BMCH2015-0240U AN�I'm I.f� VOICE (760) 777-7125
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253 FAX (760)' 777-7011COMMUNITY DEVELOPMENT DEPARTMENT
INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 6/30/2015
Application Number: BMCH2O15-0240 Owner:
Property Address: 56225 RIVIERA RALPH RUBENSTEINi
APN: 76202102.7 56225 RIVIERA
Application Description: RUBENSTEIN RESIDENCE HVAC CHANGE OUT LA QUINTA, CA 922E 3
Property Zoning:
Application Valuation: $3,815.00
D
�IJiJ_0 2015
CITU OF LA QUINTA
COMMUNITY Dl VELOPMENT DEPARTMENT
Applicant:
HARRISON ENTERPRISES INC DBA G
31-170 RESERVE DRIVE STE A
THOUSAND PALMS, CA 92276
Contractor: •
HARRISON ENTERPRIISES INC DBA G
31-170 RESERVE DRPVE STE A
THOUSAND PALMS, CA 92276
(760)343-7488
Llc. No.: 686310
LICENSED CONTRACTOR'S DECLARATION
WORKER'S COMPENSATIOrl. DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter
I hereby affirm under penalty of perjury one of the following declarations:
9 (commencing with Section 7000) of Division 3 of the Business and Professions Code,
I have and will maintain a certificate of consent to self -insure for workers'
and my License is in full force and effect.
compensation, as provided for by Section 3700 ofthe Labor Code, for the performance
License Class: C20 License No.: 686310
of the work for which this permit is issued.
Date: Contractor: J +-kty
1 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 c2rrier and policy number are:
OWNER -BUILDER DECLARATION
Carrier: Policy Number:
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State
I.certify that in the performance of the work for which this permit is issued, I
License Law for the following reason (Sec. 7031.5, Business and Professions Code: Any
shall not employ any person in any manner so as to become subject to the workers'
city or county that requires a permit to construct, alter, improve, demolish, or repair
compensation laws of California, and agree that, it I should become.subject to the
any structure, prior to its issuance, also requires the applicant for the permit to file a
workers' compensation provisions of Section 3700 of the Labor Code; I shall forthwith
signed statement that he or she is licensed pursuant to the provisions of the
comply with those provisions.
Contractor's State License Law (Chapter 9 (commencing with Section 1000) of Division 3
���—
of the Business and Professions Code) or that he or she is exempt therefrom and the
Date: S Applicant:
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
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL,
($500).:
AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO
(� I, as owner of the property, or my employees with wages as their sole
ONE HUNDRED THOUSAND DOLLARS ($100,000). -:N ADDITION TO THE COST OF
compensation, will do the work, and the structure is not intended or offered for sale.
COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,
(Sec. 7044, Business and Professions Code: The Contractors' State. License Law does not
INTEREST, AND ATTORNEY'S FEES.
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
APPLICANT ACKNOWLE )GEMENT
are not intended or offered for sale. If, however, the building or improvement is sold
IMPORTANT: Application is hereby made to the BOJ ding Official for a permit subject to
within one year of completion, the owner -builder will have the burden of proving that
the conditions and restrictions set forth on this application.
he or she did not build or improve for the purpose of sale.).
1. Each, person upon whose behalf this application is made, each person at whose
1, as owner of the property, am exclusively contracting with licensed contractors
request and for whose benefit work is performed Under or pursuant to any permit
to construct the project. (Sec. 7044, Business and Professions Code: The Contractors'
issued as a. result of this application, the owner, and the applicant, each agrees to, and
State License Law does not apply to an owner of property who builds or improves
shall defend, indemnify and hold harmless the City of La Quinta, its officers, agents, and
thereon, and who contracts for the projects with a contractor(s) licensed pursuant to
employees for any act or omission related to the v`vrk being performed under or
the Contractors' State License Law.).
following issuance of this permit.
(� I am exempt under Sec. . B.&P.C. for this reason
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 issu&nce of such permit, or cessation of
work for 180 days will subject permit to cancellaticm.
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:
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 representative! of this city to enter upon the above•
mentioned property for inspection purposes.
Date: L IJ Signature (Applicant or Agent): ��'��
FINANCIAL INFORMATION
:DESCRIPTION `°Yfi �{ ,ACCOUNT 4QTY " 'AMOUNT ` rr�$ '
PAIDDATE'
EPAIU
z..
BSAS SB1473 FEE 101-0000-20306 0 $1.00 $0.00
=. ;3PAID BY �r�`t d " METHOD `
BY
Wr zCHECKLTD
Total Paid forBUILDING STANDARDS ADMINISTRATION BSA, $1:00 $0.00
,.YDESCRIPTION�',�a e 8+
k,
ACCOUNTrs r
'QTY
.. YF
AMOUNT
Tt
gr PAID
PAID DATE:
r ...4:x
, �.> r ,
HVAC CHANGEOUT - SPLIT -SYSTEM
101-0000-42402
0
$72.52
$0.00
ick 'a+PAID'.BY+
METHOD
r- r
RECEIP1
G 6
CHECK #
CLTD BY
. ,'
:1n
{ +
_
:A�DESCRIPTION
ACCOUNT
QTY
_f~AMOUNT; r
PAID €
rPAID
§r
w a Y
.,z
.
