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BMCH2017-0256LICENSED 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 License No.: 522775 / !l/ /C�E�Contractor. . Dater , 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).: (_) 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: 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 :)f the Labor Code, for the performance of th)r which this permit is issued. 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: STATE COMPENSATION INSURANCE FUND Policy Number: 9074503 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 tha-., if I should become subject to the r� workers' compensation provisions of Section 3:00 of t e La r ode, I sha orthwith comply with those provisions. Date: 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 PRQVJQED-FOR:1N•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 Zity of La Quinta, its officers, agents, and employees for any act or omission related to tl-e work being performed under or following issuance of this permit. 2. Any permit issued as a result of this appli©tion becomes null and void if work is not commenced within 180 days from date of ssuance of such permit, or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and st ete that the above information is correct. I agree to comply with all city and county ordinances and state laws relatin to building construction, and hereby authorize representakives of this city to ent r o the. above-mentioned property for inspection purposes. Date: nature (Applicantbor Agent): Tv� 4v / VOICE (760) 777-7125 78-495 CALLE TAMPICO D FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 DESIGN. & DEVELOPMENT DEPARTMENT INSPECTIONS (760)777-7153 BUILDING PERMIT Date: 6/22/2017 Application Number: BMCH2O17-0256 Owner: Property Address: 55610 RIVIERA GLAYAN MARVIN 8 JULIA APN: 775242022 55610 RIVIERA Application Description: GLAYAN / CHANGE OUT (1)165EER/13EER SPLIT SYSTEM LA QUINTA, CA 92253 Property Zoning: Application Valuation: $16,000.00 C� f w N z. o Applicant: Contractor: N cy LU Zo. SAN'S AIR CONDITIONING & HEATING SAN'SAIR CONDITICINING & HEADING p 51-530 JACKSON STREET 51-530 JACKSON STREET 41: o COACHELLA, CA 92236-2737 COACHELLA, CA 92236-2737 v � a (760)398-4287 � Llc. No.: 522775 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 License No.: 522775 / !l/ /C�E�Contractor. . Dater , 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).: (_) 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: 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 :)f the Labor Code, for the performance of th)r which this permit is issued. 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: STATE COMPENSATION INSURANCE FUND Policy Number: 9074503 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 tha-., if I should become subject to the r� workers' compensation provisions of Section 3:00 of t e La r ode, I sha orthwith comply with those provisions. Date: 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 PRQVJQED-FOR:1N•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 Zity of La Quinta, its officers, agents, and employees for any act or omission related to tl-e work being performed under or following issuance of this permit. 2. Any permit issued as a result of this appli©tion becomes null and void if work is not commenced within 180 days from date of ssuance of such permit, or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and st ete that the above information is correct. I agree to comply with all city and county ordinances and state laws relatin to building construction, and hereby authorize representakives of this city to ent r o the. above-mentioned property for inspection purposes. Date: nature (Applicantbor Agent): Date: 6/22/2017 Application Number: BMCH2017-0256 Owner: Property Address: 55610 RIVIERA GLAYAN MARVIN &JULIA AIPN: 775242022 55610 RIVIERA Application Description: GLAYAN / CHANGE OUT (1)16SEER/13EER SPLIT SYSTEM' LA QUINTA, CA 922-13 Property Zoning: Application Valuation: -$16,000.00 Applicant: Contractor: SAN'S AIR CONDITIONING & HEATING SAN'S AIR CONDITIONING & HEATING . 