11-0883 (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:
11--00000883
48080—VIA VALLARTA
649-381-023- -
MECHANICAL
'LOW DENSITY RESIDENTIAL
6000
Tay/���NINW
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Architect or Engineer:
A1R
LICENSED CONTRACTOR'S DECLARATION
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 Profe sionals Code, and my License is in full force and effect.
License Class: 2p 6 License No.: 906115 .
ate: ontractor:
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 1$5001.:
(_) 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 build's 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 _ 1 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 contractors) licensed
pursuant to the Contractors' State License Law.).
I—) I am exempt under Sec. , BAP.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: .
ANN MORRIS
48080 VIA VALLARTA
LA QUINTA, CA 92253
Contractor:
HYDES e'
42949 MADIO STREET
INDIO, CA 92201 f!
(760)360-2202
Lic. No.: 906115 1
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 8/16/11
Li
AlUo i f1 2011
A
CIT,
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 NORGUARD INS Policy Number CEWC243358
_ 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
00 of the bor Code, shall rt7�fh those provisions.
83te:pplicant
:
WARNING: FAILURE TO SECURE WO ERS' 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 nulland 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, d hereby a nze re pre entetives
of thiip Loynty,torter upon t above-mentioned property for in action rposes.
Kat/e: !d S" ature (Applicant or Agent):
Application Number . . . 11-00000883
Permit MECHANICAL
Additional desc .
Permit Fee 40.50
Plan Check Fee
10.13
Issue Date . . . .
Valuation . . . .
0
Expiration Date 2/12/12
Qty Unit Charge Per
Extension
BASE
FEE
15.00
1.00 9.0000 EA MECH
FURNACE <=100K.
9.00
1.00 116..5000 EA MECH
B/C >3-15HP/>100K-500KBTU
16.50
----------------------------------------------------------------------------
Special Notes and Comments
A/C CHANGEOUT. INSTALL NEW 5 TON
SYSTEM,
FURNACE, INDOOR COIL, CONDENSING
UNIT.
2010 CODES.
-----------------_--------------------------------------- --
Other Fees . . . . . . . BLDG STDS ADMIN (SB1473)
1.00
Fee summary Charged
Paid Credited
Due
Permit Fee Total 40.50
.00 .00
40.50
Plan Check Total 10.13
.00 .00
10.13
Other Fee Total 1.00
.00 .00
1.00
Grand Total 51.63
.00 .00
51.63
LQPERMIT
Simplified Prescriptive Certificate of Compliance: 2008 Residential HVAC Alterations CF-IR-ALT-HVAC
Climate Zones 10 - 15
Site Address:
Enforcement Agency:
Date:
Permit #:
48-080 Via Vallaita La Quinta, CA 92253 ''
City of La Quinta
Aug 16, 2011
Duct insulation
Conditioned Floor
Equipment Type1
List Minimum Efficiency2
requirement
Area
Thermostat
❑ Package Unit
0 Furnace
F7 Indoor Coil
El AFUE 78%'
p SEER 13,0
❑ COP2
C-]HSPF
❑ R 6 (CZ 10-13)
Served by system
Setback
If not already present, must be
R Condensing'Unit
E] EER
❑ Resistance
[I R 8 (CZ 14-15)
2000 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-4R
forms (no hand filled CF-4Rs allowed) are filled out and signed.Beginning October 1, 2010, a registered copy of the CF-1111
and CF-6R shall also be on site for final inspection.
1. HVAC Changeout
Required Forms:
. All HVAC Equipment
CF-611 forms: MECH-04, MECH-2I-HERS and (for split systems) MECH-25-HERS
replaced i
CF-411 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�t�c15 percent; RC, CCA _< 300 CFM/ton (Minimum Air Flow Requirement), TMAH
.
