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09-0920 (MECH)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: Property Address: APN: Application description: Property Zoning: Application valu6ti6n: Applicant: 09-00000920 55362 PEBBLE 775 -170 -006 - MECHANICAL LOW DENSITY 26Uu BEACH RESIDENTIAL Architect or Engineer: ti 10, BUILDING & SAFETY DEPARTMENT BUILDING PERMIT Owner: SCOTT SHERMAN 55362 PEBBLE BEACH LA QUINTA, CA 92253 Contractor: DANCY HVACR, MIKE 81171 LA REINA CIR INDIO, CA 92201 (760)775-0750 Lib. No.: 374657 VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 8/31/09 O ---------=-------------------------------------------------------------------------"I------------- LICENSED CONTRACTOR'S DECLARATION - WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury that l 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 Licen�l�s: C20-38 License No.: 374657 - for by Section 3700 of the Labor Code, for the performance of the work for which this permit is - issued. t k;jntractor: ,- ��� 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 EXEMPT Policy Number EXEMPT ' 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 subject to the workers' compensation provisions of Section License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or 3700 of the Labor Code all forthwith comply with those provisions. that he or she is exempt therefrom and thebasis 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).: Dat plicant. (_ )'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: FAIL RE 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 contractorls) 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 am exempt under Sec. , B.&P.C. for this reason the owner, and the applicant, each agrees to, and shall defend, indemnity and hold harmless the City 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 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. 1 agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of thi ounty toenterupon the above-mentioned property for inspection p eses. ate�j!/ 'nature (Applicant or Agent: Application Number . . . 09-00000920 Permit . . MECHANICAL Additional desc . Perrnit' Fee . . . . 33.00 Plan'Check Fee 8.25 Issue Date . . . . Valuation 0 Expiration bate 2/27/10 Qty Unit Charge Per Extension _ BASE FEE 15.00- 1.00 9.0000 EA MECH. FURNACE <=100K 9.00 1.00 0.0000 MN MDCII -D/C z-3I°IP/100K BTU 9.00 ---------------------------------------------------------------------------- Special Notes and Comments REPLACE 5 TON SPLIT'A/C CONDENSER Fee summary Charged Paid Credited Due Permit Fee Total 33.00 .00 .00 33.00 Plan Check Total 8.25 .00 .00 8.25 Grand Total 41.25 .00 .00 41.25 s CERTIFICATE OF COMPLIANCE: RESIDENTIAL ]Pae i ®f 1 CF -1R -A title: Projec►T• A5 Date` ''.:}{j;:` ;�{'; Iii'• - 'fi`i{"i'�:.''i: '`�iiiF ;: yzf'.;`: Project Address Configuration (split or package) ! I rl�"! , y '!�r f t M it ti �yu1 3a yc, r Ii'� I 'Eil �a W + t if i s f• y t� Pti 17 '53 3 ❑ Duct systems with less than 40 linear feet of ducts in unconditioned space. ❑ Documentation Author Telephone CF -4R pages 3 and 4 of 8 ❑ High EER CF -6R pages 3 and 8 of 12 _ 7CV D '� Y{ ,i• ?it rE .P b;l a �:Asi�S�?rJ;��" +�1. Y ,1�1. ..r Compliance Method (Prescriptive — HVAC and/ Climate Zone C. D, E)v�r,'` a 11,'nc or Duct System A.lteraaon - § 132(b)1 and MVAC SYSTEMS Heating Equipment Type and Capacity (furnace, heat pump, boiler, etc. Minimum Efficiency (AFUE or HSPFJ Distribution Type and Location (ducts, attic etc.) Duct or Piping Insulation R -Value Thermostat Type (setback) Configuration (split or package) - Pti 17 Existing duct systems that are extended, which are constructed, insulated or sealed with asbestos.