12-0942 (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
... • y'1� �. Date: 8/20/12
Application Number:; � X00000942. Owner:' '
Property Address: 4e57377--VIA-VISTA BLACKBLOCK FREDA `
APN: 762-24`0-008`27 -3009.62- 57377 VIA VISTA
Application description: MECHANICAL LA QUINTA, CA 92253
Property Zoning: MEDIUM.DENSITY RES WTE Application valuation: 5000Contractor.AppArchitect or Engineer: GENERAL AIR CONDITIO31170 RESERVE DRIVE��((// TxOUSAND PALMS, CA 9 (760)343-7488` t Lic. No. 686310
' - ' - • �" - LICENSEDrCONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION'
7 7y..
3
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 -(commencing with, -1 hereby affirm under penalty of perjury one of the following declarations:.
Section 7000) of Division 3 of the Business and ofessionaI! 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
L Y,_ License Class: C20- License No.: 686310 'for by Section 3700 of the Labor Code, for the performance of the work for which this permit is`>
t issued. t '
Contractor: 4 - 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
WNER-BUILDER DECLARATION - - ' ' insurance carrier and policy number are: �'
I hereby affirm under penalty of perjury t at I am exempt from the Contractor's State License Law for the Carrier ZENITH INS CO Policy Number Z071741501 t
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 f 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 becomesub' t to the workers' compensation laws of California,
r .. -
permit to file a signedstatement that he or she is licensed pursuantto the provisions of theContractor's State'. _ and agreethat, if I should become subject the workers' compensation provisions of Section
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or-� 3700of-the Labor Code, I shall forthwith mply ith those provisions.
that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by �o. - - a r
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).: -. Date:—O o 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 WORKERS' MPEN ATION COVERAGE IS UNLAWFUL, AND SHALL a }
` Contractors' State License Law does not apply to an owner ofIproperty who builds or improves thereon, f SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND ,
- . and who does the work himself or herself through his orher own employees"; provided that the - . DOLLARS (5100,000). 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.). APPLICANT ACKNOWLEDGEMENT , . -
• (_ 1 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. IMPORTANT Application is hereby made to ttte 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 1 . 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, `
I I am exempt under Sea , B.&P.C. for this reason .. the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City '
-' of La Ouinta, its officers, agents and employees for any act or omission related to thework being
performed under or following issuance of this permit. - -
Dater - 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; o 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 fortheperformance of the I certify that I have read this application and state thatthe above inf r ation 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 const tion, and hereby authorize representatives,
of this county to enter upon the above-mentioned property for insp _tion purposes. '
Lender's Name: _ / �_•..� _•......
• - CDate:8 (,Signature (Applicant or Agent): .
,, • Lender's Address:
LQPERMIT ..
Application Number"' 12-00000942
Permit MECHANICAL
Additional desc .
Permit Fee . . . . 31.50 Plan Check Fee
7.88
Issue Date . . .. Valuation . . . .
0
Expiration Date 2/16/13
Qty Unit Charge Per
Extension
BASE FEE
15.00
1.00 16.5000 EA. MECH B/C >3=15HP/>100K-500KBTU
16.50
-------- ------------------------------ ----------------------------------
Special Notes and, -Comments
CHANGE OUT 5 TON OUTDOOR CONDENSER 13
-SEER,.2010 CODES.
J. Other Fees _.. BLDG STADMIN (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
_
s,
LQPERMIT
r
Simplified Prescriptive Certificate of Compliance: 2008 Residential HVAC Alterations CF -1R -ALT -HVAC
Climate Zones 10 - IS
Site Address:
Enforcement Agency:
Date:
Permit #:
57377 VIA VISTA La Quinta, CA 92253
City of La Quinta
Aug 16, 2012
Equipment Typel
List Minimum Efficiency2
Dud insulation
requirement
Conditioned Floor
Area
Thermostat
❑ Package Unit
❑ Furnace
❑ Indoor Coil
❑ AFUE •
® SEER 13.0
❑ COP
❑ HSPF
❑ R 6 (CZ 10-13)
❑ R 8 (CZ 14-15)
Served by system
1734 sf
® Setback
If not already present, must be
® Condensing Unit
❑ 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 -411
forms (no hand filled CF-4Rs allowed) are filled out and signed.Beginning October 1, 2010, a registered copy of the CF -IR
and CF -611 shall also be on site for final inspection.
0 1. HVAC Changeout
Required Forms:
. All HVAC Equipment .
CF -6R 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 -411 forms: MECH-21 and (for split systems) MECH-25
For Split Systems: Dud leakage < 15 percent; RC, CCA <_ 300 CFM/ton (Minimum Air Flow Requirement), TMAH
-Q 15
PeFGeRk
Exempted from dud leakage testing if:
❑ 1. Duct system was documented to have been previously sealed and confirmed through HERS verification, or
[12. Duct systems with less than 40 linear feet in unconditioned space, or
❑ 3. Existing dud systems are constructed, insulated or sealed with asbestos
❑'4. The not be Ducted (ie Ductless,Mini�Spht System)y(AIso Exempt,from Refrigerant Charge)
„system,.will
.A, �p
132 NewOVAC System
Required Fo,'ii ns {, +
�.
.Cut in'.orgChangeout with
' Y ' d' F l i')' f
CF 6R fomu `MECH-04, MECH 20 HERS,and=(for split systems) MECH 22 HERS, and
new ducts : all new f"
dudingp�(all new
equipment)
MECH',25�HERS fr' _ °"
:� _
CF 4R forms sMECH-20 and `(for split system INECH-22, and MECH45'. j
fig.• .r1 afi _(� « i
For Split Systems: Duct leakage
s«6 percent, RC CCAS 350,CFM/td#;; FWD TMAH;-*SEMS, and:`either:HSPP or PSPP.
For Packaged Units: Duct
leakage<;6.percenf
❑ 3. New Ducts with/or without
Required Forms:
Replacement ;
. Includes replacing or installing all 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 -611 forms: MECH-04, MECH-2I-HERS
linear feet of duct in unconditioned space.
CF -411 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: "Aug 16, 2012
Address: 31-170 RESERVE DRIVE STE A License: 686310
City/State/Zip: THOUSAND PALMS / CA / 92276' Phone: (760) 343-7488
Reg: 212-A0044945A-00000000-0000 Registration Date/Time: 2012/08/16 16:03:01 HERS Provider: CalCERTS, Inc.
2008 Residential Compliance' Forms July 2010 .
Btn.#
0ty. of Qutnta
Bulldmg 8f Safety Division
P.O. Box 1504,78-495 Calle Tampico
4.Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Pemllt #
Project Address:
Owner's Name:. e
O
A. P. Number 24 : 2
Address: SIM
Legal Description:
City, ST, Zip:
Contractor. �� r
Telephone:
Project Description:
Address: 3(— ! 'j O r
City, ST, Zip:
Telephone- '7G o --14
State Lie. #: (, (6 City Lie. #;
Arch., Engr., Designer
-
Address:
City., ST. Zip:
Telephone:
'
Construction Type:. Occupancy:
State Lie. #:
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 . S v G 0 `=
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd .
Rec'd
TRACMG
PERMIT FEES
Pian Sete
Plan Cheek submitted
Item Amount
Structural Calm
Reviewed, ready for corrections
Plan Check Deposit. .
Truss Cates.
Called Contact Person
Plan Check Balance.
Tide 24 Cates.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2" Review, ready for correctionVissue
Electrical
Subcontaetor List
-
Called Contact Person
Plumbing
Grant Deed
Pians picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN ROUSE:-
''d Review; ready for correedonsAssue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit Issue
School Fees
Total Permit Fees