BMCH2017-009378-495 CALLE TAMPICO
VOICE (760) 777-7125
LA QUINTA, CALIFORNIA 92253 r FAX (760) 777-7011
DESIGN & DEVELOPMENT DEPARTMENT INSPECTIONS (760) 7774153
BUILDING PERMIT
Date: 3/27/2017
Application Number: BMCH2O17-0093 Owner:
Property Address: 54295 AVENIDA OBERGON 0 �j KENNETH PEDERSON
APN: 774241014 Q IJ 54295 AVENIDA OBREGON
Application Description: PEDERSON / HVAC CHANGE OUT 25cif LA QUINTA, CA 92253
Property zoning: lUj" MAR 1 2017
Application Valuation: $18,119.00
CITOF LA QUIN
OPMLNTDEPARTf,9E'$TApplicant: COMdITYDEVELT
Contractor:
IE INC HARRISON ENTERPRISES INC DBA GENERAL AIR
31225 LA BAYA 31170 RESERVE DRIVE
WESTLAKE VILLAGE, CA 91362 THOUSAND PALMS, CA 92276
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.: 686310.
Date: -5131 1 17 Contractor: — i
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
3o * f the Business and Professions Code) or that he or she is exempt therefrom and the
bais 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.).
(_) 1, 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 Na
Lender's Add
(760)343-7488
Llc. No.: 686310
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 "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: INSURANCE COMPANY OF THE WEST Policy Number: WSD5031658
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: 1-7 Applicant:
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, 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: 3 31 t" 1 _ Signature (Applicant or Agent):;2
Date: 3/27/2017
Application Number: BMCH2O17-0093
Owner:
Property Address: 54295 AVENIDA OBERGON
KENNETH PEDERSON
APN: 774241014
54295 AVENIDA OBREGON
Application Description: PEDERSON / HVAC CHANGE OUT 25 SEER
LA QUINTA, CA 92253
Property Zoning:
Application Valuation: $18,119.00
Applicant:
Contractor:
IE INC .
HARRISON ENTERPRISES INC DBA GENERAL AIR
31225 LA BAYA
31170 RESERVE DRIVE
WESTLAKE VILLAGE, CA 91362
THOUSAND PALMS, CA 92276 ,
(760)343-7488
Llc. No.: 686310
Detail: HVAC CHANGE OUT - 25 SEER/80AFUE SPLIT SYSTEM. CARBON MONOXIDE ALARM(S) TO.BE INSTALLED PRIOR TO FINAL INSPECTION. 2016
CALIFORNIA BUILDING CODES.
J r
DESCRIPTION ACCOUNT CITY
AMOUNT
BSAS SB1473 FEE 101-0000-20306 0
$1.00
Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $1.00
DESCRIPTION
ACCOUNT
CITY
AMOUNT
HVAC CHANGEOUT - SPLIT -SYSTEM
101-0000-42402
0
$76.00
DESCRIPTION
ACCOUNT
CITY
AMOUNT
HVAC CHANGEOUT - SPLIT -SYSTEM PC
101-0000-42600
0
$38.00
Total Paid for CHANGEOUT: $114.00
DESCRIPTION
ACCOUNT
CITY
AMOUNT
PERMIT ISSUANCE
101-0000-42404
0
$96.27
Total Paid for PERMIT ISSUANCE: $96.27
DESCRIPTION
ACCOUNT •
CITY
AMOUNT
TECHNOLOGY ENHANCEMENT FEE
502-0000-43611
1 0
$5.00
Total Paid for TECHNOLOGY ENHANCEMENT FEE: $5.00
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CERTIFICATE OF COMPLIANCE CF1R-ALT 02-E
Alterations to Space Conditioning Systems (formerly CF -IR -ALT HVAC) (Page 1 of 3)
Project Name: CONNIE PEDERSON Fate Prepared: 2017-03-22
A. General information
CF1R-ALT 02 is applicable to multiple space conditioning systems contained within a single dwelling unit. When multiple dwelling units must be documented, use one
CFIR-ALT 02 document for each dwelling unit.
01
Project Name
CONNIE PEDERSON
02
Date Prepared
2017-03-22
03
Project Location
54295 AVENIDA OBREGON
04
Building Type
Single family
05
CA City
La Quinta
06
Dwelling Unit Name
HOUSE
07
Zip Code
92253
08
Dwelling Unit Conditioned
1580
system
more than 40
entirely new
entirely new
Floor Area (ft')
Name
Served
System (ft2)
system?
component?
Number of Space
feet of ducts?
09
Climate Zone
15
10.
