BMCH2016-0162LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter
9.(commencing with Section 7000) of Division 3 of the Business and Professions Code,
and my License is in full force and effect.
License Class: C20, C36 License No.: 6863100
DateLc-5I 1-7 I.l (e (Contra.ctor. `mow.
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am•exempt-..from the Cohtractor'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 andthe
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).:
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.).
(� 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
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 Section3700'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 polity number are:
Carrier:- Polity Number:
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 become subject to the workers'
compensation'laws of California, and agree that, if I should become subject to the
workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith
comply with those provisions.
Da S �1 fes. Apppllieant
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 Building Official 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, indernnify;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 ofthis 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.
I agree to comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives of this city to enter upon the
above-mentioned property for inspection purposes.
Date SLI Ili SignatureXApplicant of Agent)
VOICE (760) 777-7125
78-495 CALLE TAMPICO
D?
LA QUINTA, CALIFORNIA 92253
COMMUNITY DEVELOPMENT DEPARTMENTINSPECTIONS
FAX (760) 777-7011
(760) 777-7153.
BUILDING PERMIT
Date: 5/17/2016
Application Number: BMCH2O16-0162
Owner:
Property Address: 55021 OAK HILL
BERT BRUNDIGE
APN:
55021 OAK HILL
Application Description: BRUNDIGE RESIDENCE / HVAC CHANGE OUT
LA QUINTA, CA 92253
cD
Property Zoning:
Application Valuation: $9,485.00
2 --��
2 I�V y
c s/
z
Applicant:
IE INC
Contractor: n
HARRISON ENTERPRISES 6A GEPFEBAL kIgI I�
�
31225 LA BAYA
31170 RESERVE DRIVE
p �.
WESTLAKE VILLAGE, CA 91362
THOUSAND PALMS, CA
�7
-
Z
(760)343-7488
t:7 D o., O
Lic. No.: 686310
n
------------------ ---------------------
----------------------------_---------�------
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter
9.(commencing with Section 7000) of Division 3 of the Business and Professions Code,
and my License is in full force and effect.
License Class: C20, C36 License No.: 6863100
DateLc-5I 1-7 I.l (e (Contra.ctor. `mow.
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am•exempt-..from the Cohtractor'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 andthe
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).:
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.).
(� 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
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 Section3700'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 polity number are:
Carrier:- Polity Number:
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 become subject to the workers'
compensation'laws of California, and agree that, if I should become subject to the
workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith
comply with those provisions.
Da S �1 fes. Apppllieant
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 Building Official 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, indernnify;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 ofthis 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.
I agree to comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives of this city to enter upon the
above-mentioned property for inspection purposes.
Date SLI Ili SignatureXApplicant of Agent)
Description: BRUNDIGE RESIDENCE / HVAC CHANGE OUT
Type: MECHANICAL Subtype: Status: APPROVED
Applied: 5/17/2016 MFA
Approved: 5/17/2016 MFA
Parcel No: Site Address: 55021 OAK HILL LA QUINTA,CA 92253
Subdivision: Block: Lot:
Issued:
Lot Sq Ft: 0 Building Sq Ft: 0 Zoning:
Finaled:
Valuation: $9,485.00 Occupancy Type: Construction Type:
Expired:
No. Buildings: 0 No. Stories: 0 No. Unites: 0
CITY
Details: HVAC CHANGE OUT -14 SEER/80AFUE PACKAGED SYSTEM [2013 ENERGY) CARBON MONOXIDE ALARM(S) TO BE INSTALLED PRIOR
TO FINAL INSPECTION. 2013 CALIFORNIA BUILDING CODES.
INFORMATION
Printed: Tuesday, May 17, 2016 12:44:08 PM 1 of 2
SYSTEMS
•
NAMETYPE
ADDRESSl
CITY
STATE�ZIP
PHONE FAX
EMAIL
APPLICANT
IE INC
31225 LA BAYA
WESTLAKE
CA
91362
(541)430-3635.
VILLAGE
CONTRACTOR
HARRISON ENTERPRISES INC DBA
31170 RESERVE DRIVE
THOUSAND
CA
92276
(541)430-3635
FRANCISCO @CALLTH E
GENERAL AIR
PALMS
GENERAL.COM
OWNER
BERT BRUNDIGE
55021 OAK HILL
LA QUINTA
CA
92253
(541)430-3635
INFORMATION
Printed: Tuesday, May 17, 2016 12:44:08 PM 1 of 2
SYSTEMS
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID.DATE
RECEIPT #
CHECK #
METHOD
PAID BY
:.
BSAS SB1473 FEE
101-0000-20306
0
$1.00
$0.00
Total Paid for BUILDING STANDARDS ADMINISTRATION $1.00 $0.00
BSA:
HVAC CHANGEOUT -
101-0000-42402
0
$36.26
$0.00
PACKAGED UNIT
HVAC CHANGEOUT -
101-0000-42600
0
$24.17
$0.00
PACKAGED UNIT PC
Total Paid for CHANGEOUT: $60.43 $0.00
PERMIT ISSUANCE
101-0000-42404
0
$91.85
$0.00
Total Paid for PERMIT ISSUANCE: $91.85 $0.00
-TOTALS
INSPECTIONS
_ . .PARENT PROJECTS ,....... ,...,.., ,...,., _._., .
BOND INFORMATION
ATTA
CIIMCNT.,
Printed: Tuesday, May 17, 2016 12:44:08 PM 2 of 2
SYS TERAS
Bin. #
- City, of La Qwnta
v� B0410,-; 8z Safety Division
P.O. Box 15,04,:78-495 Calle Tampico
La.Quinta; CA -92.253.- (760) 777-7012 .
Building: Permit Appiication and Tracking Sheet
Permit #
Project Address: 55021 Oakhill
Owner's Name:. Bert Brundige
A. P. Number.
Address: 55021 Oakhill
Legal Description:
Contractor: General Air Conditioning
City, ST; Zip: La Quinta, CA 92253
Telephone: 54.1-430-3635
Address: 31170 Reserve Drive
Project Description: Replace 3.5ton Package Unit
City, ST, Zip: Thousand Palins, CA 92276 .
Telephone: 760-343-7488
City Lic. -
State Lic. # : 686310
Arch., Engr., Designer.
Address: .
City., ST. Zip:
Telephone:
State Lia #: w�iy5
Construction Type:. Occupancy:
Project type (circle tine): New. Add'n Alter Repair. Demo
Name of Contact Person: Steven Schnierer .
Sq: Ft.: #Stories: # Units:
Telephone # of Contact Person: 818 -735-7876
roject $9,485.00 .
Estimated Value of Project:'
APPLICANT: DO NOT WRITE•BELOWTHIS LINE
#
Submittal
Req'd
'.`-Rev'd
TRACMG
PERb=FEES
Plan Sets
Plan Check submitted
Item Amonnt
Structural Cales.
Reviewed, ready for corrections
Plan Check Deposit. .
Truss Cates.
Called Contact Person
Plan Check Balance.
Title 24 Calcs.
'[Plans
pirked,up
Construction '
Flood plain plan
'Plans resubmitted
Necharilcal
Grading plan
V Review, ready for correctionsressue
Electrical
Subcoutactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A- Approval
Plans resubmitted
Grading
IN HOUSE:-
''a Review, ready'for corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person
A.LP.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees
CERTIFICATE OF COMPLIANCE
Alterations to Space Conditioning Systems (formerly CF -IR -ALT -HVAC)
Project Name:
BERT BRUNDIGE I Date Prepared:
CFAR-ALT-02-E
(Page 1 of 3) -
2016-05-16
A. General. Information
MR -ALT -02 is applicable to.multiple space conditioning systems contained within a single dwelling unit. When multiple dwelling units must be documented,
use one MR -ALT -02 document for each dwelling unit.
