12-0680 (MECH)P.O. BOX 1504
78-495 CALLS TAMPICO :
LA QUINTA, CALIFORNIA 92253'
Application Number:
Property Address:
APN:
Application description:
Property Zoning:
Application valuation:
12`=0000068-0_•__„ , '
51735 VIA ROBLADA
772-270-010-29 -3-11231-
MECHANICAL
LOW DENSITY RESIDENTIAL
12437
BUILDING &- SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
JIM BRANDT,
51735 VIA ROBLADA
LA QUINTA, CA 92253
VOICE (760) 777-7012 '
,FAX (760) 777-7011 '
INSPECTIONS (760) 777-7153
Date: 6/19/12
U
Contractor:
Applicant: Architect or Engineer: GENERAL AIR CONDITIONING l j!
31170 RESERVE DRIVE UN 1 OnR
THOUSAND PALMS, CA 92276
(760) 343=7488 C!'� ���,``
l�Lic. No.: 686310 ` w t a,p, o • dryi.
_ LICENSED CO TRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury that I am licens under provisions of'Chapter 9 (commencing with I hereby affirm under penalty of .perjury one of the following declarations:
Section 7000) of Division 3 of the Business and Profess als Code, and my License is in full force and effect. I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided
' License Class: C20 - Lic se No.: 686310 for by Section 3700 of the Labor
Code, for the performance of the work for which this permit is -
issued. -
. /Date: Z.... ontractor: ` I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor
Code, for the performanceofthe work for which this permit is issued. My workers'. compensation
NERLBUILDER DECLARATION insurance carrier and policy number are:.
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the Carrier ZENITH INS CO Policy Number Z07.1741501
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 anymanner so as tobecome s ject 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 subj to the workers' compensation provisions of Section
- License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or 3700 of t Labor Code, l shall forthv�ff 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 G
any applicant for,a permit subjects applicant to a civil penalty of not more than five hundred dollars IS500L: Date: t Q .Applicant:
(_ 1 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 WORKER& eOWIfENSATION COVERAGE IS UNLAWFUL, AND SHALL
-Contractors' State License Law does 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. df, 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:). - - APPLICANT ACKNOWLEDGEMENT _
(_) 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 a contractor(s) licensed I . 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, '
(_ 1 I am exempt under Sec. , BAP.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 workbeing
performed under or following issuance of this permit.
Date: Owner: 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
CONSTRUCTION LENDING AGENCY permit to cancellation.
I hereby. affirm under penalty of perjury that there is a construction lending agency, for the performance of the _ I certify that I have read this application and state that the above infor on is correct. I agree to comply with all
' work for which this permit is issued (Sec. 3097, Civ. C.). - city and county "ordinances and state laws relating to building construe , and hereby authorize representatives
• - of t 's county to enter upon eabove-mentioned property for inspect pup oses. -
Lender's Name: - -
'
at 6 S' nature (Applicant or Agent):
Lender's Address:.
LQPERMIT
. .. Application'Number - • • 12-00000680....
Permit . . MECHANICAL
Additional,.desc
• Permit Fee 40'.50 Plan Check Fee
10.13
Issue Date Valuation, _
0
Expiration Date 12/16/12.
Qty 'Unit Charge Per•
Extension
BASE FEE
15.00 -a
1.00 9.:0000 EA MECH FURNACE <=100K
9.00
1.00 16.5000'EA MECH B/C >3-15HP/>100K-50.0KBTU
16.50
------
Special Notes and'Comments
'HVAC CHANGE -OUT: -4 TON UPFLOW ,SPLIT
SYSTEM, FURNACE, CONDENSER, INDOOR COIL.
2 010.. CODES .
