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11-0817 (MECH)+ .. • 4.4 " P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY -DEPARTMENT BUILDING PERMIT Application Number: 11-00000817 Owner: Property Address: 48105 VIA HERMOSA ADAMS MARY APN: 646-100-019-. - - 48105 VIA HERMOSA Application description: MECHANICAL LA QUINTA, CA 92253 Property Zoning: LOW DENSITY RESIDENTIAL ( - Application valuation: 5800 VOICE (760) 777-70.12 . FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 7/29/11 Contractor: Applicant: Architct o� r Engineer: , J ANTHONY PLUMBING HEAT/AI 72216 NORTH SHORE STREET, qq G THOUSAND PALMS, CA 92276 (760).343-2121 Lic: No.: 777794 ClNAFg,gf 01NTA F!!�ANGE I EPT. ' LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION - I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (Wmmencing with_ I hereby affirm under penalty of perjury one of the following declarations: Section 7000) of Division 3 of the Business and Professionals Code, and my License' full force and effect. _ I have and will -maintain a certificate of consent to self -insure for workers' compensation, as provided_ License CIa : C30 -C36- License No.: 777 for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. Date., Contractor: _ I have and will maintain workers' compensation insurance, asrequired by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workerscompensation OWNER -BUILDER DECLARATION insurance carrier and policy number are: I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the Carrier CNCLD/ST FUND Policy Number 1932451-2011 following reason (Sec. 7031 .5, Business and Professions Code: Any city or county that requires a permit to _ I certify that, in the performance of the work for which this permit is issued, I shall not employ any .construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the person in any manner so as to become subject to the workers' compensation laws of California, t. permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State and agree that, if I should become subject to the workers' compensation provisions of Section - License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Coder or . • 37 0 of the Labor Code, I shall forthwith comply with those ons. - that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by 70� /i A any applicant for a permit subjects the applicant to a civil penalty of'not more than five hundred dollars IS5001.: Date: Applicant: - 1 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 . WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL Contractors' State License Law does not apply to an owner of property who builds or improves thereon, SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND and who does the work himself or herself through his or her own employees, provided that the DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN _ improvements are not intended or offered for sale. If, however, the building' or improvement is sold within SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. one year of completion, the owner -builder will have the burden of proving that he or she did not build o_ r improve for the purpose of sale.). APPLICANT ACKNOWLEDGEMENT 1 _ 1 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Seo. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of conditions and restrictions set forth on this application. . . property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed. 1. Each person upon whose behalf this application is made, each person at whose'request.and for ` pursuant to the Contractors' State License Law.). - - whose benefit work is performed under or pursuant to any permit issued as a result of this application, I—) I am exempt under Sec. B.&P.C. for this reason 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. Date: Owner: - - 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 CONSTRUCTION LENDING AGENCY - permit to cancellation. - I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the I certify that I have read this application and state that the above information is correct. I agree to comply with all. work folwhich this permit is issued (Sec. 3097, Civ. C.). .. city and county ordinances and state laws relating'to building construction, and hereby authorize represe 'ves of thiscounty o ent upon the above-men[ioned property for // inspection purposes. - Lender's Name: - - _ ' Date: Z Signature (Applicant or Agent'): Lender's Address: - - LQPERMIT - - - •Application Number 11-00000817 Permit MECHANICAL Additional desc Permit Fee . . 