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11-1152 (MECH)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: 11-00001152 Property Address: 53230 AVENIDA HERRERA APN: 774-054-011-14 -000000- Application description: MECHANICAL Property Zoning: COVE RESIDENTIAL Application valuation: 10785 `may °F4Q" Applicant: I I Architect or Engineer: PIS BUILDING & SAFETY DEPARTMENT BUILDING PERMIT Owner: BACA RUBEN G 53230 AVENIDA HERRERA .�. LA QUINTA, CA 92253 jl VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date:. 10/20/11 tti Contractor: ky__ ESSER AIR CONDITIONING f& GG)'jy cryt�j%>, P.O. BOX 1636 ""%''-'�S F t. CATHEDRAL CITY, CA 9223 (760)324-0550 LiC. No.: 489046 ---------------7--------------------------------------------------------------------------------- LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of pter'9 (commencing with I hereby affirm under penalty of perjury one of the following declarations: Section 7000) of Division 3 of the BusProfession Code y License is in.full force and effect. _ I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided Licens Class: C20 se No.: 489046 for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ate: ntractor• )&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 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 .6, 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 (5500)•: 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.).. (_) 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 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: I 1y��� Lender's Address: I - LQPERMIT insurance carrier and policy number are: Carrier MAINTSTAY BUSNS Policy Number MBS-SIP0051611 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 become subjecJ� thh kers' compensation provisions of Section 3700 of the Lab Code, hall W 14with tho revisions. 0 '14p WARNING: 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. 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 th�erty h formation ' co ct. I agre comply with all. city and county ordinances and state laws relating toding cons uc ' orize representatives o ft is co ty 5t7enter above-mentioned pr f p os Date: f{� Applicant or Agent): Application Number . . . . 11-00001152 Permit . . . MECHANICAL Additional desc . Permit Fee . . . . 40.50 Plan Check Fee 10.13 Issue Date . . . . Valuation . . . . 0 Expiration Date 4/17/12 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 SYSTEM: 4 TON 17 SEER AC/HTG SYSTEM AT SAME LOCATION. 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 'Simi' liftedPrescri.tiye'.Certificateof:Co'm�Iianee:2008Residentia'WYACAlteratitlns. ,'XF4WALT=11VAC,'. I.Climate'Zones.10015 Site Address: 5-�23,� vt:- l`�� M avt�iTR CSA -9225 Enforcement Agency: Date:Permit ?#: IV ,> I I. Conditioned Floor Equipment T t List Minimum Efficiency' Duct insulation requirement Area Thermostat ❑ Packaged Unit ❑ Furnace ❑ AFUE ❑ COP Over 40 ft of ducts added or Setback ' ❑ Indoor Coil (SEER HSPF q -o replaced in unconditioned space Served by system (if not alWe _d;___ �CCondensing Unit !� Outet-A i— K&14)� G3,EER 14-• i v ❑Resistance ❑ R 6 (CZ 10-13) GLou sf present, must be ❑ R gCZ 14-15) Installed/ (-J 1. Equipment Type: Choose the equipment being installed: if more than ore system,'use another CF -1 R -ALT -HVAC for each system. 2. Minimum Equipment Efficiencies: 13 SEER, 78916 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 CF4R forms (no hand filled CF4Rs allowed) are filled out and si ed. Beginning October 1 2010 a registered copy of the CF -1R and CF -611 shall also be on site for final Inspection. 1. HVAC Changeout Required Forms: • All HVAC Equipment replaced CF-61(forms: MECH-04, MECH-2I-HERS and (for split systems) MECH- 25 -HERS CF -4R forms: MECH- 21 and for split stems MECH-25 • Condenser Coil and /or • indoor Coil and /or CF -6R forms: MECH-2I-HERS and (for split systems) MECH- 25 -HERS CF -411 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 Fxempted 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: (all new ducting and all CF -41K 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, SIMS, 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 CF4R 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 -6R forms: MECH-04, MECH-2I-HERS CF4R forms: MECH-21 linear feet of duct in unconditioned space. For split system or packaged units: Duct leakage < 15 percent ❑ EXCEPTION: ExisUng ducts stems constructed insulated or sealed with asbestos. Contractor (Documentation Author's /Responsible Designer's Declaration Statement) • I certiN, 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 cen ifi• 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. • i'hr .le.ign 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 wi it aPIRKLio Name: ��¢�t ,� �A W S Signature Company: c`7AA-0t f.F /,v e-. Date: Date: I If Address3G!` �. License: a4 ity/State/7.ip�'� ?_ � - 22� k Phone: �63 Zt{- 2008 Residential Compliance Forms March 2010 Bin t' Qty Qf-�--QCiint�-- - - - - - - Building a Safety Division P.O. Boy. 1504, 78-495 Calle Tampico La Quints, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet LL� Project Address:j 3 2 "}J �V �. G �,Q Owner's Name: 5+ P9 4+- Eyt-e—k A- P. Number. Address: r 3 '� 3 v /+J ,..,r - (L/1 - Legal Description: City, ST, Zip: LA Contractor: 3- kV i L' ES // C . � Telephone: ' Address: ��% . $ vX l 3 t! Project Description:, R- A19 c�- fH g 'rSTe City, ST, Zip: Ci4-1r1t -D 9Ac CI -TY, (A, `1 z 2 5 s �l ► �(r1 � /� tc/ c � c�7 c?� JL � � 1-{��nu �i Telephone: 76 - :51 4. Ci °i .SG '�'� g? � 2N 6, (J1COJ ` State Lic. # : City Lic. M. Lo Cf<` a ,�✓ Arch., Engr., Designer. Address: City., ST, Zip: Telephone: ``. .=, r> r Construction Type: ype. Otxupancy. State Lic. #: A"" 3 yC`s� Project circle one New Add'n Alter Repair Demo Name of Contact Person: DA V t D W i t_ I- lA M Sq. Ft : #Stories: # Units: Telephone # of Contact Person: %(� © Estimated Value of Project: APPLICANT: DO NOT WRITE BELOW THIS UNE # Submittal Req'd Reed TRACKING PERMIT FEES Plan Sets Plan Check submitted Item Amount Structural Calcs. Reviewed, ready for corrections Plan Check Deposit Truss Calcs. Called Contact Person Plan Check Balance Title 24 Calcs. Plans picked up Construction Flood plain plan Plans resubmitted Mechanical Grading plan 2" Review, ready for correctionslissue Electrical Subcoutaetor List Called Contact Person Plumbing Grant Deed Plans picked cep S.M.L II.O.A. Approval Plans resubmitted Grading IN HOUSE-- Review, ready for eorrectionsrissue Developer Impact Fee Planning Approval Called Contact Person A.LP.P. Pub. Wks. Appr Date of permit issue School Fees Total Permit Fees ....4.11