demolish, or repair any structure, prior to itsissuance;:also requires the applicent,for the
permit to file=,a signed statement that he:oi she is licensed pursuaritto the provisions of the,Contractor's State
License'Law; (Chapter 9 (commencing with,Secnon 7000) of Division 3 of -the Business and Professions CodeYor
that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of'Section 7031.5 by
any applicant for apermit subjects the applicant to a civil pantry of not more than five hundred dollars ($500).:
1 _ Y I, asowner 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 (Sep: 7044,.Busino "ss'and.Professions Code: The
Contractors' State -License Law,does°not apply to an owner of property who buildsorimproyes.thereon,
and who'.does the work himself or herself through his or her own employees, provided that:the
improvementaare not, intended oroffered'forsale. If, however„the building or improvement is sold within
one:year-of completion, the owner -builder: will have the.burden of proving_ that he`orshe 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 ownerof
property who builds,or improves thereon, and,who contracts for the'.projects with a contractorls) licensed
pursuant to the Contractors' State License Law:).
(_ I 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
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 6/30/10
WORKER'S COMPENSATION DECLARATION
I hereby affirm:undevpenalty ofperjury one of the following declarations:
_ I have and 'will maintain -a certificate of consent to self -insure forworkers' compensation,es;prov)ded
for bysSeiaion 3700: of the. Labor Code, for. the performance of the work for this permit is
issued.
_ 1 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 PREFERRED-EMPL _ Policy Number - Wk -Ni -2 95355
_ 1 certify that, in the performance of the work for which this permit is, -issued, I shall not ernployany
person.in any manner so as to become subject to the°workers' compensation laws of California,,
and agree that, if l should become subject to the workers' compensation provisions:of'Section
3700 of the Labde; I shall f rthwith com1g;h those;provisions.
1
Date: plicant:
WARNING:, FAILURE TO SECURE WO RS''COMPENSATION'COVERAGE;IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO+ONE HUNDRED THOUSAND
DOLLARS (8100,000):, IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3708 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
APPLICANT ACKNOWLEDGEMENT
IMPORTANT Appiication 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 atiwhose.request and for
whose benefit work is performed, under or pursuant to any permit issued as assault of thWapplication,
the owner, and the applicam,:each agrees to, and shall defend, indemnify and hold harmless the City
of,La Quints, imofficers, agents,and employees foranyaci or omission related to the work being
performed under ;or following issuence.of this permit.
2. Any permit issued as a result of this'applicatlon.becomes null andvoid if work1s,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: 1-agree.to; comply with all
city and countyordinances and state laws.relating t wilding construction, and hereby authorize representative_ s
of th' county to ter upon ,the above-mentioned p rty for inspectionpurpos s -
Dat ignature (Applicant or Agent
' Application Number - ' - ~ ' I0-08000585
Permit . ' `' ' ' MECHANICAL
.
Additional ueao
Permit Fee ' ' ' '
33.00
Plan Check Fee '
' 8'25
' ' . '
Valuation - ' .
' V
oogpiratioo Date ' '
12/27/10
Qty Unit�ez
ioo
-
BASE
FEE
z�'00
1`00, g'OOVO
EK Y0]C8
FURNACE <=100K
9'00
1'00 9'0080
EA &0]CH
o/C <~3Hg/100K B%%J
9'00
----_-------__--- ----_-_----_---- -_------
Special Notes and Conmuento
-----_------------- -----__----
--- -------
-------------- - -B?�\C
OUT SAME SIZE
oaMmLooaTzoN 13 SEER
lI EER'
_---____---__-----__--_---_--__------_-----_------_-_-__----_
` Other Fees ' . ' ' -
_-----_--_----
' ' ' ^ 8I��GGII�; ADMIN (S81473)
_
1`.00 '
� Fee summary Charged
Paid Credited
~--`-^~---
Doe /
----�------�----- -��-------
Permit Fee Total
------^~�^
33.00
----~-----
'VV ,00
i
33'00 '
Plan Check Total
8'25
_00
8-25 !
Other Fee Total
I^OO
.'0.0
'00 '08
L-Oo '
Grand Total
412.25
.00 .00
42.25
4PERMM
Sim li8ed Prescriptive Certificate of Com fiance: 2008 Residential RVACAlteradons CF -1R ALT-HVAQ
Climate Zones 10 to 15
En otc men ency:
Dat
PermitAl.
4 n,
J
Conditioned Floor
Equipment T. e' List Minimum Efficiency2
Duct insulation requirement
Area
Thermostat
0 Pfiekaged Unit
10'�ce ❑ AF
Gr!'In r ❑SEER
COP
❑.HSPF
Over 40 ft of ducts added or
replaced in unconditioned ace
p space
Served b stem
Y s3'
etback
(Ifnot.dready
.Coil
ondensing Unit ❑EER
❑Resistance '
❑ R 6 (CZ 10-13)
sf
present, must be
❑ Other
❑.R 8 (CZ 14-15)
installed)
1. Equipment Type: Choose, the equipment being, installed,• if more than one system, use another CF -I R ALT -HVAC for each system.