FGF PaGkaged Units, Durk
`
Exempted from duct leakage testing,-if:ii '
10 1 Duct�system*was documented to have been previously sealed and confirmed through HERS verification, or
❑ 2. Duct systems with less than40 linear feet in unconditioned space, or
3. Existing duct systems are constructed, insulated or sealed with asbestos -
❑'4. Thessystem,w.ill not be,Ducted (ie DnctlessMinSpht _System).(AIsoE�xempt fromRefrigeant Charge)
[12. New HVAC System
. Cut intor Changeout with=.,y
ducts:}(all
_",_-
' ]6`
°MECH-04, HERS, MECH-22 HERS MECH 2.5; HERS
new new j,
ducting and all new
CF;6R¢forms MECH,20 andl(for split systems) and
CF 4R forms:JMECH,2t'0, and,(for split systems) MECH;22 and;MECH 25 # � e, ,
.te
equipment•)= -
�. ?`; # .4 _ +` r :. i�'�#c u' a. �ti ►: '" e[tx% T,
For Split Systems:"Duct 1eakages<16 percent, RC;TCCA.>_r350 CFM/ton "FWDNTMAH,�STMS; andreither HSPP o'r'PSPP.
For Packaged Units:{Duct leakage#< 6 percent»:`
❑ 3.,New•Ducts with/or without`«
Required Forms:
Replacement''- y-.',�- 1
-
. Includes replacing or installing all.new ducting
and/or outdoor condensifibwnitand/or indoor
CF4R forms: MECH-04, MECH-20-HERS, and (for split systems) MECH-25-HERS
coil and/or furnace. No or some equipment
CF-411 forms: MECH-20 and (for split systems) MECH-25
changed. - t ay;
.
For Split Systems: Duct leakage < 6 percent; RC, CCA >_ 300.CFM/ton, TMAH
For Packaged Units: Duct leakage < 6 percent I
❑ 4. 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-4R 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 �
. 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: Mark Hyde Signature: Mark Hyde
Company: CERTIFIED COMFORT SYSTEMS INC Date: Aug 16, 2011 -
Address: 77-825 WILDCAT DRIVE License: 906115
City/State/Zip: PALM DESERT/ CA / 92211 Phone: (760) 360-2202
Reg: 211-A0042032A-00000000-0000 Registration Date/Time: 2011/08/16 15:08:13 HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms July 2010
r'.
Bin #
Permit .#
1`
Project Address:" t4t —016,C) V t
A. P. Number:
Legal Description:
Contractor:
Address: `� 01
City, ST, Zip:
Telephone: '36o —ZZ
State Lic. # :1j66�
Arch., Engr.,'Designer:
Address:
City, ST, Zip:
Telephone:
State Lic. #:
Name of Contact Person:
Telephone # of Contact Person:
Submittal
Plan Sets
Structural Calcs.
Truss Calcs.
Energy Calcs.
Flood plain plan
Grading. plan
Subcontactor List
Grant Deed
H.O.A. Approval
M HOUSE:-
' Planning Approval
—[-Pub. Wks. App
r
School Fees
"Z.
City of La Quinta
Building a Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building
Permit Application and Tracking Sheet
A V e: 0
Ct ' 1 i /
rr/ 51 Telephone:
Ia . • Project Description: G
Lic. #:
MUAM_Eonstruction Type:
Occupancy:
Project type (circle one):
New Add'n Alter Repair Demo
Sq. Ft.:
#Stories:
�#Units:
Estimated Value of Project: 4000 QU0
APPLICANT: DO NOT WRITE BELOW THIS LINE
Recd
TRACKING .
PERMIT FEES
Plan Check submitted
7fltetm
Amount
Reviewed, ready for corrections
ck Deposit
Called Contact Person
Plan Check Balance
Plans picked up
Construction
Plans resubmitted
Mechanical
2' Review, ready for correctionstissue
Electrical
Called Contact Person .
Plumbing
Plans picked up
S.M.I.
Plans resubmitted
Grading
'"' Review, ready for correctionslrssue
DeveloperImpact Fee
Called Contact Person
A.LP.P.
Date of permit issue
Total Permit Fees
0