12-0483 (MECH)Ti4P.O. BOX 1504 VOICE (760) 777-7012
78-495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 "BUILDING &SAFETY DEPARTMENT-, INSPECTIONS (760),777-7153
BUILDING PERMIT .. ,
r _ _ Date: 5/03/12
Application Number: 12-00000483 Owner:
Property Address: 47.180 VIA LORCA r MACHACEK JAMES MICHAEL
APN:. 643-160-027-153 -26152 - 47180 VIA LORCA
Application description: MECHANICAL LA QUINTA,' CA' 92253- t
Property Zoning: LOW DENSITY RESIDENTIAL
Alication voluotion: 13500
Contractor:
Applicant: t s 'Architect or Engineer: GENERAL AIR.•CONDITI
- 31170 RESERVE DRIVE
�. THOUSAND PALMS, CA
(760)343-7488
Lic. NO.: 686310
LICENSED CONT TOR'S DECLARATION -
- _ I hereby affirm under penalty of perjury that I amlicensed un
r provisions of Chapter 9 (cGnmencing with _
Section 7000) of Division 3 of the Business and. Professi]ans�eo.`
odeand my License is in full force and effect.
[[ License Class: C20 686310
l\ Date: �3 1 Z Contractor:
O LDER 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.). -
(_) 1, as•owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.
7044, Busiriess 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. , 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:
LQPER.MIT .
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 ZENITH INS CO Policy Number Z071741501
I certify that, in the performance of the work f r which this permit is issued, I shall not employ any
person in any manner so as to become su a to the workers' compensation laws of California,
and agree that, if.1 should become subjec the workers' compensation provisions of Section '
3700 of the Labor Code, I shall forthwit omply with those provisions:01
,
Date: S�3%1 �. Applicant:
WARNING: FAILURE TO SECURE WORKE NSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES ND 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 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 of 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 ssa tion of work for 180 days will subject
permit to cancellation.
I certify that 1 have read this application and state that the above inf ation is correct. I agree to comply with all
city and county ordinances and state laws relating to building const ion, and hereby authorize representatives -- -
of this county'to enter upon the above-mentioned property for ins ion purposes.
ate: 1311 2-- Signature (Applicant or Agent): -
r
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 ZENITH INS CO Policy Number Z071741501
I certify that, in the performance of the work f r which this permit is issued, I shall not employ any
person in any manner so as to become su a to the workers' compensation laws of California,
and agree that, if.1 should become subjec the workers' compensation provisions of Section '
3700 of the Labor Code, I shall forthwit omply with those provisions:01
,
Date: S�3%1 �. Applicant:
WARNING: FAILURE TO SECURE WORKE NSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES ND 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 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 of 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 ssa tion of work for 180 days will subject
permit to cancellation.
I certify that 1 have read this application and state that the above inf ation is correct. I agree to comply with all
city and county ordinances and state laws relating to building const ion, and hereby authorize representatives -- -
of this county'to enter upon the above-mentioned property for ins ion purposes.
ate: 1311 2-- Signature (Applicant or Agent): -
Application Number 12-00000483
• Permit MECHANICAL
Additional desc
Permit.Fee 66.00 Plan Check Fee
16.50
Issue Date . . Valuation
0 "
Expiration Date 10/30/12
Qty Unit Charge Per
Extension .
BASE FEE
15.00
2.00 9.0000 EA MECH FURNACE <=100K
18.00
2.00 16.5000.EA MECH B/C >3-15HP/>100K-50OKBTU
33.00
Special Notes 'and Comments
HVAC CHANGE OUT - (2) 13SEER/78AFUE
SPLIT SYSTEMS .•[2008 ENERGY] CARBON
MONOXIDE ALARM(S) TO'BE INSTALLED PRIOR
TO FINAL INSPECTION. 2010 CALIFORNIA
BUILDING CODES.