` 3 ❑ Duct systems with less than 40 linear feet of ducts in unconditioned space. ❑ Refrigerant Charge CF -6R pages 3, 5 and 6 of 12 CF -4R pages 3 and 4 of 8 ❑ High EER CF -6R pages 3 and 8 of 12 CF -4R page 5 of 8 Cooling Equipment Type Minimum and Capacity (A/C, heat Efficiency eva cooling) SEER or EER Duct Location Duct Insulation (attic, etc.) R -Value Thermostat Type (setback) Configuration (split or package) ® z - Pti 17 Existing duct systems that are extended, which are constructed, insulated or sealed with asbestos.` 3 ❑ Duct systems with less than 40 linear feet of ducts in unconditioned space. ❑ Refrigerant Charge CF -6R pages 3, 5 and 6 of 12 CF -4R pages 3 and 4 of 8 SEALED DUCTS, REFRIGERANT CHARGE (TXV) AND EER Before the permit can be finalized, a signed CF -611 Form and CF -411 Form must be provided to the building department for any of the C Il.....i.... --U.— ..o....;.e.,.a„+c +ho+ pro ✓ . ✓ Compliance Requirements Sealed Ducts (Climate Zones 2 and 9-16) - Installer testing and HERS Rater field verification required TXV (Climate Zones 2 and 8-15) - Installer testing and HERS Rater field verification required' ❑ Refri erant Charge (Climate Zones 2 and 8-15) - Installer testing and HERS Rater field verification required' ® ALTERNTAVE to Duct Testing: High EER as indicated in Table 8-3 of the Residential Compliance Manual (SEE Table 8-3 for additional requirements and available Compliance Options) - Installer testing and HERS Rater field verification re uired The prescriptive requirement for either a refrigerant charge or a rx v aces not apply to pacKagea units. EXCEP'T'IONS Tf.. .,f rho P-11--- +hr n+innc — ✓ thn dr.wt cuctom ie ovvmnt from sPale-d dnctc i� # ✓ Exceptions 1 ® Duct systems that are documented to have been previously sealed as confirmed through field verification and diagnostic testing in accordance with procedures in the Residential ACM Manual. 2 ❑ Existing duct systems that are extended, which are constructed, insulated or sealed with asbestos.` 3 ❑ Duct systems with less than 40 linear feet of ducts in unconditioned space. ` Duct alterations are exempt from duct sealing ONLY if they meet Exception z above. t SPECIAL. FEATURES REQUIRING ITERS RATING VERIFICA'T'ION A _/ ].-J' .d.7-1- _1:.. .-+.... ....+ -PA.- --+ and rood LM12Q ✓ Compliance Requirements Installer Forms (if applicable) ITERS Rater Forms (if applicable) ® Duct Sealing CF -6R pages 3 and 4 of 12 CF -4R page 1 of 8 ❑ Thermostatic Expansion Valve (TXV) CF -6R pages 3 and 5 of 12 CF -4R page 3 of 8 ❑ Refrigerant Charge CF -6R pages 3, 5 and 6 of 12 CF -4R pages 3 and 4 of 8 ❑ High EER CF -6R pages 3 and 8 of 12 CF -4R page 5 of 8 Bin # 1 Permtt # oa, Bui Project Address: 5-�-36 ,? P,t:�1"r li A. P. Number: City of La Quinta Building ex Safety Division P.O. Box 1504, 78.495 Calle Tampico !a Quinta, CA 92253 - (760) 777-7012 Permit Application and Tracking Sheet Owner's Name: �6 7r_ Address: r --Z City, ST, ZSPf4/d,,1171 e"6. 9-,2 :2-5-;:T Contractor:Af C�,oK Telephone: �P�D — 5 Y -3 - 01 Address: g%� Project Description: j TUB p City, ST, Zip:1 Telephone: State Lie. #Lie. 7 �6 �� % City Lie. #:/h/7,9 Arch., Engr., Designer: Address: City, ST, Zip: Telephone: State Lie. #: Name of Contact Person: Telephone # of Contact Person: # Submittal Plan Sets Structural Cales. Truss Cates. Energy Cale& Flood plain plan Grading plan Subcontsetor List Grant peed H.O.A.