12-0124 (MECH)P.O. BOX 1504 4
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Application Number: C 12-00000124 Owner:
Property Address: 80298 HERMITAGE CLARK GILSON
APN: 762-230-023- - - 80298 HERMITAGE
Application description: MECHANICAL LA QUINTA, CA 92253
Property Zoning: LOW DENSITY RESIDENTIAL V.
Application valuation: 20000 �
® � ` \Contractor:
Applicant: Architect or Engineer: , ,; 9ENERAL AIR CONDITIONING
31170 RESERVE DRIVE
THOUSAND PALMS, CA 92276
5"r (760) 343-7488
Lic. No. • 686310
------------------
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 Profe oonals Code, and my License is in full force and effect.
Licens CIass: C20 License No.: 686310
ate: ?/ � Z tractor:
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, 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 contractors) licensed
pursuant to the Contractors' State License Law.).
( ) 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: 4K
LQPERMIT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
---------- -------
WORKER.S COMPENSATION DECLARATION
Date: 2/09/12 ,•
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 ZENITH INS CO Policy Number Z071741501
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 beco a subject to the workers' compensation laws of California, .
and agree that, if I should become bject to the workers' compensation provisions of Section
3700 of the Labor Code, 1 shall fo with c ply with those provisions.
9 iZ pplicant:
WARNING: FAILURE TO SECURE WO RS'- MPENSATION 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.
APPUCANT 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 certify that I have read this application and state that the kcuction,
n is correct. I agree to comply with all
city and county ordinances and state laws relating to buildiand hereby authorize representatives
of�this county to eenterr,uupon the above-mentioned property rposes.
Date: 2 (7 Ii nature (Applicant or Agent):
Application Number . . . . . 12-00000124
Permit . . . MECHANICAL
Additional desc .
Permit Fee . . . . 66.00
Plan Check Fee
16.50
Issue Date . . . .
Valuation . . . .
0
Expiration Date 8/07/12
..Qty Unit Charge Per
Extension
BASE
FEE
15.00
2.00 9.0000 EA MECH
FURNACE <=100K
18.00
2.00 16.5000 EA MECH
B/C >3-15HP/>100K-S00KBTU
33.00
----------------------------------------------------------------------------
Special Notes and Comments
HVAC ADDITION: 2 SPLIT SYSTEMS,
FURNACES
INDOOR COILS & CONDENSING UNITS AT
GROUND LEVEL. 2010 CODES.
- ----------------------------------------------------------------------------
-Other Fees . . . . . ... . . BLDG STDS ADMIN.(SB1473)
1.00
Fee summary Charged
-------------------------------------
Paid Credited
--------------------
Due
Permit Fee Total 66.00
.00 .00
66.00
Plan Check Total 16.50
:00 .00
16.50
Other Fee Total 1.00
.00 .00
1.00
Grand Total 83.50
.00 ..00
83.50
LQPERMIT
Sim lified Prescri tive Certificate of Com liance: 2008 Residential HVACAlterations CF -IR -ALT -HVAC
Climate Zones 10 to 15
Site Address:
Enforcement Agency:
Date: Q �Z
Permit 4:
V
Conditioned Floor
Equipment T el
List Minimum Efficiency 2
Duct insulation requirement
Area
Thennostat
❑ ackaged Unit
�Ftrnace
Adoor
�AFUE 80%
❑ COP
Over 40 ft of ducts added or
Setback
Coil
[EER l 3
❑ HSPF _
replaced in unconditioned space
❑ 6
Served by system
2,000
(/f nor already
muss be
IV Condensing Unit
C+}' ER / /
13 Resistance
R (CZ -13J
13 R 8 (CZ 1 144-15)
sf
present,
installed)
C3 Other
].Equipment Type: Choose the equipment being installed; if snore than one system, use another CF- l R-ALT-HVACfor each system.
2. Minimum Equipment Efficiencies: 13 SEER, 78% AFUE, 7.7KSPF 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
si ed. Beginning October 1, 201.0, a registered copy of the CF -IR and CF -6R shall •also be on site for final inspection.
1. HVAC Changeout
Required Forms:
sAll HVAC Equipment replaced
CF -6R forms: MECH-04, MECH-2I-HERS and (for split.systems) MECH-.25-HERS _ _.• __ .� __
CF4R forms: CH -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: (a)1 new ducting and all
CF -41Z 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 -611 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.
• 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 1 and 6 of the California Code of Regulations.
• The design features identified on this Certificate of Compliance are consistent with the • orm tion documented on other pylic ompliance forms, worksheets,
calculations, plans ands specifications submitted to the enforcement age nc fora roal with t e ermit a lication.
Name: Co i(een WaA-4;S611
Si ture:
Company: , ,
t�en>°r�c.( A�r r Gond ¢-,ort,
Date: Z
Address: 31/70 12eserve_,9rrt✓e,
License:
�8�3rb
[-Ci(Y—IstatelZip:—r—A-o,,.,6a^-,t k � , G,} Gr
Phone: 760..343_.-74ffP
Sim �lified Prescri tive Certificate of.Com liance:.2008 Residential HVACAIterations CF -IR -ALT -HVAC`
Climate Zones 10 to 15
Site Address: g , A Qr � i
L(� V
Enforcement Agency:
Date;Z) 2
Permit #:
Conditioned Floor
Equipment T et
List Minimum Efficiency'
Duct insulation requirement
Area
Thermostat
❑ ckaged Unit
r `mace
9" FUE8o%
❑COP
Over 40 ft of ducts added or
replaced in unconditioned space
Served y system
Setback
(IJ'not already
door Coil
�ER ! 3
❑ HSPF _
C3R 6 (CZ 10-13)
0� sf
present, mus! he
Condensing Unit
ER 1/
❑ Resistance
❑ R 8 (CZ 14-/5)
installed)
❑ Other
1. Equipment Type: Choose the equipment being installed: if more than one system, use another CF -1 R-ALT-HVACfor 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 CF4Rs allowed) are filled out and
si ed. Beginning October 1, 2010, a registered copy of the CF -IR and CF -611 shall also be on site for final inspection.