May 3, 2012 12:51:21 PM AORTEGA
------------------------------ ----
Other Fees . . . . . BLDG STDS ADMIN (SB1473)
1.00
Fee summary Charged Paid Credited
Due
Permit Fee Total 66.00 .00 .00
Plan Check Total 16.50 .00 .00
16.50
Other Fee Total 1.00 .00 .00'
1.00
Grand Total 83.50 .00 .00
83.50
LQPERMIT -
- -
Simplified Prescriptive Certificate of Compliance: 2008 Residential HVAC Alterations CF -YR -ALT -HVAC
Climate Zones 10 - 15
Site Address:
Enforcement Agency:,
Date:
Permit #:
47180 VIA LORCA (SYS 1) La Quinta, CA 92253
City of La Quinta
May 2. 2012
-
Duct insulation
Conditioned Floor
Equipment Typel
List Minimum Efficiency2
requirement
Area
Thermostat
❑ Package Unit
® Furnace
® AFUE 78%
❑ COP
❑R 6 (CZ 10-13)
Served by system
® Setback
® Indoor Coil
® SEER 13.0
[3HSPF
[3R 8 (CZ 14 -IS)
1441 sf
If not already present, must be
® Condensing Unit
[3 EER
❑.Resistance
installed) .
❑ Other
1. Equipment Type: Choose the equipment being installed; if more than one system, use another CF -1 R -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. F 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-111and
CF -6R 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-HEIRS
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
i '
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 uvas documented to have been previously sealed and confirmed through HERS verification, or
[12. Duct systems with less than 40 linear feet inunconditioned space, or
p 3. Existing duct systems are constructed, insulated or sealed with asbestos
0'4. The 5, . will not be Du&66'(ie.�Ductless,Mini-5plitzSystem)v(Also�Exempt fromI efrigerant_ -barge)
❑ 2. NeVi%HVAC Sy"stem
Required Forms �°,
.Cut moor Changeout with","
new ducts':`(all new
*-4 •- * r `w
CF 6R forms MECH-04, MECH 20 HERS, and (for,split systems) MECH;22 H RS, and
dudmg all new .
MECHx25 HERS w
CF 4R forms MECH 20, and (for split systems) MECH=22� and MECH 25,
equipment) .
_
` s'. .t Vt
For Split Systems:=Duct leaks a < 6 > 350 CFM/ton .FWD TMAH STMS and either F -SPP bV,PSPP.
9 percent, RC,'CCA ,,
.,
For Packaged Units: Duct leakage < 6,percent
❑ 3. NewzDucts with/or without:
Simplified Prescriptive Certificate of Compliance: 2008 Residential HVAC Alterations CF -IR -ALT -HVAC
Y
Site Address:
Enforcement Agency:
Y
y
'47180 -VIA LORCA (SYS 2) La Quinta,'CA 92253
City'of La'Quinta '
May.2'- 2012 4
Equipment Type1
List Minimum Efficiency2
Duct insulation
requirement
Conditioned Floor
Area
Thermostat "
r
+
Simplified Prescriptive Certificate of Compliance: 2008 Residential HVAC Alterations CF -IR -ALT -HVAC
Climate Zones -10 - 15
Site Address:
Enforcement Agency:
Date:
Permit #:
'47180 -VIA LORCA (SYS 2) La Quinta,'CA 92253
City'of La'Quinta '
May.2'- 2012 4
Equipment Type1
List Minimum Efficiency2
Duct insulation
requirement
Conditioned Floor
Area
Thermostat "
❑ Package Unit
+
® Furnace
'® AFUE 78%
❑ COP,
❑ R 6 (CZ 10-13)
Served, by system
® Setback.
® Indoor Coil
® SEER 13.0
❑ HSPF
❑ R 8 (CZ 14 -IS)
1400 sf
If not already present, must be
'
® Condensing Unit
❑ EER
❑ Resistance
a
installed)
❑ Other
1. Equipment Type: Choose the equipment being installed; if more than one system, use another CF -IR -ALT -HVAC for each system. T
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 he 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.