- Approval IN HOUSE-- Planning OUSE:Planning Approval Pub. Wks. Appr School Fees Construction. Type: cwxupaney: Project type (circle one): New Add;n Alter Repair Demo Sq. Ft.: # Stories: # Units: Estimated Value of Project: d APPLICANT: DO NOT WRITE BELOW THIS LINE 'd P.40'd• TRACKING PERMIT FEES Plan Check submitted Item Amount Reviewed, ready for corrections Plan Check Deposit Called Contact Person Plan Che --k Balance Plans Oicked up Construction Plans resubmitted Mechanical 2" Review, ready for correetionslissue Eleetrica.l Called Contact Person Plumbing Plans picked up S.M.I. Pians resubmitted Gradin: ''' Review, ready for corrections/issue Developer Impact Fee Called Contact Person A.I.P.P. Date of permit issue Total Permit Fees G (Page 1 of 2) CF -4R Project Address I Sherman, Scott J Builder / Installer 55-362 Pebble Beach / La Quinta / CA / 92253 Mike Dancy HVAC Builder / Installer Contact Telephone Plan Number / Permit Number Mike Dancy 7607750750 —17 HERS Rater Telephone Sample Group Number Dave Bricker - CJHJEJEJRJS® ID #CC99380828 7605419025 2 Compliance Method (Prescript)fa Climate Zone 15 Certifying Signature _ Date Sample House Number Firm HERS Provider Energy Driven Solutions Inc: CJHJEJEJRJS® Address City/State/Zip P.O. Box 6705 La Quinta /CA /92248 d.• 4� CERTIFICATE OF FIELD VERIFICATION &DIAGNOSTIC TESTIN Copies to: BUILDER, HERS PROVIDER AND BUILDING DEPARTMENT HERS RATER COMPLIANCE STATEMENT This house was: ✓ Tested As the HERS rater providing diagnostic testing and field verifica tested compliance requirements as checked on this form. The HE correct tape is used before a CF -4R may be released on every tes and signed CF -6R has been received for the sample tand �tested bt The installer has provided a copy of CF -6R (Installation a ❑ New Ducts are fully ducted (i.e., does not eebb M ldin� Jz ❑ New ducts with cloth backed, rubber adhesive duct tape i -- +/h adhesive duct tape to seal leaks at duct connection ✓ MINIMUM REQUIREMENTS FOR DUCT LEAKAGE1 F+` Procedures or geld verification and dia ostic,test o air d .f f8u S f ( Duct Diagnostic Leakage Testing Results System # 1 f ,, -Rify that the house identified on this form complies with the diagnostic mus check and verify that the new distribution system is fully ducted and ling The HERS rater must not release the CF -4R until a properly completed plenums.or platform TV I returns to lieu of ducts). d;.mastic and draw ba sed in combination with cloth backed, rubber CION COMPLIANCE -CREDIT sy'sfems ar'e'available in RACM, Appendix'RC4.3. y NEW CONSTRUCTION::, Duct Pressurization Test Results (CFM @ 25 Pa) t + Measured Values 1 Enter Tested Leakage Flow in CFM 2 Fan Flow: Calculated (Nominal: ✓ Cooling O Heating,❑ Measured)`' Enter Total Fan Flow in CFM: 2000 3 Pass if Leakage Percentage < 6% [ 100 x [ Line #1 / Line #2 ] ] _ ❑ Pass ❑ Fail ALTERATIONS: Duct System and/or�HVAC Equipment Change -Out i] M M 4 Enter Tested Leakage Flow in�FM'.from aCF-6R: Pre -Test `of Eki"sting Dudt-System Prior"to Duct System Alteration and/or'Equipment Change -Out. € p 5 'Enter Tested Leakage�Flow in CFM. Fina Test,iofNew Duct System or Altered -Duct System for'Duct� System Alteration and/of�Equipment Change Out. ..� 1'63 kq i rj; 6 Enter Reduction in Leakage -for Altered Duct System [ Line -#4 -Minus L; ine=#5]-(6nlyfjif Applicable). 