HomeMy WebLinkAbout243 (2)MECHANICAL PERMIT (HVAC) APPLICATION
City of Hermosa Beach - Community Development Department
I hereby certify at I have read and examined this application and know the same to be true and correct. All provisions of laws and
ordinances gov ning this type of work will be complied with whether specified herein or not. No person shall be allowed to perform
work under this ermit in violation of the labor code of the State of California. I further state that I am properly licensed as required
by Section 703�t.�ef t�e State Business and Professional Code (or claim exemption under Section 7044).
Signature of Cont actor
Signature of Owner (If Owner/Builder)
f...\application\mechanic 9/1/13.xlsx rev 8/29/13
QTY
Amount
JOB ADDRESS:
/)11(
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.
$43
$43
.
45
JOB DESCRIPTION:
Floor Furnace, Including Vent
$55
-1; J e -
Heater -Suspended, Recessed Wall or Floor
Mounted
$43
PROPERTY OWNER(S) NAME:
C_` �o 0,S�{ t c
l�
Gas Piping System (Enter No. of Outlets):
a. 1-5 Outlets (Inclusive), Total Fee
b. 6 or More Outlets (Per Outlet)
$33
$7
ADDRESS:
21-4E9 ?C
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
1
Lt
CITY, STATE, ZIP:
t -k -e fleLOSC-x BC,C,Cti
$43���11
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: �
i2 -Le - ---13c
$99
$99
MECHANICAL CONTRACTOR:
C\L s - nce.t 1C.
Air Handling Unit/Air conditioner (Including Ducts)V—�
1. Under 10,000 C.F.M.
2. Over 10,000 C.F.M
$55
$55
EMAIL
EMAIL ADDRESS.:
icel, �. c,p(1C.t( cob.,
Evaporative Cooler (Non -Portable)
$43
Vent Fan/Single Duct
$33
ADDRESS:
6'2c -I CourStf )
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:
S b Crlv CA (1 S
/
Any Equipment Regulated but not Included Above
(Includes Factory Fireplace)
$111
PHONE:
`�Dr_�3 59
"�li
Miscellaneous
$33
BUSINESS LIGE
D G " C �7
Supplemental Permit Fee
$17
Issuance Fee
$60
STATE LICENSE NO:
c.-4-2-05
TOTAL FEE
*PLEASE CONTACT THE PUBLIC WORKS DEPARTMENT AT (310) 318-0214 IF
TYPE OFBU'ltAc le SArrli
NO. OF STORIES:
1
NO. OF METERS:
k
NO. OF FAMILI ES:
WORK IS GOING TO BE DONE IN THE PUBLIC RIGHT OF WAY (SIDEWALK OR STREET.)
DATE ISSUED: ( 11511q
ISSUED BY: \Jr
PERMIT NO: I4/( p_0732.5 / (
I hereby certify at I have read and examined this application and know the same to be true and correct. All provisions of laws and
ordinances gov ning this type of work will be complied with whether specified herein or not. No person shall be allowed to perform
work under this ermit in violation of the labor code of the State of California. I further state that I am properly licensed as required
by Section 703�t.�ef t�e State Business and Professional Code (or claim exemption under Section 7044).
Signature of Cont actor
Signature of Owner (If Owner/Builder)
f...\application\mechanic 9/1/13.xlsx rev 8/29/13
STATE OF CALIFORNIA — THE RESOURCES AGENCY ARNOLD SCHWARZENEGGER, Governor
CALIFORNIA ENERGY COMMISSION
1516 NINTH STREET
SACRAMENTO, CA 95614-5512
ww.v.energy. ca. gov
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 R -ALT -HVAC form (or •
• CF -1 R -ALT form), all required CF-6R-MECH-HERS forms, and all required CF -4R
forms. To hep simplify verifying that all of these forms are registered when required,
please follow 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 registered•atthe time of permit
application.
• 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 -1R -ALT -HVAC form (or CF -1R -ALT form)
ALL required CF-6R-MECH-HERS forms
ALL required CF -4R forms
NOTE:.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
• After -final .inspection the installing contractor shall provide a copy of the
• egistered energy compliance forms to the homeowner.
•HERS Providers (currently approved for alterations):
CaICERTS -- www.calcerts.com
CBPCA — www.cbpca.orq
For'moii'e information regarding residential HVAC alterations, required energy
; omf:liance-Corms, or:th& registraVon;of forms, please view the newly developed 20.08.
Energy Standards :Online Learning Center at www.energyvideos:com. Or, contact the ;
Energy Standards Hotline at: 1-800-772-3300.
Dated+: October 13, 2010