2. Minimum Equipment Eftkienciesr 13 SEER, 78%AFUE, 7.7HSP.Ffor 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: a copy,given to th6,homeowner. At4fmal, ,,the -inspector verifies that the work listed on this.form�was in fact the work completed by the
installe a inspector also verifies that each:appropriate CF -6R and registered CF -4R forms.(no hand filled CF-4Rs allowed) are filled out and
si Be nin October 1 2010 a registered copy of the,CF,llt And, CF 6R,shall also be on site for Mal inspection.
1. HVAC Changeout
Required Forms:.
• All HVAC Equipment replaced
CF -6R forms: MECH-041, MECH-2I-HERS and (for split systems) MECH- 25 -HERS
CF4R forms: MECH= 21 and fors lit systems) MECH-25
Coil and/or
• Condenser n a
• Indoor Coil oil
CF -6R forms: MECH-21-HERS and (for split systems) MECH- 25 -HERS
CF4R.forms. MECH-21 and (for split systems) MECH=25
• Furnace
For Split Systems: Duct leakage < 15 percent; RC, CCA2! 300 CFM/ton(Minimum Air Flow Requirement), TMAH
For Packaged. Units: Duct..leakage < 15 percent
Exempted from duct'leakage testing -if-.
❑ 1. Ductsystem was documented to have�been previously sealed and confirmedthrough HERS verification, or
❑ 2. Duct systems with less than 40 linear feet in unconditioned space, or
❑ 3..Existin ;duct systems are.constructed, 'insulated or sealed with asbestos
❑ 2. New HVAC ;System
Required Forms:
• Cut in, or Changeoyt with new
ducts: (all new ducting and all
CF -6R forms: MECH-04, MECH-20-HERS,and (forsplit systems) MECH-22-HERS, and MECH-25-HERS
new -equipment)
CF -4R forms: MECH 20 -,Nand (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 withApplacement
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 .
Re uired,Forms¢
• .Includes adding or.replacing morethan 40
linear feet of duct in unconditioned space.
CF -6R f6rms:.MECH-04, MECH-2I-HERS 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.
• 1•am eligible under Division3.of the California Business and Professions;.Code to accept responsibility for the:design identified on this Certificate ofCompliance..
• I certify that:the energy features and performance specifications for the design identified,onthis Certificate of Compliance conform to the requirements ofTitle 24,
Parts I and 6of the California Code -of Regulations.
• The design features'identif ed onthis Certificate�of Compliance are,consisteni with, the,'information docume d on other applicable•compliance forms, worksheets,
calculatjoa&plansland s ions submitted to the,enforcement.agency fora provali with it apfilightion.
Name:
k MA
Signature:
Company:
Dater
Address: � 1 �1 Jle
` !
License:
I "1
Ci /State7Zi ,
ty p A to . �1. U►-�� a --I In
Phone: - 3
WOO
City of La Quin,ta
Bullog & Safety Dhoon _.
Pem*'# P.O. Box 1504, 78-495 Calle Tampico
f 4 Qulnta, CA 92253 - (760) 777-7012 �
r Building Permit Application and Tracking Sheet
w
Project Address: UA./� Ownec's Name: 5 (�
A P.- Number. Address-7
Legal Description: Cty,,ST, Zip: lL GG
Ain —
Contractor. Telephone. —
Address:. ewof- Project Description:
City. ST, Zip: v . ihQ
Telepboac:7 g� ' D -
M.
State Lic.?)City Lic. #; /
Arch., Bngr., Designer.
Address:
City., ST, Zip:
Telephone: Construetion•Type: Occupancy:
=min=Project
State; Lic. #s type (circle one): New Add'n Aker Repair 'Demo
Name of Contact Person: Sq, Ft- #, i #Units:
��jj
Telepbone#•ofContact Person: � � Estirnated.V.alue.of.Proj "I Li
APPUCANT: DO NOT WRITE. BELOW THIS'UNE
If Submittal Req'd Reed TRACKING ?RRMrr FEES
Plan Sets
Plan Check submitted Item Amount
Structural Cates.
Reviewed, ready for corrections Plan Check Deposit
Truss Cala.
Called.Contact'Person Ylan Check Balance.
Title 24 Cates.
Plans picked, up Construction
Flood plalmplau
Plans;resubmitted Mechanical
Grading plan
20' Review, ready for cor-Mcdonsiluue Electrical
Subcontactor List
Called Contact Person Plumbing
Grant Deed
Plans picked up S.M.I.
H.Q.A. Approval
Plans resubmitted Grading
IN HOUSE:-
Review, ready for correetionsHssue Developer Impact Fee
Planning Approval'
Called:Contact Person A.LP P.
Pub. Wks. Appr
y
Date of permit issue
Total P.ernilt Fees