11-0933 (MECH)-4- ,
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
11-00000933
Property Address:
52170 AVENIDA HERRERA
APN:
773-224-008-15 -000000-
Application description:
MECHANICAL
Property Zoning:
COVE RESIDENTIAL
Application valuation:
5000
T4'!t 4 XP 4"
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
DEW RICHARD STANLEY
50601 FIRRIDGE AVE
SCAPPOOSE, OR 97056
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 8/30/11
Contractor:
Applicant: Architect or Engineer: AIR EXPERTS AIR CONDITIONG-H D A a
PO BOX 94
LA QUINTA, CA 92247
(760)777-1724 Af1�.
Lic. No.: 725283Ok AUS 3 O 2011
CITY OF !A QUINT,
FINANCE DEPT:
--------------------------------------------------------------------------------------------
ED NTRACTOR'S DECLARATION
I hereby affirm under penalty of perjur at I am li sed under provisions of Chapter 9 (commencing with
Section 70001 of Division 3 of the BLksmess an rofessionals Code, and my License is in full force and effect.
LicensseeryCl ss: 20 License No.: 725283
DD: '( -54 GI D6ntraetor:
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).:
(_) 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 1, 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 (Sec. 3097, Civ. C.).
Lender's Name: _
Lender's Address:
LQPERMIT
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
N issued.
Y"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 GUARD INS GROUP umber PAWC226751
certify that, in the performa 'of the wo for which this permit is issued, I shall not employ any
person in any manner so s to becom ubject to the workers' compensation laws of California;
a d agree that, if I shout become ject to the workers' compensation provisions of Section
00 of the Labor Code, I to
cthwith comply with those provisions.
ate: / A icant:
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.
I . 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 b as null and void if work is not commenced
within 180 days from date of issuance of su permit, r cessation of work for 180 days will subject
_ permit to cancellation.
I certify t t I have read this application and state that t e above in rmation is correct. I agree to comply with all
City
unty rdinances and state laws relating to building co ruction, and hereby authorize representatives
oft 's my enter upon the above-mentioned prope pe oses.
i
Date: gnature (Applicant or Agent):
Application Number . . . . . 11-00000933
Permit . . . MECHANICAL
Additional desc .
Permit Fee . . . . 40.50
Plan Check Fee ,.
10.13
Issue Date . . . .
Valuation
�0
Expiration Date 2/26/12
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
INSTALL NEW HVAC PACKAGE SYSTEM ON ROOF
- NON SCREENED. 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
LQPERMIT
Bin.# , .. ......
City Of Quin r
Building 81 Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit # 3
3
Project Address: '—Z 70
Ile --121449P wner's Name: G
A. P. Number:
Address: Z I % U AvcmWe--e",e /4
Legal Description:
City, ST, Zip: L ( 7225 3
Contractor: I �X�� ' J
Address: Po �a X Cj �-
Telephone:
Project Description:
City, ST, Zip: Z4 Cle,"
9 ZZLi 7
Telephone: G
vl' ' :jlJJ•C' nYN
C— V/\) t
State Lic. # : '7 ZS- 2
Arch., Engr., Designer:
City Lic. #;
Address:
City, ST, Zip:
Telephone:
State Lic. #:
;.: .: Construction an
^� •��' - �?• �' Type: Occupancy:
'ect type (circle circle one New Add'n Alto Repair Demo J )
Name of Contact Person:
Sq. FL: /�,0#
Stories: #Units:
Telephone # of Contact Person:
Estimated Value of Project: d JJ
APPLICANT: DO NOT WRITE BELOW THIS UNE
Nrpubmi.thl,
Req'd
Recd
TRACKING PERMIT FEES
Plan Check submitted Item Amount
Cala.
Reviewed, ready for corrections Plan Check Deposit
cs.
Called Contact Person Plan Check Balance
Title 24 Cala.
Plans picked up Construction
Flood plain plan
Plans resubmitted Mechanical
Grading plan
Z"' Review, ready for correctionslissue Electrical
Subcontattor List
Called Contact Person Plumbing
Grant Deed
Plans picked up S.M.I.
