10-0273 (MECH)e *'A
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 10-00000273
Property Address: 55456 FIRESTONE
APN: 775 -151 -068 -
Application description: B MECtAA rl (CA i•.
Property Zoning: . LOW DENSITY RESIDENTIAL
Application valuation: 5500
Applicant:
T4ht 4 a (P Q"
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Architect or Engineer:
. IJA—
VeMS�D
CONTRACTOR'S DECLARATION ,
1 hereby affirm under penalty of perjurI m censed under provisions of Chapter 9 (commencing with
Section 70001 of Division 3 of the Bu (((Hess a rofessionals Code, and my License is in full force and effect.
License s: _22 0 Li ee No.: 725283
Date: Contractor:
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, 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 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.).
(_) 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
Owner:
HUBLEY RESIDENCE
55456 FIRESTONE
LA QUINTA, CA 92253
(
.Contractor:
AIR EXPERTS AIR CONDITI
PO BOX 94
LA QUINTA, CA 92247
(760)777-1724
Lic. No.: 725283
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 4/01/10
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
1 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 EXEMPTlicy Number EXEMPT
I certify that, in the perfo --- oft work for which this permit is issued, I shall not employ any
person in any manne so as t b ome subject to the workers' compensation laws of California,
and agree that, if. I s ould. be a subject to the workers' compensation provisions of Section
r� 3700 of the Labor C de, I forthwit comply with those provisions.
Date: / U . -Applicant:
WARNU, 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 becomes null and void if work is not commenced
within 180 days from date of issuance aae
it, or cessation of work for 180 days will subject
permit to cancellation. '
I certify that 1 ave read this application and state thnformation is correct. I agree to comply with all
city and co nt ordinances and state laws relating totruction, and hereby authorize representatives
of this ty oenter upon the above-mentioned prpection purpas
Date: �� . Signature (Applicant or Agent):
. e ri
Application Number . . . . . 10-00000273
Permit . .
. ELEC-SERVICE
CHANGE
Additional desc .
Permit Fee . . .
. 33.50
Plan Check
Fee
.00
Issue.Date . . .
.
Valuation
.
. .0
Expiration Date
9/28/10
Qty Unit Charge Per
Extension
BASE
FEE
15.00
1.00 18.5000 EA ELEC
SVC <=600V/<=200A
18.50
----------------------------------------------------------------------------
Special Notes and
Comments
REPLACE AIR CONDITIONING & HEATING UNIT
16 -SEER.
-----------'-----------------------------------------------------------------
Other Fees . . .
. . . . . . BLDG STDS ADMIN (SB1473)
1.00
Fee summary
Charged
-
Paid Credited
Due
- ----- - - - - - - - - - --
Permit Fee Total
---- - - - ----
33.50
-- - - - - ------ - - -
.00 ..00
- ----
-- - - - - - -
33.50•
Plan Check Total
.00
.00
.00
.00
Other Fee*Total
1.00
.00
.00
1.00
Grand Total
34.50
.00
.00
34.50
LQPERMIT
Bin #
City of La Quinta
Building 8i' Safety Division '
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012 '
Building Permit Application and Tracking Sheet '
Permit #
Project Address:
1 � y�p�-i,C E S%7�+�.➢�
Owner's Name:
A. P. Number:
Address:YeES�� C,
Legal Description:
Contractor:/� `4y
t� a � i� — / T—,
City, ST, Zip: L GL
Telephone:
Address: 06JCqq
Project Description:
City, ST, Zip: a�. ZZ
lAL� A, L 'v
Telephone: 'X0 i% 7 /
,bAl
State Lic. # :
City Lie. #:
Arch., Engr., Designer:
Address:
City., ST, Zip:
Telephone: ::..,.�:. ~Y Construction Type: Occupancy:
..
