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BMCH2015-0338Z I - 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: BMCH2O15-0338 Property Address: 55710 OAK TREE B33 APN: 775231017 Application Description: ROZEK RESIDENCE / HV Property Zoning: Application Valuation: $8,000.00 Applicant: 'CAVANAUGH ELECTRIC DBA CAVANAUGH 'ELECTRIC & AIR CONDITIONING 4 uudw COMMUNITY DEVELOPMENT DEPARTMENT BUILDING PERMIT 83-231 HIWAY 111 INDIO, CA 92201 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: _ License No.: :LIC -0000032 n/ ��/ Date: Contractor: �VitCA.f//9t/ 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 ($500).: (__j 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 Address: VOICE (760) 777-7125• FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 8/31/2015 Owner: GARY ROZEK 55710 OAK TREE LA QUINTA, CA 92253 Contractor: CAVANAUGH ELECTRIC & AIR COND (760)347-3610 Llc. No.: :LIC -0000032 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 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 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 provisions. Date: Applicant WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE (YJNLAWFUL, 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, 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 above. . mentioned property for inspection purposes. Date: Signature (Applicant or Agent) FINANCIAL . • 1 • DESCRIPTION�L �;?r " ?' z " "ACCOUNT ' QTY`' AMOUNT PAID r PAID.DATE A� _ .: ... a b BSAS SB1473 FEE 101-0000-20306 0 $1.00 $1.00 8/31/15 PAID BY, METHOD ?.¢ _ "> RECEIPT # F� CHECK #` �CLTD BY, CAVANAUGH ELECTRIC & AIR COND CHECK R8843 21168 MFA Total Paid forBUILDING STANDARDS ADMINISTRATION BSA $1.00. $1.00 DESCRIPtTION I , ' �", E :, � ACCQ.UNT �n QTY ., .. .... AMOUNT€ _.^ m E PAID # PAOMATE ; _.:F . HVAC CHANGEOUT - SPLIT -SYSTEM 101-0000-42402 0 $145.04 $145.04 8/31/15 a ., 3 s. PAID BY'' :� `' e` . - ,. t - z METHOD _ s — — ;RECEIPT # gam" CHECK # CCTD BY` CAVANAUGH ELECTRIC & AIR COND CHECK R8843 21168 MFA DESCRIP-TION �W <,'ACCOUNT �QTY, AMOUNT. 4 PAID PAID DATE' _,, HVAC CHANGEOUT - SPLIT -SYSTEM PC 101-0000-42600 0 $72.52 $72.52 8/31/15 e PAID BY `sm �_ is I-yMETHOD ` a r RECEIPT # -CHECK # ,` CLTD BY., ax , 4 CAVANAUGH ELECTRIC & AIR COND CHECK R8843 21168 MFA Total Paid forCHANGEOUT: $217.56 $217.56 >} �; DESCRIPTION a`: .F tACCOIINT� .> ;QTY i' "PAID `_ PAID DATE �, �AINIOUNT PERMIT ISSUANCE 101-0000-42404 0 $91.85 $91.85 8/31/15 �x �` PAID BY,,, e� _ METHOD 'RECEIPT #,F CHECK CCTD BY. CAVANAUGH ELECTRIC & AIR COND CHECK R8843 21168 MFA Total Paid forPERMIT ISSUANCE: $91.85 $91.85 TOTALS:0.4 Description: ROZEK RESIDENCE / HVAC CHANGE OUT Type: MECHANICAL Subtype: Status: ISSUED Applied: 8/31/2015 MFA Approved: 8/31/2015.MFA Parcel No: 775231017 Site Address: 55710 OAK TREE B33 LA QUINTA,CA 92253 Subdivision: TR 20717-2 SEE ASSR MB 769 PGS 3134 Block: Lot: 8 . Issued: 8/31/2015 MFA 3S36 • Lot Scl Ft: 0 Building Scl Ft: 0 Zoning: Finaled: Valuation: $8,000.00 Occupancy Type: Construction Type: Expired: 2/27/2016 MFA No. Buildings: 0 No. Stories: 0 No. Unites: 0 Details: HVAC CHANGE OUT - (2) TWO UNITS 13 SEERSPLIT SYSTEM [2008 ENERGY] CARBON MONOXIDE ALARM(S) TO BE INSTALLED PRIOR TO FINAL INSPECTION. 2013 CALIFORNIA BUILDING CODES. ADDITIONAL °31T@3 FINANCIAL INFORMATION Printed: Monday, August 31, 2015 3:38:15 PM . 1 of 2 CRWlYSTEMS •DESCRIPTION , ACCOUNT ^QTY AMOUNT PAID PAID*DATE -RECEIPT # CHECK # METHOD PAID BY A ; BY. <. � , BSAS SB1473 FEE 101-0000-20306 0 $1.00 $1.00 8/31/15 R8843 21168 CHECK CAVANAUGH ELECTRIC & AIR COND MFA' Total Paid forBUILDING STANDARDS ADMINISTRATION $1.00 $1.00 BSA: HVAC CHANGEOUT - 101-0000-42402 0 $145.04 $145.04 8/31/15 R8843 21168 CHECK CAVANAUGH MFA SPLIT -SYSTEM ELECTRIC & AIR COND HVAC CHANGEOUT - 101-0000-42600 0 $72.52 $72.52 8/31/15 R8843 21168 CHECK CAVANAUGH MFA SPLIT -SYSTEM PC ELECTRIC & AIR COND Total.Paid forCHANGEOUT: $217.56 $217.56 CAVANAUGH PERMIT ISSUANCE. 101-0000-42404 TO $91.85 $91.85 8/31/15 R8843 21168 CHECK ELECTRIC & AIR COND MFA Total Paid for PERMIT ISSUANCE: $91.85 $91.85 PARFNT,PR(]IFfTS BOND INFORMATION——— A TTA fUI E!•�l �j �� r „� ., ..,, », ��.. »n ,...»... it — ', Printed: Monday, August 31, 2015 3:38:15 PM 2 of 2 CB?W1ySTCMS CERTIFICATE.OF COMPLIANCE CF1R-ALT 02-E Alterations to Space Conditioning Systems (formerly CF -1R -ALT -HVAC) - x (Page 1 of 3 ) Project Name: • G.Rozek Date Prepared: 2015-08-20 A. General Information " CF111-ALT-02 is applicable to multiple space conditioning systems contained within a single dwelling unit. When multiple dwelling units must be' documented, use one CF11R-ALT-02 document for each dwelling unit. 01 Project Name G.Rozek 02 Date Prepared 2015-08-20' - .03 Project Location 55-710 Oak Tree 04 Building.Type " Single family 05 CA City La Quinta. -06 Dwelling Unit Name House • 07 Zip Code. 92253 08 Dwelling Unit Conditioned 3030 - , system a ducted refrigerant containing— Inslling new SC system Installing more than 40 Floor Area (ft2) Installing entirely new Name , Served Number of space conditioning kystem? ""} 09 Climate�Zone 15 , 10 (SC) systems in this dwelling 2 . System 1' Livin S ace t �'.."