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07-2440 (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: 8/31/01 Application Number: 07-,=00002440— Owner: Property Address: 78575—VILLETA DR ALAS JANINE _ __._..7.8575 villeta- drive APN: 604-144-011,226_-23.26.9. -.-___ Application description: MECHANICAL LA QUINTA, CA 92253 Property Zoning: LOW DENSITY RESIDENTIAL D Application valuation: 11644 Contractor: AUG 312��7 Applicant: Architect or Engineer: DESERT AIR CONDITIONING, I C. 590 WILLIAMS ROAD CITY OF /1 PALM SPRINGS, CA. 92264 FINANCE DEPT. Jv (7'60)323-3383 Lic- No.: 276586 LICENSED CON�.CCADECLARATION WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury that I am licen ed pr v" ions of er 9 (commencing with_ I hereby affirm under penalty of perjury one of the following declarations: Section 70001 of Division 3 of the Busi nd Pr ssi ode nd 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 LicenseClass: C20 -C43 - io 76 for by Section 3700 of theLabor Code, for the performance of the work for which this permit is ' Ir , .._ issued. Date `9� Contracto . , _ 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 OWNER -BUILDER DECLARATION insurance carrier and policy number are: ' hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the'. Carrier STATE FUND Policy Number 0019960-2006 . 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 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 bec;7 subject he 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 Ca , h (o�ytFiwith o y with ose 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).: at - © ?Applicarit. (_ 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' 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.). - 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 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 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 • (.certify that I have read this application and state that the above informatio is c re . I a e to comply with all work for which this permit is issued (Sec. 3097, Civ. C.1. city and county ordinances and state laws relating to buil' nstru io nd er y au representatives of this county.to ent upon the above-mentioned property insp urp s - Lender's Name: _- - - - .Date$ Signature (Applicant -or Agent): " Lender's Address: LQPERMIT W , Installation Cartifrrata Pracnr;r%*;% a ruw61L—J MIA^ __v_- Project Title: - --t-t— 391Y r%ncraawn . f..r-oK-AL• 1 - Q Q Date: ?'1� �O - ©2005 CaICERTS EnforcementA en Use Only Building Permit u roject Addre 7S 7�Qj (/ t I �� Climate Zone: n v C j I`�talling Contractor: 4 Telephone: Plan check Date Company Name: Field check Date M -e IMPORTANT: This CF -0R form is only for use when an HVAGonly alteration is made to an existing home Use one form for each system being altered: This is system #--L_ of Z systems altered in this house. Copies to: Homeowner, HERS Rater, and Buildin Department List the SnP_r`Jfinntinnc fnr 4hc nn...6.:..��.,u..a „ - -...-- - - • ••-��.......+. ...uaa... a noaaucu Uquivillellr exactly. Z5,v Heat Exchanger N/A U Heat Pump fan coil N/A Hvdronic fan coil ..,. Package heatpump A/C Condenser .11 Indoor DX coil ER' IE Hydronic coil I Provide EER if needed for compliance (line 24 of CF -1 R -ALT). Installer must provide adequate documentation to verify EER. In some cases the specific furnace may need to be verified in order to achieve a specific EER. In some cases a time delay relay and/or TXV may need to ve verified in order to achieve a specific EER. Loads are sensible for cooling. "" Capacities axe sensible at design conditions for cooling and adjusted (altitude, downflow, etc.) output for heating. XV: If TXV is required by the CF -1 R form (line 23 on CF -1 R -ALT form), it has been installed and access has been provided for . visual verification by HERS rater. Sampling is allowed for TXV verification. Entirely New Duct System: (Line 5 of CFAR ALT) ❑ For Entirely new duct systems, the required leakage is 6% rather than 15% for altered systems. The alternative to duct sealing by increasinq the efficiency of the equipment is not an option for entirely new ducts stems. I, the undersigned, verify that the equipment listed above is: 1) the actual equipment installed in the home; 2) equal to or more efficient than required by the.Certificate of Compliance (CF -1 R -ALT Form); and 3) equipment that meets or exceeds the appropriate requirements for manufactured devices (Appliance Efficiency Standards), where applicable. I, the undersigned; verify that diagnostic test results listed on this form were performed in conformance with the requirements for compliance and that the newly installeopr retrofitted mechanical system components conform with the Mandatory requirements pecified in Sego 150(51),69e 296ypuilding Energy Efficiency Standards. Version 03-10-06 This form can only be used on A� J Z!� - (f) I www.calcerts.com Certificate of Compliance Prescriptive Method - HVAC -only Alteration CF -1 R -ALT Project Title: tY'\ 'L a Date: 43. %IQ o? O CaICERTS 2005 IMPORTANT: This CF -1 R -ALT form is only for use when an HVA myalt tion is made to an existing home Use one form for each system being altered. This is system # of systems altered in this house. Section 6 - Minimum Requirements for Equipment to be Installed/Altered. Instaged egtiipm ust match typenocation and meet or exceed efticiencies/R-values. 28 Configuration: BtpUt system O Package Unit 29 ❑Handler as furnace, AFUE OHeatptrnp FAU OHydronic FAU OOther 30 O Heat Exch anger 31 D Outdoo r Condensln Unit Heatpump thcien SEER/HSPF: EER d tl 32 C3009 or heating C OHeatpum OHydronic 33 13Location: length (R): R-vaWe: All mandato measures a 1 to an altered component. See MF -1 R - ALT form. Compliance Statement: This certificate of compliance lists the building features and specifications needed to comply with Title 24, Parts 1 and 6 of the California Code of Regulations, and the administrative regulations to implement them. This certificate has been signed by the individual with overall project responsibility. The undersigned recognizes that compliance using duct sealing,. verification of refrigerant charge, and TXV require installer testing and certification and verification by an approved HERS rater. Home Owner or Authorized Agent, Documentation Author N3aN,-ne- Name: Address: City/State/Zip: �G Q L4 �� �- G aa5 Company me: Iqll Z17 C_ Address: S O Ut/, // . Phone. City/S Phone: ?6 ) e— d` 3 -3.3� V Signature: Signature: Enforcement Agency (Building De artment Notes/Comments: Name: Title: Department: Phone # Fax #: Signature or Stamp: Required forms. CF -1 R -ALT: by anyone. Required at time of permit application. Copies to home owner, enforcement agency, HERS rater. CF -6R -ALT.: by installing contractor. Required to dose permit—Copies; to home owner, enforcement agency, HERS rater. CF -4R -ALT: by HERS rater. Required to dose permit. Copies to home owner, enforcement agency, installer. The CF -4R forms for a sam le group shall not be released until all testing and verification is completed and passed for the entire -group. version -03-10-06 This forth can only be used on projects being verified by CaICERTS certified raters. Page 2 of 2 www.calcerts.com