State Lie. #: d:;;.1�5;;i;:?<:: ..
ry��yr Project type (circle one): New Add'n Alter Repair Demo
Name of Contact Person: �% 41.4,4 11i1q E ^/ Sq. Ft.: 1640 # Stories: # Units:
Telephone # of Contact Person: — Estimated Value of Project: '00=
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Plan Sets
Req'd
Recd
TRACKING
Plan Check submitted
PERMIT FEES
Item Amount
Structural Cales.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance,
Tide 24 Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2" Review, ready for correctionsfissue
Electrical
Subcontactor 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 correctionsrssuc
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
Schodl Fees
Total Permit Fees
Prescriptive Certificate of Compliance: Residential CF -11R -ALT
Residential Alterations Page 1 of 1
Project Name: Climate Zone # of Stories
UZL6 V _-
General Information:
Site Address: Ss- ZA Quo .j -rA CA 97 -Z -S --Z,
Date ,
� U
LS
Enforcement Agency:
Building Type:p-Single Family ❑Multi Family
Front Orientation: ❑ N ❑ E OM171
Project Type: ❑ Alteration HVAC Replacement ❑ Duct Replacement ❑
Conditioned Floor Space (CFS): 1(pp
NOTE: This form is not to be used for new construction or additions.
HVAC Systems — Hea
'no:
Duct Insulation
Thermostat
Configuration (Split
Equipment Type
Capacity
AFUE
HSPF
R -Value
Type
or Package)
jOd 4ax� moo
0
Z
5 ,(/
Z 7 -
HVAC tems -
HVAC
Ina:
Pipe Insulation
Thermostat
Configuration (Split
Equipment Type
Capacity
SEER
EER
R -Value
Type
or Package)
�--
HERS Verification Summary:
Duct SealiWA Testing - HERS verification is required for this measure.
❑ Yes ZI No In Climate Zones 2 and 9-16, if more than 40 linear feet of new or replacement duds are installed in unconditioned
space, the duds are to be sealed per §152(b)1Dii and the newly installed duds are to be insulated per §151(1)10.
O gxception: Existing duct systems that are extended, which are constructed, insulated or sealed with asbestos.
❑ Yes No In Climate Zones 2 and 9-16, if the existing space -conditioning system (HVAC equipment and ducting) is replaced,
the duds are to be sealed per §152(b)1 Di.
�es ❑ No In Climate Zones 2 and 9-16, if the existing HVAC equipment is replaced (including the replacement of the air
handler, outdoor condensing unit of a split system, cooling or heating coil, or the furnace heat exchanger) the ducts
are to be sealed per §152(b)1 E.
❑ Exception: Duct systems that are documented to have been previously sealed confirmed through HERS
verification in accordance with procedures in the Reference Residential Appendix RA3.
❑ Exception: Duct systems with less than 40 linear feet in unconditioned space.
❑ Exception: Existing ducts stems are constructed, insulated or sealed with asbestos.
Re erant Charge — Split System — HERS verification is required for this measure.
,ZYes ❑ No In Climate Zones 2 and 8-15, when the existing HVAC equipment is replaced (including the replacement of the air
handler, outdoor condensing unit of a split system A/C or heat pump, cooling or heating coil, or the furnace heat
exchanger) a refrigerant charge measurement shall be verified per §152 b 1 F.
Central Fan Integrated (CFI) Ventilation System and Fan Watt Draw
The ventilation requirements of §150 o do not apply to existing residential homes.
Ducted Spiit�,8ystems - Air Conditioners and Heat Pumps: Airflow - HERS verification is required for this measure.
❑ YesNo In Climate Zones 10 through 15, when the existing space -conditioning system (HVAC equipment and ducting) is
replaced, the airflow and fan watt draw shall be verified per §152 b 1 Ci to meet therequirements of §151 7B.
Documentation Author's Declaration Statement
I certify tha ertificate of Compliance documentation is accurate and cpfnpletef
Name: ZAl(/A ,41 ✓L A1E ,,j
Signature: �--�-
Company: tieFXP A uC �N }J,73oar -/t���
``
Date:
Address:`Ro .90,)c
City, State, Zip Code: �LA CA ZZ'V-7
Phone: 760 777 f 7 Z
Registration Plumber. Registration Date & Time: HERS Provider.
2008 Residential Compliance Forms PDAC January 2010