14-0618 (MECH)r.4
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application description:
Property Zoning:
Application valuation:
14-00000618
80355 VIA VALEROSA
777-250-007- -
MECHANICAL
LOW DENSITY RESIDENTIAL
22468
T4'�l 4 4 Q"
Architect or Engineer:
NW
------------------
LICENSED CONTRACTOR'S DECLARATION
BUILDING & SAFETY DEPARTMENT.
BUILDING PERMIT
I 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 LicenseNo.: 686310
O jr� r3 1,4 Contractor
l/ 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 70001 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, 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.).
I _ 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:
LQPERMIT
Owner:
WILLIAM AND ANN IWATA
80355 VIA VALEROSA
LA QUINTA, CA 92253
(760)619-3304
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 5./13/14
Contractor:
GENERAL AIR CONDITIONI
31170 RESERVE DRIVE
THOUSAND PALMS, CA 922
(760)343-7488
Lic. No.: 686310
-----------------------------------------------
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.
� thave 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
u insurance carrier and policy number are:
Carrier ZENITH INS CO Policy Number Z071741503
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_ cl 144Applicant:
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 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 hereby authorize representatives
ofthis county to enter upon the above-mentioned property,for inspection purposes.
� f e
Date:'e� i3 )4 Signature (Applicant or Agent)
Application Number . . . . . 14-00000618
Permit . . . MECHANICAL 2013
desc .
4Additional
Permit Fee . . . . 143.00 Plan Check Fee
.00
Issue.Date . . . Valuation .
. 0
Expiration Date 11/09/14
Qty Unit Charge Per
Extension
2.00 35.7.500 EA MECH FURNACE
71.50
2.00 35.7500 EA MECH CONDENSER/COMP
71.50
Special Notes and Comments
HVAC CHANGE OUT - (2)14.5SEER/78AFUE
SYSTEMS [2008 ENERGY] CARBON MONOXIDE
ALARM(S) TO BE INSTALLED PRIOR TO FINAL
INSPECTION. 2013 CALIFORNIA BUILDING
CODES.
-------------------------------------------------- --------------------
Other Fees . . . . . . . . . PERMIT ISSUANCE M/P/E
90.57
PLAN CHECK, MECHANICAL'
95.32
Fee summary Charged Paid Credited
Due
----------------- ---- ----- -- - -
Permit Fee Total 143.00 .00 .00
143.00
Plan Check Total .00 00 .00
.00
Other Fee Total 185.89 .00 .00
185.89
Grand Total .328.89 .00 .00
328.89
LQPERMIT - .. .
Bin.#
City Of % Quinta
Building 8i' Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La
La Quinta, CA 92253 - (760) 777-7012
Permit Application and Tracking Sheet
Permit #
116
Project Address: ill 3�S vi cL V0.\er�s�
Owner's Name: r Arr J,, w
.A. P. Number:
Address: R0 355 V � Val CC o.54
Legal Description:
City, ST; Zip: �a Qvi�n}G CA G 22.53
Contractor: �ere w\ Asi
Telephone: � D - (oI q - 33 p}
:.
Address:3��1� j2eSe,tvz �r
Project Description:
City, ST, Zip: hov s c-t. m Cil
e I a C-e-Z -S+6 c k
Telephone: -''<>'s.<'>€>
P - '�O 343 788
3>.„%::::::...:::::::
'>::;:>:;>: _::<:»:<:<;:<:!»:;<::>:::=;
�-) VA C S sic s
State Lic. # : (o$(p3 (Q
City Lie. #;
Arch., Engr., Designer:
Address:
City., ST, Zip:
Telephone:
<:<.:::>;.:.>.:;>:<;.:;•;:n!<::•;::;Y:F;#:;>:::>::>:;:;>
f,:
Construction Type: Occupancy:
State Lic.#•
vY: • F.. n.....nv:....;:::;i:Y.:...::.
