12-1013 (MECH)P.O. BOX 1504 VOICE (760) 77777012
- 78-495 CALLE TAMPICO (� FAX (760) 777-7011
• LA QUINTA, CALIFORNIA 92253 - BUILDING & SAFETY DEPARTMENT \�' INSPECTIONS. (760) 777-7153
BUILDING PERMIT
Date: 9/04/12
Q 1pplication'Nilmber 12-00001 013 Owner:
Property Address: -79420-'CALLE VISTA VERDE DOW RESIDENCE
APN: 604-392-037-78 -25953 - PO BOX 836
Application description: MECHANICAL SAN LUIS OBISPO, CA 93406
Property Zoning: LOW DENSITY RESIDENTIAL '
r Applicatiori Valuatibi): IUUU D /0\
Contractor: Ln�
Applicant: Architect or Engineer: GENERAL AIR CONDITIONING SEp 0.42 1
31170 RESERVE DRIVE
THOUSAND PALMS, CA 92276`
(760) 343-7488 CITY OF LAQUIPITA
Lic. No.: 686310
CE DEPT.
• ----------------------
LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION_
hereby affirm under penalty of perjury that I am I' nsed 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 P essional. C.
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 License No.: 686310 for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
• , issued.
Date:1 Z -.contractor:. _ 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 that I am exempt from the Contractor's State License Law for the Carrier ZENITH INS CO Policy Number Z071741501
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 th 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 bec 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 become ject to the workers' compensation provisions of Section
License Law (Chapter 9 (commencing with Section 70001 of Division 3 of the Business and Professions Code) or 3700 of the Labor Code, I shall f with 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 /// i
any applicant for a permit subjects the applicant to a civil penaltyof not more than five hundred dollars ($500).: D Appli
to cant;:'
(_ 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' MPENSATION 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.).,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 tothe 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,
• 1 _ 1 I am exempt under Sec. , B.&P.C. for this reason the owner,and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City
• r 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. -
_ 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 i mation 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 con r ctiori, and hereby authorize representatives
of this county to enter upon the above-mentioned property for ins ction purposes.
Lender's Name:
�Date: 41 Signature (Applicant or Agent):
_.r _ _.
Lender's Address:
LQPERMIT
Application Number
. . . 12-00001013
Permit . .. . . . :
MECHANICAL
Additional desc .
Permit Fee
31.50
Plan Check Fee.,:
7.88
Issue Date-
Valuation
0
Expiration Date
3/03/13
Qty ' Unit Charge"
Per
Extension
BASE FEE
15.00
1.00 16.5000
EA MECH B/C
>3-15HP/>100K-500KBTU
16.50
a'Special Notes and Comments
HVAC CHANGE OUT 3 TON
SPLIT SYSTEM.
-------------------_----------------------------
Other Fees . .
BLDG
STDS ADMIN (SB1473)
1.00
Fee. summary Charged PaidCredited".
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
•f
Climate Zones 10 - 1S'
r
Enforcement Agency:
Simplified Prescriptive Certificate of Compliance:' 2008 Residential HVAC Alterations CF-lR-ALT-HVAC
Climate Zones 10 - 1S'
Site'Address:
Enforcement Agency:
. R
#:
Simplified Prescriptive Certificate of Compliance:' 2008 Residential HVAC Alterations CF-lR-ALT-HVAC
Climate Zones 10 - 1S'
Site'Address:
Enforcement Agency:
Date:
#:
79420 CALLE VISTA VERDE La Quinta, CA 92253
City of La Quinta
Sep 4. 2012
TPermit
Duct insulation
Conditioned Floor
Equipment Type1
List Minimum Efficiency2
requirement
Area
Thermostat
❑ Package Unit
® Furnace
0 Indoor Coil
0 AFUE 78%
0 SEER 13.0
❑ COP
❑ HSPF
❑ R 6 (CZ 10-13)
Served by system
0 Setback ",•
If not a,ready present' must be
0 Condensing Unit
❑ EER
❑ Resistance
❑ R 8 (CZ 14-15)
1200 sf
r.
installed)
❑ Other
I
I•
-
1. Equipment Type: Choose the equipment being installed; if more than one system, use another CF -IR -ALT -HVAC for each system. •t •
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 fog 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 end 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.
