10-0214 (MECH)P.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
Date:- 3/17/10
Application Number:30-0_-0000.21.4 Owner:
Property 'Address: 7895`VIA�LIVORNO RHODES LARRY JOE
APN: 643-140-022-78 -26152 - 47895 VIA LIVORNO
Application description: MECHANICAL LA QUINTA, CA 92253
Property 7onin4: LOW _DENSITY RESIDENTIAL ��� +•
Application valuation: 11400
- _..---
Applicant: - --- --Architect or En (neer. - _ GENERAL �R -
pp -- - ~ 9 U R GOND TIONING
31170 ES RVE'f�ieIVE72 q4,
THOUSAND S, CA 92240 j
(760) 3 4 3-7 4194"i �t
LiC. No. r3`0 `zt;1C4
111��� �E•�.
LICENSED CONTRACTOR'S DECLARATION - WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury that 1 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 Sof t Business and Professionals Code, and my License is in full force and effect. _ I have and will maintain acertificate of consent to self -insure for workers' compensation, as provided
License C ss: C20 -— License No.: 686310 for by Section 3700 of the Labor Code: for the performance of the work for which this permit is
issued.
te: act t I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor
Code,, for the performance of the work for-whichthis permit is issued. My workers' compensation
OWNER -BUILDER DECLARATION insurance carrier and policy number are: '
Ihereby affirm under penalty ofperjury that I am exempt from the Contractor's State License Law for the _ Carrier PREFERRED . EMPL Policy Number WKN1295355
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
ectionLicense Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or - 3700 of the ab ICode, I sh II forthwith comply with those provisions.
that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031..5 by jl�a,� /i '
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).: Date•: pplicant: - l- - Y Lr�
(_) 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 Lawdoes 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 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
improve for the purpose of sale.). . .I I • 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 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 acontractorls) 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,
(_) I am exempt under Sec. , B.&P.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 affirmunder 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
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 160 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 uilding construction, and hereby authorize representatives
of this county to enter upon the bove-mentioned pro y for inspe ton purpose
I
ate: L Si ture (Applicant or Agent):
Application Number 10-00000214
Permit MECHANICAL
Additional desc .
Permit Fee 33.00
Plan Check Fee
8.25
Issue.Date
Valuation . . . .
0
Expiration Date 9/13/10
Qty Unit Charge Per
Extension
BASE -FEE
15.00
1.00 9.0000 EA MECH
FURNACE'<=100K
9.00•.
9.00U0 EA MECH
!i/C z=_3HP/ LOOK BTU
- 9.00
---------------------------------------------------------------------
-Special Notes and Comments
HVAC ' SYSTEM WITH. NEW CONDENSER
-..
(13 SEER) FURNACE (80%)AFUE. 2007
CODES
----------------------------------------------------------------------------
Other Fees BLDG STDS ADMIN (SB1473)
1.00
Fee summary Charged*
Paid.. Credited
Due
Permit Fee Total 33.00
.00 .00
33.00
Plan Check Total 8.25
.00 .00
.8.25
Other Fee Total. 1.00
.00 .00
1.00 .
Grand.Total 42.25
.00 .00
42.25
'. LQPERMIT
..
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GENERAI.
Air Conditioning & Heating
31-170 Reserve Drive • Thousand Palms, CA 92276
(760) 343-7488 9 Fax (760) 343-7494
www.callthegeneral.com
Residential C mfortl I
Survey ��
INSTALL DATE JOB# 3 CUSTOMER# n5 0.
NAME 4 4 /F2 V A /7 Cj .P'es
BILLING ADDRESS
CITY 4 A- &U reef A. STATE �Y_ A- ZIP CODE g 2 -
PHONE
PHONE CELL FAX
JOB ADDRESS
CITY STATE ZIP CODE q &61S Z�)
MAP PAGE
NEW EQUIPMENT EXISTING EQUIPMENT
o ^%
CONDENSER - CONDENSER MODEL #
L��\JCOIL �I � t\ CONDENSER SERIAL #
FURNACE v ' PERMIT YES' NUJ
THERMOSTAT C&000 WARRANT
FILTRATION MISC
PLATFORM SIZE %
❑ FINANCING DAYS 0 CREDIT CARD C.O.D.S! vz
V4/11/ZU1V 11:ZV MA Ytsu:34374a4 GENERAL AIR CONDITIONING Io 001
d &l ( U d /_1 I- 1 I l L, UU\Oat�>
Simplified Prescriptive Certificate of Compliance: 2008 Residential EVA CAfteradons CF -IR -ALT -HVAC
Climate Zones 10 to 15
Site Address: �^
C
Ert oreeme Agency:
Date:
Permit!!:
( SAY N
I 141,-
�-
Equipment T ca
List Minimum Efficiene
Duct insulation reuirement
Conditoned Floor
area
Thermostat
13PackageeddUnit
oor Coil
❑ AF
❑SEER
❑ COP
❑ HSPF
Over 40 ft of, ducts added or
replaced in unconditioned
Served by system
����..,,��
13TR ck
(tfnoralready
Condensing Unit
❑ EER
_spar
13 Resistance
C7 R 6 (CZ 10-13)
sf
present miwsi be
❑ Other
I
❑ R 8 (CZ 14-15)
twilled)
I. Equipment Type: Choose the equipment being installea(• if more than one system, use another CF -1R ALT -HVAC for each system.
