12-0156 (MECH)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: =12-0000,0156
Property Address:
56215 PEBBLE BEACH
APN:
775 -131 -077 -
Application description:
MECHANICAL
Property Zoning:
LOW DENSITY RESIDENTIAL
Application valuation:
10619 ,
T4, ht 4 XP Q"
Applicant: Architect or Engineer:
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
-------------- - -------------------'----------------
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that 1 a licensed under provisions of Chapter 9 (commencing with ,
Section 7000) of Division 3 of the Business a ro yes '0hals Code, and my License is in full force and effect.
Lice n Class: C20 -C43 License No.: 276586
Date:2' (I�1+L ntractor:
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 1$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 proving that he or she did not build or -
improve for the purpose of sale.).
(_ 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.).
(_) 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:
LQPERM IT
Owner:
KATHRYN BERGMAN
56215 PEBBLE BEACH
LA QUINTA, CA 92253
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 2/17/12
D
Contractor:
DESERT AIR CONDITIONI :F:E-
590 WILLIAMS ROA5 212
PALM SPRINGS, CA 9226 1
(760)323-3383
Lic. No.: 276586 TYOFLA4u1NT�►
-----------------------------------------------
WORKER'S COMPENSATION DECLARATION
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.
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 EVEREST NATL Policy Number 7600007908111
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 ecome subject to the workers' compensation laws of California,
and agree that, if I should beg
a su 'ect to the workers' compensation provisions of Section
at3700 of the Labor Code, I s i omply with those provisions.
eltle: Z 17 J/1111� plicant:
WARNING: FAILURE TO SECURE WO KERS' 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 inf ation is correct. I agree to comply with all
city and county ordinances and state laws relating to building cons ion, an ereby authorize representatives
of this county to enter upon a above-mentioned property f ectio oses.
te: 2 4 fit nature (Applicant or Agent):
Application Number . . . . . 12-00000156
Permit MECHANICAL
Additional desc .
Permit Fee 40.50
Plan Check Fee
10.13
Issue Date
Valuation . . . .
0 -
Expiration Date 8/15/12
Qty Unit.Charge' Per
Extension
BASE
FEE
15.00
1.00 9.0000 EA MECH
FURNACE <=1OOK
9.00
1.00 16.5000 EA MECH
B/C >3-15HP/>100K-500KBTU
16.50_
------------------------------------------------------------------------------
Special Notes and Comments
HVAC CHANGE -OUT. 4 TON SPLIT SYSTEM,
FURNACE,. CONDENSER, INDOOR COIL,
AT
GROUND LEVEL. 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
LQPERMIT
Simplified-Prescriptive Certificate, of'Compliance:•`2008. Residential HVACAlterations CF-IR-ALT-HVAC
Climate Zones.10 - 15
Site Address:
Enforcement Agency:
Date:
Permit #:
65-215 PEBBLE BEACH La Quinta, CA 92253
City of La Quinta '
Feb 13, 2012
Equipment Typel
List Minimum Efficiency2
Duct insulation
requirement
Conditioned Floor
Area
Thermostat
❑ Package Unit
® Furnace
® Indoor Coil
® AFUE 80%
B SEER 16.0
❑ COP13
❑ HSPF
R 6 �� 10-13)
Served by system
® Setback
If not already present, must be
® Condensing Unit
❑ EER
❑ Resistance
[3 R g CZ 14-I5)
-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. Minimum Equipment Effldendes. 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-4R
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-6R forms: MECH-04, MECH-2I-HERS and (for split systems) MECH-25-HERS
replaced
CF-4R forms: MECH-21 IIINOand (for split systems) MECH-25
• Condenser Coil and /or
• Indoor Coil and /or
CF-611 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
[13. Existing dud systems are constructed, insulated or sealed with asbestos
❑ 4. The system.will not be Ducted (ie. Ductles�Mini-Split.System)-(Also Exempt:frgm�Refn,�'gerantC_ arge)
❑ 2. New HVAC System
Requi ed Forms: + F, 141,
. Cut in or Changeout with_
new ducts: (all new
`4 r �e�+
CF 6R forms 'MECH-04, MEC 1 20';HERS, and,,, r split sy terns) MECH.22 HERS, and
g an �4`
ductin" d all newr•.:
MECH=25 HERS t t f � � I! � '�
a x
CF-4R forms z0, and (for split systems 2and MECH-25f 1
equipment) f •o
tMECH MECH-2
�
;,
,df` .�1 _ �� •r ;ter � ..��>�°
For Split Systems: Duct leakage < 6 percent; RCS CCA'>_"350 CFM/ton, FWD; TMAH, STMS, and either HSPP or 12512P.
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 > 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-4R forms: MECH-21
For split system or packaged units: Duct leakage < 15 percent
❑ 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: Jacqueline Zabik Signature: Jnoqueline T.nbik
Company: DESERT AIR CONDITIONING INC Date: Feb 13, 2012
Address: 590 WILLIAMS ROAD License: 276586
City/State/Zip: PALM SPRINGS / CA / 92264 Phone: (760) 323-3383
Reg: 212-A0007869A-00000000-0000 Registration Date/Time: 2012/02/13 13:08:29 HERS Provider: Ca10ERTS, Inc.
2008 Residential Compliance Forms July 2010
Bin #
Qty of La Quinta
Building ar Safety Duron
P.O. Box 1504) 78-495 CaFe Tampico
La Quirita, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
Pioject Address: —JC
D
Owner's Name:
A. P. Number:
Address:
Legal Description-
ContractorW4)e4 4 6xr mddmn
City, ST, Zip: n j•911'
TtPh,=:nq-1 2dQ
Address,
City, ST, Zip: lin
Telephone:
StateLic,#: City Lic. J,
•J
Desipw-
Address;
City, ST, Zip.
Telephone:
State Lic. 0:
Name of Contact Person:
I ])"e
Construction Tpe: /Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
Sq. Ft:
I # sto, J 0 Uits:
Telephone #of Contact Person: 3?,2rz, Estimated Value of Project Al 9-670 ---- - -
APPLICANT: DO NOT WRITE BELOW THIS LINE
N Submittal Rtq-d Reed TRACKMG PERMIT FM
HIM sets
P1213 Check submitted
item Amount
Structural Cates.
Reviewed, ready for corrections
Plan Cbc& Deposit
Truss CRICL
called contact Person
Plan Check Balance.
Tide 24 Coics.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading pion
V Review, ready for carrectionslissue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Dead
Plans picked up
S.M.I.
H.OA, Approval
Plans resubmitted
Grading
IN HORSE
Reyiew, ready for cormcdonsillnue
Developer Impact Fee
Planning Approval
Called Contac Person
A.LP.P
Pub. Wks. Appr
Date of permit issue
Scwl Feer
Total Permit Few