10-1061 (MECH)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN: "
Application description:
Property Zoning:
Application valuation:
Applicant*t t
10-00001061
47380 VIA KORON
643-100-017-196 -26152 -
MECHANICAL
LOW DENSITY RESIDENTIAL
7200
Architect or Engineer:
LICENSED CONTRACTOR'S DECLARATION
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with
Section 70001 of Division 3 of the Business and Professionals Code, and my License is in full force and effect.
License Class: C20 censeNo.: 374937
Date: !�/ 3 Convact0r-
I 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 contractor(s) licensed
pursuant to the Contractors' State License Law.).
( 1 I am exempt under Sec. , BAP.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
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: • 10/13/10
Owner:
VANDENAKKER PETER
47380 VIA KORAN
LA QUINTA, CA 92253
(
D.
e
Contractor:
PALM DESERT AIR COND C C OCT 13 2010
42081 BEACON HILL
PALM DESERT,. CA 92211 CITY OF LA QUINTA
(760)346-0677 `INACEr���
Lic. No.: 374937 —'
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 SOUTHERN INS Policy Number WSIO036802-01
_ 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 tot workers' compensation provisions of Section
" / /P377f00 of the Labor Code, I shall forthwith c ly with those provisions. - -
Date: /6 � /Applicant----_T==r 5
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 ordinances and state laws relating to building construction, and hereby authorize representatives
.of this coounnttQytoo ennter upon the above-mentioned property for inspection urposes.
Dater Signature (Applicant or Agent):��� .
Application Number
10-00001061
Permit . . . .• MECHANICAL
Additional desc
-
Permit Fee . .
42.00
Plan Check Fee
10.50
Issue Date
Valuation
0
Expiration Date
4/11/11
Qty_ Unit Charge
Per
Extension
BASE
FEE
15.00
1.00 9.0000
EA MECH
FURNACE <=100K
9.00
1.44,. 9.0000
DA MECH
ADPL KEY/ALT/AUL)
9.00
1.00 9.0000
EA MECH
B/C <=3HP/100K BTU
9.00
--------
Special Notes and Comments
--------------------
------
'FURNACE , INDOOR COIL,
& CONDENSING
UNIT
CHANGE OUT 16.50 SSER
2007 CODES.
Other Fees
BLDG STDS ADMIN (SB1473)
1.00
Fee summary Charged
Paid Credited
.Due.•
Permit Fee Total
42.00
.00 .00
42.00
Plan Check Total
10.50
.00 .00
10.50
Other Fee Total
1.00
.00 .00
1.00
Grand Total
53.50
.00 .00
53.50
LQPERMTT -
-
-
Sim lifted Prescri ive-Certificate of Com fiance: 2008 Residential HVAC Alterations CF -IR -ALT -HVAC
Climate Zones, 10 to 15
VANUEN AKKER, PETER Svstem•1
Site Address:
47-380 VIA KORON, LA QUINTA, CA 9253
Enforcement Agen
City of La Quina
Date:
10/13/2010
, Permit A
Equipment Type'
List Minimum Efficient
Duct insulation requirement
Conditioned Floor
Area
Thermostat
Packaged Unit
® Furnace
o
®AFUE 8Q /o ❑ COP
Over 40 ft of ducts added or
d
®Setback
® Indoor Coil
® SEER 16.50 ❑ HSPF
replaced in unconditioned space
Served by system
not already
® Condensing.Unit
® EER 13.00 0 Resistance
❑ R 6 (CZ 10-13)
sf
present, must be
❑ Other.
❑ R 8 (CZ 14-15)
installed)
1. Equipment Type: Chocue the equipment being installed; if more than one system, use another CF -1 R4LT--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 beconducted. 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 CFAR forms.(no hand filled CF-4Rs allowed).a. filled out and
signed. Beginning .October 1,2010, a rezistered copy of the CF -1R and.CF-fit shall also be on site.for fatal _'_ ection.
®1. HVAC Cbangeout
Required Forms;
® All HVAC Equipment replaced
CF -6R forms: MECH-04, MECH-21-F{ERS and (for split systems) MECH- 25 -HERS
CFAR'forms: MECH- 21 and forsplit-systems) MECH-25
® Condenser Coil and /or
® Indoor Coil and;/or
CF -6R forms: MECH-21 -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
For Packaged Units: Duct leakage < 15 percent
Exempted firom duct leakage testing if
0 1. Duct system was documented to have -been previously sealed;and confumed!through HERS verification, or
0.2. Duct systems .with lessthan .40'linear feet in unconditioned space, or
0 3.. Existin ductsystems.ace; constructed, insulated or sealed with. asbestos
❑ 2. New HVAC S stem -
Required'Forms:
❑ Cut in or Changeout with new
ducts: (all new ducting:.all
CF -6R fommis: MECH-04, MECH-20-HER:S,aiid (for split systems) MECH-22-HERS, and MECH-25-HERS
new equipment)
CF -4R forms: 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.e they NSPP>or PSPP.