2. Minimum Equipment Efficiencies: 13 SEER 78'166 AFUE, 7.7HSPF for typical residential systems.
HERS VERMCATION SUMMARY Listed below arc 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 forts (no hand filled CF -4 allowed) are filled out and
--Ks
si October 1 20110 a reglirtered COPY of the CF -1R and CF -6R shall also be on site for final inspection.
Iff 1. HVAC Changeout
Required Forms:
• All HVAC Equipment replaced
CF -6R forms: MECH-04, MECH-21-14ERS and (for split systems) MECK- 25 -HERS
CF -411 forms: MECH- 21 and for split stems MK14-25
• Condenser Coil and/or
• Indoor Coil and/or
CF -6R forms: MECH-2I.-HERS and (for split systems) MECH- 25-14ERS
• Furnace
CF -4R forms: MECH- 21 and (for split systems) MECH-25
For Split Systems: Duct leakage < 15 percent; RC, CCA > 300 CFNVton(Minimum Air Flow Requirement), TMAH
For Packaged Units: Duct leakage < 15 percent
Exempted from duct leakage testing if:
❑ 1. Duct system was documented to have been previously scaled and confirmed through HERS verification, or
❑ 2. Duct systems with less than 40 linear feet in unconditioned space, or
❑ 3. Existing,duct Eystems are constructed, insulated or sealed with asbestos
❑ 2. New HVAC System Required Forms:
• Cut in or Changeout with new CF -6R forms: MECH-04, MECH-20-HERS,and (for split systems) MECH-22-HERS, and MECH-25-HERS
ducts: (all new ducting md all
CF -4R forms: MECH 20-, and (for split systems)MECH-22, and MECH 25
new equipment)
For Split Systems: Duct leakage < 6 percent; RC, CCA > 350 CFM/ton, FWD, TMAH, SIMS, and either HSPP or PSPP.
For Packaged Units: Duct leakage < 6 percent
❑ 3. New Ducts with Replacement
R aired Forms:
• Includes replacing or installing all new ducting
CF -6R forms: MECH-04, MECH-20-HERS,and (for split systems) MECH-25-HERS
and/or outdoor condensing unit and/or indoor
CF -4R forms: MECH-20 and (for split systems) MECH-25
coil and/or furnace. Not all equipment changed.
For Split Systems: Duct leakage < 6 percent, RC, CCA >_ 300 CFM/ton, TMAH
For Packaged Units: Duct leaka e < 6 percent
❑ 4. New Ducting over 40 feet
Required Formas:
• Includes adding or replacing more than 40
CF -6R forms: MECH-04, MECH-2l-HERS CF -41K :errs: MECH-21
linear feet of duct in unconditioned Vace,
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 fcawres and perfonmmncc specifications for the design identified on thi's Certificate of Compliance conform to the requirements of Title 24,
Parts 1 and 6 of the California Code of Regulations.
W The design features identified on this Certificate of Compliance are conaistcnt with the information document0tvA other applicable compliance Forms, worksheets,
calculatio lana and s ons submitted to the enforcement agency for approval w' e i s n.
Name:
Signature:
Company:
ate: 5 / !
Address:
License: .
City/State/Zip:
Phone: --7100
Bin #,
. ' . 4 y. .
G Quinta
' ' of U,
k � •, Building 8t Safetq.Div Ior�
° P.O. Box 1504, 78.495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and. Tracld Sheet
Permit # '
"1
Project Address: f)rOwner's
Name:. r
A. P. Number:
Address:.
Legal Description:
City, ST, Zip: �� &IY
Contractor:
Address:Z21 f� �'.
Telephone• I A.10 MD..��'•:
z•s
Project Description: r eo
City, ST, Zip:
a 1
Telephone: - !�a• l
State Lic. # : City Lic. #;
Arch, Engr., Designer:
Address:
City., ST, Zip:
Telephone:'
State Lic. ..�
ConstructionT e: Occu an
Alter !,*epair Demoa?�
proJ type one) New . Add
t
Name of Contact•Person: (
Sq. FL:
#Storks:
# Units:
Telephone # of Contact Person: 3 7 Estimated Value of Project: 00
APPLICANT: DO. NOT WRITE. BELOW THIS LINE
#
Submittal
Plan Sets
Req d'
Rec'•d
TRACKING PERMIT FEES
Plan Check submitted Item Amount
Structural Cates.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person
Plan'Check Balance
Title 24 Calls.
Plans picked up
— Consiruetion
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2"" Review, ready for corrections issue
Elect. cal
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up.
S.MJ.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
M Review,.ready for correctionslissue
Dev-doper Impact Fee
Planning Approval
Called Contact Person
A.IP.P.
Pub. Wks. Appr
Date of permit issue
School,Fees .
Total Permit Fees