11-0338 (MECH).0:0. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: X11, 000003,31=
Property Address: 47880 VIA TRIESTE
APN: 643-130-059-100 -26152 -
Application description: MECHANICAL
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 10952
Applicant:
Architect or Engineer:
P JA
4
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licen un
der provisions of Chapter 9 (commencing with
Section 7000) of Division 3 of the Business and Prole onals Code, and my License is in full force and effect.
License Class: C20 686310
Date: I ntractor:J'L7seNo.:
"
-BUILDER DECLARATION
I hereby affirm under penalty of.perjury that I am exempt from the Contractor's State License Law for.the
fpllowing 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 fivehundred dollars ($500).:
(_ 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
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 I, as owner of the property, am exclusively contracting with licensed contractors to construct the project ISec.
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.l.
(_ 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: PIK
LQPERMIT
Owner:
BRUNE NEAL W
47.880 VIA TRIESTE
LA QUINTA, CA 922
Contractor:
GENERAL AIR CONDI
31170 RESERVE DRI
THOUSAND -.PALMS, C
(760)343-7488
Lic. No.: 686310
VOICE (760) 777-7012
FAX (160) 777-7011
INSPECTIONS (760) 777-7153.
D�
.O ING'PR 05 2011
92 2'MTY OF LA QUINTA
F! RICE ®EpT
Date: 4/05/11
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
1 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
issuedlot.
•1 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 EVEREST NATL Policy Number 7600006147101
_ 1 certify that, in the performance of the ork for which this permit is issued, I shall not employ any
person in any manner so as to beco a subject to the workers' compensation laws of California,
and agree that, if 1 should become s sect to the workers' compensation provisions of Section
3700 of the Labor'Code, I shall fort ith comply with those provisions.
t83 e: 4plicant:
WARNING: FAILURE TO SECURE,WORKE PENSATION.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 issuancjsuch or cessation of work for 180 days will 'subject
permitto cancellation.
I certify that I have read this application and state tormation is correct. I agree to comply with all
city and county ordinances and state laws relating uction, and hereby authorize representatives
of this county to enter upo a above-mentioned-pction purposes..te: ignature (Applicant or Agent
Application Number 11-00000338
Permit MECHANICAL
Additional desc .
Permit Fee . . . . 40.50
Plan Check Fee
10.13
Issue Date
Valuation.
0
Expiration Date 10/02/11
Qty Unit Charge Per
Extension.
BASE
FEE
15.00
1.00 9.0000 EA MECH
FURNACE <=100K
9.00
1.00 16.5000 EA, MECH
B/C >3-15HP/>100K-500KBTU
16.50.
Special Notes and Comments
INSTALL NEW FURNACE, INCOOR COIL,
CONDENSING UNIT (13 SEER) 80% AFUE. 2010
CODES
----------------------------------------------------------
--------------------------
Other
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
[Simplified -Prescriptive Certificate of Compliance: -1008 Residential HVAC Alterations CF -IR -ALT -HVAC
Climate Zones 10 to 15
Site Ad ress:
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,q /tt � T,-",s
r,tt S L�
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Enforcement Agency:
Date:
Permit #:
Equipment T et
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
List Minimum Efficienc Z
si ed. Beginning October 1, 2010, a registered copy of the CF -IR and CF -611 shall also be on site for final inspection.
Duct insulation requirement
Conditioned Floor
Area
Thermostat
❑ Packaged Unit
CF -6R 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-2l-HERS and (for split systems) MECH- 25 -HERS
"mace
CF -4R forms: MECH- 21 and (for split systems) MECH-25
❑ AFUE 80 �i�
❑COP
Exempted from duct leakage testing if.
Over 40 ft of ducts added or
❑ 2. Duct systems with less than 40 linear feet in unconditioned space, or
Setback
Indoor Coil
Required Forms:
❑SEER /3
11HSPF
new equipment)
replaced in unconditioned space
Served by system
(If not already
ondensing Unit
Required Forms:
❑ EER / /
_
❑ Resistance
and/or outdoor condensing unit and/or indoor
❑ R 6 (CZ 10-13)
sf
present, must be
❑ Other
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.
❑ R 8 (CZ 14-15)
For split system or packaged units: Duct leakage < 15 percent
installed)
I. Equipment Type: Choose the equipment being installed; if more
than one system, use another CF -I R-ALT-HVACfor each system.
2. Minimum Equipment E>rcienrioc• 1 ? .4FFR 7,90i A17[11- 7 71renc r__ ..-:....,
• 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, plans andspecifications submitted to the enforcement agency for appro al with t e permit application.
[UU6 Residential Compliance Forms March 2010
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
si ed. 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 replaced
CF -6R 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-2l-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 ducts stems 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, plans andspecifications submitted to the enforcement agency for appro al with t e permit application.
Name: --?'I (.(%o.;IL's6'1
Si lure:
Company:
G,en,era.,' 41'r Corf -,'o n ,`
Date:
Address: —3`I-70 PeServe K7't t` ✓�i
License:
l7cty/State/Zip:—r—�D�SGtneL pqLs,
Phone: 760_343_-74ffg
[UU6 Residential Compliance Forms March 2010
tsm f
City of La -Quin t'a
• Building &r Safety Division
Permit #
7j �jgLa
P.O. Box 1504, 78-495 Calle Tampico
Quinta, CA 92253
'
1l
- (760) 777-7012
Building Permit Application and. Tracking Sheet
Project Address: 1. f gg� C c 1
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Owner's Name:A
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ea4 I,.
A. P. Number:
Address: g �b�
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Legal Description:
Cit, ST, Zip: L�t� 6,q -
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Contractor:Co enwL ±1 C_
Tel "
Address:
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Project Description: 41101,
City, ST, Zip: �0
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Telephone: v iJ {:C;T•.{C j:r fi:}':]v rv.: ;:;'.: :v. ! f!
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;City
State Lic. # : 3 Lic. #; 3 &0 Ip
Arch., Engr., Designer:
Address:
City., ST, Zip:
Telephone:!•>:,;....r.<:;;,...,•<::,:::?:>:>: ,••:,
Construction Type: Occupancy:
State Lic. #.-r> < ; . r:> ><%;>a< .
N",
t'v:f�.::iivr: �Y !
' Project type (circle one): New Add'n Alter Repair Demo
.............. ir...
Name of Contact•Person:
Sq. Ft.: # Stories: # Units:
Telephone # of Contact Person:
Estimated Value of Project:
APPLICANT: DO. NOT WRITE. BELOW THIS LINE
#
Submittal
Roe
Recd
TRACMG
PERMIT FEES
Plan Sets <
Plan Check submitted
Item
.Amount
Structural 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
2'4 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/issueDeveloper
Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
Schodl Fees
Total Permit Fees