® 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-HERSi < '
• Furnace
CF -4R forms: MECH-21 and (for split systems) MECH-25
For Split Systems: Duct leakagei,< 15 percent; RC, CCA <_ 300 CFM/ton (Minimum Air, Flow Requirement), TMAH ;
Exempted from duct leakage testmg'f: ` e _
❑ 1 Duct,system was documented to have been previously sealed and confirmed through HERS veri fication, or ' ` '
„•
❑ 2, Duct systems with less than_40 linear feet in unconditioned space, or
p 3. Existing duct systems are `constructed, insulated or sealed with asbestos -
0'4: The ystem will not be Ducted°(ie:-Ductless Mini -Split System),(Also:Exempt from=Ref[i "erant Cnar e)OF
❑ 2. New HYAC.System
Requiired Forms
. Cut inior Changeout with"
CF 6R forms. MECH-04, MECH-20 HERS, and (for split systems) MECH-122 I QRS, and
('.�MECH25%HERS,,
new ducts:;' all neAWv
ductinge0�all ne
# :
. �r r _ �(�
forms MECH-20, systems) 25
equipment)`
CF 4R and (for split MECH-22, and MECH
For Split 5ystemsc°Duct leakage < 6 percent, -RC TCCA > 350 CFM/ton, FWD, TMAH„STMS, and either iSPP o�>PSPP.
�..a .. -
is ?x-, �. - ..,.. .F' i
For. Packag":Unit is Duct leakage�< 6 percent - :,
❑ 3. New-Ducts,w_ith/or without'::Required
Forms:
Replacements,,..
y `
. Includes replacing or installing all`new
ducting and/or outdoor.conclensing unit
CF -6R 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.
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 form's: MECH-04, MECH-2I-HERS
linear feet of duct in unconditioned space.,. '
CF -4R forms: MECH-21 ,
For -split -system or packaged units: Duct leakage < 15 percent e ;
❑ EXCEPTION: Existing duct systems constructed, insulated or sealed with asbestos.
Contractor (Documentation Author's /Responsible Designer's Declaration Statement) ti
• 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 de'sigA identified on this Certificate of
Compliance.• t
• I certify that the energy features and performance specifications for the design identified on this Certificate of Compl ante 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: Danielle Garcia Signature: Danielle Garcia
Company: HARRISON ENTERPRISES INC Date: May 2, 2012
Address: 31-170 RESERVE DRIVE STE A + _ Licenee:.686310 .
City/State/Zip: THOUSAND PALMS / CA / 92276 Phone: (760) 343-7488
. t
Reg: 212-AO02208OA-00000000-0000 ,Registration Date/Time:.2012/05/02 21:13:13 HERS.Provider:`CalCERTS,'Inc.
2008 Residential. Compliance Forms t July 2010
Bin r##
Qty Of La Quinta
Building 8f Safety Mlon
Permit # P.O. Box 1504, 78-495 Calle Tampico
4 Qulnta, CA 92253 - (760): 777-7012
11.0�43?i
.Building Permit -Application and Tracking Sheet
Project Address: 4111;10 V . V 1
r�
Owne'r's Name: m
bac. a��K
A. P. Number: , `
`A 3 l (D oa 2
"".
'I -7 h f' 1
Address: `� I V \ V I qL :- V[,�ji
Legal Description:
City, ST, Zip: v
( ( 2253
Contractor:
Address: 3
City. ST, Zip:'—�
..1�,
" • "'. '• '
Telephone:
Project Description:
Telephone: '� i�
State Lic. # r33�
N`r s. /a'
; `�'/`' ;>o,;`�„
City Lic. C (o
Arch., Engr., Designer:
Address:
Telephone:'
State Lic. #:
Name of Contact Person: p G(.9 e-4 vy ,
Construction Type: Occupancy:
Project. a circle one New Addzh Alter Repair ' Demo
• Sq. FL: �1�- #•Stories: # Units:
Telephone # of Contact Person: 7!o O 3 LI -6 % 4 g $
Estimated Value of Project: G16U. Co
APPLICANT: DO. NOT WRITE. BELOW THIS LINE
#
Submittal
Req'd
Recld
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Ca[cs.
Reviewed, ready for corrections
Pian Check Deposit
Truss Coles..
Called Contact Person
Plan Check Balance.
Title 24 Cales.
Plans picked up
Construed m-
Flood plain plan
Plans resubmitted
Mechan(cd
Grading plan
2'd Review, ready for corrections4ssue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Pians picked up.
S.M.I.
H.O.A. Approval
Pians resubmitted
"Grading
IN
7rd Review,.ready for corrections/issue
Developer Impact Fee
Planning'Approval
Called Contact Person
A.I.P.Y..
Pub. Wks..Appr
Date of permit Issue
School Fees
Total Permit Fees