11-0306 (MECH)P.O. BOX 1504 .
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Tityl- 4 4 Q"
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am
lic nsed under provisions of Chapter 9 (commencing with
Section 7000) of Division 3 of the Business and Pr f ssionals Code, and my License is in full force and effect.
License Class: C20 License No.: 686310
D� 31t..$ t. . Contractor..1
'OWNER -BUILDER DECLARATION
.1 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 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)::
1 _ 1 1, 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 herownemployees, 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 I, as owner of the property, am exclusively contractingwith 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.).
1 _ 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
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 3/28/11
Owner:
LINNES SARAH
80595 VIA TALAVERA
LA QUINTA, CA 92253
(760)771-2665
Contractor:
GENERAL AIR CONDITIONING MAR 28 2011
31170 RESERVE DRIVE
-
THOUSAND PALMS,.CA 92276
(760) 343-74ss ClTy OFFNAN E QUINTA
LIC. No.: 686310 OFpT
-----------------------------------------
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.
-_ Ihave and will maintain workers' compensation insurance, asrequired -by Section 3700 of the tabor
- Code, for the performance of the work for which this permit is issued. My workers' compensation
insurance carrier and policy number are: -
Carrier EVEREST. NATL Policy Number 7600006147101
I certify that, in the performance offthe' ork for which this permit is issued, I shall not employ any
person in any manner so as to bsubect to the workers' compensation laws of California,
and agree that, if I should becomecttothe workers' compensation provisions of Section3700 of the Labor Code, I shallith comply with those provisions.
Date/Z$APPlicant: �
C.. ,
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 ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
APPLICANT ACKNOWLEDGEMENT
.IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the
conditions and restrictions set forth on this application. -
1 . Each person upon whose behalf this application is made, each person at whose request and for
whose benefit work is performed under or pursuant to any permit issued as a result of this application,
the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City
of La Quinta, its officers, agents and employees for any act or omission related to the work being
performed under or following issuance of this permit. -
2. Any permit issued as a result of this application becomes null and void if work is not commenced
within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject
permit to cancellation.
I certify that I have read this application and state that the above inf rmation is correct. I agree to comply with all
city and county ordinances and state laws relating to building cons ction, and hereby authorize representatives
Of this county to enter upon the above-mentioned property for ins 'ion purposes.
Date:3 z -i3 Signature (Applicant or Agentl:
Application Number:
1 11-00000306
Property.Address:
80595 VIA TALAVERA
APN:
777-270-022-
Application description:
MECHANICAL'
Property Zoning:
LOW DENSITY
RESIDENTIAL
Application valuation:
8285
Applicant:
Architect or Engineer:
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am
lic nsed under provisions of Chapter 9 (commencing with
Section 7000) of Division 3 of the Business and Pr f ssionals Code, and my License is in full force and effect.
License Class: C20 License No.: 686310
D� 31t..$ t. . Contractor..1
'OWNER -BUILDER DECLARATION
.1 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 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)::
1 _ 1 1, 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 herownemployees, 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 I, as owner of the property, am exclusively contractingwith 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.).
1 _ 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
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 3/28/11
Owner:
LINNES SARAH
80595 VIA TALAVERA
LA QUINTA, CA 92253
(760)771-2665
Contractor:
GENERAL AIR CONDITIONING MAR 28 2011
31170 RESERVE DRIVE
-
THOUSAND PALMS,.CA 92276
(760) 343-74ss ClTy OFFNAN E QUINTA
LIC. No.: 686310 OFpT
-----------------------------------------
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.
-_ Ihave and will maintain workers' compensation insurance, asrequired -by Section 3700 of the tabor
- Code, for the performance of the work for which this permit is issued. My workers' compensation
insurance carrier and policy number are: -
Carrier EVEREST. NATL Policy Number 7600006147101
I certify that, in the performance offthe' ork for which this permit is issued, I shall not employ any
person in any manner so as to bsubect to the workers' compensation laws of California,
and agree that, if I should becomecttothe workers' compensation provisions of Section3700 of the Labor Code, I shallith comply with those provisions.
