10-0354 (MECH)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application description:
Property Zoning:
Application valuation:
Applicant:
10-00000354
54945 AVENIDA HERRERA
774-302-024-10 -000000-
MECHANICAL
COVE RESIDENTIAL
10000
T-4bt 4 4 Q"
Architect or Engineer:
10
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
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 andf4ofessionals Code, and my License is in full force and effect.
License Class: C201� License No.: 595145
Date: L - J1_tQontractor. 4-1`'
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).:
(_ I 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 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
1 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
Owner:
YOUNG LESLIE
54-945 AVENIDA HERRERA
LA QUINTA, CA 92253
Contractor:
DCS HEATING/AIR CON
72078 CORPORATE WAY
THOUSAND PALMS, CA
(760)343-5566
Lic- No.: 595145
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 4/23/10
APR 23 2010 I ,
LA
WORKER'S COMPENSATION DECLARATION
rherl nder alty of perjury one of thefollowing declarations:
e and ' 1 maintain a certificate of consent to self -insure for workers' compensation, as provided
or by Sec on 3700 of theLabor Code, for the performance of the work for which this permit is
sued.ve and wi maintain workers' compensation insurance, as required by Section 3700 of the Labor
ode-fo he performance of the work for which this permit is issued. My workers' compensation
sura a carrier and policy number are:
INS Policy Number 72WECLS7131
ertify 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 beco a subject to the workers' compensation provisions of Section
N37/i0/10 of the Labor Code I sh I orthwith comply with those provisions.
Date: 1, ��" Applicant:
WARNING: FAILURE TO SECURE W RS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS ($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 formation is correct. I agree to comply with all
city and county ordinances and state laws relating to building c uction, an hereby authorize representatives
of thig c�unDt op ef/tQ(upon the above-mentioned prope y for section poses.
Date: Signature (Applicant or Agent):
Application Number . . 10-00000354
Permit . . . MECHANICAL
Additional desc . .
Permit Fee . . . .28.50 Plan Check Fee
7.13
Issue Date . . . . Valuation
0
Expiration Date . . 10/20/10
Qty Unit Charge Per
Extension
BASE FEE
15.00
1.00 4.5000 EA MECH VENT INST/ DUCT ALT
4.50
1.00 9.0000 EA MECH APPL REP/ALT/ADD
9.00
----------------------------------------------------------------------------
Special Notes and Comments
HVAC -CHANGE OUT [570N PACKAGED UNIT]
ROOF MOUNTED MECHANICAL EQUIPMENT SHALL
BE SCREENED PER LQMC SECTION 9.60.140
(B)1 - 2007 CALIFORNIA MECHANICAL CODE.
April 23, 2010 1:04:46 PM AORTEGA
----------------------------------------------------------------------------
Other Fees . . . . . . . . . BLDG STDS ADMIN (SB1473)
1.00
Fee summary Charged Paid Credited
----------------------------------------
Due
-'----------------
Permit Fee Total 28.50 .00 .00
28.5.0
Plan Check Total 7.13 .00 .00
7.13
Other Fee Total 1.00 .00 .00
1.00
Grand Total 36.63 .00 .00
36.63
LQPERMIT
Simplified Prescriptive Certificate of Compliance: 2008 Residential HVACAIterations CF -IR -ALT -HVAC
Climate Zones 10 to 15
Site Address: 6-yjC(6_A.
Enforcement Ais
ency:
Da
Permit #:
e
L g
1423 VW
to• ns
Conditioned Floor
E Ment Type
List Minimum Efficiency Z
Duct insulation requirement
Area
The ostat
ackaged Unit
❑ Furnace
❑FUE
❑COP
Over 40 ft of ducts added or
etback
❑ Indoor Coil
R_�
❑ HSPF
replaced in unconditioned space
❑ R 6 (CZ 10-1)
Served by system
5- sf
(If not already
present, mast be
❑ Condensing Unit
ER 1
❑ Resistance
❑ R 8 (CZ 14-I5)
installed)
❑ Other
1. Equipment Type: Choose the equipment being installed; if more than one system, use another CF -/R -ALT -HVAC for each system.