<z:» v.....;::;>::::>:#:z>
Project type (circle one): New Add, n Alter Repair Demo
Name of Contact Person: ske-N ehSc
Sq. Ft.:
# Stories:
# Units:
Telephone #,of Contact Person: 9S I - 2- L4 1- (og 7(,
Estimated Value of Project: ZZ., 46 $ _ no
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Rec'd
TRACKING
PERMIT FEES.
Plan Sets
'Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance
Title 24 Cales.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2°” Review, ready for corrections/issue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
'"' Review, ready for corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees
Simplified Prescriptive Certificate of Compliance: 2008 Residential HVACAlterations CF -IR -AL -&-HVA
Climate Zones 10 - 15
Site Address:
Enforcement Agency:
Date:
Permit #:
80355 VIA VALEROSA (SYSTEM 1) La Quints, CA 92253
City of La Quints
May 8, 2014
Duct insulation
Conditioned Floor
Equipment Type1
List Minimum Efficiency2
requirement
Area
Thermostat
[]Package Unit
® Furnace
®AFUE 78%
❑COP
❑ R 6 (CZ 10-13)
Seryed by system
® Setback
® Indoor Coil
® SEER 14.5
L)HSPF
®R 8 (CZ 14-I5)
326 sf If
not already present, must be
11 Condensing Unit
13 EER
❑ Resistance
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 -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 -61Z 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
CF -6R forms: MECH-04, MECH-2I-HERS and (for split systems) MECH-25-HERS
.Indoor Coil and /or
CF -4R forms: MECH-21 and (for split systems) MECH-25
. Furnace
For Split Systems: Duct leakage < 15 percent; RC,"CCA <_ 300 CFM/ton (Minimum Air Flow Requirement),-TMAH
FGF Pa ka"dAd UnIM. Duet leakage e. 15 peFeeFit4
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 tRan 40 linear feet in unconditioned space, or
`02 -
'[3-3; Existing duct systems are..- nstructed, insulated or'sealed with asbestos -
❑ 4_. The system will not be Ducted (ie. Ductless Mini -Split System) (Also Exempt from Refrigerant Charge)
❑ 2:.New HVAC System
Required Forms:
. Cut in or Cltatigeout with
CF SR forms MI_Cti-04, MECf' -0 HERS; and tfor split systems) MECH 22-tf€it5 and
new
::
...
ductin=::anrT:>'Anew::---'
__.,Y.:;�;;;c:.>::;<:-_;:':iNECH-20, and {far:,spiit systefns}:m cm22,
,, a ......
-......._....>.................. u...
•. Dint teaks e < 6= argent RC CCA 350:CFM loft FY' :TMAH .5?MS :_and;:either1SPPr'PSPP.:: i i'":: ...
For SpIt�,Systems.,.. _. ..: g__,..:. �:...., -
For Pa4k ed U tts..._ •.. ,P _.._....:. %'>'
_
❑ 3. New Ducts withq% r vvithot� :::.;::::;i::,;:._ �:.::::,:...R.
v}red:FbfKtns::':?`:,:.:...: •: ;::.:-::::::': `;;,;.::....:. <::;:;>:::::::::::.:::::<;=..:.. ..
. Includes:;re.placirid .or installing ai flew
ddc6ng ana'/oi'outdoar condensing:=unit
CF -6R forms: MECH-04, MECH-20-HERS, and (for split systems) MECH-25-HERS
anis%or indoor coil "06r. furnaciCho or some
CF -4R forms: MECH-20 and (for split systems) MECH-25
equipment changed_
For Split Systems: Duct leakage 1�s6 percent; RC_, CCA >_ 300 CFM/ton, TMAH
For Packaged Units: Duct leaka, 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-411forms: MECH-21 =
For split system or packaged units: Duct leakage < 15 percent I
❑ 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: Dayana Valdez Signature: Doyon Valdez -
Company: HARRISON ENTERPRISES INC Date: May 8, 2014
Address: 31-170 RESERVE DRIVE STE A License: 686310
City/State/Zip: THOUSAND PALMS / CA / 92276 Phone: (760) 343-7488
Reg: 214-A0032518A-000000000-0000 Registration Date/Time: 2014/05/08 12:54:22 HERS Provider: 'Ca10ERTS„ Inc.
