11-0480 (MECH)4 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: 5/09/11
Application Number: 11-00000480 Owner:
Property Address: 80298 HERMITAGE CLARK GILSON
APN: 762-230-023- - - 80298 HERMIT -1, Q
Application description: MECHANICAL LA QUINTA, - - 253
Property Zoning: LOW DENSITY RESIDENTIAL (� q
Application valuation: 10743 ' m 09 2�1�
Contractor: C LAf�U�N7A
Applicant: Architect or Engineer: GENERAL AIR C NDITI�I2iC����s�
31170 RESERVE DRIVE plpl.
THOUSAND PALMS, CA 92276
(760)343-7488
\\�( Lic. No.: 686310
er�
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LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I amjicensed under provisions of Chapter 9 (commencing with
Section 7000) of Division 3 of the Business and iofessionals Code, and my License is in full force and effect.
License Class: C20 j License No.: 686310
ate: 5A / I ` Cont r. —1
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 _ 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.).
(_ 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 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 ISec. 3097, Civ. C.)•
Lender's Name: I It
//��'
Lender's Address: 14 r
LQPERMIT
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the following declarations:
_ 1 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 t�lbecome 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 s, 11 forthwith comply with those provisions.
t1a e: `� % A ant:
WARNING: FAIL RE TO SECURE RKE S' 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. �1
I certify that I have read this application and state that the abovd information is correct. I agree to comply with all
city and county ordinances and state laws relating to building c' struction, and hereby authorize representatives
of this county to enter upon th bove-mentioned property for i rpectio purposes.
ate: nature (Applicant or Agent):
L
LQPERMIT
Application Number . . . 11-00000480
Permit . . .
MECHANICAL
Additional desc .
Permit Fee . . . .
40.50
Plan Check Fee
10.13
Issue Date . . . .
Valuation . . . .
0
Expiration Date
11/05/11
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
HVAC CHANGE -OUT, NEW
FURNACE, CONDENSER,
13 SEER, & 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
Sim lified Prescri tive Certificate of Compliance:- 2008.Residential HVA C Alterations CF -IR -ALT -HVAC_'
Climate Zones 10 to 15
Site Address:
PermJ:_
Enforcement Agency:
Date:(9
Permit #:
Conditioned Floor
Equipment T et
List Minimum Efficiency?
Duct insulation requirement
Area
- Thermostat
❑ Packaged Unit
g,Furnor
❑ AFUE0'013 �o
❑ COP
Over 40 ft of ducts added or
Setback
door Coil
❑SEER 13
❑ HSPF
replaced in unconditioned space
p. P
Served b system
Y Y
(!f"not already
�kondensingUnit
❑EER / /
_
❑Resistance
❑ R 6 (CZ 10-13)
❑ R 8 (CZ 14-/5)
sf
present, must be
installed)
C3 Other
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 mast 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
ed. Beginning October 1, 201.0, a registered co of the CF -112 and CF -6R shall also be on site for final inspection.
. HVAC Changeout .
it,
Required Forms:
• All HVAC Equipment replaced
CF -6R forms: MECH-04, MECH-2l-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 duct systems are constructed, insulated or sealed with asbestos
112. 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 egdipment 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 Califomia Business and Professions Code to accept responsibility for the design identified on this Certificate of Compliance.
• 1 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 " onn, tion documented on other 1pph ompliance forms, worksheets,
calculations, plans andspecifications submitted to the enforcement a enc fora ro al ivith t e ennit a lication.
Name: S��
Sig ture:
Company:
Date:
Address:
�
'License'.-
License`. 1o8�3�v
[5i-ty/State/Zip:—r—A_D��� p�LMZ� G� G���7�
,1---748T
Phone: -7&0-3Itj
CaICERTS.- CF=1R Registration
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Rater Directory
Forms80298 HERMITAGE
Site Address: La Quinta, CA 92253
Mcmbcnhiplicncsts CEC Registration: 211-A0022138A-00000000-0000
Events CF -IR -ALT -HVAC: CLICK HERE TO DOWNLOAD
induury At"ners Assigned Company: HARRISON ENTERPRISES INC
N,— Do you know your HERS.Rater?
To register for our If you do, you may want to send this CF -1R to them.
monthly
newsletter, please CaICERTS.Rater ID:
click here. OR
My Rater Quick Select: [Energy Driven Solutions, Inc.
Every CaICERTS rater has a license number.
/fyou need to find the rater by name [Click HERE] to search our directory.
10 SEND CF 1RT0 HERS,t2ATERA
[CLICK HERE] to do another
Copy'rit*.ht b`• ^_OI O.CaICERSS, Inc. All rights reserved. Revised:.tanuary I I. ^_010
[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-R8k, (877-437-7787)
Fax: 916-985-3402 Contact Us
'®T
BBB �Futd u3 on Facebaak®�
Bin #
'Permit #
r
Project Address: 909cl
O
City Of La Quinta
Building w Safety Division ,
P.O. Box 1504,78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012.
Building Permit Application and. Tracking Sheet
14erm Owner's Name:
A. P. Number:
Address: 9'0;Lc1 P i"evx t
Legal Description:
City, ST, Zip: 9�
Contractor:;>;
Telephone: ��,(� ;•>y:�
-•„ `sf
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Address: 3
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Project Description:
City, ST, Zip:
ILI
Telephone.-76�,r;::;,.;,..:.::::.,;,•,.:
4 .y n •.49:.Y'4+}n.''<�Ji:��`vry �1:. vvi:•�:�':
:,r,,,. ..
State Lic. # :
3
City Lic. #;
Arch., Engr., Designer:
Address:
City., ST, Zip:
.
Telephone:'
State Lic. #:
^fir.alb*':;'%;`.fF•��$:t'..'t:'a',;;:;J:?:.:`:;.;�r {:
;•</>,' •�;<'C'� ,.;�;.<.� r:� F;::-.
j�.N+�f'S�j.<Y`�:'`f{..`'1'S{�lvFiiv�{'..
:_res s<.
-
Construction Type: Occupancy:
project type (circle one): New'Add'n After Repair Demo'
Name of Contact -Person:
Sq. FL:
# Stories:
# Units:
Telephone # of Contact Person:
Estimated Value of Project: '16 743 '
APPLICANT: DO. NOT WRITE. BELOW THIS LINE
#
Submittal
Plan Sets
Req'd
Recd
TRACKING PERMIT FEES
Plan Check 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 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:-
'"' Reyiew,.ready for corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
' School Fees
Total Permit Fees