Date/Z$APPlicant: �
C.. ,
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 inf rmation is correct. I agree to comply with all
city and county ordinances and state laws relating to building cons ction, and hereby authorize representatives
Of this county to enter upon the above-mentioned property for ins 'ion purposes.
Date:3 z -i3 Signature (Applicant or Agentl:
Application Number 11-00000306
Permit MECHANICAL
Additional desc .
Permit Fee . . . . 33.00
Plan Check Fee
8.25
Issue Date
Valuation . .
-0
Expiration Date 9/24/11
Qty Unit Charge Per
Extension
BASE
FEE
15.00
1.00 9.0000 EA MECH
FURNACE <=100K
9.00
1.00 9.0000 EA MECH
B/C <=3HP/100K BTU
9.00
-----------------------------------------------------------------------------
Special Notes and Comments
INSTALL HVAC CHANGE OUT 13 SEERS
TONS.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
Sim lifted Prescri tive'Certificate of Compliance:- 2008 Residential H VA C Alterations CF -IR -ALT -HVAC
Climate Zones 10 to 15
Site Address: 8os4s' Ur'ec. %6t.+!&ye
Enforcement Agency:
Date:
Permit #:
a�.
Equipment T e'
List Minimum Efficiency'
Duct insulation re uirement
Conditioned Floor
Area
Thermostat
❑ Packaged Unit
Furnace
❑AFUE 80 %
❑COP
Over 40 ft of ducts add ed or
Setback
ndoor Coil
❑SEER 13
❑ HSPF
replaced in unconditioned space
Served by system
(If not already
JZI-Condensing Unit
❑ EER T/_
❑ Resistance
❑ R 6 (CZ 10-13)
sf
present, must he
❑ Other
❑ R 8 (CZ 14-15)
installed)
1. Equipment Type: Choose the equipment being installed; if store than one system, use another CF -1 R -ALT -HVAC for each system.
2. Minimum Equipment Efficiencies: 13 SEER, 78% AFUE, 7.7HSPF for 0,pical residential systems.
HERS VERIFICATION SUtMMARY"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 fortes 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
si ed. Beginning October 1, 2010, a registered co of the CF -1 R and CF -6R shall also be on site for final inspection.
I. HVAC Changeout
Required Forms:
• All HVAC Equipment replaced
CF -611 forms: MECH-04, MECH-2I-HERS and (for split systems) MECH- 25 -HERS
CF -4R forms: MECH- 21 and fors lits stems) MECH-25
• Condenser Coil and/or
• Indoor Coil and/or
CF -6R forms: MECH-21-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
For Packaged Units: Duct leakage < 15 percent
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 than 40 linear feet in unconditioned space, or
❑ 3. Existing duct systems are constructed; insulated or sealed with asbestos
❑ 2. New HVAC System
Required Forms:
• Cut in or Changeout with new
ducts: (all new ducting and all
CF -6R forms: MECH-04, MECH-20-HERS,and (for split systems) MECH-22-HERS, and MECH-25-HERS
new equipment)
CF -4R forms: MECH 20-, and (for split systems)MECH-22, and MECH 25
For Split Systems: Duct leakage < 6 percent; RC, CCA > 350 CFM/ton, FWD, TMAH, STMS, and either HSPP or PSPP.
For Packaged Units: Duct leakage < 6 percent
❑ 3. New Ducts with Replacement
Required 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 leakage < 6 percent
❑ 4. New Ducting over 40 feet
Required Forms:
• Includes adding or replacing more than 40
linear feet of duct in unconditioned space.
CF -6R forms: MECH-04, MECH-2I-HERS CF -4R forms: MECH-21
For split system or packaged units: Duct leakage < 15 percent
❑ EXCEPTION: Existing ducts stems 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 I and 6 of the California Code of Regulations.
• The design features identified on this Certificate of Compliance are consistent with the ' orm tion documented on other pplic ompliance forms, worksheets,
calculations, andspecifications
plans submitted to the enforcement a enc for a to at with t e permit a lication.
