13-0583 (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:
13-00000583
78620 VIA MELODIA
646-290-032- -
MECHANICAL
LOW DENSITY RESIDENTIAL
8768
Tiht 4 XP Q"
Architect or Engineer:
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
--------------------------------------------------
LICENSED CONTRACTOR'S DECLARATION
hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with
Section 7000) of Division 3 of the -Business and Professionals Code, and my License is in full force and effect.
License Class: C20 '` License No.: 686310
Dalie: , Contractor. � w.. L7� � �---•
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).: -
(_) 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.).
(_) 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 1 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: _
Lender's Address:
LQPERM IT
Owner:
RACHEL MANSFIELD
78620 VIA MELODIA
LA QUINTA, CA 9225.3
(
VOICE (760) 777-7012
� FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 5/06/13
Contractor:
GENERAL AIR CONDITIONING D
31170 RESERVE DRIVE
THOUSAND PALMS, CA 92276
(760) 343-7488 MAY O 2013
Lic. No.: 686310j[
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 .
fy Section 3700 of the Labor Code, for the performance of the work for which this permit is ,
is ad:
issue
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 ZENITH INS CO Policy Number Z071741502
_ 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 to the workers' compensation provisions of Section
3700 of the Labor Code, I shall forthwith comply with those provisions. '
Date: Applicant:
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 1 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 county. to enter upon the above-mentioned property for inspection purposes.
r / �
Date 6 l– 8ignatui—e(Applicant or Agent
L' —
' Application Number .. . . . . 13-00000583
Permit MECHANICAL
Additional desc .
Permit Fee . . . . 42.50 Plan Check Fee
10.63
Issue Date . . . . Valuation . . .
0
'Expiration Date 11/02/13
Qty Unit Charge' Per
Extension
' BASE FEE
15.00
1.00 11.0000 EA MECH FURNACE >100K
11.00
1.00 16.5000 EA MECH B/C >3-15HP/>100K-500KBTU
16.50
Special Notes and Comments
HVAC CHANGE -OUT - 13 SEER/78 AFUE, (1) 3 ,
TON UNIT [2008 ENERGY] CARBON MONOXIDE
ALARM(S) TO BE INSTALLED PRIOR TO FINAL
INSPECTION. 2010 CALIFORNIA BUILDING
CODES.
s
- ---
---,------------ - ------- ---------------------------- --------------
Other
Other Fees '. BLDG STDS ADMIN (SB1473),
7 -------
1.00
Fee summary Charged. • Paid Credited
Due
Permit Fee Total 42:50 .00 :00
42.50 ,
Plan Check Total 10:63 y;' .00 - .00
10. 63
Other Fee Total. - 1.00 .00, '.00
1.00.
Grand Total-, 54:13 _ .00 .00
54.13
' - -
71
LQPERMIT _
-
I
i
-
ff
Vlty U� LM QuihW
. •
i
.m.uu'6 � � l Y��'...vv .
P.O. ou isK'78.495 CaAe TxnpW
Ptd
U.Qdrz4 CA 92253 •-(760) 777-7012
Building P Application and Tiaddng Sheet
Ptvjoocwddm=78626 VIA MELODIA.
Owner`sNema. RACHEL MANFIELD• '
q P.N=b---
A4dmw. 78620 VIA MELODIA
%l pesadpttoa
CRY ST. ZIP: LA QU I NTA, CA 92253
�Cottnxcfur< GENERAL A/C & HEATING lalcptw=
31170 RESERVE DRIVE
RQIedDe®alPdat►: CHANGE OUT (1) A/C 3 TON.
C.City, ST. Zip: THOUSAND PALMS, CA 92276 FURNACE 70,000 BTRU.& COIL
�Tetephoae 760-343-7488 f
stile Lis Y : 686310
IArcfi., 6ngi, Dedra:
• . .
city. sr. z o:
Tia
CanstuCtioa oo�tp®aay:
stah Lir. 0:
Ptajt d 07c (*de om0): Near Awn Alter Repair Demo
Name of Contiot pet = PATRICK_
9a. gc: sr pin
_
Tdybowtomonitapmon. 760-343-7488' B'd, of $8768.00
AMACAIir: DO NOT WIFM BELOW TIM UNE
'
p 8a�aaltLtl d • 8tx�d
- '[$AQ[�ic f6R�'t�s• .
�tSaSob
PIuCMetbatbmipcd item A>m-L
Stti�tahl Cklei
itorlc+red. ready [er oartedtam PEta Clads Depoala.
Tfm
caged ContactPaaaa PlanClred Balance.
Il8eZ/ did
Piam pidce4 up Caaapae8oa
`
I
blood pwa plan
Roo rudb4tted Idadtatileil
OiadiaLplan
Z'Rcdcw.readyforeeteee$easna►x 1'aaptrleal
sabeostaetor lilt
Catlyd Conbe Pamm nvnLbti8
Graet Dted
Pians ~ up SALL
ll.Oml Apprsral
Plans ewabmlited Gradkz
I
�i l{01JS83-
'' ikviev i ready for oestectloaa/fsae Dewdaw Impact Fee
' i Pl+ttaeAmdAppro.a!
