13-1486 (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:
13-00001486
54599 INVERNESS
775-092-022- -
MECHANICAL
LOW DENSITY RESIDENTIAL
9289
Ti`ht 4 4 "
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Architect or Engineer:
W
LICEWtD ONTRAC OR'S DECLARATION
I hereby affirm under penalty of perjuryondes
d r provisions of Chapter 9 (commencing with
Section 7000) of Division 3 of the Busnals Code, and my License is in full force and effect.
License Class: C20 nseNo.: 374937
i
Date: Contractor:
-� i-/��/ VOWNER- R DECLARATION -
I hereby affirm under penalty of pe - ry that 1 ampt from the Contractor's State License Law for the
following reason (Sec. 7031 .5, Business and Prrrofessions 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):
(_) 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 prov-ing 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.). -
( ) 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:
LQPERMIT
Owner:
RUDY WARTLIK
54599 INVERNESS WAY
LA QUINTA, CA 92253
(
Contractor:
PALM DESERT AIR CI
42081 BEACON HILL
PALM DESERT, CA 9:
(760)346-0677
Lic. No.: 374937
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 11/22/13
WORKER'S COMPENSAT N DECD l. N—
I hereby affirm u er penalty of perjury one of the following decla ions:
_ I ve 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
certify that, in the performance of the work f r which t ' permit is issued, I shall not employ any
person in any manner so as to beco su lett to orkers' compensation laws of California,
and agree that, if I should be subje to
w rkers' campensati ovisions of Section
70I10'.o�/f the Labor Code, I all forthw' co ply 'th thos isions.
Date: 11 Z t 4ipplicant
WARNING: FAILURE TO SECURE WORKERS' MPE T COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PE TIES A IVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS ($100,000). IN ADDITION TO T 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 informati is correct. I agree to comply with all
city and county ordinances and state laws relating to buildi tr , and hereby au ize representatives
of thi u r upon the above-mentioned pro y for in q ion p ses.
Date:MSignature (Applicant or Anen(t):
V \�
Application Number . . . . . 13-OOOD1486
Permit . . . MECHANICAL 2013
Additional desc . .
Permit Fee . . . . 83.42 Plan Check Fee
.00
Issue Date . . . . Valuation . . .
. 0
Expiration Date 5/21/14
Qty Unit Charge Per
Extension
1.00 35.7500 EA MECH FURNACE
35.75
1.00 11.9200 EA MECH APPL REP/ALT
11.92
1.00 35.7500 EA MECH CONDENSER/COMP
35.75
-----=----------------------------------------------------------------------
Special Notes and Comments
HVAC CHANGE OUT - (1) 13SEER/78AFUE
SPLIT SYSTEM [2008 ENERGY] CARBON
MONOXIDE ALARM(S) TO BE INSTALLED PRIOR
TO FINAL INSPECTION. 2010 CALIFORNIA
BUILDING.CODES.
------------------------- --------------------------------------------------
Other Fees . . . . . . . . . PERMIT ISSUANCE M/P/E
90.57
PLAN CHECK, MECHANICAL
52.43
Fee summary Charged Paid Credited
----------------------------------------
Due
-----------------
Permit Fee Total -83.42 .00 .00
83.42
Plan Check Total .00 .00 Ob
.00
Other Fee Total 143.00 :00 .00
143.00
Grand Total 226.42 .00 .00
226.42
LQPERMIT
PiG.-Bok-1504 78-49-5* �CalleTampibo,- La-.Qu�lnw;,,C"ali-f"o'tnia:92'21-1
Tel: (1150)'.77T-7-01 2 - FaX .(160)777-7112;
rRail: Building,@L&;Qoin.ta.Org
Building. Permit Application '& Tradkiho She#t
Prcij1e0AddreW- 54-599 INVERNESS WY.
Owner's Name: WARTLIK, RUDY
Address,: 54-599 INVERNESS WY.
Lept Description:.
'City,,,State,,Zip,:, LA QUINTA, CA 92253
l,
Palm Desert Air Conditioning & Heating Company
Telephone: (
.1 Ad 42-081 Beacon Hill
Proj60f pescripton:
'0ky1-0tPtP1'4iP.:: Palm Desert, CA 92211
REPLACE (1) AIR CONDITIONING SPLIT SYSTEM.