Name: Co Ifeen 1#0-.6Zi{l
Si tures
Company:
6&rl�eraJ tot r C—OrtX ¢�'on t`
Date:
3-�
Address: n_
iii % d PeS+'(U2 11 r,' V ei
License:
k_-ty/State/Zip:_rA_0i,16a4,,t �ALLh�s� Gh} 7(
Phone: -760 -3 43 — -7 4fff
,uuo t(esictentiat (,ompliance hones March 2010
, CaICERTS - CF -1R Registration
Page 1 of 1
t.
af�rtlu#s_"F+ ns ► Ho�tte Eiaergp Provider
Home Home ..k Danielle Garcia logged in [Logoutj
k [Home]
Ak+ao ua • `CONGRATULATIONS .
Training - Your CF -I R -ALT -HVAC Registration is complete!
Rater
-Directory t You may want to print this page for your records.
-. - ..
r f
^ Ferms Site Address 805995 VIA TALAVERA -
`V� La uinta, CA 92253
`r 3.
J _ CEC Registration: 211-A0015501A-00000000-0000
CF -IR -ALT -HVAC: CLICK HERE TO DOWNLOAD f t
[ndauy Pumas Assigned Company: HARRISON ENTERPRISES INC
�� Do you know your'HERS Rater? ,
To register for our If you do, you may,want to send this CF -IR to them. t
monthly '4f • CaICERTS Rater ID
newsletter, please 1 ' ? .
click here. " OR_.
My Rater Quick Select: Energy Dnven Solutions, Inc.
"Every CaICERTS rioter has a license number.
If you need to find the rater by name [Click HERE] to search our directory.
kSENDCFIRTOFdERS;RATERq #b
- [CLICK•HERE]'to do another
- l op�-right t"_Ol) ( il(
J. -,RTS In :All°u hts reserved. Revised: ;laniary 11. 2010 `
JTerins and Conditions] [Privacy Statement], [Class Cancellation Policy]
CaICERTS, Inc:, 31 Natoma St Suite 120; Folsom, CA"95630
Office: 916-985-3400,Tol1 Free: 877-HERS-R8R, (877-437=7787)
a Fax: 916-985-3402 Contact Us
l
SOL
w BBB' 6 Fut 6Wck ry
Fmd ue on •
- r t,�``.�„�T,u�,.�,�y�.r�.a,•dia4aar�ri
httnc-//www,ralrt:rtc rnm/niihlir. rf1 R Cfm9nrniPrt id=1 OS976 10.5/2011
(,ity of La Quinta
Building & Safety Division
P.O. Box 1504, 78.495 Calle Tampico
U Quinta, CA'92253 - (760) 777-7012 0
Building Permit -Application and. Tracking Sheet
Permit #
Project Address: �,�
SOS-` S
Owner's Name:, c5a r L vi ti,O—S
A. P. Number:
Address: goSR S 146, a. 7-a Ila i4
Legal Description:
City, ST, Zip: lam.- QUa
Contractor:co
Telephone:
& �.
:::+,:'`` ..'�." { ` f \, yy.::, '•:
S;: { < • <:: `<%
:>::�5`. �'^•f�,>sf::��;��.z#t� Fly,,:
Address: 3
Project Description: YCIAC
City, ST, Zip: YA 0 /
Telephone: 3 x; : w< .;::...::::;•:>::» :;. ........::.
i 30
State Lic: #
City Lie.
Arch., Engr., Designer:
Address:
City., ST, Zip:
Telephoner
State Lic.
4> : t>_ r:,;. -.;z.>;.:>.;:..... , >•.<.i::: .
Construction Type: Occupancy:
Project type circle one New Add'n Alter Repair Demo
Name of Contact•Person:
Sq.1?t.:
#.Stories:
#Units:
Telephone # of Contact Person:
Estimated Value of Project: fj's28S 60
APPLICANT: DO. NOT WRITE. BELOW THIS LINE
#
Submittal
Plan Sets
Req'd'
Recd
TRACKING
Plan Check submitted
PERMIT FEES
Item Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance,
Title 24 Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2nd 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 resubmittedGrading
IN HOUSE:-
''J Review,.ready for corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.I?.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees