10-0350 (MECH)e9b' _ a
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
T c&t
4,ih-!tt 4
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT -
Owner:
HEMINGWAY RANDOLPH-R
48151 VISTA CIELO
LA QUINTA, CA 92253
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 4/22/10
Contractor: U ADf► ��%n �I
Applicant: Architect or Engineer. PREFERRED PLUMBING HTG A/ U U
P.O. BOX 5120 L.
PALM SPRINGS, CA 9226- OFLAQ
.{760),322-3173 1
FNA,V1l rA
Lic. No.. 457554
s
_ _ _ _ _ -- _ _ _ _ _ _ _ _ _ _ _ _ _ _ _- _ _ _ _ _ _ _ _ - _ _- _ _ 77 _ _ - _ - - - - - _ _ _ _ _ ----- _ -- _ _ _ _ _ _,_ _ _ _ _ _ _ _ _ _ _ _ _ _ _._ _ _ _ _ _,- - _ ^•h- _
LICENSED CONTRACTOR'S DECLARATION '` WORKER'S COMPENSATION DECLARATION �.
I hereby affirmunder penalty of perjury that I a 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 rofessionals 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 Class: C10 C16 C2 'cense o. 4,97554 - - for by Section 3700 of.the.Labor Code, for the performance of the work for which this permit is
issued.
ate, w- C ractor: 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.
O R- ILDERDECLARATION - -. - 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 OAK RIVER INS - IPolicy Number 2200056449-101
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 personinany manner so as to become 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 ome'subiect he ers' ompensation provisions of Section
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or 3700 of the Labor Code; shall f h co y se provisions.
that he or she is exempt therefrom and the basis for the. alleged exemption. Any violation of Section 7031.5 by */0
Yany applicant for a permit subjects the applicant to a civil penaltyof not more than five hundred dollars IS5001.: ` te:icant: -
(=) 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 WARNING: FAILURE TO SECURE WORKER OMP SATION 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 PENALT D 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 SECTION3706OF 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 the Director,of Building and Safety for a permit _subject to the
7044, Business and Professions Code: The Contractors' State License Law does not apply town 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 '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
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 1 have read this application and state that the abo nformation is Corr I agree to comply with all
workfor which this permit is issued (Sec. 3097, Civ. C.1. city and county ordinances and state laws relatir to buildin nstructi nd re au prize representatives
_ of thi county to enter upon the above-mentioned propett r ins ion pu p e ,
Lender's Name: -
ate:nature (Applicant or Agent
Lender's Address: __
`!TO -7-00000350 - _
Application Number:
- "*
Property Address:
48151 VISTA CIELO
. APN: -. .-. _ .._
646-100-032- - _ _ __ .. _ w -. - - -
Application description:
-MECHANICAL
Property Zoning:
LOW DENSITY RESIDENTIAL'
Application valuation:
4613
Owner:
HEMINGWAY RANDOLPH-R
48151 VISTA CIELO
LA QUINTA, CA 92253
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 4/22/10
Contractor: U ADf► ��%n �I
Applicant: Architect or Engineer. PREFERRED PLUMBING HTG A/ U U
P.O. BOX 5120 L.
PALM SPRINGS, CA 9226- OFLAQ
.{760),322-3173 1
FNA,V1l rA
Lic. No.. 457554
s
_ _ _ _ _ -- _ _ _ _ _ _ _ _ _ _ _ _ _ _ _- _ _ _ _ _ _ _ _ - _ _- _ _ 77 _ _ - _ - - - - - _ _ _ _ _ ----- _ -- _ _ _ _ _ _,_ _ _ _ _ _ _ _ _ _ _ _ _ _ _._ _ _ _ _ _,- - _ ^•h- _
LICENSED CONTRACTOR'S DECLARATION '` WORKER'S COMPENSATION DECLARATION �.
I hereby affirmunder penalty of perjury that I a 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 rofessionals 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 Class: C10 C16 C2 'cense o. 4,97554 - - for by Section 3700 of.the.Labor Code, for the performance of the work for which this permit is
issued.
ate, w- C ractor: 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.
O R- ILDERDECLARATION - -. - 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 OAK RIVER INS - IPolicy Number 2200056449-101
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 personinany manner so as to become 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 ome'subiect he ers' ompensation provisions of Section
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or 3700 of the Labor Code; shall f h co y se provisions.
that he or she is exempt therefrom and the basis for the. alleged exemption. Any violation of Section 7031.5 by */0
Yany applicant for a permit subjects the applicant to a civil penaltyof not more than five hundred dollars IS5001.: ` te:icant: -
(=) 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 WARNING: FAILURE TO SECURE WORKER OMP SATION 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 PENALT D 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 SECTION3706OF 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 the Director,of Building and Safety for a permit _subject to the
7044, Business and Professions Code: The Contractors' State License Law does not apply town 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 '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
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 1 have read this application and state that the abo nformation is Corr I agree to comply with all
workfor which this permit is issued (Sec. 3097, Civ. C.1. city and county ordinances and state laws relatir to buildin nstructi nd re au prize representatives
_ of thi county to enter upon the above-mentioned propett r ins ion pu p e ,
Lender's Name: -
ate:nature (Applicant or Agent
Lender's Address: __
Application Number . . . . . 10-00000350
Permit MECHANICAL
Additional desc .