51-530 JACKSON STREET 51-530 JACKSON STREET COACHELLA, CA.92236-2737 COACHELLA, CA 92336-2737 (760)398-4287 Llc. No.: 522775 . Detail: HVAC CHANGE OUT - (1)16SEER/13EER SPLIT SYSTEM. CARBON MONOXIDE ALARM(S) TO BE INSTALLED PRIOR TO FINAL INSPECTION. 2016 CALIFORNIA BUILDING CODES. rmANr iAI immDMAT1(1N ' DESCRIPTION ACCOUNT QTY AMOUNT ' BSAS SB1473 FEE 101-0000-20306 0 $1.00 Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $1.00 DESCRIPTION ACCOUNT QTY AMOUNT HVAC CHANGEOUT - SPLIT -SYSTEM .101-0000-42402 0 $76.00 DESCRIPTION ACCOUNT QTY AMOUNT HVAC CHANGEOUT - SPLIT -SYSTEM PC 101-0000-42600 0 $38.00 Total Paid for CHANGEOUT: $114.00 - DESCRIPTION ACCOUNT QTY AMOUNT PERMIT ISSUANCE 101-0000-42404 0 $96.27 Total Paid for PERMIT ISSUANCE: $96.27 DESCRIPTION ACCOUNT QTY AMOUNT TECHNOLOGY ENHANCEMENT.FEE 502-0000-43611 0 $5.00. Total Paid for TECHNOLOGY ENHANCEMENT FEE: $5.00 STATE OF CALIFORNIA ALTERATIONS - HVAC D$ o sio CEC-CFIR-ALT-04-E Revised 01/16 CALIFORNIA ENERGY COMMISSION CERTIFICATE OF COMPLIANCE CF1R-ALT-04-E Alterations - HVAC CZ 2, and 8-15 (Page 1 of 1) Site Address: Enforcement Agency: DatePrepared: Permit#: Equipment Type Equipment Efficiency New Ducting or Lineset: Required R -value Conditioned Floor Area (ft2) Thermostat ❑ Packaged ❑ Evpdrator Coil AFUE COP ❑ R-6 (CZ 1-10, 12&13) Ducts Served by system ❑ Setback Syst System ondensing Unit ❑ Compressor 5 ❑ R-8' (CZ 11, 14-16) Ducts ft (If not already plit SEER HSPF ❑ > R-2.8 Lineset° present, must ❑ Mini Split ❑ Lineset /EER be installed) ❑ Furnace ❑ TXV G HERS VERIFICATION SUMMARY Installer determines work to be completed and matches to one of the options belovL At permit application this form is allowed to be filled out by hand. For final inspection all forms are to be registered (no hand filled forms allowed) and a copy left on site. 1 HVAC Changeout/Repair Required Compliance Documents to be left on site for Final: All Equipment, CF111-ALT-02-E Condenser Unit, Evaporator Coil, CF2R-MCH-01-E, MCH -20-H, MCH -(23 or 24)2-H, MCH -25-H2 Compressor, TXV, Lineset, CF3R-MCH-20-H, MCH -(23 or 24)-H2, MCH -25-1-12 Air Handler/Furnace2 (Can include new ducting) Installer Requirement: Duct leakage (5 15%, or 510% to outside, or seal all accessible leaks), Air Flow z 300 CFM/ton, Refrigerant Charge. Exempted from duct leakage testing if: ❑ 1. Duct system registered with HERS provider as previously sealed, or ❑ 2. There is less than 40 linear feet of ductnn unconditioned space, or ❑ 3. Existing duct systems are constructed, insulated or sealed with asbestos (list manufacture date of building—.... ❑ 2. New HVAC System Required Compliance Documents to be left on site for Final: All new equipment and All New Ducts' CF1R-ALT-02-E including Mini Split CF2R-MCH-01-E, MCH -20-H, MCH -22-H, MCH -(23 or 24)-H2, MCH -25-H2 CF3R-MCH-20-H, MCH -22-H, MCH -(23 or 24)-H2, MCH -25-H2 Mini Splits require CF1R-ALT-02-E, CF2R-MCH-01-E, and (CF2R-CF=R) MCH -25-H Installer Requirement: Duct leakage < S%, Fan Efficacy (0.58W/CFM), Air Flow z 350 CFM/ton (or alternative), Refrigerant Charge 113. All New Duds with Replacement Required Compliance Documents to be left on site for Final: All New Ducts' and one or more of the following CFIR-ALT-02-E replaced: Condenser Unit, Evaporator