1. 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 s: Changeout with new CF -6R forms: MECH-04, MECH-20-HERS,and (for split systems) MECH-22-HERS, and MECH-25-HERS
ducts: (alal l 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 percerit; 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
linear feet of duct in unconditioned space.
CF -6R forms: MECH-04, MECH-2I-HERS CF -4R forms: MECH-21
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 orle
tion documented on other pylic otnpliance forms, worksheets,
calculations, plans ands specifications submitted to the enforcement agency fora roal with permit application.
Name: Co Iteen U)o-*,sdn
Si lure:
Company:
Gen,er�( A-• r Cond.� fi`on t`
Date:
I�-
Address: 31170 l2eSet't/e �/ tt ✓�
License: 6606,310
ki ty/State/Zip: G�n Pa,(—fn-5, 61q 9JA-7r,
Phone: 7/0_3'Y13"%4Ek
2008 Residential Compliance Forms March 2010
CaICERTS. - CF' -1R Registration Page 1 of 1A
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CONGRATULATIONS
Your CF -1 R -ALT -HVAC Registration is complete!
You may want to print this page for your records.
Site Address:
80298 HERMITAGE (SYS 1)
Quinta, CA 92253
CEC Registration: 212-A0007071A-00000000-0000
CF -IR -ALT -HVAC: CLICK HERE TO DOWNLOAD
Assigned Company_1HARRISON ENTERPRISES INC
Do you know your HERS Rater?
If you do, you may want to send this CF -1 R to them.
CaICERTS Rater ID:
OR
My Rater Quick Select: ;_Energy Driven Solutions, Inc.
Every CaICERTS rater has a license number.
Ifyou need to find the rater by name [Click HERE] to search our directory.
`� SEND CF }RTO HERS RATER °
[CLICK HERE] to do another
Copyright4201O Ca10ER.TS, Inc. All rights reserved. Revised: January 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 -R811, (877-437-7787)
Fax: 916-985-3402 Contact Us
A�
BBBa"�o�;FacebopkQ
https://www.calcerts.com/public_cfl R.cfin?project_id=167001 2/8/2012
Ca10E�I'-:CF.-1R:Registration Page l of:1
Public Horne
Secure Home
About Us
Training
Rater Directory
Forms
Membership Benefits
Events
Industry Partners
News
To register for our
monthly
newsletter, please
click here.
CEC
.Danielle Garcia logged in [Logout]
[Home]
CONGRATULATIONS
Your CF -1 R -ALT -HVAC Registration is complete!
You may want to print this page for your records.
y
Site Address: 80298 HERMITAGE (SYS 2)
La Q•uinta, CA 92253
Registration: 2 l 2-A0007072A-00000000-0000
CF-IR-ALT-HVAC:ICLICK HERE TO DOWNLOAD
Assigned Company:IHARRISON ENTERPRISES INC
Do you know your HERS Rater?
If you do, you may want to send this CF- iR to them.
CaICERTS Rater ID:
OR
My Rater Quick Select:'; Energy Driven Solutions, Inc_.
Every CaICERTS rater has a license number.
Ifyou need to find the rater by name Click HERE to search our directory.
" `" g§END CF 1,R -,TO IiERS:Ri4TER"�
[CLICK HERE] to do another
Copyright.,,^_010 CaICERTS, hrc. All riahis reserved. Revised: January I I. 1--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 -118F, (877-437-7787)
Fax: 916-985-3402 Contact Us
https://www.calcerts.com/public—cflR.cfin?project—id=167002 2/8/2012
Bin #
.0ty Of La Quin to
Building 81: Safety.Mlon
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit. Application and.Tracing Sheet
'Permit y
1 oi�► •
Project Address: 2 Q Npr�� tqp Owner's Name: C lar K CII 5D, f)
A. P. Number: Address: LN? q QY YY1 f Gl �Q
Legal Description: City, ST, Zip: L, QUint (1A 22-53
• Telephoner (
Address: Project Description: WU AV 'Repldwm 2—
City,
City, ST, Zip: ~VNQQ / 7sput 6
eMS• ()U�oto r Unifis. an.
V
Telephoae: O
'�' '6: fes: ; 'h! `
<r.%�:s'%''°;t,"•'sl , Y vnd• Y s�t�m
State Lic. # : 3 City Lic. #; Cod �o
Arch., Engr., Designer:
Address:
r;ty ST lip. ... .. , , .. . _.. .
Telephone:. ; t : x Y Construction Type: Occupancy:
State Lic. #:'project type (circle one): New Add'n Alter Repair Demo
Name of Contact Person: cc)��� � �a_-65 0YU Sq. Ft.: # Stories: #Units :
Telephone # of Contact Person: - Estimated Value of Project-, D.00.0 • 00
APPLICANT: DO. NOT WRITE. BELOW THIS LINE
# Submittal Req'd RWd TRACMG PERMIT FEES
Plan Sets Plan Check submitted Item Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Cales.
Called Contact Person
flan Check Balance.
'title 24 Calcs.
Plans picked up
Ciinstrucdon
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2rt° 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
''d Review,.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