Conditioning (SC) Systems in
1
Yes
Yes
Yes
No
this Dwelling Unit:
No
B. Space Conditioning (SC) System Information
01
02
03
04 --:''
' OS t
06,4
07
08
09
10
SC System
SC System
CFA served
Is the SC
system a
Installing a
`" refrigerant `
"Installing new SCS
Installing
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
1580
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: 417-A020063208A-000-000-0000000-0000 Registration Date/Time: 2017-03-22 13:31:26 HERS Provider: CHEERS
CA Building Energy Efficiency Standards - 2016 Residential Compliance Report Version: 2016.1.005 Report Generated: 2017-03-22 13:31:40
Schema Version: rev 10/16
CERTIFICATE OF COMPLIANCE
CF1R-ALT-02-E
Alterations to Space Conditioning Systems (formerly CF -1R -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
0.8
HP
cooling
SEER
25
Setback
section is not
section is not
components
components
applicable
applicable
Reoulred Documentation: ;Y
CF2R-MCH-01-E - Space Conditioning Systems r µ
- Duct Insulation requirement for the new portions of supply -air and retum-air ducts or plenums: R6.(CZ 1 10 -i2 and 13) and RB (CZ 11 and 1416)
CF211 and CF3R-MCH-20-H - Duct Leakage Test required when heating or cooling components are installed inducted systems, or when more than 40 ft of duct length is replaced
-Leakage rate compliance: <=15% or <=10% leakage to outside, or seal all accessible leaks.
CF2R and CF3R-MCH-25-H Refrigerant Charge verification required when refrigerant containing components are installed or altered (applicable In CZ 2, 8-15).
CF2R and CF3R-MCH-23 Airflow Rate >= 300 CFM per ton required when MCH -25 is required.
Exceptions,
Duct systems registered with HERS provider as previously sealed are exempt from MCH -20 Duct Leakage Testing requirements.
Heating -only systems and Air Handler Furnace changes do not require verification of Air Flow MCH -23, or Refrigerant Charge MCH -25.
-Existing duct systems constructed, insulated or sealed with asbestos are exempt from MCH -20 Duct Leakage Testing requirements.
E. Entirel New or Complete Replacement Duct System, with or"without E ui ment Chan eout Sections 150.2 b 1Dila and 1S0.2(b)1E,F
Y P P Y q p 8 ( 1 11
This section does notappiy to this project.
F. Entirely New or Complete Replacement Space Conditioning System (Section 150.2(b)1C)
This section does not apply to this project.
Registration Number: 417-A020063208A4MO-00040000000-0000 Registration Date/Time: 2017-03-22 13:31:26 HERS Provider: CHEERS
CA Building Energy Efficiency Standards - 2016 Residential Compliance Report Version: 2016.1.005 Report Generated: 2017-03-22 13:31:40
Schema Version: rev 10/16
CERTIFICATE OF COMPLIANCE CFiR-ALT-02-E
Alterations to Space Conditioning Systems (formerly CF -IR -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:
Patrick Somers
Pa trick Somers
Company:
Signature Date:
General Air Conditioning
2017-03-22
Address:
CEA/ HERS Certification Identification (if applicable):
31170 Reserve Drive
City/State/Zlp: a
Phone:
Thousand Palms CA 92276 -
760-343-7488
Responsible Person's Declaration statement
1 certify the following under penalty of pedury, 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.
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.
S. 1 will ensure that a registered copy of this Certificate of Compliance shall be madeavailable wRh the building peimit(s) Issued for the building, and made available to the enforcement agency for all applicable
inspections. I understand that a registered copy of this Certificate of Compliance Is requlredto be Included withthe documentatlon the builder provides to the building owner at occupancy.
Responsible Designer Name:
' j'`t `. t 1� <(
Responsible Designer Signature:
"P
Patrick Somers
e t iiV k'So li►tB rs
company:
Date Signed:
General Air Conditioning
2017-03-22
Address:
License:
31170 Reserve Drive
686310
City/State/Zip:
Phone:
Thousand Palms CA 92276
760-343-7488
Registration Number: 417-A020063208A-000-000-0000000-0000
Digitally signed by CHEERS'". This digital signature Is provided In order
to secure the content of this registered document, and In no way Implies
Registration Provider responsibility for the accuracy of the information.
Registration DateMme: 2017-03-22 13:31:26
HERS Provider: CHEERS
CA Building Energy Efficiency Standards - 2016 Residential Compliance Report Version: 2016.1.005 Report Generated: 2017-03-22 13:31:40
Schema Version: rev 10/16