7 Enter Tested Leakage Flow in CFM'to Outside (Only ifjApplicable). t N 8 Enter New Duct System - Pass if Leakage Percentage < 6%' [ 100 x [ Line #5 / Line #2 ] ] ❑ Pass ❑ Fail TEST OR VERIFICATION STANDARDS: For Altered Duct System and/or HVAC Equipment Change -Out Use one of the following four Test or Verification Standards for Compliance 9 Pass if Leakage Percentage < 15% [ 100 x [ Line #5 / Line #2 ] ] 8.2 ✓ Pass ❑ Fail 10 Pass if Leakage to Outside Percentage < 10% [ .100 x [ Line #7 / Line #2 ] ] ❑ Pass ❑ Fail 11 Pass if Leakage Reduction Percentage > 60% [ 100 x [ Line. #6 / Line #4 ] ] and Verification by Smoke Test and Visual Inspection O Pass ❑ Fail 12 Pass if Sealing of all Accessible Leaks and Verification by Smoke Test and Visual InspectionPass C1 Fail Pass if One of Lines #9 through #12 Pass 4 , ✓Pass ❑Fail 4 Residential Compliance Forms Generated by CJHJEJEJRJS® http://www.CHEERS.org December 2005 CERTIFICATE OF FIELD VERIFICATION &'DIAGNOSTIC TESTING (Page 2 of 2) CF -4R Project Address ] Sherman, Scott ] 55-362 Pebble Beach / La Quinta / CA / 92253 Builder / Installer Mike Dancy HVAC ' V THERMOSTATIC EXPANSION VALVE (TXV) Procedures for field verification of thermostatic expansion valves are available in RACM, Appendix RI System #1 .V Yes ' ❑ No Access is provided for inspection. The procedure shall consist of visual verification that the TXV is installed on the system and installation of the specific equipment shall be verified. Yes is a pass .I / Pass ❑Fail M INSTALLATION CERTIFICATE (Page 3 of 12) CF -6R Site /AddressPermit Number r FR Q1 � AEA 01J. to kU/mr2l e� �.� An installation certificate is required to be posted at the building site or made available for all appropriate inspections. (The information provided on this form is required) After completionof final inspection, a copy must be provided to the building department (upon request) and the building owner at occupancy, per Section 107103(a). HVAC SYSTEMS: Heating Equipment Equip Type (pkg. heat um CEGCertified Mfr. Name and Model Number # of Identical Systems Efficiency � (AFUE, etc.) 2CF-IRvalue)(attic,etc. Duct Location Duct or Piping R -value Heating Load Btu/hr Heating Capacity Btu/hr Cooling.Equipment Equip Type (pkg. heat um CEC Certified Mfr. . Name and Model Number # of Identical Systems Efficiency (SEER or EER) 2CF-IRvalue) Duct Location atti etc. Duct R-value(Btu/hr) Cooling Load Cooling Capacity Btu/hr 1. > symbol. reads greater than or equal to what is indicated on the CF -IR value. Include both SEER and EER if compliance credit forhigh. EER air conditioner is claimed. ✓ E1 I, the undersigned, verify that equipment listed above is: l) is the actual equipment installed, 2) equivalent to or more efficient than that specified in the certificate of compliance (Form CF -1R) submitted for !compliance with the Energy Efficiency Standards for residential buildings, and 3) equipment that meets or exceeds the :appropriate requirements for manufactured devices (from the Appliance Efficiency Regulations or Part 6), where applicable. Installing Subcontractor (Co. Name) OR General Contractor (Co. Name) OR Owner Signature: Date: Copies to.:. BUILDING, DEPARTMENT, HERS RATER (IF APPLICABLE)'BUILDING OWNER AT OCCUPANCY Residential Compliance Forms April 2005 INSTALLATION CERTIFICATE (Page 4 of 12) CF -6R Site Addresst� n (� Permit N r INSTALLER COMPLIANCE STA FOR DUCT LEAKAGE INSTALLER COMPLIANCE STATEMENT The building was: ✓ ❑Tested at Final ✓ ❑ Tested at Rough -in INSTALLER VISUAL. INSPECTION AT FINAL CONSTRUCTION STAGE: ❑ Remove at least one supply and one return register, and verify that the spaces between the register boot and the interior finishing wall are properly sealed. ❑ If the house rough -in duct leakage test was conducted without an air handler installed, inspect the connection points between the air handler and the supply and return plenums to verify that.the connection points are properly sealed. ❑ Inspect all joints to ensure that no cloth backed rubber adhesive duct tape is used ✓ DUCT LEAKAGE REDUCTION P/aceditres for field verillcadon and diagnostic testing afair d1stributinn .euc/mne aro avm;mhio i.. DArn r e.....,..,n.