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12-0772 (MECH)P.O. BOX 1504 VOICE 760 777-7012 78-495 CALLE TAMPICO FAX (760), 777-7011 LA QUINTA, CALIFORNIA 922.53. BUILDING .& SAFETY DEPARTMENT ' INSPECTIONS (760) 777-7153 BUILDING PERMIT _ D Q Date: 2 Application Number: "*6, 0�07Z Owner: Property Address:` �4T62'S VIA MONTIGO HANDLER FRANKLIN ' APN: 643-120-030-258 -26152 - 47625 VIA MONTIGO�� i ��®� Application description: MECHANICAL LA QUINTA, CA 92253 A Z Property Zoning: LOW DENSITY RESIDENTIAL - Application valuation: 9255 C NA' E Qu IV :4 agPT. Contractor: . Applicant: Architect or Engineer: PALM DESERT AIR COND CO INC 42081. BEACON HILL PALM DESERT, CA 92211- �(760)346-0677 � N Li c. No.; 374937 LICENSED CONTRACTOR'S DECLARATION - WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing 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 is in full force and effect:_ I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided License Class: C20 Lic i No.: 374937 for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. /te:z Contractdr= --c%9:"—"-� v 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 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 MID CENTURY Policy Number A09454905-12 - 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, 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 Code) or 3700 of the Labor Code, I shall forthwith co7l with those provisions. that he or she is exempt, therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by ate: e any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($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 WARNING: FAILU E 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 TOTHE 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 or improve for the purpose of sale.). - APPLICANT ACKNOWLEDGEMENT j 1, ds Uwnei m olid piuperty, am exeklxwely Contracting wlTn ncensea CantfaCtaPS 10 CanstrUCt the project (Sec. IMPURTANT 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, (_ 1' I am exempt under Sec. , BAP.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 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.I. " • - - Lender's Name: - �- Lender's Address: LQPERMIT' 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 ereby authorize representatives of t county to enter upon the above-mentioned property for innsppec, pur ses: Date: Z l=` • nature (Applicant or Agent). Z !/- Application Number . : . 12=00000772" Permit MECHANICAL " Additional desc Permit Fee 40.50 Plan Check Fee 10.13 Issue Date Valuation . . 0 Expiration Date 1/08/13 Qty Unit Charge Per Extension BASE FEE 15.00 1.00 9.0000 EA MECH FURNACE <=100K 9.00 1.00 16.5000 EA- MECH B/C >3-.15HP/>100K-50OKBTU 16.50 ---------------------------------------------------------------------------- Special Notes and Comments REPLACE (1) AIR CONDITIONING SPLIT SYSTEM. 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 1.0.0 .00 .00 1.00 Grand Total 51.63 :00 .00 51.63 LQPERMIT , J^ � . , 4 f Enforcement Agency: Date: Permit #: 47-625 VIA MONTIGO La Quinta, CA 92253 City of La Quinta 1.31ul Simplified Prescriptive Certificate of Compliance: 2008 Residential HVAC Alterations CF-lR-ALT-HVAC Climate Zones 10 - 15 Site Address: Enforcement Agency: Date: Permit #: 47-625 VIA MONTIGO La Quinta, CA 92253 City of La Quinta 1.31ul 9, 2012 Equipment Typel List Minimum Efficiency2 Duct insulation requirement Conditioned Floor Area Thermostat ❑ Package Unit 0 Furnace 0 AFUE 78% []COP _ p Setback • Indoor Coil p SEER 13.0 [1HSPF [I R 6 (CZ 10-13) : Served by system not not already present, muslbe • Condensing Unit ❑ EER ❑ Resistance ❑ R 8 (CZ 14-15) 1600 sf in in ❑ 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 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. - 