`* Yes: unit. " B. Space Conditioning (SC) System Information w 01 02 03 04 05 06. 07 08 ,09 10 r Is the SC Installing a Z ' SC System Identification or -Location SC System oir Area - CFA served by this SC-� , system a ducted refrigerant containing— Inslling new SC system Installing more than 40 Installing entirely new Installing entirely new Name , Served System (ft2) kystem? ""} component?- components? =feet ofoucts? duct system? SC system? - - Alteration Type System 1' Livin S ace 1515. �'.."`* Yes: �� Y,es � Yes No - No No Altered space e - - . conditioning system rcSystem 2 Bed Rooms 1515 U.S.Eneryfl Yes es Wes Yes SSa Naomi No No Altered space, , conditioning system Registration Number: 315-A1010598B-000000000-0000 Registration Date/Time: 2015-08-20 20:26:43 HERS Provider: USERA CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2014-03-31 Report Generated: 201-5-08-20 20:27:32 Schema.Version: 0.555SDD - , CERTIFICATE OF COMPLIANCE CF1111-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 ' r 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 gas All new Central split All new - Less than or System 1 furnace heating . AFUE .78 AC cooling SEER 13- Setback equal to 40 R-8 components components. feet Central gas All new " Central split All new Less than or System 2 furnace heating AFUE .78' AC cooling SEER 13 Setback' equal to'40 R-8 _ components components feet 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 15%, or15 30% leakage to outside, or seal all accessible leaks. ti CUR -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 2 300 CFM/ton required when MCH -25 is required. Exceptions: • T .4 .,.....___ Duct systems registered with HERS proved eras previously -seal! �e exe�mpt¢rom-MCH=20-Duct Le eSesting r gw#ements. -Heating-only systems�andlAir Handler/Furnace changes do not require verification of Air Flow MCH -23, or Refrigerant Charge MECH-25. - - A h 9' k d Y 1 t -Existing duct systemskcons�tructed, ins �latetl or staled with°asbe os are exempt -from -MCH -20 Duct Leakage Testing requIreme. ts. Registration Number: 315-A101059813-000000000-0000 Registration Date/Time: 2015-08-20 20:26:43 HERS Provider: USERA CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2014-03-31 Report Generated: 2015-08-20 20:27:32 +' ' Schema Version: 0.555SDD Documentation Author's Declaration Statement 1. 1 certify that this Certificate of Compliance documentation is accurate and complete. Documentation Author Name: Rod Cavanaugh Documentation Author Signature: Signature Date: Company:,-' Cavanaugh Electric & Air Conditioning ". 2015-08-20 Address: CEA/ HERS Certification Identification (if applicable):- pplicable):83-231 83-231Highway 111 - 286936 City/State/Zip: - Phone:., Indio CA 92201 _ 760-347-3608' - 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. lam 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. ' 4. The building design features or system design features identified on this Certificate of Compliance are consistent with the information provided on other applicable compliance documents, worksheets, ' calculations, plans and specifications submitted to the enforcement agency for approval with this building permit application. 5. 1 will ensure•that a registered -copy of this•Certificate,of Comptiance-shall-beavailable•with•the•building permit(s),issued•for the building, and made available to the enforcement agency for all applicable a " • 4 P i a 9 Inspections. I understand that 1registered,copy-of this Certificate of Complianceois required-to•be.includedrith the documentation the builder provides to the building owner at occupancy. k d } '�. n w Responsible Designer Name: � Responsible Designer Signature: '`' ooC C6L✓� Rod Cavanaugh 1' • ' . Company: k Cavanaugh Electric,&Air Conditioning°d"""" '_ 4I) e�ignecl:/ . 2019-0820 Address: 83'231 Highway 111 ' - - J.S. -Energy L 6 ssoclation City/State/Zip: . Phone: Indio CA 92201 760-347-3608 - _TM ; r "•This digital signature, is provided ki order to secure the content of this'iegistered documeni, end in no - way implies Registration Provider. responsibility for - _ R -A the accuracy of the information. oc: - - - U.S. Energy Raters Assiallon _ R Registration Number: 315-A1010598B-000000000-0000 Registration Date/Time: 2015-08-20 20:26:43 HERS Provider: USERA CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version 2014-03-31 • Repoit Generated: 2015-08-20 20:27:32 • . Schema Version: 0.555SDD ,