12-0267 (MECH)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 12-00000267
Property Address: 53748 VIA DONA
APN: 772-420-999-31 -298944-
Application description: MECHANICAL
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 13390
Td�/ 4 4 Q"
Architect or Engineer:
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 3/21/12
Owner:
SANDY BOSWORTH
53748 VIA DONA
LA QUINTA, CA 92253
Contractor:
ALL SEASONS A/C, PLMBG & n
P.O..BOX 1112 �'L1
PALM DESERT, CA 92261
(760) 568-2663 rl� MAR 2 2012
LiC. No.: 827420
CITY OF LA QuiNTe
----------------------------------------------------------------------------------------------� —
LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury am ' ensed under pr ' ' s of Chap (commencing with I hereby affirm under penalty of perjury one of the following declarations:
Section 7000) of Division 3 of the loess and Pro essionals e, a my Lice s..iafull force and effect. _ I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided
Licens ass: C20 C36 cense 20 for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
issued.
ate: Co a or: 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
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 1$500).:
(_ 1 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 1, 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 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: s
Lender's Address:
LQPERMIT
insurance carrier and policy number are:
Carrier NORGUARD INS Policy Number ALWC124752
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 come subject to the workers' c nsation of California,
ppod agree that, if I uld become subject to the w� com is,
of Section
% A700 of the Lab Code, I shall f hwith comply nRr1NSt pro 'sions.
WARNIhTG: FAILURE TO SECURE WORKERS' COMPENSATION -COV WAAGE 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 informatio ' orrect. y with all
city and county ordinances and state laws relating t i ding con tructio , her utho iz re tatives
of thjs cou ty enter upon the above-mentione rope for ins ect' rposes.
D/ate: Sign a (Applicant or A ent):
Application Number . . . . . 12-00000267
Permit . . . MECHANICAL
Additional desc .
Permit Fee . . . . 40.50 Plan Check Fee
10.13
Issue Date . . . . Valuation . . . .
0
Expiration Date 9/17/12
Qty Unit Charge Per
Extension
BASE FEE
15.00
1.00 9.0000 EA MECH FURNACE <=100K
9.00
1 . nn 1F Snnn FA mp N R/f —,I' 1 5HR/-,1 QQK-500KPTTT
16.50
----------------------------------------------------------------------------
Special Notes and Comments
HVAC CHANGE -OUT: INSTALL NEW FURNACE,
INDOOR COIL & CONDENSER. 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
Simplified Prescriptive Certificate of Compliance: 2008 Residential HVAC Alterations CF-1R-ALT-HVAC
Climate Zones 10 - 15
Site Address:
Enforcement Agency:
Date:
7
Permit #:
53748 Via Dona La Quinta, CA 92253
City of La Quinta
Mar 19, 2012
Duct insulation
Conditioned Floor
Equipment Typel
List Minimum Efficiency2
requirement
Area
Thermostat
❑ Package Unit
m Furnace
m AFUE 78%
❑ COP
❑ R 6 (CZ 10-13)
Served by system
m Setback
p Indoor Coil
Q SEER
❑ HSPF
❑ R 8 (CZ 14-15)
800 sf
If not a'read resent must be
y p
p Condensing Unit
[I EER
❑ Resistance
installed)
❑ Other
1. Equipment Type: Choose the equipment being installed; if more than one system, use another CF-IR-ALT-HVAC for each system.
2. Minimum Equipment Efflciencles: 13 SEER, 78% 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-15R and registered CF-4R
forms (no hand filled CF-4Rs allowed) are filled out and signed.Beginning 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
CF-6R forms: MECH-04, MECH-2I-HERS and (for split systems) MECH-25-HE 2S
replaced
CF-4R forms: MECH-21 111NOand (for split systems) MECH-25
• Condenser Coil and /or
• Indoor Coil and /or
CF-6R forms: MECH-04, MECH-2I-HERS and (for split systems) MECH-25-HE 2S
. Furnace
CF-4R forms: MECH-21 and (for split systems) MECH-25
For Split Systems: Duct leakage < 15 percent; RC, CCA <_ 300 CFM/ton (Minimum Air Flow Requirements, TMAH
Exempted from duct leakage testing if:
❑ 1. Duct system was documented to have been previously sealed and confirmed through HERS verifk:ation, or
❑ 2. Duct systems with less than 40 linear feet in unconditioned space, or
❑ 3. Existing duct systems are constructed, insulated or sealed with asbestos
❑ 4. The system will not be Ducted (ie,.,Ductless Mini-Split System) .(Also-Exempt-fro_m[Ref riger_ant Cha _rge)
❑ 2. New HVAC System
Required Forms: FV
s.
. Cut insor Changeout with,
new ducts: (all new
' ' ' ' r ' # l `r>
CF76R forms: MECH-04, MECH-20;'HERS, and (for split systems) MECH-22-HERS, and
ducting in all new
MECH725'HERS j �- �} Q
CF-4R-forms: °MECH 20, and (for split systems) MECH-22, an&MECH-25
equipment) �
f1 �r
� _i ....- r ,�-^, � ". .� � 4 ■ . !!
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/or without
Required Forms:
Replacement '
. Includes replacing or installing all new
ducting and/or outdoor condensing unit
CF-6R forms: MECH-04, MECH-20-HERS, and (for split systems) MECH-25-HERS
and/or indoor coil 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
CF-6R forms: MECH-04, MECH-2I-HERS
ICF-4R
linear feet of duct in unconditioned space.
forms: MECH-21
For split system or packaged units: Duct leakage < 15 percent
❑ 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 ideitified on this Certificate of
Compliance.
• I certify that the energy features and performance specifications for the design identified on this Certificate of Compliarce conform to the
requirements of Title 24, Parts 1 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 the permit application.
Name: David Beale Signature: bavid Beide
Company: ALL SEASONS AIR CONDITIONING PLUMBING & HEATING INC Date: Mar 19, 2012
Address: 73605 DINAH SHORE DR STE 1310M License: 827420
City/State/Zip: PALM DESERT/ CA / 92211 Phone: j760) 568 -
Reg: 212-A0013689A-00000000-0000
2008 Residential Compliance Forms
Registration Date/Time: 2012/03/19 15:56:31 HERS Provider: Ca10ERTS, Inc.
July 2010
Bin #
City Of La Quintd
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:
Owner's Name: SaM
A. P. Number:
Address:
Legal Description:
Contractor:All S �y-�,n(
�,(1V �J
City, ST, Zip: Q (/�, 02253
;><<#:>:
Telephone: , ''3
Address:
Project Description: C
Ji�,,/� j�`/�I��/� /1 p� (�} I
City, ST, Zip:FN I f Y L.�= t`.�CO CA IZZ-6l
Telephone: h ne '`: •:. `
State Lic. # : City Lie. #:
Arch., Engr., Designer:
Address:
City., ST, Zip:
Telephone:
:;:x>::>r;;�:>::;•:>:<•;;:;:.;:;:;�>.<.:>:«::;<:zs�.
$'#if:.. •:..:..
:•::::;;4:::;;: :N;:::x::<
Construction Type: 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:
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Rec'd
TRACKING
PERMIT FEES
Plan 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.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 of permit issue
School Fees
Total Permit F' --es