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12-0927 (MECH)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: r Property Address: APN: Application description: Property Zoning: Application valuation: A....r.. . 12-00000927 55215 FIRESTONE 775 -151 -021 - MECHANICAL LOW DENSITY RESIDENTIAL 4000 Architect or Engineer: PIP 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 and Professionals Code, and my License is in full force and effect. /cense Clas : 20 License No.: 364956 ate: ontracto 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 contractors) 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: IAK" Lender's Address: r LQPERMIT Owner: HEATHER GREEDEN 55215 FIRESTONE LA QUINTA, CA 92253 Contractor: D ACS AIR CONDITIO P O BOX 5428 LA QUINTA, CA 9 24 (760)641-6517 Lic. No.: 364956_ VOICE (760) 777-7012 FAX (760) 777-7011, INSPECTIONS (760) 777-7153 Date: 8/15/12 SERVICALISE 12 IL) CITY 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 shouKsubec, jtothe workers' compensation provisions of Section 00 of the Lab ahwit comply with those provisions. pate: plicam: 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 that the above information is correct. I agree to comply with all city and county rd' antes and state laws relating to buildin rnaE' n�andhere �, authorize representatives of th' countyerupon the above-mentione ins/p iSn Oat.: nature (Applicant or Agent)• / Application Number . . . . 12-00000927 Permit . . . MECHANICAL Additional desc . Permit Fee . . . . 40.50 Plan Check Fee 10.13 Issue Date . . . . Valuation 0 Expiration Date 2/11/13 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 ---------------- Notes and Comments HVAC CHANGE -OUT: 4 TON SYSTEM, FURNACE, CONDENSER, EVAPORATOR COIL. 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 Y Dill" City of La Quinta Building 8t Safety Division P.O. Box 1504, 78-495 Calle Tampico ' La Quinta, CA 92253 - (760) 777-7012 Build in g Permit Application and Tracking Sheet Permit # j� � Project Address: r� 1kowner's Name: c,: e_r', A A. P. Number: Address: AA Legal Description: City, ST, Zip: Contractor: . C. ele hone: p Address: r Project Descripti J ci— City, ST, Zip: Tele h n 0 P . 1 �Effy State Lic. #: City Lic. #: Arch., Engr., Designer: Address: City, ST, Zip: Telephone: : Construction Type: e Occupancy: State Lic. #: Project type (circle one): New Add'n Alter Repair Demo Name of Contact Person: Sq. Ft.: # Stories: # Units: Telephone # of Contact Person - Estimated Value of Project:±z J APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Req'd Recd TRACKING PERMIT FEES Pian 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 corrections/issue Electrical Subcontactor List Called Contact Person Plumbing Grant Deed Plans picked up S.111.1. H.O.A. Approval Plans resubmitted Grading IN HOUSE:- ''" Review, ready for correctionstissue Developer Impact Fee Planning Approval Called Contact Person A.I.P.P. Pub. Wks. Appr Date of permit issue School Fees Total Permit Fees Sinn lifieti' Prescriptive,Ci rtificafe of Cofnpliance:'2008 Reside'nlial'HVA.Cl2eralions : ` CF=TR-ALT-HVAC Climate Zones 001S. -- Site Address: I— Enforcement Agrney: Date: �j Permit #: 2008 Residential Compliance Forms March 2010 Conditioned Floor Equipment T r List Minimum Efficient .: Duct insulation requirement Area �m ❑ Packaged Unit QAFurnace ❑ AFUE ��Theostat Over 40 ft of duds added or Bletback O COP I�� door Coil ❑SEER replaced in unconditioned space Served by system Oftiot atreadv ❑ HSPF O R 6 10.13) SO must be [)'Condensing Unit O EER (CZ c� sf present, ❑ Resistance ❑ R 11 (CZ 14-13) installed) ❑ Other 1 Equipment Type: Choose the equipment being installed: ijmore than one system, use another CF -IR -ALT -HVA Cfor each system. 2. Minimum Equipment Efficiencies: 13 SEER, 78.0 AFUE. 1.7HSPF jor 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 forums shall be left on site for final inspection and a copy given to the homeowner. At final, the inspector verifies that the wont listed on this form was in fact the work completed by the installer. The inspector also verifies that each appropriate CF -61K and registered CFAR forms (ito hand filled CF4Rs allowed) are fitted out and signed. Beginning October 1, 2010 a registered copy of the CF -111 and CF -61t shall also be on site for final Inspection. ❑ 1. H VAC 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 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 CFAR 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 %%ith less than 40 linear feet in unconditioned space, or ❑ 3. Existing ducts stems are constructed, insulated or sealed with asbestos ❑ 2. New HV AC System Required Forms: • Cutin 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 dulling pd all CF -4R forms: MECH 20-, and (for split systerns)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. Por Packaged Units: Duct leakage <6 percent O 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 CFMhon, TMAH For Packaged Units: Duct leakage < 6 percent ❑ 4. New Ducting over 40 feet Required Forms: • Include, 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: Existing ducts sterns constructed, insulated or sealed with asbestos. Contractor (Documentation Author's /Responsible Designer's Declaration Statement) • 1 certiR, that this Certificate of Compliance documentation is accurate and complete. • 1 am eligible under Division 3 of the California Business and Professions Code to accept responsibility for the design identified on this Certificate of Compliance. r I cen if}- that the anergy features and performance specifications for the design identified on this Certificate of Compliance conform to the mquifements of Title 24, Parts I ,nd 6 of the Califomia Code of Regulations. • i ht• Se>ign feawres idemit a on this Certificate of Compliance are consistent with the information documented on other applicable compliance forms, worksheets. calculations, Plans.ands cifications submitted to the enforcement a enc fio approvalwith the permit application. Name. Signature: Company: Z:� ^ Date: t� 2008 Residential Compliance Forms March 2010