H.O.A. Approval
Plans resubmitted Grading
IN HOUSE:-
Review, ready for corrcctionslissue Developer Impact Ree
Planning Approval
Called Contact Person A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees
Simplified Prescriptive Certificate of Compliance: 2008 Residential HVAC Alterations CF-IR-ALT-HVAC
Climate Zones 10 - 15
Site Address:
Enforcement Agency:
Date:
Permit #:
52-170 Avenida Herarra La Quinta, CA 92253
City of La Quinta
Aug 29, 2011
Duct insulation
Conditioned Floor
Equipment Typei
List Minimum Efficiency2
requirement
Area
Thermostat
0 Package Unit
❑ Furnace
® AFUE 78%
❑ COP
❑ R 6 (CZ 10-13)
Served by system
2 Setback
❑ Indoor Coil
® SEER 13.0
❑ HSPF
❑ R 8 (CZ 14-15)
1600 sf
If not already present, must be
[j Condensing Unit
C] EER
❑ Resistance
installed)
❑ Other
1. Equipment Type: Choose the equipment being installed; if more than one system, use another CF-IR-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-611 shall also be on site for final inspection.
211. HVAC Changeout
Required Forms:
• All HVAC Equipment
CF-611 forms: MECH-04, MECH-2I-HERS
replaced
CF-411 forms: MECH-21 ,Ra (08F split systems) 04EGN 2
• Condenser Coil and /or
CF-611 forms: MECH-04, MECH-21-HERS t3Rd (`-- Split _yStIR) ^_MEG14-25 HERS
• Indoor Coil and /or
-+ �•"- '
CF-4R forms: MECH-21 ,^(c^- split s��^^-�� ^���� -24
• Furnace
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
❑ 4. The;system,will not be Ducted (ie..Ductless Mini-Split System),(Also Exempt from: Refrigerant'Charge)
❑ 2. New HVAC System
Required Forms: w 1 v
. Cut in'or Changeout with
te
t-`
0
new ducts: (all new
ducting and all new
CF-6R forms: MECH-04, MECH- and (for split systems) MECH-22-HERS,. and,MECH-25-HERS
HERS,
CF-4R for`ms: MECH 20, and (for split systems) MECH-22, and MECH 25 ' `" s �✓
I j ,.
%r�
equipment)"_��
�. .� �;/s t
For Split Systems: Duct leakage < 6 percent; RC, CCA >_ 350 CFM/ton, FWD, TMAH, STMS, and either HSPP or PSPP.
For Packaged Units: Dud leakage < 6 percent
❑ 3. New Ducts with/or without
Required Forms:
Replacement
. Includes replacing or installing all new ducting
and/or outdoor condensing unit and/or indoor
CF-611 forms: MECH-04, MECH-20-HERS, and (for split systems) MECH-25-HERS
coil and/or furnace. No or some equipment
CF-4R forms: MECH-20 and (for split systems) MECH-25
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
linear feet of duct in unconditioned space.
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.
• 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.
• 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 information documented on other applicable compliance
forms, worksheets, calculations, plans and specifications submitted to the enforcement agency for approval with the permit application.
Name: Paul Van Vlymen Signature: Paul Van Vlymen
Company: AIR EXPERTS AIR CONDITIONING-HEATING Date: Aug 29, 2011
Address: PO BOX 94 License: 725283
City/State/Zip: LA QUINTA / CA / 92247-0094 Phone: (760) 777-1724
Reg: 211-A0044661A-00000000-0000 Registration Date/Time: 2011/08/29 15:57:57 HERS Provider: Ca10ERTS, Inc.
2008 Residential Compliance Forms July 2010
CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-4R-MECH-21
Duct Leakage Test — Existing Duct System (Page 1 of 2)
Site Address:
52-170 Avenida Herarra, La Quinta CA 92253 ( System
Enforcement Agency:
Permit Number:
1)
City of La Quinta
11933
Enter the Duct System Name or Identification/Tag: System i
Enter the Duct System Location or Area Served: Whole House
Note: Submit one Installation Certificate for each duct system that must demonstrate compliance in the
dwelling.
This installation certificate is required for compliance for alterations and additions in existing dwellings to
space conditioning systems and duct systems.
Note: For existing dwellings, a completely new or replacement duct system can also include existing parts of
the original duct system (e.g., register boots, air handler, coil, plenums, etc.) if those parts are accessible
and they can be sealed. For a completely new or replacement duct system installed in an existing dwelling,
use the Installation Certificate titled "Duct Leakage Test - Completely New or Replacement Duct System. "
Duct Leakage Diagnostic Test - existing duct system
Select one compliance method from the following four choices.