2. Minimum Equipment Efficiencies: 13 SEER, 78%AFUE, 7.7HSPFfor 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
sign Be innin October 1, 2010, a registered copy of the CF -1R and CF -6R 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
• Indoor Coil and/or
CF -6R -.
forms: MECH-2I-HERS and (for split systems) MECH s _
'
CF -4R forms: MECH- 21 and (for split systems) MECH-25 ='
• Fumace
For Split Systems: Duct leakage < 15 percent; RC, CCA >_ 300 CFM/ton(Minimum Air it(nW)
For Packaged Units: Duct leakage < 15 percentpEPT• '
& SAFEN
gt11Lp�NG
Exempted from duct leakage testing if.
ED
01. Duct system was documented to have been previously sealed and confirmed through RS v pFlOV
❑ 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: J
• Cut in Chang with new
CF -6R forms: MECH-04, MECH-20-HERS,and (for split s It an ECH-25-HERS..
(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 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 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.
• 1 am eligible under Division 3 of the Cali fomia 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 information documented on other applicable compliance forms, worksheets,
calculations, plans and specifications submitted to the enforcement agency for approval with t4ne uapplication.
Name: 1c_-,� +ft(`1.y�
Signature:
Company:vc� ♦ r
Date:
Address:/ ,
License:
6 V_3
City/State/Zip: G a?
Phone: '7(,o Y 3- s $I6
2008 Residential Compliance Forms March 2010
Bin #
City of La Quinta
Building 8r Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
,, �, [
ld' d3bq
Project Address: S l
�S.—
Owner's Name:
A. P. Number:
6`11L(5 -Address: A-0<—
-0tLegal
LegalDescription:
City, ST, Zip:
Contractor: G� V
Telephone: `N �
eP �,�„ r
Address � O fi(jf�0
ject Description:
City, ST, Zip:
Telephone: ?
f.:• y >
City Lic. #:
State Lic. # : `j S� S
Arch., Engr., Designer:
Address:
City., ST, Zip:
Telephone: M
State Lic. #: `n
Name of Contact Person: ��i S^✓� ' �(1 �✓�,� "�
Construction Type: Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
Sq. Ft.: # Stories: # Units.
Telephone # of Contact Person: % — �
Estimated Value of Project: Q Q b p
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Plan Sets
Req'd
Recd
TRACING PERMIT FEES
Plan Check submitted Item Amount
Structural Caics
Reviewed, ready for corrections Plan Check Deposit
Truss Cales.
Called Contact Person Plan Cheek Balance.
Title 24 Cala.
Plans picked up Construction
Flood plain plan
Plans resubmitted Mechanical j t1
Grading plan
2" Review, ready for corrections issue Electrical ^
Subcontactor List
Called Contact Person hoPlumbing .---
Grant Deed
Plans picked up S.M.1. ~
H.O.A. Approval
Plans resubmitted Grading
IN HOUSE:-
''' Review, ready for correctionstissuc Developer Impact Fee ~'
Planning Approval
Called Contact Person A.I.P.P.
Pub. Wks. Appr
Date ofermit issue wry
P
School Fees
Total Permit Fees �p...
CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING CF-4R-MECH-21
Duct Leakage Test — Existing Duct System (Pagel of 2)
Site Address: I Enforcement Agency: Permit Number:
54945 Avenida Herrera,La Quinta,CA92253 City of La Quinta 10-0000354
Enter the Duct System Name or Identification/Tag:
Enter the Duct System Location or Area Served:
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 sy5temil-11.
Select one compliance method from the followingtfo` TQUh i!&V`
Option 1. Measured leakage less than 15%hof FanL'4, inflow
Option 2. Measured leakage to outsile s thn.10 /o of Farrmt�irlow
.�`1�fl
3. 60%
Option Reduce leakage by �more�,Dan� -conduct smoke test to seal all accessible leaks.
