12-0324 (MECH)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN: -
Application description:
Property Zoning:
Application valuation:
1.2_0.0.0.0.0.3.2.4
!7$6'8=0=V IP,`cMEL OD I A
646-050-046- - -
MECHANICAL
LOW DENSITY RESIDENTIAL
1600
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
HOLMES DONALD
78680 VIA MELODIA
LA QUINTA, CA 92253
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 3/28/.12
MAR
Contractor.
" 2012
Applicant: Architect or Engineer. PREC H & A INC
P.O. Box• 11090' 67Y0F LA
PALM'DESERT, CA 92255 t !P1 ---
(760)776-1550
P, Lic. NO.: 818759
LICENSED CONTRACTOR'S DECLARATION - - WORKER'S COMPENSATION DECLARATION -
hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with
I hereby affirm under penalty of perjury o'ne 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 lass: C20–C36 •. OF License No.:818759
, for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
2 y
_
issued.
X
ate✓ ontractor:C.✓'. -
- I have and will maintain workers' compensation insurance, as requiredbySection 3700 of the Labor.
Code, for the performance of the work for which this permit is issued. My workers' compensation
OWNER -BUILDER DECLARATION _.
insurance carrier and policy number are: - - - - -
Ihereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law. for the
:Carrier FARMERS. INS Policy Number N 2008 71 19
following reason (Sec. 7031.5, Business and Professions Code: Any city or county that requires 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 Codeshall forthw'u h comply with those provisions.
that he or sheis exempt therefrom and the basis for.the alleged exemption. Any violation of Section 7031.5 by
�
!. JN
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).:
t 'IL licam- r V-
(_ 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
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 ($100,0001. 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 or.0
- _ -
' improve for the purpose of sale.).
APPLICANT ACKNOWLEDGEMENT
1—) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.
IMPORTANT Application is hereby made to the Director of Building and Safety for a permitsubject to the
- 7044, Business and Professions Code: The Contractors' State License taw. 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 _ 1 I.am exempt under Sec. , BAP.C. for this reason - -
the owner, and the.applicant, each agrees to, and shall defend, indemnity 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 for which this permit is issued (Sec. 3097; Civ. C.).
city and county ordinances and state laws relating to building construction, and hereby authorize representatives
of this county to enter u on the bove-mentioned property for i pection purp es.
p
Lender's Name:
'��/Z—Si �,
.1
� Ir
e: ture (Applicant or Agent:
Lender's Address: -
LQPERMIT
Application Number . . . 12-00000324
Permit . . . MECHANICAL
Additional desc
_
Permit Fee 31.50
Plan Check Fee
7.88'
Issue Date
Valuation . . . .
0
Expiration Date 9/24/12
Qty Unit Charge Per
Extension
BASE
FEE
15.00
1.00 .16.5000 EA MECH
B/C >3-15HP/>100K-500KBTU
16.50
-----------------
Special Notes and Comments.
--------------------------------------
_
CHANGE OUT CONDENSING UNIT. 2010
CODES.
Other Fees BLDG STDS ADMIN. (SB1473)
1.00
Fee summary Charged
Paid Credited '
Due
- Permit Fee Total' 31.50
.00 .00
31:50•
r Plan Check Total 7.88
.00 - •.00
'7.88..
Other Fee Total 1.00
'.00, 00
.1.00
-Grand Total 40.38
r.•
.00 _.00..
40.38.
' _ _ .. _ ` .. • r ..- -
, . -.
_ .. a _. ,'-
LQPERMIT - -
-
Simplified Prescriptive Certificate of Compliance: 2008 Residential HVAC Alterations CF -IR -ALT -HVAC
Climate Zones 10 - 15
Site Address:
Enforcement Agency:
Date:
Permit #:
78-680 Via Melodia La Quinta, CA 92253
City of La Quinta
Mar 27, 2012
Duct insulation
Conditioned Floor
Equipment Typel
List Minimum Efficiency2
requirement
Area
Thermostat
❑ Package Unit
❑ Furnace .
❑ Indoor Coil
❑ AFUE
® SEER 13.0
❑ COP
❑ HSPF
❑ R 6 (CZ 10-13)
Served by system
® Setback
If not already present, must be
® Condensing Unit
.❑EER
❑Resistance
[I R 8 (CZ 14 -IS)
1200 sf
installed)
❑ Other
1. Equipment Type: Choose the equipment being installed; if more than one system, use another CF -1R -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 -611 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 -111
and CF -611 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-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 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
❑ 3. Existing duct systems are constructed, insulated or sealed with asbestos
❑ 4. The system, will not be Ducted (ie:. D uctl s M►n�-S;AIit�Systemaj(AlsoExem��tmfro,,Refngeant2Ckiarge)
❑ 2. NewHVAC Sysfem
Requieed Foirms:r
. Cut in �or,Chbngeout with
t� ��
new ducts (all new
.
CF 6Wforms'MECH-04, MECH 20 HERSWj dI(for split systems) MECH 22=HERS, and
MECH 25 HERS "x �'�
�r "�
ducting all new. ,�
equipment);,R'
r MECH 0%� a�nd(fos split systems) MECH-X MECH 25 ;
For Split Systems :Duct leakage
<,'6 percent,;RC ;CCA�Zx350 CFM/tony.FWD; TMAH, SIMS, and'eithec_HSPVoe'PSPP:
For Packaged`Units: Duct
6 peicent
leakage -k6.
❑ 3. Newucts�with/or without
Required Forms:
Replacement--
. 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 -411 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
114. 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: Gerald Dobbins Signature: Gerald Dobbins
Company: PREC H & A INC Date: Mar 27, 2012
Address: P 0 BOX 10991 License: 818759
City/State/Zip: PALM DESERT / CA / 92255 Phone: (760) 776-1550
Reg: 212-A0015078A-00000000-0000 Registration Date/Time: 2012/03/27 15:38:43 HERS Provider: Ca10ERTS, Inc.
2008 Residential Compliance Forms Julv 2010
Bin. #
, o :. ...
Y. oft � Q[u111
. .. `Buil�rlg Bz.Safety Division . .
P.O. Box 1504,78-49.5 Calle Tampico„
La.Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
Project Address:. ,6�d 1 . �j'�/
'Owner's Name:. o
A P. Number
Address:7-�id �/'q P/
Legal Description:
Contractor. O rC S v� ! �' f �_
City, ST, Zip:
N
Telephone: ' .� ;r .. r)?,• : s �z
Address: ®A fv
./�
ProjecYDescription:
Jct
City, ST, Zip:/SOFT lf�t. Zr
Telephone:
p 7d- V -rf� .
;y
� � �^.
City Lia #
'
State Lie. #:
Arch., Eng., Designer
Address: '
City., ST, Zip:
�•
•
`
Telephone:•
State Lic. #: '
Name of Contact Person: y � i&
Construction Type:. Occupancy:
Project type (circle one): New Add'n Alter •Repair Demo
Sq. FL:
#Stories:
F# Units:
Telephone # of Contact Pelson:
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACMG
PERMIT FEES
Plan Sets
Pian Check submitted.item
Amount
Strgctural Calcs.
Reviewed, ready for corrections
Plan Check Deposit. .
Truss Cates.
Called Contact Person
Plan Check Balance
Title 24 Calm
Plans pieked up
Construction
Flood plain plan
Plans resubmitted..
Mechanical
Grading plan
Review, ready for corrections/issue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Pians picked up
S.M.L
H.O-A- Approval
Plans resubmitted
Grading
IN HAUSE:-
''' Review; ready for correctionsfissue
Developer Impact Fee
Planning Approval.
Called Contact Person
AXP.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees