BMCH2016-0420LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that 1 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: Contractor:`
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 prciperty, 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 of the Labor Code, for the performance
ofthe:wo rk 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: INSURANCE COMPANY OF THE WEST Policy Number: WSD50316S8
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.
t)at''�10! it 18 l(0
Applicant:' C�
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 ori 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 8 Ilo Signature (Applicant or Agentf�
Q�
VOICE (760) 777-7125
78-495 CALLE TAMRICO
D
fAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253
DESIGN & DEVELOPMENT DEPARTMENT.
INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 11/18/2016
Application Number: BMCH2O16-0420
Owner:
Property Address: 80288 RIVIERA
SCOTT BIRD
APN: 762130016
8 ELPULGAR
w
Application Description: BIRD /HVAC CHANGEOUT (1) SPLIT SYSTEM
ORINDA, CA 92253
Property Zoning:
coAwcc
o i,_ w
Application Valuation: $14,487.00
® 0
4C LL
Applicant:
Contractor:
ILL. 2
o UJ
IE INC
HARRISON ENTERPRISES INC
NERftAIRi-: ca
31225 LA BAYA
31170 RESERVE DRIVE
WESTLAKE VILLAGE, CA 91362
THOUSAND PALMS, CA 9227
C a
U
(760)343-7488
Llc. No.: 686310
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that 1 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: Contractor:`
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 prciperty, 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 of the Labor Code, for the performance
ofthe:wo rk 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: INSURANCE COMPANY OF THE WEST Policy Number: WSD50316S8
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.
t)at''�10! it 18 l(0
Applicant:' C�
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 ori 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 8 Ilo Signature (Applicant or Agentf�
y
Date: 11/18/2016
Application Number: BMCH2O16-0420
Owner:
Property Address: 80288 RIVIERA
SCOTT BIRD
APN: 762130016
8 EL PULGAR
Application Description: BIRD/ HVAC CHANGEOUT (1) SPLIT SYSTEM
ORINDA, CA 92253
{ Property Zoning:
Application Valuation: $14;487.00
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
LIc. No.: 686310
Detail: HVAC CHANGE OUT - (1)14SEER/80AFUE SPLIT SYSTEM [2013 ENERGY] CARBON MONOXIDE ALARM(S) TO BE INSTALLED PRIOR TO FINAL
INSPECTION. 2013 CALIFORNIA BUILDING CODES.
s-
1 1
DESCRIP`TION
FORMATION
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 - PACKAGED UNIT
101-0000-42402
0
$38.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
HVAC CHANGEOUT - PACKAGED UNIT PC
101-0000-42600
0
$25.33
Total Paid for CHANGEOUT:
$63.33
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PERMIT ISSUANCE
101-0000-42404
0.
$96.27
Total Paid for PERMIT ISSUANCE:
$96.27
Bin: #
• ..
City. of. La- Quinta
Building 8c Safety Division
P.O. Box 1504,78-495 Calle Tampico
La.Quinta, CA 92253 -:(760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
Project Address: 80288 Riviera
Owner's Name:. Scott and Barbara Bird
A. P. Number.
Address --.80288 Riviera
Legal Description:
City, ST, Zip: La Quinta, CA 92253
Contractor. General Air Conditioning and Plumbing
a
Telephone: 6309s
Address: 31170 Reserve DrivePro*4Descrip6on:
Replace 3 ton A/C, coil, & 70,000 BTU .
City, ST, Zip: Thousand Palms, CA 92276
furnace
CO,
Telephone: 760-343-7488 f
State Lic. # : 686310 City Lic. #.-
Arch., Engr., Designer.
Address:
City., ST, Zip:
Telephone:
V Y : -��.
r :�;„,�js;;:�ti� ,r
Construction type: . Occupancy:
State Lic. #: "
Project type (circle one): New Add'n Alter Repair Demo .
Name of Contact Person: Steven Schnierer
Sq. Ft.:
# Stories:
#Univ:
Telephone # of Contact Person: 8.18-735.-7876 ro
Estimated Value of Project $14,487.00 .
APPLICANT: DO NOT WRITE BELOW THIS UNE
# Submittal Req'd Recd TRACKING PERMIT FEES'
Plan Sets
Plan Check submitted
Item Amount
Structural Calcs.
Reviewed, ready for corrections
Plan ChcdoDeposit. .
Truss Cates.
Called Contact Person
Plan Check Balance.
Title 24 Cales.
Pians picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2i4 Review, ready for correction&r sue
Electrical
Subeontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.L
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
3d Review', ready for earrections/issae
Developer Impact Fee
Planning Approval
Called Contact Person,
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees '
Total Permit Fees
4
CERTIFICATE OF COMPLIANCE
Alterations to Space Conditioning Systems (formerly CF -1R -ALT -HVAC)
Project Name:
SCOTT & BARBARA BIRD ( Date Prepared:
CF1R-ALT-02-E
(Page 1 of 3 )
2016-11-17
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 MR -ALT -02 document for each dwelling unit.