Coil, CF2R-MCH-01-E, MCH -20-H, MCH -(23 or 24)-H, MCH -25-H Compressor, TXV, Lineset, Furnace' CF3R-MCH-20-H, MCH -(23 or 24)-H, MCH -25-H Installer Requirement: Dud leakage < 5%, Air Flow >_ 350 CFM/ton (or alternative), Refrigerant Charge Exempted from dud leakage testing if: ❑ 1. Existing duct systems are constructed, insulated or sealed with asbestos ❑ 4. New Ducting over 40 feet Required Compliance Documents to be left on site for Final: New ducting but less than All New Duds' I CF1R-ALT-02-E, CF2R-MCH-20-H, CF311-MCH-20-1-1 Installer Required to: Duct leakage (5 15% or, <_10% to outside or, or seal all accessible leaks) ❑ EXCEPTION: Existing duct systems constructed, insulated or sealed with asbestos. 'All new ducting requires R-8 insulation when more than 40 ft installed in CZs 11 & 14-16 and R-6 in CZs 1-10, 12 &13, and R-6 insulation when less than 40 ft installed. This includes in walls, between floors etc. 2 Heating only systems and Air Handler/Furnace changes do not require Air Flow MCH -(23 or 24), or Refrigerant Charge verification MCH -25 ' All New Ducts is when at least 75%of the duct system is new duct material, and up to 25%may consist of reused parts from the dwelling unit's existing duct system (e.g., registers, grilles, boots, air handler, coil, plenums, duct material) ° R-2.8 (1" thick insulation) for linesets 1" and less. Contractor (Documentation Author's /Responsible Designer'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 California Business and Professions Code to accept responsibility for the information on this document. 3. That the energy features and performance specifications for the design identified on this Certificate of Compliance conform to the requirements of Title 24, Parts 1 and 6 of the California Code of Regulations (CCR). 4. 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 Fart 6 of the CCR. S. 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, c lations, plans and specifications submitted to the enforcement agency for approval with this building permi ation. a c Responsible Designer Name: Res nature: v-C Date Signed: License: Company: Address: I City/State/Zip: Phone: for assistance or questions regarding the Energy Standards, contact the Energy Hotline at: 1-800-772-3300 Bin # City of La Quina Building 8r Safety* Division 78-495 Calle Tampico. La Quinta, CA 92253.- (760).777-7012 Building 'Permit Application and Tracking Sheet Permit # Project Address: J Owner's Name: A. P. Number: Address: —5-;e Legal Description: City, ST, Zip: I -A. G Z-,� Contracto - s Telephone: .Address: ect Description:_ City, ST, Zip: Telephone . V2 ............. State Lic. # City Lic. #; Arch., Engr., Designer: Address: City, ST, Zip: Telephone: one: Construction i ct on Type:cy: OCc an up State Lic. #: <.::;:"=z:.'•. Alter Repair Demo >z ...».. Project type (circle one): New Add>• > Name of Contact Person: lti/ice Sq. Ft: # Stories: # Units: Telephone # of Contact 4621 tr Estimated Value of Project: �•�+� APPLICANT: DO NOT WRITE BELOW THIS LINE ` # Submittal Req'd Rec>d TRACIONG PERMIT FEES Plan Sets Plan Check submitted Item Amount Structural Calcs. Reviewed, ready for corrections Plan Check.Deposit Truss talcs. Called Contact Person Plan Check.Balance Title 24 Calcs. Plans picked up Construction Flood plain plan Plans resubmitted Mechanical Grading plan 2"" Review, ready for correctionsfissue Electrical Subcontactor List Called Contact Person Plumbing Grant Deed Plans picked up S.M.I. H.O.A: Approval Plans resubmitted Grading IN HOUSE:- 3d Review, ready for corrections/issue Developer- mpact Fee Planning Approval Called Contact Person A.I.P.P. Pub. Wks. Appr Date of permit issue, School Fees Total Permit Fees