Permit. Fee . . . . 31.50
Plan Check Fee
7.88
Issue Date
Valuation
0 -
Expiration Date 10/19/10
. Qty UnitCharge Per
_ . - . _.. __ _. .., .. ,
� Extension - .. .. .
BASE
FEE
15.00
1.00 16.5000 EA MECH
B/C >3=15HP/>100K-500KBTU
16.50
Special Notes and Comments
REPLACE CONDENSER (13.25 SEER) &
COIL.
2007 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
LQPERMIT
Simplified Prescri tive Certificate of Compliance: 2008 Residential HVACAlterations CF -IR -ALT -HVAC
Climate Zones 10 to 15
Site Address: t
En orcementAgency:
Date-
Permit 1{:
N -`a/- iv.10-35o
Conditioned Floor
Equipment T el
List Minimum Efficienc z
Duct insulation requirement
Area
Thermostat
❑ Packaged Unit
❑ Furnace
❑ AFUEPA
❑ COP
Over 40 ft of ducts added or
Ketback
jpindoor Coil
1' kSEER1,��
❑ HSPF
replaced in unconditioned space
Served by system
(If not already
Condensing Unit
VEER
_
❑ Resistance
❑ R 6 (CZ 10-13)
1161 sf
present, must be
❑ Other
❑ R 8 (CZ 14-15)
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 Efdencies: 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 -4R 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 -6R 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-2I-HERS and (for split systems) MECH- 25 -HERS
CF -4R forms: MECH- 21 and (for split systems). MECH-25
• Furnace
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 CF -6R forms: MECH-04, MECH-20-HERS,and (for split systems) MECH-22-HERS, and MECH-25-HERS
ducts: (all new ducting and all
CF -4R forms: MECH 20-, and (for split systems)MECH-22, and MECH 25
new equipment)
For Split Systems: Duct leakage < 6 percent; RC, CCA 2:350 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 -411 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 2ercent
❑ 4. New Ducting over 40 feet
Required Forms:
• Includes adding or replacing more than 40
linear feet of duct in unconditioned space.
CF -611 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 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 andspecifications submitted to the enforcement agency for approval with the permitapocation.
Name:�4 ens
Signature:
CompanyA: ((��
)9% 6 '. `few In li
Date:
Ll — /— /C)
-11re) r, -
rae ,
Address -License:
2-/d—// sU in 0 n e lj
L/S 75— L/1
City/State/Zip: �� C G� L
Phone: 7Z) . 3a —3 / I3
2008 Residential Compliance Forms March 2010
Bin #
,City of La Q'inita
Building U Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permitfl
Project Address:' a f $ i ��� C ¢ b
Owner's Name: �� �a
A. P. Number:
Address: 15 5 C; �l0
Legal Description:
City, ST, Zip:Q �� q � a s 3
Preferred Air Conditioning dba
Contractor: P r e f e r r e d Plumbin Heatin &Ai.
Telephone:_
Address: -PO Box 5120
l
Project. Description:
City, ST, Zip:palm Springs, CA ' 9226
n�Qrise GU; J
Telephone: (7 6 0) 322-'3173
8,e y1,5r.0,, (,p
State Lic. # 45755-4 City Lic.
Arch., Engn, Designer:
Address:
City, ST, Zip:
Telephone:
d
Construction Type: Occupancy:
State Lic. #:
Project,type (circle one): New Add'nAlter, Repair Demo
Name of Contact Person:
Sq. Ft.; ) 1 f
# Stories: %
# Units:
Telephone # of Contact Person:
Estimaied Value of Project: �p
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACKING !
PERAM FEES
Plan Sets
Plan Check submitted
Ite
Amount
Structural Calcs.
Reviewed, ready for corrections
MallCheck Deposit
Truss Calcs.
Called Contact Person
Pia Check Balance
Energy Calcs.
Plans picked up
Con traction
Flood plain plan
Plans.resubmitted
Mec lanical
Grading, plan'
2"d Review, ready foi'corrections/issue
Ele rlcal
Subcontactor List
Called Contact Perjon
Pln bing
Grant Deed
Plans picked up
S.M I.
H.O.A. Approval
Plans resubmitted
Gra ling
INHOUSE:-
Review, ready for correctionsrissue
Devi toper Impact Fee
Planning Approval
Called Contact Person
A.I..P.
Pub. Wks. Appr "
Date of permit issue
School Fees '
Tota I Perin It Fees