S - 3
y
hDATE:
HVAC CHANGEOUT - SPLIT -SYSTEM PC
101-0000-42600
0
$36.26
$0.00
PAID -BY:_..r�
rMETHOD
4 =RECEIPT#
CHECK# `
' CLTD BY
A. .,.
Total Paid forCHANGEOUT: $108.78 $0.00
', DESCRIFTION's s
ACCOUNTr
QTY
K;: AMOUNT,e^_
PAID
PAIDDATE:
41, r ,°5}
,
_`
;
PERMIT ISSUANCE
101-0000-42404
0
$91.85
$0.00
s ". PAID' BY ;;,> �` tr
r : �. i jMETHOD + _
r
RECEIPT # .'
CHECK # +
CLTD BY `
r
Total Paid for PERMIT ISSUANCE: $91.85 $0.00
TOTALS:• 0-
a
Bin.#
City, of.La Quinta
Building a Safety Division
P.O. Box 1504,78-49.5 Calle Tampico
14.Quinta, CA 92253 - (760) 777-7012
02.-:4A-0 Building Permit Application and Tracking Sheet
Permit #
g GNzo 5
Project Address: 56225 Riviera
ame:. Ralph &.Kathleen Rubenstein
A. P. Number.
77.6225
Address: Riviera
Legal Description:
Contractor: General Air Conditioning
ip: La Quinfa, CA 92253
Telephone: orfs
P '>�>x
Address: 31170 Reserve Drive
Project Description: Replace 4ton Evaporative Coil
City, ST, Zip: Thousand Palms, CA 92276
Telephone: 760-343-7488.101"V
"
State Lic. #: 686310
City Lic. #:
Arch, Engr., Designer:
Address:
City, ST, Zip:
Telephone: P
State Lic. #: ^ . y�
Name of Contact Person: Steven Schnierer "
Construction Type: Occupancy: .
Project type (circle one): New .Add'n Alter 'Repair Demo
Sq. Ft.: #Stories: #Units:
Telephone # of Contact Person: 8.18-735-'7876 X 1
Estimated Value of Project $3,815.00 .
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACMG
PERMIT FEES
Plan Sets
Plan Check submitted
Item Amount
Structural Cales.
Reviewed, ready for corrections
Plan Check Dep•3sit. .
Truss Calcs.
Called Contact Person
Pian Check Bala nee
Title 24 Cates.
Plans picked up
Construction
Flood plain plan
Pians resubmitted
Mechanical
Giading plan
tad Review, ready for correctionsrissue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.L
H.O.A. Approval
Plans resubmitted
Grading
11Y HOUSE:-
'^' Review; ready for correctionsfissue
Developer Impact Fee
Planning Approval
Called Contact Person
A.LP.P.
Pub. wks. Appr
Date of permit Issue
School Fees
Total Permit Bees
Description: RUBENSTEIN RESIDENCE HVAC CHANGE OUT
Type: MECHANICAL Subtype: Status: APPROVED
Applied: 6/30/2015 EVA
Approved: 6/30/2015 EVA
Parcel No: 762021027 Site Address: 56225 RIVIERA LA QUINTA,CA 92253
Subdivision: TR 24801 Block: Lot: 1
Issued:
Lot Sq Ft: 0 Building Sq Ft:'O Zoning:
Finaled:
Valuation: $3,815.00 Occupancy Type: Construction Type:
Expired:
No. Buildings: 0 No. Stories: 0 No. Unites: 0
Details:. HVAC CHANGE OUT - 13 SEER / SPLIT.SYSTEM [2008 ENERGY] CARBON MONOXIDE ALARM(S) TO BE INSTALLED PRIOR TO FINAL
INSPECTION. 2013 CALIFORNIA BUILDING CODES.
s"AUUIIIUN/�LSI;IES'
y
II 1 7.. .a�.� �a, �•. .. ilii Y , in �•.. i,�,i • .y;,� i•i
mm
MNANdALINFORMATION � �
Printed: Tuesday, June 30, 2015 11:19:49 AM 1 of 2
_ sysrrMs
DESCRIPTION
ACCOUNT
CITY
AMOUNT
PAID
PAID DATE
RECEIPT #
CHECK #
METHOD
PAID BY
CLTD
;
BY
BSAS SB1473 FEE
101-0000-20306
0
$1.00
$0.00
Total Paid forBUILDING STANDARDS ADMINISTRATION
S1.00 $0.00
BSA:
HVAC CHANGEOUT -
101-0000-42402
0
$72.52
$0.00
SPLIT -SYSTEM
HVAC CHANGEOUT -
101-0000-42600
0
$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
TOTALS:00
BOND INFORMATION
Printed: Tuesday, June 30, 2015 11:19:49 AM 2 of 2
SYSTEMS
CERTIFICATE OF COMPLIANCE
Alterations to Space Conditioning Systems (formerly CF -IR -ALT -HVAC)
Project Name:
CF1R-ALT-02-E
(Page 1 of 3 )
PALPH RUBENSTEIN I Date Prepared: . 2015-06-29 I
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 CF1R-ALT 02 document for each dwelling unit.
