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11-0274 (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: 3/18/11 Application Number: �11-00000274 �, Owner: Property Address: .47845 VIA TRIESTE HOLMSTROM ELAINE APN: 643-130-049-49 726152 - 47845 VIA TRIESTE Application description:. MECHANICAL LA QUINTA, CA. 92253 Property Zoning: LOW DENSITY RESIDENTIAL G+ Application valuation: 6185 Ri�1R icy 2011 Contractor:. Applicant: Architect or Engineer: GENERAL AIR CONDITIONING I Ci'filt`. ',A 44, U I N TA 31170 RESERVE DRIVE ?�r;A ,,£.Ptg f - THOUSAND PALMS, CA 92276 \ (760)343-7488 LiC. No.: 686310 LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury that I licensed 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 a Professionals 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 ass: C20 License No.: 686310 for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ate: 3 g mractor: 11 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 OWNER -BUILDER 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 EVEREST NATL Policy Number 7600006147101 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 b me 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 beco ubject 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 the La ode, I shal hwith 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 any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).: e: / licant: (_) 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 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. 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, 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 am exempt under Sec. , 8.&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 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 inform on is correct. I agree to comply with all city and county ordinances and state laws relating to building construc , and hereby authorize representatives of this county to enter up n the above-mentioned property for inspect purposes. ' j�e: 3 ignature (Applicant or Agent): I K ` Application Number . . . . . 11-00000274 Permit MECHANICAL Additional desc . Permit Fee" 31.50 P1an..Check Fee 7.88 Issue Date Valuation .0 Expiration Date . 9/14/11 Qty Unit Charge Per Extension BASE FEE 15:00 1.00 16.5000 EA MECH B/C >3-15HP/>100K-500KBTU 16.5.0 Special Notes and Comments INSTALL NEW CONDENSER (13 SEER), INDOOR COIL. 2010 CODES. -----------------_-_-------_-------------------------------------------------- Other Fees. . ." BLDG STDS ADMIN (SB1473) 1.00 Fee summary- Charged ' Paid Credited Due Permit Fee Total 31.50 .00 .00' 31.50 Plan Check Total 7.88 .00 .00 7.88 Other Fee Total 1.00. .00 .00 1.00 Grand Total 40.38. .00" .00 40.38 FI . CING THROUGH: REBATES �h GENERAL Air Conditioning & Heating 31-170 Reserve Drive • Thousand Palms, CA 92276 (760) 343-7488 9 Fax (760) 343-7494 www.callthegeneral.com Residential Comfort Survey INSTALL DATE. - l I JOB# .11T� 3 CUSTOMER# ` l NAME 01 I � (StrJm , Ll Ct / f J JOB ADDRESS g 7 g 4 5 ,/ CL 7rl S I - CITY La & STATE (I ZIP CODE 9ao,i3 PHONE*- CELL FAX SEPARATE BILLING ADDRESS? ❑ YES ❑ NO NEW EQUIPMENT COND FAU COIL TSTAT FILTRATION MISC PERMIT . ❑ YES ❑ NO M NOTES_ \A C EXISTING EQUIPMENT CONDM# S# FAUM# S# COIL M# UNIT LOCATION: S# CRANE? ❑ YES ❑ NO SIZE WARRANTY PLATFORM SIZE ATTIC HEIGHT OPENING (, ❑ FINASN -"`---T DAYS ❑ CARM CARD ;r❑ C.O.D. O COSTCO Certificate of Product Ratings- AHRI Certified Reference Number: 3722780 Date: 3/17/2011 Product: Split System: Air -Cooled Condensing Unit, Coil Alone Outdoor Unit Model Number: 14ACX-060-230-11 Manufacturer: LENNOX INDUSTRIES, INC. Indoor Unit Model Number: LH42/62E9+TD Manufacturer: ADVANCED DISTRIBUTOR PRODUCTS Trade/Brand name: ADP Manufacturer responsible for the rating of this system combination is ADVANCED DISTRIBUTOR PRODUCTS Rated as follows in accordance with AHRI Standard 210/240-2008 for Unitary Air -Conditioning and Air -Source Heat Pump Equipment and subject to verification of rating accuracy by AHRI-sponsored, independent, third party testing: Cooling Capacity (Btuh): 58000 EER Rating (Cooling): 12.00 SEER Rating (Cooling): 14.50 Ratings followed by an asterisk (') indicate a voluntary rerate of previously published data, unless accompanied with a WAS, which indicates an involuntary rerate DISCLAIMER AHRI does not endorse the product(s) listed on this Certificate and makes no representations, warranties or guarantees as to, and assumes no responsibility for, the product(s) listed on this Certificate. AHRI expressly disclaims all liability for damages of any kind arising out of the use or performance of the product(s), or the unauthorized alteration of data listed on