.'TelellJlioria-NQ.-?(760) 346-0677
'8iateAic.'.#:.' 374937
-C1ty,`1ib.A: 100886
:Ar6h.'/Enq gh6r--.
'Addreis,
:City
TdIe'oh-6n6. No.:,.
Construdon Type:
Occupancy:
State :.'.Li
Project Type! El. New ..S Add?h'- 0, Alt&413 Repair:-, L3 -D , 6Mo
Name of.Contact:P.erson: KARL BROWN
;Sq. Ft.:
Stories:
#-Units:
:C6ht9ct,TdI6phdh6 No." (760) 346-0677
Estimated Value. of Proj,d.ct:. $9,289.00
APPLICANTDO, NOT WRITE,
BELOW THIS, LINE
Submittal,
Req'!'
Req',dl
tracking
Permit F6e's
Plin'S66
PIan:CheckSu6m-1ttdd
Item
Amount'.
Stnu&uraI:U6s;:
Rev'Iewed, Ready -"for Correcfions:
Plan Check,136posk
TtUss:'C,416§
alled)Q ntadt Person
Plah Check, Balance
Tit!614 Calm..
Plans Picked Up
Construction
Flood. P. iih Plan.
Plans, Resubmitted
Mechanical
Grading Plan.:
2nd Review, Ready, for Corrections -Electrical'
SU'bc6ntracf& wt
Cafled'C66tact Per'son
Plumbing
Grtht,Qeed
-'Plans,, PldWkl' Up
S.M.I.
HQA. Ap prdval .
Plans,lResubMitted
Grading
IN HQUSE
3° Revie,w, Readyfor,Corrections
Developer ImpacfFee
Plaq6ing Approyal
Called toniact:Person
Pub. WoftiApoer
bate of Reimit issue
9611661 Fees;
Total �Permitk Fee's
T
Simplified Prescriptive Certificate of Compliance: 2008 Residential HVAC Alterations CF -IR -ALT -HVAC
Climate Zones 10 - 15
Site Address:
Enforcement Agency:
Date:
Permit #:
54-599 INVERNESS WY. La Quinta, CA 92253
City of La Quinta
Oct 9, 2013
Duct insulation
Conditioned Floor
Equipment Typel
List MinimumEfficiency2
requirement
Area
Thermostat
❑ Package Unit
® Furnace
® Indoor Coil
® AFUE 78%
® SEER 13.0
❑ COP
[3HSPF
❑ R 6 (CZ 10-13)
Served by system
® Setback
If not already present, must be
® Condensing Unit
❑ EER
❑ Resistance
❑ R 8 (CZ 14-15)
1600 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. Atinimurn 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 -611 and registered CF -411
forms (no hand filled CF-4Rs allowed) are filled out and signed.Beginning October 1, 2010, a registered copy of the CF -1R
and CF -6R shall also be on site for final inspection.
® 1. HVAC Changeout
Required Forms:
• All HVAC Equipment
CF -611 forms: MECH-04, MECH-2I-HERS and (for split systems) MECH-25-HERS
replaced
CF -411 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
.Furnace
CF -4R forms: MECH-21 and (for split systems) MECH-25
For Split Systems: Duct leakage < 15 percent; RC, CCA < 300 CFM/ton (Minimum Air Flow Requirement), TMAH
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
❑ 4. The system will not be Ducted (ie. Ductless Mini -Split System) (Also Exempt from Refrigerant Charge)
❑ 2. New HVAC System
Required Forms:
. Cut in or Changeout with
new ducts: (all new
CF -611 forms: MECH-04, MECH-20-HERS, and (for split systems) MECH-22-HERS, and
ducting and all new
equipment)
MECH-25-HERS
CF -411 forms: MECH-20, and (for 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 -611 forms: MECH-04, MECH-2I-HERS
linear feet of duct in 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.
• 1 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 9, 2013
Address: 42-081 BEACON HILL License: 374937
City/State/Zip: PALM DESERT/ CA/ 92211 Phone: (760) 346-0677
Reg: 213-A0076974A-000000000-0000 Registration Date/Time: 2013/10/09 14:36:55 HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms July 2010