11-0005 (MECH)! �4
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application. Number! 11-0000,0005
Property Address: 78805 W HARLAND DR
APN: 604-23.2-007-136 -2.3268
Application description: MECHANICAL
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 139.24
I
Architect or. Engineer:
PJ A
LICENSED CONTRACTOR'S DECLARATION
M
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
I hereby affirm under penalty of perjury that I am licensedunder, provisions of Chapter9 (commencing,with
Section 7000) of Division 3 of the Businessland Professionals Code, and my. License is in full'force:,and effect.
License Class: C/20 icense.No:: 595145
Date:. � ` ontractor: ,
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 tothe '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 exempttherefrom,,and the basis =for 'the alleged exemption. AnyNiolation ofSeetion,7031.5 by
any applicant for a permit subjects the applicant;to:a civil penalty of not more tharifive hundred dollars 1$5001::
1 _7
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 througty s or her own employees„provided that the
improvementsare novintende&or offeredforsale. If, however, the building or improvement is sold within
one.year of completion, the owner -builder will have theburden 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•ISec,
7044, Businessa4Professions Code: The Contractors' State License LawAoes not apply to an owner of
property who builds orimproves�thereon, and who contracts for the.. projects with a contractor(sl licensed
pursuant,to,the Contractors” State License Law.),
(_ 1 .(,ani exempt under Sec. ; W&P.C, for this,reason
Date: Owner
CONSTRUCTION LENDING AGENCY
I hereby.affirm under penaltyofperjury that there is 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:,
wj� :iJ:JLiii
Owner:
VIRGIN KIM ALLEN
78805 WEST HARLAND DRIVE
LA QUINTA, CA 92253
Contractor:;
DCS HEATING/AI'R CONDITONNG
72078 CORPORATE WAY, #101
THOUSAND PALMS, CA 92276
(760)343-5566
Lic. No.: 595145
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 1/03/11
WORKER'S COMPENSATION'DECIARATION
I hereby affirm under penalty of perjury one ofthe following:declaratiortsr
I have. and will maintain a.certificate of consent iorself4nsure for workers' compensation, as provided
for by Section; 3700:of the Labor Code, for the'performance,of the:work for which;this permTis
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 HARTFORD INS Policy Number 72WECLS7.131
_ I certify that, in the performance:of'the work for which this permitis issued, I,shall notempjoy any
person in any manner so as to, become!!subject: to the workers' compensation laws of California,
and agree that, if I should become subject to theworkers' compensation,provisions of Section
1 3700�of th Labor .shall.fI-eorthw' omply: with those provisions.
ate: 1 ,/6 G� , pplicant: - -
WARNING: FAILURE TOSECURE.WORKERS' COMPENSATION COVERAGE IS,UNLAWFUL,.AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES:UP'TO'ONE HUNDRED THOUSAND
DOLLARS (9:100,000). IN ADDITION TO TH&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: an& Safety for -a permit subject -to the
conditions and restrictions set forth on, this application.
1.. Each personupon whose beha(bthis application is made, each 'person at whose request and .for
whose benefit work js.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 Lai Ouinta, its officers, agents and employees for any act or omission related to the work tieing
performed undevor 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 perniit;,or cessation of'work :for 180 days will subject,
permit to cancellation:
I certify that I have readthisapplication and state that the above information is correct. I agree:to,comply with all
'city and county ordinances and state laws relating to building construction,. and hereby authorize representatives -
'county to nte_r`u nthe atiove,mentioned property f9 in pur oses.
ate:ignature (Applicant or,Agent): (//
f _ I;.6.
Application Number . . . 11-0.0000005
Permit. . .
MECHANICAL
Additional desc .
Permit Fee . . . .
40.50
Plan Check Fee
10.13
Issue Date . . . .
Valuation
0
Expiration Date . .
7/02./11
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 5 TON 16
SEER COMPLETE SPLIT.
SYSTEM- 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
.0.0 .00
10.13
Other Fee Total
1.00
.0`0 .00
1..00
Grand Total
51.,63
.0.0 ..00
51.63
LQPERMIT
-- MR,
City of La Quints
itfift-at Safety`'DhWw
P.O: Box 1504, 78=495 Cale Tamploo-
[a (Nfta, .CA.92253 - (760) 777--7012
Buiiding Permit Application and Tracking Sheet
Project Address: � G� �/�Sf- G„ �/ Owne#'sName: ,'" i.r
A.P. Number: Address: We 4
Legal Description: City, ST, Zip:/,q
Cofar101 Telenkone:
Address:
WV S O (
Projekx Doskziption
ox c 5 -4 -en 16 Sttr
city, ST, Zip. . 41-5,
1123-76
It, le
; . s
Telephone: 7
Ong etc, -e
City'I.% #;
Arch, Engr., Desiper,
Address:
City, SP, Zip:
Telephone:
State Lid. #:
Nameof Contact:Person:
((�,. o, „
Construction Type: j/ Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
Sq. Et:: # Stories: # Units:
Telephone#.of Contact Person:
Estimated Value of Project
1'�{
APPLICANT: DO NOT WFdTE BELOW THIS UNE.
