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12-1208 (MECH)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: Property Address: APN: Application description Property Zoning: Application valuation: Applicant: (7 12-00001208 i 54278 INVERNESS 775 -101 -020 - MECHANICAL LOW DENSITY RESIDENTIAL 8095 T4&t " BUILDING & SAFETY DEPARTMENT Architect or Engineer: I P` BUILDING PERMIT LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect. License Class: C20 Lice a No.: •374937 1116atel « ntractor=— 3� OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the following reason (Sec. 7031.5, Business and Professions Code: Any city or county that requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) 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—) 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 Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who does the work himself or herself through his or her own employees, provided that the improvements are not intended or offered for sale. If, however, the building or improvement is sold within 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 contractor(s) licensed pursuant to the Contractors' State License Law.). (_ 1 I am exempt under Sec. , B.&P.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 (Sec. 3097, Civ. C.)• Lender's Name: Lender's Address: rp LQPERMIT Owner: STEPHEN & SUSAN COOOPER 54278 INVERNESS LA QUINTA, CA 92253 FFD Contractor: PALM DESERT AIR COND 42081 BEACON HILL PALM DESERT, CA 92211 (760)346-0677 Lic. No.: 374937 VOICE (760\'77"-8� FAX (760) 1 INSPECTIONS (760) 777-7153 Date: 10/11/12 IM H OCT 112012 L CITY OF LA QUINTA FINANCE DEPT. WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. 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 insurance carrier and policy number are: Carrier MID CENTURY Policy Number A09454905-12 I certify that, in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree that, if I should become subject to the workers' compensation provisions of Section 3700 of th Labor Code, I shall forthwith c ly with those provisions. D te: plicant=� r WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000)• IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. 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 all city and county ordinances and state laws relating to building construction, and hereby authorize representatives oft county to enter upon the above-mentioned property for inspect/io�n�pur/p/o/,s/e3/. atq! ture (Applicant or Agent): - Q LQPERMIT Application Number . . . . . 12-00001208 Permit . . . MECHANICAL Additional desc . Permit Fee . . . . 40.50 Plan Check Fee 10.13 Issue Date . . . . Valuation . . . . 0 Expiration Date 4/09/13 Qty Unit Charge Per Extension BASE FEE 15.00 1.00 9.0000 EA MECH FURNACE <=100K 9.00 1.00 16.5000 EA MECH B/C >3-15HP/>100K-500KBTU 16.50 ---------------------------------------------------------------------------- Special Notes and Comments HVAC CHANGE -OUT: REPLACE (1) GAS/ELECTRIC PACKAGE SYSTEM. 2010 CODES. ---------------------------------------------------------------------------- Other Fees . . . . . . . . . BLDG STDS ADMIN (SB1473) 1.00 Fee summary Charged ----------------- ---------- ---------- Paid Credited ---------- --- Due - ------ Permit Fee Total 40.50 .00 .00 _ 40.50 Plan Check Total 10.13 .00 .00 10.13 Other Fee Total 1.00 .00 .00 1.00 Grand Total .51.63 .00. .00 .51.63 Simplified Prescriptive Certificate of Compliance: 2008 Residential HVAC Alterations CF -1R -ALT -HVAC Climate Zones 10 - 15 Site Address: Enforcement Agency: Date: Permit #: 54-278 INVERNESS La Quinta, CA 92253 City of La Quinta Oct 10, 2012 Duct insulation Conditioned Floor Equipment Typel List Minimum Efficiency2 