•, 2008 Residential Compliance• Forms July 2010
Simplified Prescriptive Certificate of Compliance: 2008 Residential HVACAlterations CF-lR-ALT.-HVAC
Climate Zones 10 - 15
Site Address:
Enforcement Agency:
Date:
Permit #:
80355 VIA VALEROSA (SYSTEM 2) La Quinta, CA 92253
City of La Quinta
May 8, 2014
Duct insulation
Conditioned Floor
Equipment Typei
List Minimum Efficiency2
requirement
Area
Thermostat
❑ Package Unit
® Furnace
® Indoor Coil
® AFUE 78%
® SEER =
13COP
❑ HSPF
❑ R 6 (CZ 10-13)
Served by system
If
® Setback
not already present, must be
® Condensing Unit
❑ EER
❑ Resistance
0R 8 (CZ 14-15)
3267 sf
installed)
❑ 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-411
forms (no hand filled CF-411s allowed) are filled out and signed. Beginning October 1, 2010: a registered copy of the CF-IR
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
CF-6R forms: MECH-04, MECH-2I-HERS and (for split systems) MECH-25-HERS
. Indoor Coil and /or
CF-411 forms: MECH-21 and (for split systems) MECH-25
. Furnace
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 docurnenfed to have been previously sealed and confirmed through HERS verification, or
❑ 2. Duct systems with less thi"'40 linear feet in unconditioned space, or
0-3..Existing duct systems are'."hstructed, insulated or sealed with asbestos
❑ 4.. The system will not be 136fted '(ie. Ductless Mini-Split System) (Also Exempt from Refrigerant Charge)
❑ 2:.New HVAC System
Requir..Forms:
. Cut in or.Cttdngeoul h
w[t
:; :: .:.. .;>..;;:..
CF-6R forms MECtl=04 MECti-30=FiE�RS anal (fat spl[t systems). MECH 22=f+fER5, and
new ducts (aQ
,
MECH-2. HE#35...:
�
duct[n ::a.n ..ail new":
4—� ;
,_>y,::::;>::::::.:,:...;:��-�::;:::.:..:...
C-4Et€orti s: MECH-20, and'{dor split systems MECH-22„and AM1ECIi 25
equ[pmerit ):
,.
For Spltt Systems:.. Duct leaks e < 6.6 ent; RC, CGA � 350 CFM/Lbn FWI3 :.TMAH'S4MS,
.....,.:.:: _ ., leaks . , ...e ..
r ent<:�= -
For Uuert` a 6'= t -
❑ 3. Necg Ducts:with/ar
RepEacemetit`.:
. Indudes;;repladfng'or installing ail: flew
ducEing;andl--- `outdoor condensii.g: unit
CF-6R forms: MECH-04, MECH-20-HERS, and (for split systems) MECH-25-HERS
ani!/or indeor coil and%or. fumac"o or some
CF-4R fors: 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 leikage:< 6 percent
❑ 4. New Ducting over 40 feet
Required Forms:
. Includes adding or replacing more than 40
CF-6R fors: 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: Dayana Valdez Signature: Dayann Valdez
Company: HARRISON ENTERPRISES INC Date: May 8, 2014
Address: 31-170 RESERVE DRIVE STE A License: 686310
City/State/Zip: THOUSAND PALMS / CA / 92276 Phone: (760) 343-7488
Reg: 214-A0032524A-000000000-0000 Registration Date/Time: 2014/05/08 12:58:41 HERS Provider: Ca10ERTS, Inc.
2008 Residential Compliance Forms July 2010