11-0576 (MECH)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: , b 11-00000576
Property Address:
54781 INVERNESS
APN:
775 -091 -051 -
Application description:
MECHANICAL
Property Zoning:
LOW DENSITY RESIDENTIAL
Application valuation:
13065 -
Td�/44Q"
Applicant: Architect or Engineer:
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
--------------------------------------------------
LICENSED NTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I a lic sed under provisions of Chapter 9 (commencing with
Section 7000) of Division 3 of thSJUmigess a Pr essi e, and my License is ]p09I force and effect.
Licens Class: C20 -C36 0.: 777794
ate�� tractor•
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.).
1 _ 1 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. , 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 (Sec. 3097, Civ. C.).
Lender's Name:
Lender's Address:
LQPERMIT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 6/02/11
Owner: 6/
KUM CHUNG
54781 INVERNESS/ n
BERMUDA DUNES, 0
92 ,3
�j� r n
Contractor:
J ANTHONY PLUMBING HEAT
72216 NORTH SHORE STREET, 01
THOUSAND PALMS, CA 92276
(760)343-2121
LiC. No.: 777794
--------------------------------------------'---
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 STATE FUND Policy Number 1932451-2011
I certify that, in the performance of)he work for which this permit is issued, I shall not employ any
person in any manner so as to Vbcomesubject to the workers' compensation laws of California,
and agree that shout beAmejecorkers' compensation pr 1s ns of Section
370 of the L or , I with those provisions.
SJat� � PPIi nt:
/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 th the ab 'nformati is correct. I agree to co with all
city and county ordinances and state la s 'n o buil ' g co tructi , and hereby authorize re s tatives
of this county to enter upon the above men ' pr e y for ' s c ' ur o as.
Si ture (Ap n
Application Number . . 11-00000576
Permit . . . MECHANICAL
Additional desc .
Permit Fee . . . . 40.50
Plan Check Fee
10.13
Issue Date . . .
Valuation . .
0
Expiration Date 11/29/11
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. INSTALL AMANA 4
TON 14
SEER SPLIT SYSTEM. 2010 CODES.
-----------------------------7----------------------------------------------
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
LQPEEN1IT
Simplified Prescriptive Certificate of Compliance: 2008 Residential HVAC CF -IR -ALT -HVAC
Alterations
Climate Zones 10 - 15
Site Address:
Enforcement Agency:
Date:
Permit #:
54781 inverness La Quinta, CA 92253
City of La Quinta
I May 17, 2011
Equipment Typel
List Minimum Efficiency2
Duct insulation
requirement
Conditioned Floor
Area
Thermostat
❑ Package Unit
0 Furnace
0 Indoor Coil
0 AFUE 80%
0 SEER 14.0
❑ COP
� HSPF
El R 6 (CZ 10-13)
Served by system
0 Setback
If not already present,
0 Condensing Unit
❑ EER
[]Resistance
CZ 14-i5
❑ R 8( )
1 0 sf
—�-�
must be 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, Z 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 -111 and CF -611 shall also be on site for final inspection.
0 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 5 300 CFM/ton (Minimum Air Flow Requirement), TMAH
For Packaged Units: Duct leakage < 15 percent
Exempted from duct leagage testing if:
❑ 1. Duct system was documented to have been previously sealed and confirmed through HERS verification, or
0 2. Duct systems with less than 40 linear feet in unconditioned space, or
❑ 3. Existing -duct -.systems are constructed," insulated, or sealed with -asbestos ,
❑ 2. New HVAC it
Required Forms: l+ j f • ti Y
l
System r
+'►? f _ .i ;� !/ l
. Cut in or Changeout
with new ducts: (all
f
new ducting��all
` r * ►
CF;6Riforms: MECH-04 MECH-20-HERS and (for split systems) MECH-22=HERS and
+ '.
MECH-25-HERS ''/ I A
rb �
- I
CF.=4R forms: MECHt20„and (for,split systems) MECH;22,,and MECH,25
new equipment)'
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
1:13. New Ducts with/or without
Required Forms:
Replacement
. Includes replacing or installing all
new ducting and/or outdoor
condensing unit and/or indoor coil
CF -611 forms: MECH-04, MECH-20-HERS, and (for split systems) MECH-25-HERS
and/or furnace. No or some
CF -411 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 dud in
CF -611 forms: MECH-04, MECH-2I-HERS
unconditioned space.
CF -411 forms: MECH-21
For split system or packaged units: Dud leakage < 15 percent
El EXCEPTION: Existing dud 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: Kevin Robinson Signature: Kevin Robinson
Company: J ANTHONY PLUMBING HEATING & AIR CONDITIONING Date: May 17, 2011
Address: 72216 NORTH SHORE ST #101 License: 777794
City/State/Zip: THOUSAND PALMS / CA / 92276 Phone: (760) 328-8096
* 0
Rea: 211-A0023802A-00000000-0000 Registration Date/Time: 2011/05/17 15:25:33 HERS Provider: Ca10ERTS. Inc.
Bin #
Permit #
Project Address: jj—,;,=X:74
A. P. Number.
Lega( Description:
Contractor: \g
Address:
city, ST, —zir1-AVg4,U,0
Telephone.
State Lic. # : '7 7
Arch., Engr., Designer.
Address:
City., ST. Zip:
Telephone: .
State Lic. #:
Name of Contact Perso
Telephone # of Contact PersoTi--��
# Submittal Req'd
Plan Sets
Structural Cafes.
Truss Calcs.
Mile 24 Caics.
Flood plain plan
Grading plan
Subcoutactor List
Grant Deed
H.O.A. Approval
IN HOUSE --
Planning Approval
Pub. Wks. Appr
School Fees
City of La Quint'a
"Building & Safety DMIon
P.O. Box 1504, 78-495 Calle Tampico
4 Quanta, CA 92253 - (760) 777-7012
B611d-ing Permit_ Application and Tracking Sheet
/ZivSS Owner's Name:
Address:
City' ST' Zip- vlGLt� C��
Telephone� s _ (�
Project Description: ,-1
or
� 0124: o
:ity Lic. i •
Total Permit Fees
Construction Type: occupancy:
Project type (circle one): New Add'n Alter Repair Demo
Sq. Ft:
# S ones: # Units:
Estimated Value of Proj : /3
APPLICANT:
DO NOT WRITE BkOW THIS LINE
Recd
TRACING PERMIT FEES
Plan Check submitted Item Amount
Reviewed, ready for corrections Plan Check Deposit
Called Contact Person Plan Check Balance
Plans picked up Construction
Plans resubmitted Mechanical
2i0 Review, ready for corrections/issue Electrical
Called Contact Person Plumbing
Plans picked up S.M.L
Plans resubmitted . Grading
Review, ready for correctionvissue Developer Impact Fee
Called Contact Person A.LP.P.
Date of permit Issue
Total Permit Fees