BMCH2015-011678-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253,y
Application Number: BMCH2O15-0116
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COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING PERMIT
Property Address:
55104 OAKTREE
APN:
775161021
Application Description:
PGA/SELKOW/(1) 20SEER/78AFUE SPLIT
Property Zoning:
Application Valuation:
$6,180.00
Applicant:
a
CERTIFIED COMFORT SYSTEMS INC
42-949 MADIO STREET
Q CL
INDIO, CA 92201
Q
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 Clas/sC20,CC36 License No.: 906115
Contractor
OWNER -BU R DEC ION
I hereby affirm under penalty of perj ry that I exempt from the Contractor's State
License Law for the following reason (Sec. 70 1.5, 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
($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.).
(_) 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 Addre!
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Owner:
LARRY SELKOW
55104 OAKTREE
LA QUINTA, CA 92253
Contractor:
CERTIFIED COMFORT SYSTEMS
42-949 MADIb STREET
INDIO, CA 92201
(760)360-2202
Llc. No.: 906115
Date: 4/7/2015
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 Section 3700 of the Labor Code, for the performance
of the workfor 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 policy number are:
Carrier: Policy 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 pro isions.
Di� i
e:- Applicant: /
WARNING: FAILURE TO SECURE WORKER ' OM ATION COVERAGE IS UNLAWFUL,
AND SHALL SUBJECT AN EMPLOYER T RI PENALTIES ANQ CIVIL FINES UP TO
ONE HUNDRED THOUSAND DOLLA ($ 000). IN ADDITION TO THE COST OF
COMPENSATION, DAMAGES AS PROVI ED 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, 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 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 ab
mentioned property for inspection purposes.
Date i / Signature (Applicant or A
C3
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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 Section 3700 of the Labor Code, for the performance
of the workfor 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 policy number are:
Carrier: Policy 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 pro isions.
Di� i
e:- Applicant: /
WARNING: FAILURE TO SECURE WORKER ' OM ATION COVERAGE IS UNLAWFUL,
AND SHALL SUBJECT AN EMPLOYER T RI PENALTIES ANQ CIVIL FINES UP TO
ONE HUNDRED THOUSAND DOLLA ($ 000). IN ADDITION TO THE COST OF
COMPENSATION, DAMAGES AS PROVI ED 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, 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 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 ab
mentioned property for inspection purposes.
Date i / Signature (Applicant or A
CERTIFICATE OF COMPLIANCE CF1R-ALT:02-E
Alterations to Space Conditioning Systems (formerly CF -1R -ALT -HVAC) (Page 1 of 3 )
Project Name: 55-104 Oaktree Date Prepared: 2015-03-30
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 CF111-ALT 02 document for each dwelling unit.
01
Project Name
55-104 Oaktree
02
Date Prepared
2015-03-30
03
Project Location
5-104 Oaktree
04
Building Type
Single family
05
CA City
La Quinta
06
Dwelling Unit Name
55-104 Oaktree
07
Zip Code
92253
08
Dwelling Unit Conditioned
1330
Floor Area (ft2)
SC System
SC System
CFA served
-. system al
refrigerant. `
Number of space conditioning
Instill frig
09
Climate Zone
15
10
(SC) systems in this dwelling
1
ducted
containing
system
more than 40
unit.
entirely new
B. Space Conditioning (SC) System Information
01
02
03
fi 04
'j.05
+ ` 06 `��jj �
} 07 4:
t 08 1
09
10
`
y'
,o,Is the SC-
'I'nst'allin'g a
SC System
SC System
CFA served
-. system al
refrigerant. `
„Installing new SC
Instill frig
Installing
Installing
Identification or
Location or Area
by this SC
ducted
containing
system
more than 40
entirely new
entirely new
Name
Served
System (ft2).
system?
component?
components?
feet.of ducts?
duct system?
SC system?
Alteration Type
System 1
Whole House
1600
Yes
Yes
Yes
No
No
No
Altered space
conditioning system
C. Extension of Existing Duct System, Greater Than 40 Feet (Section150.2(b)1Diib)
This section does not apply to this project.
Registration Number: 215-A008261SA-000000000-0000 Registration Date/Time: 2015-03-30 09:15:29 HERS Provider: CaICERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2014-03-31 Report Generated: 2015-03-30 09:15:31
Schema Version: 0.555SDD
CERTIFICATE OF COMPLIANCE CF1R-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)1E 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 '
Central split
All new
Central split
All new
This field or
This field or
System 1
HP.
heating
AFUE
0.78
AC
cooling
SEER
20
Setback
section is not
section is not
components
components
applicable
applicable
Required Documentation:
CF2R-MCH-01-E - Space Conditioning Systems Ducts and Fans
-Duct insulation requirement for new plenums: R6.