01
Project Name
BERT BRUNDIGE
02
Date Prepared
2016-05-16
03
Project Location
55021 OAKHILL
04
Building Type
Single family
05
CA City
La Quinta
06
Dwelling Unit Name
BERT BRUNDIGE
07
Zip Code
92253
08
Dwelling Unit Conditioned
1335
MAO
Floor Area (ft2)
SCS y stem
SCS stem
y
CFA served
'system a '
.
refrigerant
ZInstalli *',ew SC
Installing
Installmgr
"Installing
Identification or
Number of space conditioning
by this SC
09
Climate Zone
15`.
10
(5C) systems inthis dwelling
Unit.
1
Name
Served
System (ft2)
system?component?
B. Space Conditioning (SC) System Inffoormationo
01
02
04
.05
06
07
' 0
09
10
X03
Is the SC
Installing a
01F41
MAO
SCS y stem
SCS stem
y
CFA served
'system a '
.
refrigerant
ZInstalli *',ew SC
Installing
Installmgr
"Installing
Identification or
Location or Area
by this SC
ducted
.:
Aht"ainmg
system
rr ore.than 40
entirely, new
entirely new
Name
Served
System (ft2)
system?component?
components?
feet of ducts?
duct system?
SC system?
Alteration Type
System 1
Location 1
1335
Yes
Yes
Yes
No
N.o
No
Altered space
conditioning system
C. Extension of Existing Duct System, Greater Than 40 Feet (Section150.2(b)ZDiib)
This section does not apply to this project.
Registration Number: 216-A0180606A-000000000-0000
CA Building Energy Efficiency Standards - 2013 Residential Compliance
Registration Date/Time: 2016-05-16 06:50:56
Report Version: 2013 Rev 1.007
Schema Version: 0.5555DD
HERS Provider: CalCERTS
Report Generated: 2016-05-16 06:51:13
CERTIFICATE OF COMPLIANCE CF111-ALT-02-E
Alterations to Space Conditioning Systems (formerly CF -IR -ALT -HVAC) (Page 2 of 3 )
D. Altered Space Conditioning System (Sections 150.2(b)lE and F)
#
01
02
.03
04
05
06
07
08
09
10
11
12
Heating
Cooling
System
Heating
Altered
Heating
Minimum
Altered
Cooling
Minimum
Required.
New or
Identification
System:
Heating
Efficiency
Efficiency
Cooling
Cooling
Efficiency
Efficiency
Thermostat
Replaced.
New Duct
or Name
Type.
Components_
Type
Value
System Type
Components,
Type
Value
Type.
Duct Length.
' ,R -Value
Cent
All new.
Central entral
All new
-
-Less than or
System 1
packaged HP,
heating
AFUE
0.8
packaged AC
cooling . -
SEER
14
Setback
equal to 40
R-8
components
components
feet .
Reouired Documentation:
MR -MCH -OS -Er Space, Conditioning Systems Ducts and Fan's:
-Duct insulation requirement for new plenums: R6.
CF211-MCH-20-H & COR -MCH -20-H = Duct Leakage testing:�equired when heating or cooling components are installed in ducted systems, or when more than 40 ft of duct length, is replaced.
.:
Leakage rate compliance: 5 15%, or 510% leakage'to outside, or seal all accessible leaks.
�=.
sem-
CF2R-MCH-25-H & MR -MCH -25-H Refrigerant Charge Vehiic6an required when refrigerant containing components are installed or altered (applicable in CZ 2, 8-15).
MRMR-MCH-23 & MR -MCH -23 AirF-low 2 300CFkM%ton require&when MCH -25 is required
Exceptions:
=Duct systems registered"with HERS -provider as previously sealed are exemp"pt from MCH 20 Duct Leakage Testing requirements.
