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10-0431 (MECH)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: 10-00000431 Property Address: 47415 VIA CORDOVA APN: 643-100-027-206 -26152 Application description: MECHANICAL Property Zoning: LOW DENSITY RESIDENTIAL Application valuation: 7443 Appli ant: Architect or Engineer: ----------------- LICENSED CONTRACTOR'S DECLARATION r BUILDING & SAFETY DEPARTMENT BUILDING PERMIT 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. License Class: C20 License No.: 780198 Date: S -18—(O 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 fora 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 contractor(s) licensed pursuant to the Contractors' State License Law.). I—) 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: CONLY, GLEN 47415 VIA CORDOVA LA QUINTA, CA 92253 ( Contractor: AIR PRO SERVICES P.O. BOX 1120 CATHEDRAL CITY, CA 92235 (760)343-5502 Lic. No.: 780198 VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 5/18/10 WORKER'S COMPENSATION DECLARATION:••+U^ - 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 NORGUARD INS Policy Number AIWC126845 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 should become subject to the workers' compensation provisions of Section 3700 of the LaborVINAL all f with comply with those provisions. Date: l���0 Applicant: WARNING: FAILURE TO SECURE' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIALTIES 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. certify that I have read this application and state that the above information is correct. 1 agree to comply with all city and county ordinances and state laws relating to building constructigpdang hereby authorize representatives ty for i of this county to enter upon the above-mentioned properec oses. Date: .%i`'61" Signature (Applicant or Agentl: Application Number . . . . 10-00000431 Permit . . . MECHANICAL Additional desc . . Permit Fee . . . . 42.50 Plan Check Fee 10.63 Issue Date . . . . Valuation 0 Expiration Date 11/14/10 Qty Unit Charge Per Extension BASE FEE 15.00 1.00 11.0000 EA MECH FURNACE >100K 11.00 1.00 16.5000 EA MECH B/C >3.-15HP/>100K-500KBTU 16.50 ---------------------------------------------------------------------------- Special Notes and Comments CHANGE OUT EXISTING HVAC EQUIPMENT 16 -- SEER (5)TON SPLIT SYSTEM ---------------------------------------------------------------------------- Other Fees . . . . . . . . . BLDG STDS ADMIN (SB1473) 1.00 Fee summary Charged ------------------------------------- Paid Credited -------------------- Due Permit Fee Total 42.50 .00 .00 42.50 Plan Check Total 10.63 .00 .00 10.63 Other Fee Total 1.00 .00 .00 1.00 Grand Total 54.13 .00 .00 54.13 LQPERAIIT Bin # City of La Quinta Building Br Safety Division P.O. Box 1504, 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Permit # L13� Project Address: 7 r-• kl"4 � �� Owner's Name: FOU C G N I , A. P. Number: Address: 17 q S, R lo.t? ✓.4 Legal Description: Ci STZi City, , P: L� � 9AJ.5 3 Contractor:Telephone: H ,� c e s �' Address: 7.2 0 88 Wath SAVe6 S f SAF. E Project Description: w E is %N (raC City, ST, Zip: n Telephone: hone: 760 3,11 S s L y a , 3eo S S � 6 S T s State Lic. # : 7 ,� o,( i City Lic. #: 3 0 7 $ Arch., Engr., Designer: Address: City, ST, Zip: Telephone: #> Construction Type: Occupancy: State Lic. #: type ' air Demo C Project a circle one): New Addn Alter Re J ) P Name of Contact Person: ,e e ?p es Sq. Ft.:#Stories: #Units: Telephone # of Contact Person: 7& O --.? q1 — g5 d_ Estimated Value of Project: 7 y APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Req'd Recd TRACKING PERMIT FEES Plan Sets Plan Check submitted Item Amount Structural Calcs. Reviewed, ready for corrections Pian 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.M.I. H.O.A. Approval Plans resubmitted Grading IN HOUSE:- '"' Review, ready for corrections/issue Developer Impact Fee Planning Approval Called Contact Person A.I.P.P. Pub. Wks. Appr Date or permit issue School Fees Total Permit Fees ..-N,"•- btmpiniea Prescriptive Certificate of Compliance: 2008 Residential HVAC Alterations CF -IR -ALT -HVAC Climate Zones 10 to 15 Atte ,gaaress: Y� /S- Enoreement f Agency: Date: Permit #: ol;Q o 5 --- P_/o Equipment T Concitioned Floor List Minimum Efficiency' Duct insulation requirement Area Thermostat O Packaged Unit eFumace R`AFUE dD O COP Over 40 ft of ducts added or i�Setback back Blflfn erindoor Coil RSEER I& ❑ HSPF replaced to unconditioned space Served. by system t already ErCondensing Unit InER /,S O Resistance O R 6 (CZ 10-13) Q cos sf present, must be O Other O R 8 (CZ 14-15) installed) 1. Equipment Type: Choose rhe equipment being installed. ijmore than ore system. use another CF -1 R-ALT-HP4C jor each system. 1. Minimum Equipment Effuleneles: /3 SEER 7840 AFUE. 7.7HSPFjortypica/Pesidential systems. HERS VERIFICATION SUMMARY Listed below are four HVAC alteration Options. The installer decidbs what work is being done and picks one of the appropriate Options. Each Option lists HERS the 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 listed work on this forte vias in fact the worts completed by the installer. The inspector also verifies that each appropriate CF -6R and registered CF4R fortes (no hand filled CF4Rs allowed) are filled out and signed. Beginning October 12010 a registered copy of the CF -1R and CF -6R shall also be on site for final Inspection. 8'1: HVAC Changeout Required Forms: • All HVAC Equipment replaced CF -6R forms: MECH-04, MECH-2I-HERS and (for split systems) MECH- 25 -HERS CF-41kforms: 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 -HERBS • Furnace CF4R fortes: MECH- 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 Fxempted from duct leakage testing if: O 1 Duct system was documented to have been previously sealed and confirmed through HERS verification, or O 2. Duct systems with less than 40 linear feet in unconditioned space, or O 3. Existing ducts stems are constructed, insulated or sealed with asbestos O 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 new equipment) CF -4R forts: MECH 20-, and (for split systems)MECH-22, and MECH 25 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 O 3. New Ducts with Replacement Req~ Forms: • Includes replacing or installing all new ducting CF -6R forms: MECH-04, MECH-20-HERS,and (for split s -stems) 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 O 4. New Ducting over 40 feet Required Forms: • Includes adding or replacing more than 40 linear feet of duct in unconditioned space, CF -611 forms: MECH-04, MECH-2I-HERS CF4R firms: MECH-21 For split system or packaged units: Duct leakage < 15 percent O EXCEPTION: Exisfing 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. 1 certiN, 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 apps icable compliance forms, worksheets, calculations, plans ands cifiications submitted to the enforcement for a2e approval with the peqnilipation- Name: Signature: Company: `on. Date: o ea, cis S -l8-l0 Address: %a �� S� License: City/Statc/Zip: "J4.� Phone: 76.2-35/1-SS'o� 2008 Residential Compliance Forms March 2010