❑ 1. Measured leakage less than 15% of fan flow
❑ 2. Measured leakage to outside less than 10% of Fan Flow
C] 3. Reduce leakage by 60% and conduct smoke and fix all leaks
® 4. Fix all accessible leaks using smoke and HERS rater verify
Note: (One of Options._l, 2, or 3 must be attempted,before,utilizing Option. -A.)_
DeterminenominalFan Flow using one of. -the following three calculation methods.rr (f
✓ ® Cooping system method: Size 4,cor denser in Tons 4 x 400 =1 1600 CFM
✓ ❑ Heating system meth 1.7 x Output Capacity in Thousands of Bt hr = _ CFM_
El Measured system airflow using -RA3.3 airflow test procedures: CFM y
yjb-
Option 1 used then: !
--
Allowed leakage = Fan Flow 1600 x 0.15 = 240 CFM
Actual Leakage-= 336 CFM
Pass if Leakage Actual is less than Allowed
❑
Pass E] Fail
Option 2 used then:
2
Allowed leakage = Fan Flow 1600 x 0.10 = 160 CFM
Actual Leakage to outside = _ CFM
Pass if Leakage Actual is less than Allowed
Pass Fail
Option 3 used then:
Initial leakage prior to start of work = _ CFM
Final leakage after sealing all accessible leaks using smoke test = _ CFM
3
Initial leakage _ - Final leakage _ = Leakage reduction CFM
((Leakage reduction _ / Initial leakage x 100% _ /6 Reduction
Pass if % Reduction > 60%
Pass Fail
Option 4 used then:
4
All accessible leaks repaired using smoke. HERS rater must verify (No sampling). No smoke
allowed to leak from system. Including ducts, plenums, air handler and door panel.
Pass if all accessible leaks have been repaired using smoke
g
Pass Fail
> 4D
E
Reg: 211-A0044661A-M2100001A-M21A Registration Date/Time: 2011/08/31 19:12:33 HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms March 2010
CERTIFICATE OF FIELD VERIFICATION& DIAGNOSTIC TESTING CF-411-MECH-21
Duct Leakage Test - Existing Duct System (Page 2 of 2)
Site Address:
52-170 Avenida Herarra, La Quinta CA 92253 (System
Enforcement Agency:
Permit Number:
.z
City of La Quinta
11933
® Outside air (OA) ducts for Central Fan Integrated (CFI) ventilation systems, shall not be sealed/taped off
during duct leakage testing. CFI OA ducts that utilize controlled motorized dampers, that open only when OA
ventilation is required to meet ASHRAE Standard 62.2, and close when OA ventilation is not required, may
be configured to the closed position during duct leakage testing.
® All Supply and return register boots must beirsealed to the drywall if; smoke test is utilized for, compliance
- applies"to duct leakage.compliance option 3 (leakage reduction by 60%) and option 4 (fix all accessible
leaks) described above�
. r
® New duct installationsscann_ot utilize building cavities as'fplenums or platform returns in lieu of ducts.
® Mastic and draw bands must be used in combination with cloth backed rubber adhesive duct`tape to seal
leaks at all new duct connections
DECLARATION STATEMENT
• I certify under penalty of perjury, under the laws of the State of California, the information provided on this form is true and correct.
• I am the certified HERS rater who performed the verification services identified and reported on this certificate (responsible rater).
• The installed feature, material, component, or manufactured device requiring HERS verification that is identified on this certificate (the
installation) complies with the applicable requirements in Reference Residential Appendices RA2 and RA3 and the requirements specified
on the Certificate(s) of Compliance (CF -111) approved by the local enforcement agency.
• The information reported on applicable sections of the Installation Certificate(s) (CF -611), signed and submitted by the person(s)
responsible for the installation conforms to the requirements specified on the Certificate(s) of Compliance (CF -SR) approved by the
enforcement agency.
Builder or Installer information as shown on the Installation Certificate (CF -6111)
Company Name: (Installing Subcontractor or General Contractor or Builder/Owner)
AIR EXPERTS AIR CONDITIONING -HEATING
Responsible Person's Name:
CSLB License:
Paul Van Vlymen
1725283
HERS Provider Data Registry Information
Sample Group # (if applicable): N/A
Q tested/verified dwelling
❑ not-tested/verified dwelling in
la
HERS sample group
HERS Rater Information CaICERTS Certificate # CCl-1798588189
HERS Rater Company Name:
Air Solutions of the Desert
Responsible Rater's Name:
Responsible Rater's Signature:
Walter W Nellis
Walter W Nellis
Responsible Rater's Certification Number w/ this HERS Provider:
Date Signed: 8/30/2011
CC2004361
Reg: 211-A0044661A-M2100001A-M21A Registration Date/Time: 2011/08/31 19:12:33 HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms March 2010