.:
Air Handler/Furnace do quirevenfication Alr Flow MCF23!or RefngerantLharge MECT
Heating -only systems and changes not re of
�s
insulated from MCH DuLeTesting�requirements
Existingduct systems constructed, or sealed withasbestoare exempt -20 akage
fW%. APO,
'W.. ` w ... .. _, is ?Rx...._ .' 'W ,.
. _ - � .
E. Entirely New or Complete Replacement Duct System, with or without Equipment Changeout (Sections 150 2(b)1Dna-and 150.2(b)1E, F)
This section does not,apply to this project.
F. Entirely New or Complete Replacement Space Conditioning System (Section 150.2(b)1C)
This section does not applyto this project,
Registration Number: 216-A0180606A-000000000-0000
CA Building Energy Efficiency Standards - 2013 Residential Compliance
Registration Date/Time: 2016-05-16 06:50:56
Report Version: 2013 Rev 1.007
Schema Version: 0.555SDD
HERS Provider: CaICERTS
Report Generated: 2016-05-16 06:51:13
CERTIFICATE OF COMPLIANCE CRR -ALT -024
Alterations to Space Conditioning Systems (formerly CF-lR-ALT-HVAC) . (Page 3 of 3 )
Documentation Author's Declaration Statement
1. 1 certify that this Certificate' Of Cornpliance documentation is accurate and complete.
Documentation Author Name:
Documentation Author Signature:
Jacoby, Ian
cyan dacobJr
Company:
Signature Date: .
i PERMIT E RATERS
2016-05-1606:50:56
Address:
CEA/HERS Certification Identification (if applicable):
31225 -La Baya Drive #213.
City/State/Zip:
Phone:'.
West Lake Village CA 91362
:'
818-735-7876
Responsi0e�0erson's Declaration statement
4W
certify the following under penalty of perjury, under the„„l1laws o�f.the State of California:
1. The information;provided'on this Certificate o 'C'J liance,is true and correct.
' `$
2. 1 3 t� BB'uslness and. Professions Code to.accept4esponsibilityfor the building design or system design identified on this Certificate of Compliance (responsible designer).
am eligible under.Division of Kke
3. That the`energy features and performance specifications, material, and manufactured devices for the building design or system design identified on this Certificate of Compliance conform to the
Title 24, Part 1 P5rti6 Code Regulations
requirements of and of the .Californ of
' ...,
4. The building design features or system design features identified on -this Certificate of Compliance are6consistent-with the information provided onptherrapplicable compliance documents, worksheets,
agency fo3r'approval with this bwldamg permit application,:
calculations, plans.and specifications submitted,to the enforcement -
y - ..L
�s'
rtifi 6:% nr. 1448: > 3"..e i A�3 S ^fig"
5. twill ensure that a registered copy ofithi�s Certificate C pliance shall be,made>availatile withrthe bulldmg'permit(s),irsued forahe build g, and made avail -abler 0,3. a enforcement agency for all applicable
inspections. I understand that a regi eyed copy of this{Gert fcate of C ompliance s,required to.be;included with the documentation the builder pro)v des to�the-buililddiingowner at occupancy.
P.
Responsible Designer Name: r : rN Z
Responsible Dess g r Signature:
Jacoby, Ian
cyan �acobJr
company:
Date Signed:;
HARRISON ENTERPRISES INC dba GENERAL AIR CONDITIONING
2016-05-16 06:50:56
Address:
License:
31470 RESERVE DRIVE STE A
686310
City/State/Zip:
Phone:
THOUSAND PALMS CA 92276
760-343-7488
Digitally signed by Ca10ERTS. This digital signature is provided in order to secure the content of this registered document, and in noway implies Registration Provider responsibility for the accuracy of the information.
Registration Number: 216-A0180606A-000000000-0000 Registration Date/Time: 2016-05-16 06:50:56 HERS Provider: CaICERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013 Rev 1.007 Report Generated: 2016-05-16 06:51:13
Schema Version: 0.555SDD -