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 -6R 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 leakaget<¢15 percent; RC, CCA <_ 300 CFM/ton (Minimum Air Flow Requirement), TMAH For. Pask..yed Unit::• n •ter 1-11-_._ �� 15 . peFeeRf Exempted from duct leakage testingif: _<,❑ 1"Duct-system*ivas documented to have been previously sealed and confirmed through HERS verification, or -❑ 2, Duct systems with less th6n'40 linear feet in unconditioned space, or `0,3. Existing duct systems are constructed, insulated or sealed with asbestos '11'4'T e -system will not be Duct(id;(ie Ductless Mm�i-Split System) (-Also,Exemptrfr m�Refriger t,Charge) ❑ 2. New"•HVAC System Required) ,brms 7F4111T �u , 7S yxM•+1 17FW757 . Cut inior,Changeout with new ducts:",(all new iMECH-25 ',,tt•� CF 6R'fo 4ms i ECH-04, MECH=20-HERS,lands(for�split systems) MECH-,22 HERS, and � HERS =a r." n °,€� ducting all new equipment), •' _ s ' x :s + f zY CF 4R:forms MECH 20, and.(for split systems) MECH 22, and MECH 25 ( r d For Split Systems:yDuct leakage <6,percent RC'CCA >•350 CFM/ton, FWD; TMAH STMS, and either HSPP'or-PSPP For Packaged Units: Duct leakage< 6 percent -w.- ❑ 3. New;Ducts`with/or without+isr:• . Required Forms: cent t nr:;;h; F Replaem . Includes replacing or installing all.new ducting and/or outdoor condensing.unit CF -611 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. r.''r `- - f,t• i 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 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: Karl Brown Signature: Karl Brown Company: PALM DESERT AIR CONDITIONING CO INC Date: Jul 9, 2012 Address: 42-081 BEACON HILL License: 374937 City/State/Zip: PALM DESERT/ CA/ 92211 Phone: (760) 346-0677 RegF�212-A0036077A`-}00000000-0000 Registration Date/Time: 2012/07/09 12:03:11 HERS Providerk Ca10ERTS;'Inc 2001 Residential Compliance�Forms July 2010• y U • P.O. Box.1504`• 78-495 Calle Tamplco,t± La Q'uintk Cahforrlia.9221-1 �= � Tel (760.)J77-70.12 -'Fax: (760)-,77777112-, , o ER, V1Lebslte: www.La-Quinta:Org:• Email: Building@l.a=Quinfa 0179 ��<ncoFm'Sy`�a f Bin MPermit #; 1,111)"' Bbildi• t PermitrApplication &Tracking S'heet'° Project Address: 47-625 VIA MONTIGO ", Owner's Name: HANDLER, FRAN -A.P..Number: • Address: '47-625 VIA. MONTIGO Legal Description: City; State,^Zip: 'LA QUINTA, CA 92253 ` Contractor: Palm Desert Air Conditioning & Heating Company Telephone: ( ' Address: 42-081 Beacon Hill Project Description: City, State; Zip: 'Palm Desert, CA 92211 REPLACE *AIR CONDITIONING SPLIT SYSTEMS. - _ .. • r +... 4; . Telephone No:: (760) 346-0677;;, .not 'rrrr I6Kr" 1... 7:. ...;J M,tip.q••..Re..Rs'e,x.�.� �-..f'.:.A•A State: Lic'. #:' 374937 City-Lic #' ,100886 Arch.%Engr /Designer: ::Address: City, State,,.Zip: Telephone No.: sr ,. ,. t , z r �.-� ;Construction Type: Occupancy: State:-Lic'::#: 3 a' ' 'n �� ` Project Type: ❑New •'®`Add'n - ❑Alter •.❑ Repair � ❑ Demo :Name.of Contact Person: KARL BROWN Sq. Ft. #Stories' # Units: Contact Telephone -No.: (760) 346-0677 Estimated Value of Project: $9,255.00 , APPLICANT. DO: NOT WRITE BELOW THISaINE . # Submittal Req'd Recd Tracking Permit Fee's Plan Sets Plan' Check Submitted Item r Amouhf Structural Calcs.. Reviewed, Ready for Corrections, :Plan 0 ck Deposit , Truss Calc.: Called: Contact Person Plan Check Balance:. Title: 24 Calcs. Plans Picked Up, Constriction . Flood Plain.Flan Plans, Resubmitted Mechanical Grading Plan 2nd`Review, Ready for Corrections Electrical. SubcontractorListCailed:Contact Persori Plimbilg' `• Grant Deed Plan. Picked Up H.Q:A.,Apprpval Plans Resubmitted ! Grading;' . IN HOUSE, V Review, Ready.forCorrections, Devetoger Impact Fee Planning Approval Called Contact Person A;I:p.,p., Pub. Works Appr'I Date of Permit Issue School Fees _ Total: Permit Fee's:• ;� c. 1• � , a .. -- ,