CF2R-MCH: 20-H & CF3R-MCH-20-H — Duct Leakage testing required when heating or cooling components are installed in ducted systems, or when more than 40 ft of duct length is replaced.
-Leakage rate compliance: <_ 15%, ors 10% leakage to outside, or seal all accessible leaks.
CF2R-MCH-25-H & CF3R-MCH-25-H Refrigerant Charge Verification required when refrigerant containing components are installed or altered (applicable in CZ 2, 8-15).
CF2RCF3R-MCH-23 & CF3R-MCH-23 Air Flow >_ 300 CFM/ton required when MCH -25 is required.
Exceptions: I-
-Duct systems registered with HERS provider as previously sealed are exempt from MCH -20 Duct Leakage Testing requirements.`*�s
�:
-Heating-only systems and Air Handler/Furnace changes do not require verification of Air Flo ,MCH!23�or Refrigerant Charge,MECH-25:
-Existing duct systems constructed, insulated or sealed with asbestos,are exemptfrom MCH=20 Duct Leakage Testing requirements.
E. Entirely New or Complete Replacement Duct System, with' or withopt,Equ)pment Changeout (Sections 150.2(4)1Diia'.and;150.2(b)lE, F)
This section does not apply to this project.
F. Entirely.New or Complete Replacement Space Conditioning System (Section 150.2(b)lC)
This section does not apply to this project.
Registration Number: 215-A0082615A-000000000-0000 Registration Date/Time: 2015-03-30 09;15:29 HERS Provider: CaICERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2014-03-31 Report Generated: 2015-03-30 09:15:31
Schema Version: 0.555SDD
CERTIFICATE OF COMPLIANCE CF1R-ALT-02-E
Alterations to Space Conditioning Systems (formerly CF -1R -ALT -HVAC) (Page 3 of 3 )
Documentation Author's Declaration Statement
1. 1 certify that this Certificate of Compliance documentation is accurate and complete.
Documentation Author Name:
Documentation Author Signature:
Hyde, Mark
Company:
Signature Date:
CERTIFIED COMFORT SYSTEMS INC
2015-03-30 09:15:29
Address:
CEA/ HERS Certification Identification (if applicable):
42949 Madici
City/State/Zip:
Phone:
Indio CA 92201
(760) 360-2202
Responsible Person's Declaration statement
I certify the following under penalty of perjury, under the laws of the State of California:
1. The information provided on this Certificate of Compliance is true and correct.
2. 1 am eligible under Division 3 of the Business and Professions Code to accept responsibility for the building design or system design identified on this Certificate of Compliance (responsible designer).
3. That the energy features and performance specifications, materials, components, and manufactured devices for the building design or system design identified on this Certificate of Compliance conform to the
requirements of Title 24, Part 1 and Part 6 of the California Code of Regulations.=''
Ari f�.^.r N -`w,
4. The building design features or system design features identified on this Certificate of Compliance are consistent with the information -provided ori other applicable compliance documents, worksheets,
calculations, plans and specifications submitted to the enforcement dgency for:' pproval;with this building permit application.'"
5. 1 will ensure that a registered copy of this Certificate of.Compliance iKall;be.made'available with,the building permits) issued forthe;liuilding, and'made available.to the enforcement agency for all applicable
inspections. I understand that a registered copy of thisCert ficate of Compliance is,required to be. included with the,documentation =he;buiider provides to the building owner at occupancy.
Responsible Designer Name: �C f t,
Responsible Designer Signature:zz}
Hyde, Mark
Company:
Date Signed:
CERTIFIED COMFORT SYSTEMS INC
2015-03-30 09:15:29
Address:
License:
42949 Madio
906115
City/State/Zip:
Phone:
Indio CA 92201
(760) 360-2202
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: 215-A0082615A-000000000-0000 Registration Date/Time: 2015-03-30 09:15:29 HERS Provider: CaICERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2014-03-31 Report Generated: 2015-03-30 09:15:31
Schema Version: 0.555SDD
INFORMATION
4DESCRIPT6N .,_ACCOUNT - . a` �� , QTY' `; .'.AMOUNT.. „- PAID PAID DATE
BSAS SB1473 FEE 101-0000-20306 0
$1.00 $0.00
PAID BY. - -`' i , °+': : t • METHOD ;',.'• w } + °RECEIPT # CHECK #;t,
,CLTD BY.