01
Project Name
SCOTT & BARBARA BIRD
02
Date Prepared
2016-11-17
03
Project Location
80288 RIVIERA
04
Building Type
Single family
05
CA City
LA QUINTA
06
Dwelling Unit Name
WHOLE HOUSE
07
Zip Code
92253% `
`
X08-=
DwellingUnit Conditioned
Floor Area
1000
Installing
Installing
Installing
(ft2)
Location or Area
by this SC
ductedrf
ift ntaimng' I
J
Number of space conditioning
entirely new
09
Climate Zone
15�
' 10
(SC) systems in this dwelling
1'
component?
components?
feet of ducts.
A; ��
unit.
Alteration Type
VIA,. 411
B. Space Conditioning (SC) System Information
01
02
03
04P05
—_,
i Q6 �
07
08
09
10
Is the SCS
(Installing_a
L '
SC System
SC System
CFA served
system a
refrigerant
Installing new SC
Installing
Installing
Installing
Identification or
Location or Area
by this SC
ductedrf
ift ntaimng' I
V system ,-it
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
1000
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.
J
Registration Number: 416-A0008725A-000000000-0000
CA Building Energy Efficiency Standards - 2013 Residential Compliance
Registration Date/Time: 2016-11-17 11:42:23
Report Version: 2013 Rev 1.008
. . HERS Provider: CHEERS
Report Generated: 2016-11-17 11:42:31
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)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
All new
Central split
All new
This field or
This field or
SYSTEM 1
furnace
heating
AFUE
0.80
AC
cooling
SEER
14.00
Setback
section is not
section is not
components
components
applicable
applicable ,
Required Documentation:
CF211-MCH-014 - Space Conditioning Systems Ducts and Fans
-Duct insulation requirement for new plenums: R6. +'I
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: <_ 15%, or15 10% leakage to outside, or seal all accessible leaks.\ ,.
CF2R-MCH-25-H & CF3R-MCH-25-H Refrigerant Charge Verification required when refrigerant containirig`components'are installed or altered (applicable in CZ 2, 8-15).
CF2RCF3R-MCH-23 & CF311-MCH-23 Air Flow 2 300 CFM/ton required when MCH -25 is required }X
Exceptions: ', r
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 MC _2 or Refrigerant Charge MECH-25.
-Existing duct systems constructed, insulated or sealed with asbestos are exempt from MCH -20 Duct Leakage Testing requirements.
Bi °{ 1 Ir—JI t K-7 f K-7— I ..,. J Vic_
E. Entirely New or Complete Replacement Duct System, with or without'Equipment Cha'ngeout (Sections 150.2(b)iDiia and 150.2(b)1E, F)
rT" s section doeJs notappl to this ect.
F. Entirely New or.Complete Replacement Space Conditioning System (Section 150.2(b)1C)
This section does not apply to this project.
Registration Number: 416-A0008725A-000000000-0000
Registration Date/Time: 2016-11-17 11:42:23
HERS Provider: CHEERS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013 Rev 1.008 Report Generated: 2016-11-17 11:42:31
Cil
CERTIFICATE OF COMPLIANCE CF1R-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
Patr6ck.Sofnzv'k
Company:
Signature Date:
General Air Conditioning
2016-11-17
Address:
CEA/ HERS Certification Identification (if applicable):
31170 Reserve Drive
City/State/Zip: r' "
Phone:
Thousand Palms CA 92276``:""\ -!)J7
6 343-7488
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. r.F,
2. 1 am eligible under Division 3 of the Business and Professions Code to accept responsibility: for the ilding 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 agencytfor-ap roval with this building permit application.
S. I will ensure that a registered copy of this Certificate of Compliance shall bbe'madeavailablle with the-building„permit(s sued 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 required to beinclwith the documentation the builder provides to the building owner at occupancy.
Responsible Designer Name:yC■tl y��ry }[ th y� py�'qq[[
rvic,poWnns.iyble�:Designer
Patrick Somers
Signature:
ResSo 011
�GltYcGjvSOVYLP,v'S�
Company:
Date Signed:
General Air Conditioning
2016-11-17
Address:
License:
31170 Reserve Drive.
686310
City/State/Zip:
Phone:
Thousand Palms CA 92276
760-343-7488
Digitally signed by CHEERS'"'. This digital Signature is provided in order
to secure the content of this registered document, and in no way implies
I Registration Provider responsibility for the accuracy of the information.
Registration Number: 416-A0008725A-000000000-0000
;Registration Date/Time: 2016-11-17 11:42:23
HERS Provider: CHEERS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013 Rev 1.008 Report Generated: 2016-11-17 11:42:31