this Certificate. Certified ratings are valid only for models and configurations listed in the directory at www.ahridirectory.org. TERMS AND CONDITIONS This Certificate and its contents are proprietary products of AHRI. This Certificate shall only be used for Individual, personal and confidential reference purposes. The contents of this Certificate may not, in whole or in part, be reproduced; copied; disseminated; entered into a computer database; or otherwise utilized, in any form or manner or by any means, except for the user's Individual, personal and confidential reference. CERTIFICATE VERIFICATION®® The information for the model cited on this certificate can be verified at www.ahridirectory.org, Air -Conditioning, Heating, click on "Verify. Certificate" link and enter the AHRI Certified Reference Number and the date on �® ON ®® and Refrigeration Institute which the certificate was issued, which is listed above, and the Certificate No., which is listed below. ©2011 Air -Conditioning, Heating, and Refrigeration Institute CERTIFICATE NO.: 129448683501563525 Simplified Prescri tive Certificate of Com liance: 2008 Residential HVACAlterations CF -IR -ALT -HVAC Climate Zones 10 to 15 2M Residential Compliance Forms March 2010 Site Address: Tf ; sty Enforcement agency: • !a- &tL,' n,4v,_ Date: 3-0-11 Permit #: Equipment Type' List Minimum Efficienc z Duct insulation re uirement Conditioned Floor Area Thermostat ❑ Packaged Unit ❑ Furnace ❑ AFUE 80'% ❑ COP Over 40 ft of ducts added or Ks�etback Indoor Coil ❑SEER 13 ❑ HSPF replaced in unconditioned space Served by system Ujnor already ondensing Unit ❑ EER / / ❑ Resistance ❑ R 6 (CZ 10-13) sf present, must be ❑ Other ❑ R 8 (CZ /4-1)) installed) 1. Equipment Type: Choose the equipment being installed; if more than one system, use another CF -1 R -ALT -HVAC for each system. 2. Minimum Equipment Efficiencies: 13 SEER, 78% AFUE, 7.7HSPF for t}pical residential systems. HERS VERIFICATION SUtNINIARY 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 si ed. Beginning October 1, 2010, a registered copy of the CF -IR and CF -6R shall also be on site for final inspection. 1. 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-611forms: MECH-2I-HERS and (for split systems) MECH- 25 -HERS • Furnace CF -411 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 s: Changeout with new ducts: CF -6R forms: MECH-04, MECH-20-HERS,and (for split systems) MECH-22-HERS, and MECH-25-HERS (all l new ducting and all d MECH-22, and MECH 25 systems) new equipment) CF -4R forms: MECH 20-, an( forsplits ) 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 CF4R 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 Cumpliance 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 ' orm tion documented ori other ppli compliance forms, worksheets, calculations, plans and specifications submitted to the enforcerirent agency for appro al with t e permit application. Name: C[ Lpe`l Sicure: Company: G,en�e��( t4r r CDrldr f.`On t� Date: 3 dress: _30-70 /e(*Ue �tt✓� License: City /State/Zip:�%D lc�S1nyG�►�� / Phone: 700—.3�3_%aTff9 2M Residential Compliance Forms March 2010 Bin # City of La Quinta Building Bi Safety DMSlon P.O. Box 1504, 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 Building Permit -Application and Tracking Sheet Permit # �^ 11 ` Project Address:!V' Sl1 V,'&— S f �2 . A. P. Number. Owner's Name: Address: City, ST, Zip: La_L,, +,�,- Legal Description: Contractor:x<r Telephone �( >cA',j:`:'' �h;. «; ^' z r°';`;az`u: Address: City, ST, Zip: '� �1�,7 Project Description: VA C �f (a'1I e PJ U-46 Telephone: 3 � w-•., i,; •r: ::n':.,;•:;;>: ;.,::,::: `•�%�tj ti is>::::;;�::> ;��,��:. wr MFF' 4 State Lie. # City Lie. C Arch., Engr., Designer: Address: ---------------- City., ST, Zip: Telephone ,.E:::;:z :;•:> <:>f;:«::v::::.:k:.:;: • `' •' '''"' State Lie. #: y f {Y, :<r.: ,<; : T r " Construction Type: Occupancy. project type (circle one): New Add'n Alter. Repair Demo Name of Contact Person: Sq. Ft.: #. Stories: #Units: Telephone # of Contact Person: Estimated Value of Project: 40� 8 S• CO O APPLICANT: DO. NOT WRITE. BELOW THIS LINE # Submittal Req'd Recd TRACMG PERMIT FEES Plan Sets Plan Check submitted Item Amount Structural Cales. Reviewed, ready for corrections Plan Check Deposit Truss Coles. Called Contact Person Plan Check Balance Title 24 Calcs.. Plans picked up Construction ' Flood plain plan Plans resubmitted Mechanical Grading plan 2"a 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 .. '"' Review, ready for corrections/issue Developer Impact Fee Planning Approval Called Contact Person A.LP.P.. Pub. Wks. Appr Date of permit issue School Fees Totat Permit Fees