33.00 Plan Check Fee 8.25 Issue Date . . Valuation 0 Expiration Date 1/25/12 Qty Unit Charge Per' Extension BASE FEE 15.00 1.00 9.0000 EA MECH FURNACE <=100K 9.00 1.00 9.0.000 EA MECH B/C <=3HP/100K BTU 9.00 ---- -- ---------------- Special Notes and Comments HVAC CHANGE OUT 5 TON.14 'SEER FURNACE , INDOOR COIL & CONDENSING UNIT 2010 CODES. -----_---------------.-------------------------------- Other,Fees BLDG STDS ADMIN (SB1473) 1.00 Fee summary Charged Paid Credited Due Permit Fee Total 33.00 .00 .00 33:00 Plan Check Total 8.25 .00' .00 8.25 Other Fee Total 1.00 .00 00 1.00 Grand Total 42.25 .00 .00 42.25 LQPERMIT Simplified. Prescriptive Certificate of Compliance: 2008 Residential HVAC Alterations CF-IR-ALT-HVAC Climate Zones 10 - 15 Site Address: Enforcement Agency: Date: Permit #: 48105 VIA HERMOSA La Quinta, CA 92253 City of La Quinta Jul 29, 2011. Equipment Typel List Minimum Efficiency2 Duct insulation -requirement Conditioned Floor Area Thermostat ❑ Package Unit CEJ Furnace p Indoor Coil 2 AFUE 8% 0 SEER 14.0 ❑ COP ❑ HSP F , El R 6 (CZ 10-13) Served by system 21 Setback not already present, must be * Condensing Unit p EER ❑Resistance ❑ R 8' (� 14-15) 2000 sf 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 Efficiencies: 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-6R and registered CF-4R forms (no hand filled CF74Rs allowed) are filled out and signed.Beginning October 1, 2010, a registered copy of the CF-IR 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-611 forms: MECH-04, MECH-2I-HERS and (for split systems) MECH-25-HERS . 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 Requirement), TMAH Exempted from duct leakage 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 in unconditioned space, or [13. Existing duct systems are constructed, insulated or sealed with asbestos ❑ 4. The system:.will not be Ducted (ie. Ductless-Mini.Split System).(Also-ExemptfiromAefrigerant Charge) ❑ 2. New;HVAC S stem Y Re Fors:m q uired . Cut in or Changeout with:' ` ,..z_' . new ducts: (all new CF 6R formsi• MECH-04 MECH=20 HERS, and'(for split systems) MECH 22 HERS, and MECH-25-HERS ducting and all newt /. i CF-4R forms- MECH 20 and ;(,for split systems) MECH-22� and MECH 25 �` �Of equipment) 4 x y , For Split Systems: Duct leakage < 6 percent; RC, CCA`> 350 CFM/ton, FWD; TMAH, SIMS, and-either HSPP' oe'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 and/or indoor CF-6R forms: MECH-04, MECH-20-HERS, and (for split systems) MECH-25-HERS coil and/or furnace. No or some equipment CF-411 forms: MECH-20 and (for split systems) MECH-25 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-611 forms: MECH-04, MECH-2I-HERS linear feet of duct in unconditioned space. CF-411 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 identified on this Certificate of Compliance. . I certify that the energy features and performance specifications for the design identified on this Certificate of Compliance 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: Kevin Robinson Signature: Kevin Robinson Company: 1 ANTHONY PLUMBING HEATING & AIR CONDITIONING Date: Jul 29, 2011 Address: 72216 NORTH SHORE ST #101 License: 777794 City/State/Zip: THOUSAND PALMS / CA / 92276 Phone: (760) 328-8096 Reg: 211-A0038489A-00000000-0000 Registration Date/Time: 2011/07/29 15:43:25 HERS Provider: Ca10ERTS, Inc. 2008 Residential Compliance Forms July 2010 Bin # Qty of La Quinta Building 8T 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�IR, Owner's Name: A. P. Number: Address: Legal Description: City, ST, Zip: Contractor: SERVICES � J ANTHONY109 Address: THOUSAND PALMS, CA 92276 . Telephone: � � .Y `.:Y;::rr:: a:,?;:. •���• Project Description: City, ST, Zip: Telephone: ::.M�,€''<>`<>:<•�;>> :;>�;':>%.: ::Y! tj'\:•3:f:%;:��:y%'.):if'?Sn��''f.•::ji_::2{'.'%X',i:Y State Lic. #: City Lic. #•: 1 Arch., Engr., Designer: Address: rl City., ST, Zip: Telephone: P i: :!JYY??�i:•i?:t;.}.; .}'i-+.vY:v:??:*' ov:�:�:�<;Y;:`::..i:t;�c2'y4: `{:;{S\};.iri.,':;;;':�,2• < ..:. ;`.;.i.0 fiti::a...: ?';.iv':x?<:w<>.'' •::, g:•:?: ;<. E;«<a, +...z Construction Type: . Obcupancy: project type (circle one): New - Add'.i Alter Repair Demo State Lic. #: Name of Contact Person: Sq. Ft.: #Stories: #Units: Telephone # of Contact Person: Estimated Value of Project 53V V APPLICANT: DO NOT WRITE BELOW THIS LINE 4 Submittal Req'd Recd 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 Constructian Flood plain plan Plans resubmitted Mechanical Grading plan 2°" Review, ready for corrcctionsfissue 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 Fees c`'