- a.—.i 2 NEW CONSTRUCTION: Access is provided for inspection. The procedureshall consist of visual Duct Pressurization Test Results (CFM @ 25"Pa) Measured Values verification that the TXV is installed on the system and installation of the 1 Enter Tested Leakage Plow in CFM: specific equipment shall be verified. 2 Fan Flow: Calculated.(Nori» nal: ✓ ❑ Cooling ✓ ❑ Heating) or ✓ ❑ Measured If Fan Flow is Calculated as 400 cfm/ton x number of tons or as 21.7 cfm/(kBtu/hr) x Heating. Ca aci in Thousands ofBhi/hr enter total calculated or measured fan flow in CFM here: nA O O {�! ✓ ✓ 3 Pass if Leakage Percentages 6% for Final or 5 4a/a at Rough -in: 100 x Line # i / ine # 2 ❑Pass ❑Fait ALTERATIONS: Duct"System and/or HVAC Equipment Change -Out ;<= ,?' yy<y:`'T°' 4 Enter Tested Leakage Flow in CFM from Pre -Test of Existing Duct System Prior to Duct y System Alteration and/or Equipment ment Chan a -Out_ - 5 Enter Tested Leakage Flow in CFM from Final Test of New Duct System or Altered � y Duct System for Duct System Alteration and/or Equipment Chan a -Out 1 _ ,,+�'=;-�. _ 6 Enter Reduction in Leakage for Altered Duct System ine # 4) Minus_(Line # S —(Only if A livable 7 Enter Tested Leakage Flow in CFM to Outside (Only if Applicable) 8 Entire New Duct System - Pass if Leakage Percentage S 6%a for Final or S 4% at Rough -in 100 x L(Line # 5) / Line # 2 ❑ Pass ❑ Fail. TEST OR VERIFICATION STANDARDS: For Altered Duct.System and/or HVAC Equipment Change- Out Use one of the followin four Test or Verification Standards for compliance: ✓ V-1 9 Pass if Leakage Percentage 5 15% [100 x ( (Line # 5) / (Line # 2)]] 4ft-Pass ❑ Fail 10 Pass if Leakage to Outside Percentage:5 10%. [100 x L_(Line # 7) / (Line # 2)]]'❑Pass ❑Fail 11 Pass if Leakage Reduction Percentage > 60% [100 x L_(Line # 6) / (Line # 4 )]] and Verification b Smoke Test and Visual Inspection Pass ❑Fail 12 1 Pass if ealing of all Accessible Leaks and Verification by Smoke Test and Visual Ins •onl' M-1 ❑ Pass ❑ Fail Pass if One of Lines # 9 throu h # 12 pass I.L.I AXPass ❑Fail ✓ THERMOSTATIC EXPANSION VALVE (TXV) Procedures for field verification of thermostatic expansion valves are available in RRCM, Appendix R1. ✓ ✓ ✓ , the undersigned, verify that the above diagnostic test results Nvere performed in conformance:with the requirements for compliance credit. I, the undersigned, also certify that the newly installed or retrofit Air -Distribution System Ducts, Plenums and Fans comply with Mandatory requirements specified in Section 150 (m) of the 2005 Building Energy Efficiency.standards. Installing Subcontractor (Co. Name) OR General Access is provided for inspection. The procedureshall consist of visual Contractor (Co. Nam ) OR Owner ✓ es O No verification that the TXV is installed on the system and installation of the Date: specific equipment shall be verified. Yes: is a pass Pass Fail ✓ , the undersigned, verify that the above diagnostic test results Nvere performed in conformance:with the requirements for compliance credit. I, the undersigned, also certify that the newly installed or retrofit Air -Distribution System Ducts, Plenums and Fans comply with Mandatory requirements specified in Section 150 (m) of the 2005 Building Energy Efficiency.standards. Installing Subcontractor (Co. Name) OR General Contractor (Co. Nam ) OR Owner / Signature: Date: