10-0414 (MECH).q
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
T4ht 4 4 Q"
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Application Number:
10-000:0.0414
Property Address:
C8-06 HERMITAGE
APN:
762-210-030- - -
Application description:
MECHANICAL
Property Zoning:
LOW DENSITY RESIDENTIAL
Application valuation:
1142
Applicant: Architect or Engineer:
------------------
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 an rofessio Is Code, and my License is in full force and effect.
License Class: C20 License No.: 794315
Date: -i I r� Contractor:—'
-ontractor: A—
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 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 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 perjurythat 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
Owner:
HARRIS MARSHALL E
80622 HERMITAGE
LA QUINTA, CA 92253
(
Contractor:
DOVE AIR INC
69749 RISUENO ROAD
CATHEDRAL CITY, CA 92234
(760)327-1890
Lic. No.: 794315
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 5/11/10
E `�`1 22 2010
C;rly" , F N `A
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 EXEMPT Policy Number EXEMPT
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 su ' ct to the workers' compensation provisions of Section
T_
37`00 of the Labor Cod I all fort ith comply with those provisions.
-- J ,`- !'`/ V Applicant: ---o
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$100,0001. 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 building constructio , and hereby authorize representatives
of this co�ntyto enter upon the above-mentioned propert f inspec ' purposes.
CDate: _ _ // ' V � Signatuie.(Applicant or Agentl:' `% _
b
Application Number . . . . . 10-00000414
Permit . .
. MECHANICAL
Additional desc .
Permit Fee
21.50
Plan Check Fee
5.38 _
Issue Date . . .
.
Valuation . . .
. 0
Expiration Date
11/07/10
Qty Unit Charge Per
Extension
BASE
FEE
15.00
1.00 6.5000
EA MECH
AH <=10K CFM
6.50
-------------------------------
Special Notes and
---------------------------------------------
Comments
REPLACE LIKE FOR
LIKE 4 TON EVAP
COIL.
- ---------------------------------
Other Fees .
. . . . . . BLDG STDS ADMIN (SB1473)
1.00
Fee summary
-----------------
Charged
--------------------
Paid Credited
--------------------
Due _
Permit Fee Total
21.50
.00 .00
21.50
Plan Check Total
5.38
.00 .00
5.38
Other Fee Total
1.00
.00 .00
1.00
Grand Total.
27.88
.00 .00
27.88
LQPERMIT
,I
Simplified Prescri tivvCertifiieate:of-Com Bance: 2008 Residential HVAC Alterations CF4R4LT.-HVAC
Climate. Zones : 0 to 15.
br
Site Address:
Enforcement Agency:
Date:
1
Permit #:
Cr
Conditioned Floor
Equipment T et List Minimum Effieienc 2
Duct insulation re tiirement
Area
Thermostat
❑ Packaged Unit
❑ Furnace ❑ AFUE
❑;COP
A
Over 40 ft.of ducts added or
❑ Setback
t�lndoor Coil ❑SEER
❑ H.SPF
replaced in unconditioned space
Served by. system
(if not already
❑ Condensing Unit ❑ EER
❑Resistance
❑ R 6 (CZ 10-13)
sf
present, must be
13 Other
❑ R 8 (CZ /4-/5)
installed)
1. Equipment Type: Choose the equipment being installed,• f more than one.system, use another CF-/R-ALT-HVACfor each system.
2. Minimum Equipment E clencies: 13 SEER, 78% AFU. .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'Jnspedtor 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 co ..:of the CF -111 and CF -6I1 shall also be on site for final inspection.