For Packaged Units .Duct leakage < 6. ercent
113. New Ducts with/or without Replacement
Required Forms:
❑ Includes,replacing.or installing all new ducting
CF -6R forms: MECH-04, MECH-20-HERS;an&(f6r split systems) MECH-25=HERS
and/or outdoor condensing unit and/or indoor coil
CFAR forms: MECH-20 and (for split systems) MECH 25
and/or furnace. No, or some equipment changed.
For. `Split. Systems: Duct leakage < 6 percent, RC, CCA >_ 300 CFM/ton, TMAH
For Packaged Units: Duct leakage < 6 percent
❑ 4. New Ductin ;over 40 feet
Required Forms:
❑ Includes adding or replacing more than
linear feet ofduct inunconditioned .space.
CF-6R forms: MECH-04, MECH-2I -HERS CF -4R forms: MECH-21
For split system. or packaged units: Duct leakage < 15 percent
0 EXCEPTION: Existing:duct systems constructed insulated or scaled with.asbestos.
Contractor (Documentation Author's. /Responsible Designer's Declaration Statement).
® Icertify 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.
® I
certify that the energy: features. and performance specifications for the design identified'onthis Certificate of Compliance conform to the requirements of Title 24,
Parts 1 and 6 of the CaliforniaCodeof Regulations.
® The design features ideirtificd:on. this_C cate_of_Compliance are -consistent with4he-informationdocumented-on-otherapplicable-compliance-fbtm-worisheets,
calculations, plans and specifications submitted to the enforcement agency for . approval with the ' _ ication
Name: KARL BROWN .
ISignature:
Company: Palm Desert Air Conditioning & Heating Company
Date: 10/13/2010
Address' 42-081 Beacon Hill
License:
374937
City/state/zip: Paim Desert, CA 92211
Phone: (760) 346=0677
z vvonesiaennat t,ompuance Norms March 2010
1 NR� �.
44
P:La Quinta California 92'11
- Q..Box 1504.78=495 .Calle Tampico, •
' - Tel: (760) 777-701.2 • Fax: (760) 777-7112
--GEM.41A,DESERT -- 'Website.: www.La-Quin'ta:Org-• Email: Building;;@La4,Ui.nta.Org.. '.r?e, Ox1'�w rt
Permit #: 80.1"ding POfthit.Application & Tracking Sheet
Peoject.Address: 47-380 VIA KORON
Owner's Name: VANDEN AKKEF, PETER
A.P.-Number:
Address: 47-380 VIA KORON
Legal Description:
City, State, Zip: LA QUINTA, CA 9253
Contractor- Palm Desert Air Conditioning & Heating Company
Telephone.: (
Address: 42-081 Beacon Hill
Project• Description: t
City;,Statel'29.- Palm Desert, CA 92211
REPLACE ONE (1). AIR CONDITIONING SPLIT SYSTEM.
r
;
-
Telephone -'No.: -( 0677SSW
State: Lic. M 374937
City Lic. #: 100886
Arch'./EngrJuesigner:
: Address:,
City, State; Zip:,y
Telephone No::
{ P 7f is�9 ��.O.., &A a
�a{,,_y''jy�( N " pa�1��_
b' w iPYn �Y n..114 i. ✓'C.-`. i..'
,Construction Type: -7
Occupancy:
State: .Lic #
n �t "4 � ° _ t ti
,:-
Project.Type 13 N'ew,• ® Add?.! • 0 Alter • O Repair-• O Demo
-
Name of C- KARL BROWN
'Sq. Ft.:
# Stories:
#: Units:
'Contact Telephone No.:
(760) 346-0677
Estimated Value of Project!". $7,200.00
APPLICANT:
DONOT WRITE
BELOW THIS LINE
#
. • . Submittal
Req'4
Recd
Tracking
Permit Fee's
Plan sets
Plan Check Submitted
Item
Amount "
Structural Calcs._
Reviewed; Ready for Corrections
Plan Check Deposit
Truss Calis
';
,Called Contact Person
Plan Check Balance . -
Title 24.Calcs.
9 ,
Plans Picked Up
Construction
Flood,Piain,Plan, •
Plans, Resubmitted
Mechanical
Grading Plan,
-2nd'Review, Ready foe Corr'ect'ions
Electrical, `
Subcontractor'.List
Called,ContectPeiison
Plumbing ,
GranMee'd
Plans Picked,Up
S.M.I. •
;
H.Q.A: Approval
Plans Resubmitted
Grading
IN HOU$E
3t0 Review; .Ready for Corrections
Developer Inpact Fee
Plan. ning,Approyal
Called Contact -Person-
A.I.P.P.
'
Pub. Works Appel
Date of Permit Issue
'School Fees
`'
Total Permit Fee's