®Option 4. Fix all accessible leaks usin -smoke test, an�RS rate verify.
\
Note: (Option 1 must be attempted before.utilizin Optio„n 4)/
Determine nominal Fan Airflow using one ,of the-following,three cadulation methods.
system method: Size of condenser inNTon( `� `x = CFM
ooling
EIeating system method: 21.7 x ) eatti'ng Output Capacity (kBtuh) = CFM
Ekeasured system airflow using RA3.3 airflow test procedures: CFM
6 0�
Option 1 used then:
—
Allowed leakage = Airflow
_. 0!
15C—_
CFM
1
Actual leakage =
��FM�
Pass d
Actual leaks
a is les
s than All leaks a
Pas _ Fail
Option 2 used then:
Allowed leakage = Fan Airflow x 0.10 = CFM
2
Actual leakage to outside = CFM
Cassnail
Pass if Actual leakage to outside is less than Allowed leakage
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% = % Reduction
5assEail
Pass if % Reduction > 60%
Option 4 used then:
All accessible leaks repaired using smoke test. HERS rater must verify (No sampling).
4
Pass if all accessible leaks have been sealed using Smoke Test
as ail
Registration Number: 110-79166559-0107-1-MECH21 Registration Date/Time: 07/13/2010 17:31 HERS Provider: CHEERS
CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING CF-4R-MECH-21
Duct Leakage Test — Existing Duct System (Page 2 of 2)
Site Address: Enforcement Agency: Permit Number:
54945 Avenida Herrera,La Quinta,CA92253 City of La Quints 10-0000354
❑ Outside air (OA) ducts for Central Fan Integrated
leakage testing. CFI OA ducts that utilize controlled
meet ASHRAE Standard 62.2, and close when OA 1
during duct leakage testing.
❑ All supply and return register boots ;nu`st be seale
'A
duct leakage compliance option 3 (leakage-reducti�on
❑ New duct installations cannot utilizefbuii int �ca
❑ Mastic and draw bands must be used
duct connections.
DECLARATION STATEMENT `—
• I certify under penalty of perjury, under the
ventilation systems, shall not be sealed/taped off during duct
i mpers, that open only when OA ventilation is required to
ortxks not gequired, may be configured to the closed position
e yw Q if'"sm(5ke test is utilized for compliance — applies to
■6'0+%')wandoptto 4 (fix all accessible leaks) described above.
s as �1 s ora form returns in lieu of ducts.
with chbacke��rubber adhesive duct tape to seal leaks at all new
State of Cal'ifok,4, the information provided on this form is true and correct.
I am the certified HERS rater who performed the'verificafion,'sery ces'ide`ntified and reported on this certificate (responsible rater).
The installed feature, material, component, or manufacted.�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 -1R) approved by the local enforcement agency.
The information reported o a liaab a secti s the"tall docate CF- R)'gnetl=�a'nd submitted by the person(s)
responsible for the install 'ot�Cn ono tot reff
uire tints pe io th Ce i ActeO o Compliance (CF -IR) approved by the
enforcement P
Builder or Installer informs i0n-a Wbw on Q I tallfition a ificale C R
Company Name: (Installing Subcontra&tor or General I Contractor r Builder/ wner)
DCS Heating & Air Conditioning, Inc.
Responsible Person's Name:
CSLB License:
Buff Brown
595145
HERS Provider Data Registry Information
Sample Group # (if applicable): ested/ver.fied dwelling not-tested/verified dwelling
__
1 in a HERS sample group
HERS Rater Information
HERS. Rater Company Name:
Energy Driven Solutions Inc.
Responsible Rater's Name
Responsible Rater's Signature
Dave Bricker
Dave Bricker(Signature on File)
Responsible Rater's Certification Number w/ this HERS Provider:
Date Signed:
CCN99380828
7/13/2010
Registration Number: 110-79166559-0107-1-MECH21 Registration Date/Time: 07/13/2010 17:31 HERS Provider: CHEERS