requirement Area Thermostat ® Package Unit ❑ Furnace ❑ Indoor Coil ® AFUE 78% ® SEER 13.0 ❑ COP ❑ HSPF ❑ R 6 (CZ 10-13) Served by system ® Setback If not already present, must be ❑ Condensing Unit ❑ EER ❑ Resistance ❑ R 8 (CZ 14-15) 2000 sf 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 -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 -611 shall also be on site for final inspection. ® 1. HVAC Changeout Required Forms: • All HVAC Equipment CF -6R forms: MECH-04, MECH-2I-HERS ... .,..t,.ms) MEGH 25 WERE replaced CF -411 forms: MECH-21 ,^ + �F^-^�;� •�•^ - �� MC( LI 7C • Condenser Coil and /or CF -611 forms: MECH-04, MECH-21-HERS a^a (for split sy • Indoor Coil and /or • Furnace CF -4R forms: MECH-21 and (F^- ..^lit gyste^-s) M=igm-�� 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 duct systems are constructed, insulated or sealed with asbestos [14. ThesysNiM will not be Ducted (ie., Ductless Mini -Split System) (Also Exemptfrom -Refrigerant Charge) ❑ 2. New HVAC System Required Forms: . Cut irf"or Changeout with # CF -6R forms: MECH-04, MECH-20-HERS; and (for split systems) MECH--22-HERS, and new ducts: (all new ducting all newt` MECH-25-HERS equipment) �' CF -4R forms: MECH-20, and (far split systems) MECH-22, and MECH-25 For Split Systems: Duct leakage < 6 percent; RC, CCA >_ 350 CFM/ton, FWD, TMAH, STMS, and either HSPP or PSPP. For Packaged Units: Duct leakage < 6 percent ❑ 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 2: 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 -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 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: Karl Brown Signature: Karl Brown Company: PALM DESERT AIR CONDITIONING CO INC Date: Oct 10, 2012 Address: 42-081 BEACON HILL License: 374937 City/State/Zip: PALM DESERT/ CA / 92211 Phone: (760) 346-0677 Reg: 212-AO05669OA-000000000-0000 2008 Residential Compliance Forms Registration Date/Time: 2012/10/10 17:05:20 HERS Provider: CalCERTS, Inc. July 2010 P.O. Box 1504.78-495 Calle Tampico, • La Quinta, California 92211 4V Tel: (760) 777-7012 • Fax: (760) 777-7112 —:GEM 4a.nuERT Website: www.La-Quinta.Org • Email: Building@La-Quinta.Org tuft O C e7 S Bin #: Permit # ,� Building Permit Application & Tracking Sheet Project Address: 54-278 INVERNESS Owner's Name: COOPER, STEPHEN & SUSAN A.P. Number: Address: 54-278 INVERNESS Legal Description: City, State, Zip: LA QUINTA, CA 92253 Contractor Palm Desert Air Conditioning & Heating Company Telephone: ( Address: 42-081 Beacon Hill Project Description: City, State, Zip: Palm Desert, CA 92211 REPLACE (1) GAS ELECTRIC PACKAGED SYSTEM. Telephone No.: (760) 346-0677 State: Lic. #: 374937 City Lic. #: 100886 Arch./Engr./Designer: Address: City, State,, Zip: Telephone No.: _ Construction Type: Occupancy: State: Lic. #: Project Type: 0 New • ® Add'n - O Alter • O Repair • 0 Demo Name of Contact Person: KARL BROWN 'Sq. Ft.: # Stories: # Units: Contact Telephone No.: (760) 346-0677 Estimated Value of Project: $8,095.00 APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Req'd Recd Tracking Permit Fee's Plan Sets Plan Check Submitted Item Amount Structural Calcs. Reviewed, Ready for Corrections Plan Check Deposit Truss Calcs. Called Contact Person Plan Check Balance Title 24 Calcs. Plans Picked Up Construction Flood Plain Plan Plans Resubmitted Mechanical Grading Plan 2nd Review, Ready for Corrections Electrical Subcontractor List Called Contact Person Plumbing Grant Deed Plans Picked Up S.M.I. H.O.A. Approval Plans Resubmitted Grading IN HOUSE V Review, Ready for Corrections Developer Impact Fee Planning Approval Called Contact Person A.I.P.P. Pub. Works Appel Date of Permit Issue School Fees Total Permit Fee's