01
Project Name
PALPH RUBENSTEIN
02
Date Prepared
2015-06-29
03
Project Location
56225 RIVIERA
04
Building Type
Single family
05
CA City
La Quinta
06
Dwelling Unit Name
PALPH RUBENSTEIN
07
Zip Code
92253
08
Dwelling Unit Conditioned
2825
�„
Floor Area (ft2)
SC -System
SC System
CFA served
systema
refrigerat t
A
Number of space conditioning
Installing
09
Climate Zone
15
10
(SC) systems in this dwelling
1
ducted
s
containing
,�
system
more than 40
unit.
entirely new
B. Space Conditioning (SC) System Information-'� n ~ F! rn
Z(°
01
02
03
04
05il
r6
07}
j 08
09
10
' Is the SC
r _,mom. Px �..
Installing a
�„
SC -System
SC System
CFA served
systema
refrigerat t
A
Installing ew SC
Installing
;Installing
Installing
Identification or
Location or Area
by this SC
ducted
s
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
Location 1
2825
Yes
Yes
Yes
No
No
No
Altered space
conditioning system
C. Extension of Existing Duct System, Greater Than 40 Feet (Section 150.2(b)1Diib)
This section does not apply to this project.
Registration Number: 215-A0176508A-000000000-0000
Registration Date/Time: 2015-06-29 12:50:53
HERS Provider: CaICERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2014-03-31 Report Generated: 2015-06-29 12:50:50
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)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
Central gas
No heating
This field or
This field or
Central split
This field or
This field or
System 1
furnace
component
section is not
section is not
AC
Indoor coil
SEER
13
Setback
section is not
section is not
altered
applicable
applicable
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 inducted systems, or when more than 40 ft of duct length is replaced.
-Leakage rate compliance: 515%, or 510% leakage to outside, or seal all accessible leaks.
CF2R-MCH-25-H & CF3R-MCH-25-H Refrigerant Charge Veiification required when refrigerant containing components are installed or altered (applicable in C2 2, 8-15).
CQRCF311-MCH-23 & CF3R-MCH-23 Air Flow 2300 CFM/ton required when MCH -25 is required.
Exceptions: —
-Duct systems registered with HERS provider as previously sealed are exempt from20.Duct Le�akage-Tr a ting requirements
Flowi 4MCiH-23;
{
-Heating-only systems and Air Handler/Furnace changes do not require verification of Air or RefrigeranttChargeMECH-25 .
Existing duct systems constructed, insulated or sealed with astie�stos are exemptfom MCH -30 Duct}Leikage Testing requirements.
f
.,.`e. .�` � .
E. Entirely New or Complete Replacement Duct System, with*or with Equipment Changeoutf(Sections 150.2(b)iDlia 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)lC)
This section does not apply to this project.
Registration Number: 215-A0176508A-000000000-0000 Registration Date/Time: 2015-06-29 12:50:53 HERS Provider: CaICERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2014-03-31 Report Generated: 2015-06-29 12:50:50
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: �^
Jan
Jacoby, Ian
dacobJt
Company:
Signature Date:
Stratz Permit Service
2015-06-29 12:50:34
Address:
CEA/ HERS Certification Identification (if applicable):
5858 Dovetail Drive
City/State/Zip:
Phone:
Agoura Hills CA 91301
818-735-7876
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 ofd egulationsfir
4. The building design features or system design features identified on this Certificate of Compliance are.consistent with{the informafionprovided on otherapphcable compliance documents, worksheets,
calculations, nspecificationsmi thenforcement.n f
a s a d submitted o the this building '
plans ge cy or approvalwith permlt application.
p s is � It a.# I. ill c it. tf >:
.� :.
5. I will ensure that a registered copy of this Certificate of CCompliance shall be; made;availa6le with;the building permits} issued foritte.building, and_made availableto the ehforcement agency for all applicable
inspections. I understand that a registered copy of this Certifcate of Compliance s requ [ed to beµincluded w the dgcumeentationtthe builder provides to the building owner at occupancy.
Responsible Designer Name: i '+
Responsible Designer Signature: `-
Hernandez , Kimberly
Company:
Date Signed:
HARRISON ENTERPRISES INC dba GENERAL AIR CONDITIONING
2015-06-29 12:50:53
Address:
License:
31-170 RESERVE DRIVE STE A
686310
City/State/Zip:
Phone:
THOUSAND PALMS CA 9227,6
(760) 343-7488
Digitally signed by Ca10ERTS. 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 Number: 215-A0176508A-000000000-0000 Registration Date/Time: 2015-06-29 12:50:53 HERS Provider: CaICERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2014-03-31 Report Generated: 2015-06-29 12:50:50
Schema Version: 0.555SDD