HomeMy WebLinkAbout736 (4)MECHANICAL PERMIT (HVAC) APPLICATION
City of Hermosa Beach - Community Development Department
I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and
ordinances governing this type of work will be complied with whether specified herein or not. No person shall be allowed to perform
work under this permit in violation of the labor code of the State of California. I further state that I am properly licensed as required
by Secti d f the State Business and Professional Code (or claim exemption under Section 7044).
Signature of Contractor
Signature of Owner (If Owner/Builder)
f...\application\mechanic 9/1/13.xlsx rev 8/29/13
QTY
Amount
JOB ADDRESS:
#6
Forced -Air or Gravity -Type Furnace, Includes
Ducts and Vents:
1. Up to 100,000 B.T.U.
2. Over 100,000 B.T.U.
$43JOB
$43
I
7 e, JL42 .4.45
Aet263,4 /31:441/ a 9475f
DESCRIPTION: .
RICPat6 .W.47". r / g.
/f #-4L4
Floor Furnace, Including Vent
$55
Heater -Suspended, Recessed Wall or Floor
Mounted
$43
PROPERTY OWNER(S) NAME:
Jji1 iiii /4/✓f44A 60c2=v6F
Gas Piping System (Enter No. of Outlets):
a. 1-5 Outlets (Inclusive), Total Fee
b. 6 or More Outlets (Per Outlet)
$33
$7
ADDRESS:
73', 6.602d0 Ave 46
Appliance Vent Only
$33
Boiler/Compressor:
a. Up to 3 HP or 5000,001 to 1, 000,000 BTU
b. 3 to 15 HP or 100,001 to 500,000 BTU
'
$43
CITY, STATE, ZIP:
hG�l9 ��
$43
Absorption System:
1. 15 to 30 HP or 500,001 to 1,000,000 BTU
2. 30 to 50 HP or 1,000,001 to 1,750,000 BTU
3. Over 50 HP or Over 1,750,000 BTU
$43
PHONE:
✓/4) 4/h- 6/DD
$99
$99
MECHANICAL CONTRACTOR:
/i,4 -t1' offR 4O/P"'`
/R?jpW 77/0
Air Handling Unit/Air conditioner (Including Ducts)
1. Under 10,000 C.F.M.
2. Over 10,000 C.F.M
$55
$55
EMAIL ADDRESS:
avezi,4, AiRJ r e. -f
Evaporative Cooler (Non -Portable)
$43
Vent Fan/Single Duct
$33
ADDRESS:
/e6' . 6 79 G¢uZ
Mechanical Vent
$33
Mechanical Suppression System and Exhaust Hood
$33
Repair, Alteration, Addition to Each Heating
Appliance, Refrigerator Unit, Comfort Cooling Unit
or System (Includes Controls)
$43
CITY, STATE, ZIP:
AWM i?).7, 40 . 92 C
Any Equipment Regulated but not Included Above
(Includes Factory Fireplace)
$111
PHONE:
&/*) '176-7,677
Miscellaneous
$33
BUSINESS LICENSE NO:
Supplemental Permit Fee
$17
Issuance Fee
$60
STATE LICENSE Ng;
7 33 76
TOTAL FEE
*PLEASE CONTACT THE PUBLIC WORKS DEPARTMENT AT (310) 318-0214 IF
TYPE OF BUILDING:
%5
NO. OF STORIS:
NO. OF METERS:
NO. OF FAMILIES:
WORK IS GOING TO BE DONE IN THE PUBLIC RIGHT OF WAY (SIDEWALK OR STREET.)
DATE ISSUED: 02;24/3
ISSUED BY:
PERMIT NO ([ _ V
I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and
ordinances governing this type of work will be complied with whether specified herein or not. No person shall be allowed to perform
work under this permit in violation of the labor code of the State of California. I further state that I am properly licensed as required
by Secti d f the State Business and Professional Code (or claim exemption under Section 7044).
Signature of Contractor
Signature of Owner (If Owner/Builder)
f...\application\mechanic 9/1/13.xlsx rev 8/29/13
STATE: OF CALIFORNIA — THE RESOURCES AGENCY
CALIFORNIA ENERGY COMMISSION
1516 NINTH STREET
SACRAMENTO, CA 55614-5512
ww'.v.energy.ca. g ov
ARNOLD SCHWARZENEGGER, Governor 111
Residential HVAC Alterations and Registration of Energy Forms
Starting October 1,2010, all required energy compliance forms for residential HVAC •
alterations shall be registered with an approved HERS providerwhen HERS field .
verification and/or testing is required. This will include the CF -1 RALT-HVAC form (or •
• CF=1 R -ALT form), all required CF-6R-MECH-HERS forms, and all required CF -4R
forms. To help .simplify verifying that all of these forms are registered when required,
please•
ollow these. guidelines:
The CF -1R -ALT -HVAC form (or CF -1R -ALT form) shall be completed by hand,
signed, and submitted along with the building permit application by the individual
applying for the permit. This form will not be registeredat the time of permit
aplication..
For the Final Inspection, the building inspector shall verify that the following
energy compliance forms are completed and signed, by the installing contractor
(or homeowner if the homeowner installed the HVAC equipment and/or ducting),
and that the forms are registered by an approved HERS provider:
•;N CF -1 R -ALT -HVAC form (or CF -1 R -ALT form)
ALL required CF-6R-MECH-HERS forms
ALL: required CF -4R forms
,VOTE.: The CF -1R -ALT -HVAC form identifies which CF-6R-MECH-HERS forms and.. .
CF -4R forms are required depending on climate zone and the type of HVAC
diteradu! i.
n. After. -final inspection the installing contractor shall provide a copy of the
• ieg'istered"energy compliance forms to the homeowner. ,
HERS Providers (currently approved for alterations):
CalCERTS -- www.calcerts.com
CEFCA — www.cbpca.orq
For more information regarding residential HVAC alterations, required energy
; ornpliance `orms, or:the:.registrat on;of forms, please view the irewly developed 2008
Energy•Standards:Oniine Learning Center at::worwv.energyvideos:com. Or, contactlhe
Energy Standards Hotline at: 1-800-772-3300.
Dated: October 13, 2010