Total Paid for BUILDING STANDARDS ADMINISTRATION BSA $1.00 $0.00
J', DESCRIPTION },� , '
_ ,' -ACCOUNT
QTY`
AMOUNT
PAID
PAID DATE
HVAC CHANGEOUT - SPLIT -SYSTEM
101-0000-42402
0
$72.52
$0.00
,PAID BY ' • m.METHOD
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"�. RECEIPT #
CHECK # ,'
CLTD BY
�.; DESCRIPTION"� ° ,
_ ., ACCOUNT
QTY•t
AMOUNT. ""
PAID
PAID DATE
HVAC CHANGEOUT - SPLIT -SYSTEM PC
101-0000742600
0
$36.26
$0.00
_'PAID BY ;' '
''METHOD "
RECEIPT #
CHECK #
CLTD BY,
' Total Paid forCHANGEOUT: $108.78 $0.00
DESCRIPTION .3y '�'§
' ; .'' ACCOUNT
QTY
;,'AMOUNT
`PAID .
PAID DATE
PERMIT ISSUANCE
101-0000-42404
0
$91.85
$0.00
'PAID BY ., ', 1 ,�,
'' METHOD -
' , RECEIPT # ``
CHECK #
CLTD BY .
.Total Paid for PERMIT ISSUANCE: $91.85 $0.00
TOTALS:• •�
f�
Description: PGA/SELKOW/(1) 20SEER/78AFUE SPLIT
Type: MECHANICAL Subtype: Status: UNDER REVIEW
Applied: 4/7/2015 SKH
Approved:
Parcel No: 775161021 Site Address: 55104 OAKTREE LA QUINTA,CA 92253
Subdivision: Block: Lot:
Issued:
Lot Sq Ft: 0 Building Sq Ft: 0 Zoning:
Finaled:
Valuation: $6,180.00 - Occupancy Type: Construction Type:
Expired:
No. Buildings: 0 No. Stories: 0 No. Unites: 0
Details: HVAC CHANGE OUT - 20SEER/78AFUE SPLIT SYSTEM [2013 ENERGY] CARBON MONOXIDE ALARM(S) TO BE INSTALLED PRIOR TO
FINAL INSPECTION. 2013 CALIFORNIA BUILDING CODES.
DESCRIPTION "ACCOUNT QTY AMOUNT PAID' PAID DATE RECEIPT # CHECK # METHOD PAID BY CLTO
BY ..
BSAS SB1473 FEE 101-0000-20306 0 $1.00 $0.00
Total Paid forBUILDING STANDARDS ADMINISTRATION
$1.00 $0.00
BSA:
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SPLIT -SYSTEM
CR6.7147 SYSTEMS
Printed: Tuesday, April 07, 2015 10:39:40 AM
HVAC CHANGEOUT -
101-0000-426000
$36.26
$0.00
SPLIT -SYSTEM PC
Total Paid forCHANGEOUT: $108.78 $0.00
PERMIT ISSUANCE
101-0000-42404
0
$91.85
$0.00
~
Total Paid for PERMIT ISSUANCE: $91.85 $0.00
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SENT DATE
DUE DATE`
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Printed: Tuesday, April 07, 2015 10:39:40 AM
2 of 2
Permit#
tmCOD 6- �l
Project Address:
J
A P. Number:
Contractor:
Address:
City, ST, Zip:�C
City of La Quinta
Building .a Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La. Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Owner's Name:
Address:92
City, ST, Zip:
T
---one: Gd _ ZZ6�
State Lie. # : q o, / �—
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone:
State Lic. #:
Name of Contact Person:
Telephone # of contact Person:
# Submittal
Plan Sets
Structural Calcs.
Truss Calcs.
Energy Cales.
Flood plain plan
Grading, plan-
Subcontactor List
Grant Deed
H.O.A. Approval
IN ROUSE:
Planning Approval
Pub. Wks. APpr
School Fees
Project Description:
Lic. #: '-i Y -•
` C�
Construction Type:
Occupancy:
PrOjeype (circle one):
New Add'n Repair Demo
Sq. Ft.: '�' 3
# Stories:
# Units:
Estimated Value ofProject:
APPLICANT: DO NOT WRITE BELOW THIS
UNE
TRACKING .
PERMIT FEES
Plan Check submitted
Item
Amount
Reviewed, ready for corrections
Plan Check Deposit
Called Contact Person
Plan Check Balance .
Plans picked up
Construction
Plans resubmitted
Mechanical
21° Review, ready for corrections/issue
Electrical
Called Contact Person
Plumbing
Plans picked up
S.M.L
Plans resubmitted
Grading
"d Review, ready for corrections/issue
Developer Impact Fee
Called Contact Person
A.I.P.P.
Date of permit issue
Total Permit Fees