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
i
. Furnace -
CF;4R forms: MECH-21 and (for split systems) MECH-25
4
For Split Systems: Duct leakagef< 15 percent; RC, CCA <_ 300 CFM/ton (Minimum Air Flow Requirement), TMAH
Exempted from duct leakage.testing if:.' •4
Np -1 D"uct-system was documented to have been previously sealed and confirmed through HERS .verifcation, or
❑ 2. Duct systems with less than 40 linear feet in unconditioned space, or ,
" [3.31. Existing duct systems are constructed, insulated or sealed with asbestos
❑ 4. The systernvwill not be Duct ed'(ie Ductless Mini -Split System)3(Aiso+Exempt from Refrigerant Charge)
❑ 2. New`HVAC System
Required Fbrms < , t-
. Cut in(or Changeout withz
CF 6R forms MECH-20 HERS, and '(for split systems) MECH-22 HERS, and
new ducts:' (all new r'+
ducting and all new
,MECH-04,
MECH "25�HERS,x=
A
CF 4R forms-lMECH-20; and (for split.systems) MECH=22, and'MECH 25,
equipment)
f �:., ,def r..�°"J - : .��. i� �;...�►`
For Split Sy`steins:,Duct leakage <(6`0ercent, RC, CCA,,2! 350 CFM/ton, FWD, TMAH, STMS, and either hSPP. or5PSPP. " --__''I'•`
For Packaged Units-Duct'leakagefi<
13r3. 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 2_ 300 CFM/ton, TMAH • r
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 sealedwith 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 i6entified 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 otter applicable compliance*' "
forms, worksheets, calculations, plans and specifications submitted to the enforcement agency for approval with the permit application.
Name: Danielle Garcia a Signature: Danielle Garcia
Company: HARRISON ENTERPRISES INC , Date: Sep 4, 2012
Address: 31-170 RESERVE DRIVE STE A License: 686310
City/State/Zip: THOUSAND PALMS / CA / 92276 Phone (760) 343-7488
Reg: 212-A0048719A-00000000-0000 Registration Date/Time: 2012/09/04 11:02:59 -'HERS Provider: CalCERTS, Inca
2008 Residential Compliance Forms • ; July,'2010
Bill #
Qty Of l -c? QUinta
Builft 8i' Safery'Division
P.O. Box 1504,78-495 Calle Tampico
4.Quinta, CA 92233 - (760) 777-7012.
Building Permit Application and Tracking Sheet
Permit #
Project Address: a LO
YT,.7Addr,==:
s Name:. ( W .
A. P. Number. �i�J4j:ylfoLegal
Description:
T, Zip:
Contractor.
�r
Telephone:
Address:
Project Description: c Choutn
City, ST, Zip
2 Z -7SCk
It C1 j
Telephone: (76 0)34
r w..
RR 9K
State Lia # : 0j 6 3 (Q
City Lia #;
Arch., Engr., Designer
Address:
City., ST, Zip:
Telephone:
State Lic. #:
Name of Contact Person:
Construction Type:. Occupancy:
; n Project type (circle one): New Add'n Alter Repair Demo
Sq. Ft: # Stories: #Unit$:
Telephone # of Contact Person:
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS UNE
#
Submittal
Req'd
Recd
TRACMG
PERMPP FEES
Plan Sets
Plan Check submitted
Item Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit. .
Truss C21cs.
Called Contact Person
Plan Check:3alance •
Title 24 Calm
Plans picked up
Constracdos
Flood plain plan
Pians resubmitted
Mechanical
Grading plea
2i° Review, ready for correcfions/'ctsue
Electrical
Subcoutactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.L
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
'" Review; ready for correetionsftue
Developer impact Fee
Planning Approval •
Called Contact Person
A.%P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees