10-1248 (MECH)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 10-00001248
T-vy 4 4 Q"
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT -
Property Address. 49643 AVENIDA VISTA BONITA
APN: 773-350-055-55 -14496 -
Application description: MECHANICAL
Property Zoning: LOW DENSITY
RESIDENTIAL
Application 'u6luation: 6000
_ I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided
Applicant:
Architect or Engineer:
for by Section.3700 of the Labor Code, for the performance of the work for which this permit is
Owner:
LELAND JOHN D
49643 AVENIDA VISTA BONITA
LA QUINTA, CA 92253 .
(707)996-1975
ES
!i.
25 WILDCAT STREET
NUM{�1, J 2010M DESERT, -CA 92211
0)360-2202
"YOFLAOUINTA No.: 906115
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760),777-7153
Date: 11/15/10
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• LICENSED CONTRACTOR'S DECLARATION
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury that I am 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 and Professionals 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 ass: C20 C36 Tense No.: 906115
for by Section.3700 of the Labor Code, for the performance of the work for which this permit is
issued.
4 Date: L�ontractor:
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:
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law.for the
Carrier NORGUARD INS Policy Number CEWC133676
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 become subjec o the workers' compens provisions -of Section
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Codel 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 five hundred dollars ($500).:
1 3700 of the Labor Code, t shall forth comp) s isions.
i-.. / / 700 off
Oat /-1-L/ )- Applicant:Z
1 _ 1 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 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, proyided 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.).
(_) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (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 contracts for the projects with a contractorls) licensed
pursuant to the Contractors' State License Law.).
(. ) I am exempt under Sec. , BAP.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 ISec. 3097, Civ. C.).
Lender's Name: _
Lender's Address:
LQPERAIIT
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 issuance of such permit, or cessation of work for 180 days will subject
' permit to cancellation.
I certify that I have read this application and state that the above information is correct.' I agree to comply with jl�
city and county ordinances and state laws relating to building construction, hereby authorize representau .es
of this cis c nater upon the above-mentioned property for i echo - urposes.
Gi
jDate: Signature (Applicant or Agent):
Application Number 10-00001248
• Permit. ., MECHANICAL
Additional desc .
Permit Fee. 33.00 Plan Check Fee
8.25 -_
Issue Date Valuation,
0
Expiration Date 5/14/11
Qty Unit Charge Per`
Extension
BASE FEE
15.00
1.00. 9.0000 EA MECH FURNACE <=TOOK.
9•.00
31 nn' 9 nnnn FA MFC'H R/r.. ,<=3HP/1 OOK. BTU-
9.00
----------------------------------------------------------------------------
Special Notes and.Comments
HVAC CHANGE OUT PACKED UNIT 14 SEER 5
TON UNIT PER 2007 CODES.
Other Fees . . BLDG STDS ADMIN (SB1473)
1.00
Fee summary Charged Paid Credited
Due
Permit Fee Total 33.00 _00 .00
33.00
Plan Check Total 8.25 .00 .00
8.25
Other Fee Total_ 1.00 .00 .00,
1.00.
Grand Total' 42.25 .00 .00
42.25
.LQPERAIIT _
Simplified Prescriptive Certificate of Compliance: 2008 Residential HVAC CF-iR-ALT=HVAC
Alterations L..
Climate Zones 10 - 15
Site Address:
Enforcement Agency:
Date:
Permit #:
49-643 Vista Bonita La Quinta, CA 92253. ,
City of La Quinta
Nov 10, 2010
Equipment Typel
List Minimum Efficiency2
Duct insulation
requirement
Conditioned Floor
Area
Thermostat
R Package Unit
❑ Furnace .
Indoor
2 AFUE 80%
❑ COP
❑ R 6 (CZ 10-13)
Served by system
0 Setback
11 Coil
❑ Condensing Unit
p SEER 14.0
❑ EER
❑ HSPF
❑ Resistance
❑ R 8 (CZ 14-15)
2000 sf
If not already present,
must be nstalled)
❑ 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 decide=_ 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.a so verifies that
each appropriate CF-6R and registered CF-4R forms (no hand filled CF-4Rs allowed) are filled out and sicned.Beginning
October 1, 2010, a registered copy of the CF-111 and CF-6R shall also be on site for final inspection.
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
,
CF,-AR'forms: MECH-21 and (for split systems) MECH-25
.Furnace'
For Split Systems: Duct, leakage<F15 percent; RC, CCA 5 300 CFM/ton (Minimum Air Flow Requirement), TMAH
For-Packaged Units: Duct leakage*�15 percent
Exempted from-duct,leagage testing'�if:"
p 1. Duct system was documenfetl to have been previously sealed and confirmed through HERS versification, or
p,2. Duct systems with less than'40 linear feet in unconditioned space, or
❑ 1 Existmg=d'uct=systems are" constructed msulated;or sealed with asbestos
❑ 2. N HVAC'"
R ire-d� rr .y 1�J4ii,
S stem rr
�::, t , . � ,�,,' r. � .��.�.. '` •� g w� -•,�,. -_•.-....:�
. Cut in or Chan eout
Ftp. 9
with neweducts. (all
d'uctipg fall
CF 6Ri .rms MECH 04 MECH 20 HERS, and (for split systems). MECH 22 HERS;'-and
y�r -•ter i
MECH 2HERSf p� x' h t , y
new an
4R forms H 20 and (forlsplit system) Md M
CFMEC sECH 22;danECH�25 '
newfequipmerit)'y
For Split Systems: Duct leakage ! � percent tRC 'CCA->_-350'CFM/ton, FWD, TMAH, STMS, and either'HSPP or PSPP.
ForipackagedjUnits Duct leakage'<46 percent
❑ 3 New:Dtias'with/or without'
Required Forms:
Replacement
.Includes replacing or installing. all—
new ducting and/or outdoor.,
��CF-6R
condensing.unit and/or indoor•coilr
forms: MECH-04, MECH-20-HERS and (for split systems) MECH-25-HERS
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 linear feet of duct in
CF-6R forms: MECH-04, MECH-2I-HERS
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 ComGliance 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 ether applicable
compliance forms, worksheets, calculations, plans and specifications submitted to the enforcement agency for approval with the permit -
application.
Name: Mark Hyde Signature: Mark Hyde
Company: CERTIFIED COMFORT SYSTEMS INC Date: Nov 1.D, 2010
Address: 77-825 WILDCAT DRIVE License: 906115
u
City/State/Zip: PALM DESERT / CA / 92211 Phone: (76Q 360-2202 ,
Reg: 210-A0024438A-00000000-0000 Registration Date/Time: 2010/11/10 13:24:21 HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms , 'July 2010
Bin #
City of La Quinta
Bm1d'r V Sc Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Qtd=, CA 92253 - (760) 777-7012
Building Permit Application and Tracidng Sheet-
Permit #
PmjectAddress: — 13
�U,�
Owner's Name: y�
A. P. Number
Address: 6q q— G C4-3
Lcg* Description:
City. ST, Zip: G z Z 1�
Conhador: Ger[
Address:. -7-79-2-5 tt j ok lrZ
ProjedDescdpdun:
City, ST, zip: G Gj -L-� l
61�
Telephom
Stare Lia # : City Lic. #:
Arch, Enu-, Designer.
Address:
City, ST, Zip:
Telephone:
Construction Type:
Stale Lia #:
Project type (circle one} New Add'n Alter Repair Demo
Name of Cont= Person
Sq. Ft:
# Sto-rif=
Telephone # of Contact Person:
Estimated Value of Project 6 l b v
APPLICANT:
DO NOT WRITE BELOW THIS WYE
#
Submittal
Req'd
Reed
TRACE .NG ,
PERMIT FEES
Plan Sets
Pian Check submitted
Lt�
Amount
Structural Caks.
Reviewed, ready for corrections
Play Check Deposit
Trois Cabs.
Called Contact Pawn
Plan. Check Balance
Energy Calci
Pians picked up
C4ms"acd1on
Flood plain plan
Plans resubmitted
1
Grad• Flan
2" Review, ready for correct tonsft m
Electrical
Subeontactor Last
Called Contact Person
pq�
Grant Deed
_
Plans picked up
S_br r
H.OA Approval
Plans resubmitted
Graig
IN HOUSE:
3d Review, ready for corratonsfusae
Developer bWact Fee
PVnning Approval
Called Contact Person
Ad.P.P:
I.Pub. Wks Appr
Date of permit issue
School Fees
Total Permit Fees