CalieaCcaNetPasan Al.PB.
I Pdb. Wf:s. Appy -
I
Date of penait blue
I SdtFen
IYopl
- i
Permit Foes
Climate Zones: 10 - 1s
Site Address;
78620 VIA MEL 1A La Quinta, CA 92253
Enforc®m
City of La
Equip I ent Typel
List Minimum Effrciency2
Ductinon
requirement
O Package Unit
® Furnace
® AFUE 7840
❑ COP
01 Inddor Coil
11 SEER 13.0
13 HSPF
1
E3 R 8 (CZ 10-13)
® Condensing Unit
q Other
❑ EER
❑ Resistance
❑ R 8 (CZ 14-15)
nta I May 2, 2013 -
Conditioned Floor
Area Thermostat
Served by system ® Setback
-2222 sf If not already present, must be
installed)
2. Mtn%njum Equ%pment Effle%nciesa 13 SEER, 78°x6 nswAFUE17.7HSPF tnr typiccaal res/dential systems.-IR-ALTHVAC!pr each system,
HERS VERIFICATION SUMMARY Listed below are FOUR HVAC alteration Options. The installer decides what work is being one
and picj s one of -the appropriate Options. Each Option lists the HERS measures that must be conducted. A copy of the forms shall
be left In 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)arefilled out and signed -Beginning October 1, 2010, a registered copy of the CF -1R
and CFp6R shall also be on site for final inspection.
• ,wr nyAt, equipment CF -6R forms: MECH-04, ME= -21 and (for split systems) ME H -25 -HE
replaced RS
CF -4R forms MECH-21 and (for split systems) MECH-2S
. Cond�nser Call and /or CF -6R forms: MECH-04, MECH-21-HERS and fors Ile
• Indoor Coil and /or ( p systems) MECH-25-HERS
. Furn" CF-4R:forrns: MECH-21 and (for split systems) MECH-2S
or Split Systems: Duct leakage;', lis percent; RC, CCA 5 300 CFM/ton-(Mlnlrrrum Alr Flow Requirement),7.
1
xempt d from duct leak Qe� testin Rf
f2A
•Cuti
new
ducti
equil
For Spl
For Pii�
!m -was aocuMeh*d to have been previously sealed and confirmed through HERS verification, or
anti§ witFi`.IeSs:thai�:40.linear feet in unconditioned space, or
uct systems'are 4s�ftstructed, insulated or sealed with asbestos
iim"ll not be buc
(all new
-all A
d - _
a...ar �xssm ,. M.:p.• ..�,a�,y yy. mcmulre0 rornls:
. Incilidd s replidng"or."Installing :a ICj7ew
duciin and/or outdoor citndeT
n unit CF -6R forms: MECH-04, MECH-20-HERS, and (for split systems) MECH-25-HERS
and/oi indoor Coil and/dr•.fta'rrl ce 00 .>.yo or some CF -411 forms: MECH-20 and (for split systems) MECH-25
equipr ient changed.
For Split (Systems: Duct leakage;< 6 percent; RC, CCA a 300 CFM/ton, TMAH
For Pac4aged Units: Duct leakage < 6 percent
❑ 4. Ne Ducting over 40 feet Required Forms:
•
Includes adding or replacing more than 40CF-6R forms; MECH-04, MECH-2I-HERS
linear set of duct in unconditioned Space. CF -4R forms: MECH-21
For split system or packaged units, Duct leakage < 15 percent
❑ EX EPTION, Existing duct systems constructed, Insulated or sealed with asbestos.
ContracCpr (Documentation Author's /Responsible Designer' laration Statement)
• I certlfV that this Certificate of Compliance documentation Is accurate and Complete.
• X am ell?ible under Division 3 of the Califomia Business and Professions Code to accept responsibility for the design Identified on this Certificate of
Compliance..
• I certifylthat the energy features and performance specifications for the design identlfled on this Certificate of Compliance conform to the
requlrerrents of Title 24, Parts 1 and 6 of.the California Code of Regulations.
• The design features idenUfled on this Certificate of Compliance are consistent with the information documented on other applicable
forms, worksheets, calculations, plans and specifications submitted tcompliance
the o e enforcement agency for approval with the permit ali®tion.
:o
Game: DJnle a Garcia pp
Signature: p�161ie 6artia
mpanyi HgRRISON ENTERPRISES INC bate: May 2, 2013
Wdress; 31-170 RESERVE DRTVF ei e
Reg! 2132A0026438A-0000000000000 Registration Date
2008 Residential Compliance Forms
li
l
2013/05/02 16:39:13 URS Provider: Ca10ERT9, Inc.
July 2010