-------------------------------------------- I ---
----------------------------------------
Other Fees BLDG SIDS. ADMIN (.SB1473)
------------
1.00
Fee summaryCharged 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 A0
1.00
Grand Total 51.63 -.00 .00
'
51.63-
N' a
i�
LQPERMIT-
Simplified Prescriptive Certificate of Compliance: 2008 Residential HVAC Alterations CF -1R -ALT -HVAC
Climate Zones 10 - 15
Site Address:
Enforcement Agency:
Date:
Permit #:
51735 VIA ROBLADA La Quinta, CA 92253
City of La Quinta
Jun 18, 2012
Duct insulation
Conditioned Floor
Equipment Typel
List Minimum Efficiency2
requirement
Area
Thermostat
❑ Package Unit
® Furnace
® AFUE 78%
❑ COPy
[3 R 6 (CZ 10-13)
b system
Served b
® Setback
® Indoor Coil
® SEER 13.0
❑ HSPF
R gCZ 14-15)EER
(
18ve
If not already present, must be
® Condensing Unit
[I EER
❑ Resistance
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 -111
and CF -6111 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
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
For Split Systems: Duct leakage!.<. 15.percent; RC, CCA <_ 300 CFM/ton (Minimum Air Flow Requirement), TMAH
Exempted from duct leakage testing if:
p is Duct"system was documented to have been previously sealed and confirmed through HERS verification, or
❑ 2. Duct systems with less than.40 linear feet in unconditioned space, or
❑ 3. Existing duct systems are constructed, insulated or sealed with asbestos
❑ 4. The system will not be Ducted -(ie. Ductless -Mini -Split System) (Also -Exempt frommRefrigerant=Charge)
❑ 2. Nev"HVAC System
Required Forms: .: -k ; :G
. Cut in'or Changeout with'°
new ducts:' (all new 1
s'`1 1' 20 �" ' f t"
CF 6R forms MECH-04, MECH HERS, and (for split systems) MECH-22 HERS, and
ductiA6,j . all new
i
MEC H"25 HERS ,
f a�
CF 4R forms. MECH-20, and (for split systems) MECH=32, and MECH 25 I
e quipment)
r�
For Split Systems: Duct leakage, < 6 percent; RC :CCA >`350 CFM/ton .FWD, TMAH, SIMS, and eith"ei HSPP"o PSPP. M=:=
_� r
For Packaged Units: Duct leakage < 6 percent - -
❑ 3. -New; Ducts with/or without ;>
Required Forms:
Replacement .. I
• Includes replacing or installing jljr new
ducting and/or outdoor condensing 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 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 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: Danielle Garcia Signature: Danielle Garcia
Company: HARRISON ENTERPRISES INC Date: Jun 18, 2012
Address: 31-170 RESERVE DRIVE STE A License: 686310
City/State/Zip:. THOUSAND PALMS / CA / 92276 Phone: (760) 343-7488
Reg: 212-A0031609A-00000000-0000 Registration Date/Time: 2012/06/18 19:37:58 HERS Provider: CalCERTS, inc.
2008 Residential Compliance Forms July 2010
Btn.#
City of La QC((11ta
Bulldog a Safety Division
Box 1504,78-495 Calle Tampico
L4.Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #P.O.
AID
:`
Project Address: : jG-
I A b l q (�
Owner's Name:. iY1
A. P. Number. t}-7Jn 0 2
Address: r_;
Legal Description:
City, ST, Zip: r
Contractor.
�Q
Telephone: '
Address:
Project Description: l' V pa nor:
4
City, ST, Zip:
Telephone:
I l S
State Lic. #:
City Lir #; .
Arch., Engr., Designer
Address:
,
City., ST, Zip:
Telephone:
State Lic. #:
Name of Contact Person:
by
Construction Type:. Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
Sq. Ft :O # Stories: #Units:
Telephone # of Contact Person:
Estimated Value of Project
APPLICANT: DO NOT WRITE BELOW THIS UNE
q
Submittal
Req'd
Recd
TRACIQNG
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Stnictural Cafes.
Reviewed, ready for corrections
Plan Check Deposit. .
Truss Cafes.
Called Contact Person
Plan Check Balance
Title 24 Cafes.
Plans picked up
Construction
Flood plain plan
Plans resubmitted.'.
Mechanical'
Grading plan
2" Review, ready for correctionstissue
Electrical -
Subcontector List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Gradlo '
IN HOUSE:-
'"` Review; ready for correetionslissue
Developer Impact Fee
Planning Approval
Called Contact Personf
A.I.P.P.
Pub. R'ks. Appr
Date. of permit issue
School Fees
Total Permit Fees