01: HVAC•Changeout
Required.Eorms:
• 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-2'5
w 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 2:300 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. Existin "ducts stems are constructed; insulated or seated with asbestos
0 2. New HVAC System
Required-Forinc
• Cut in or Changeout with new
ducts: (all new ducting and all
.CF -6R forms:: MECH-04, MECH-20=HERSiand.(for split systems) MECH-22-HERS, and MECH-25-HERS.
new equipment)
CF -4R forms: MECH 20-, and (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 with Replacement
Required Forms:
• includes replacing or installing all new ducting
CF=.6R forms: MECH-04, MECH-26-HERS,and (for split systems) MECH-25-HERS
and/or outdoor condensing unit and/or indoor
C174R-.f6rms: MECH-20 and (for split systems) MECH-25
coil and/or furnace. Not all equipment changed..
F.or Split Systems:. Duct leakage < 6 percent, RC,;CCA>_ 3.00 CFM/ton, TMAH
For.Packa ed Units -.'Duct leakage < 6 percent
134.. New Ducting over 40 feet
Re aired Forms:
• Includes adding or replacing more. than 40
CF -6R forms: MECH-04, MECH-2I;-HERS CF -411 forms: MECH-21
linear feet of duct in unconditioned.space.
For split system or packaged units: Duct -leakage < 15 percent
❑_ EXCEPTION: Existin .ducts stems constructed; insulated or sealed with asbestos.. .
Contractor (Documentation Author's %Responsilli 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 Complianceconform 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 inforniationtdocumented on.other applicable compliance forms, worksheets,
calculations, plans andspecifications submitted to the enforcement agency for approval with t emit appliQe.on.
Name:r Y
Signature:
Company:
Date:
e co
Address: Q —7 s C ^
�Q fL
License: q
/
kity/State/Zip: a C� •
Phone: a �� _ 4
2008 Residential Compliance Forms March 2010
aci .:ci .v V rvry o: is a•nn a+a �uicica cuiiva.n y r.�ai �.y .. WJVVi!vvi
Bin !f
City 90 lea Quii nta
Building ez Safety Division
P.O. Box 1$04, 78-495 Calle Tampico
La Quints, CA 92253- (760). 777-7012
Building Permit Application and Tracking, Sheet .
Permit #
'Project Address: b
Owner's Name:
A. P. Number:
/
Address: 061Ac M I +Legal
Description:
City, ST, Zip: 3Cunuactor_
g-�i• A
;1_7,
Telcphoue?kAddress;
YrojectDeseription: L:
4ILO ' �_
6 '- I,t"t_In
^/Z�j-•
City, ST, Zip: 00,46-O�`Rk. e `- teQ
((e .
Telephone- W 0 3a� - $�. o
�, 6% ? 5,
State Lic. # 743 7 . City L'io. #: 03.5 1
elrch., Engr., Designer:
Addnzs:
City, Sf, 'Lip:
elephune:
;tate Lic. #:
Constriction Type; Occupancy-.
Project type (circle one): New Add'. Alter .Repair Demo
Name of Contact Person: F c s.-� „ I \ G r t'S
Sq. Ft.:
#Stories: 4 Units:
'Telephone # of Contact Person:
/
Estimited Value of Project:.
APPLICANT. D0. NO.T WNTE BELOW THIS UNE
ti
Submittal
R 'd
Recd
TRACIMG .
PERMIT FEES
Plan Sets
Puri Check submitted
Itew Amount
Structural Cal cs .
Reviewed, ready for corrections
Pian Check Deposit
Tress Cala.
Called Contact Person
Plan Check 1521s.ace
Energy Coles.
plans picked up
Constriction
Flood plain plan .
Plans mubmitted
Meehanieai
Grading.plaw
V RevleR, ready for correctionslissat
Elcetrkal
Subcoutactor List
.'
Calitd Coutact Pelson
Plumbing
Grant Deed'
Plans picked up
SM i
IMA. Approval
Plses resubuiiited'
Cradidg
IN HOUSE:-
'"' Rtview, ready for correctionslissue
Developer Impact Fee
Planning Approval
Called C'ontaet person
Pub. Wks. Appr
Date of permit issec
School Fees
—
Total Permit Fees