# ,
Submittal
RWd
Beed
TRACMG
PERMIT FEES
Plan Sem'
Plan Check submitted
Item
Amount
Structural Cales.
Reviewed, ready for corrections
Plan Check Deposit
Truss Cales.
Called Contact'Person
Pian Check Balance
Mde 24 Calce.
Phins Od ed up
Construction
Flood plain plan
Plans resubmitted
Mechaakxl
Grading,plan
20! Review, ready for eorreetionrliosue
Electrical
Subcontaetor list
Called Contact Person
Plumbing
Grant Dad
Plans packed up
H.O.A. Approval
Pians resubmitted
Grading
IN-HOUSE:-
''a Review, read* for eor ectionaftwe
B"Ooperr Impact Fee
Planning Approval Called Coateet Person A.I.P:P.
Pub., Wks. Appr Date of permlt issue .
'SchoolFees
Fees
Simplified Prescriptive Certificate of Compliance: 2008 Residential HVAC CF -1R -ALT -HVAC
Alterations
Climate Zones 10 - 15
Site Address:
Enforcement,Agency:
Date:
Permit #:
78805 West, Harland dr La Quinta, CA ,92253
City. of La Quinta
]an 3, 2011
Duct insulation
Conditioned Floor
Equipment Typel
List Minimum. Efficiency2
requirement
Area
Thermostat
❑ Package Unit
❑ Furnace
❑ AFUE
❑ COP °
❑ R 6 (CZ
0 Setback
0 Indoor Coil0
Condensing, Unit❑EER
SEER 13.0
ElHSPF
10-13)
❑ R 8 i
Served by system
1500 sf
If not already
present, must, be
0
0 Other Furn Heat Exch
❑ Resistance
1'4-15)
installed)
i. Equ/pment'Type: Choose:the'equipment being installed; if more than one system, ;use -another CF -IR -ALT -HVAC for each system.
2. Minimum Equipment Efflelencles: 13 SEER, 78°x6. 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 -411 forms (no hand filled CF-4Rs allowed) are'filled out and signed.Beginning
October 1, 2010, a registered copy of the. CF -111; and CF -611 shall also be on site for final inspection.;
0 1. HVAC Changeout
Required Forms:;
. All HVAC Equipment
CF -6R forms: MECH=04, MECH-2I-HERS and (for split systems) MECH-25-HERS
replaced
CF -4R forms: MECH-21 and (for split systems) MECH-25
. Condenser Coil and /or
. Indoor Coil and,/or
CF -6R forms: MEC -H-04, MEC -2I -HERS and (for split systems) MEC_ H=25 -HERS.
. Furnace
CF -4R forms: MEC -21 and (for split systems)' MECH-25
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.leagage 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 unconditioned space, or
❑ 3. Exisiing'�ductxsystems are.co strudted-;; insufated-orseal.ed, with -asbestos -- - -?
❑ 2. Nevv HVAC 4Requir
Tormk: V '
System'
, ? ,,
Cut i_ or Changeout
ducts: I)
r 1 J
CF 6Rfiorms;: MECH-04 ME H=20 -HERS,, and (for split sys ems) MECH-22'HERS and'
with new �� �MECH-25-HERS
new ducting and.411 7
j; J I
CF -4R forms: MECH'2. , a d, (for'Splitsystems) MECH- 2ZZ,-and MECM 25_ �- ;' " i.
new equipment), -
Foe! 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
E13. NeW'Ducts with/or without
Required Forms:
Replacement
. Includes replacing or installing all
new ducting and/or outdoor
condensing unit and/or indoor coil
CF -6R forms: MECH-04, MECH;20-HERS, and (for split systems) MECH-25-HERS
and/or furnace. No or some
CF -4R forms: MECH-20 and (for split systems) MECH-25
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
CF -611 forms: MECH'-04, MECH=2I=HERS
unconditioned space.
C04R forms: MECH=21
For split system or packaged units: Duct leakage < 15 percent
E] 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,forthe design identified,on this Certificate of Compliance conform'to
the requirements ofTitle .24, Parts and!i6_ofthe California Code of Regulations.
. The design; features identified on this Certificate of Compliance are conslstent.,W6 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: Chris Brown Signature: Chris grown
Company: D C S HEATING &,AIR CONDITIONING INC Date: ]an 3, 2011
Address: 72-078 CORPORATE WAY STE 101 Ucense: '595145
City/State/Zip: THOUSAND PALMS / CA / 92276 Phone; (760) ,343.5566
Reg;: 211-A0000077A-0:0000000-0000 Registration Date/Time--2011/01/03 121:'44-5,4 HERS Provider: Ca10ERTS, Ina:
2008 ResidenE:ial Compliance Forma July 2010.