BMCH2017-0003LICENSED 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 P fessions Code,
and my License is in full force and effect.
License Class: C20, Cj36 License No.: 7777
Date: l Z ' l 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 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:
(760)328-8096
Llc. No.: 777794
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
1 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 wor 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: MIDWEST EMPLOYERS CASUALTY COMPANY Polity 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 37 of the Labor Code, I shall forthwith
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 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 peimit 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 stat aws relating to building
construction, and hereby authorize representatives oft is cit to enter upon the
above-mentioned property for inspection purposes.
Date: / Signature (Applicant or Age ).
i -
,
�i
78-495 CALLE TAMPICO U � �
VOICE (760) 777-7125 .
LA QUINTA, CALIFORNIA 92253
FAX (760) 777-7011
DESIGN & DEVELOPMENT DEPARTMENT
INSPECTIONS (760) 777-7153
BUILDING PERMIT
1/1 017
Application Number: BMCH2O17-0003
Owner:
Property Address: 78273 SCARLET CT.
MC CLAIN r o
APN: 60402405678273
SCARLET CT
Application Description: MCCLAIN / HVAC CHANGE OUT
LA QUINTA, CA 92253 C5::3
Property Zoning:
.1
Application Valuation:
o
4 " z
Applicant:
-
Contractor:
J ANTHONY PLUMBING HEATING & AIR CONDITI
J ANTHONY PLUMBING HEATIN TI
72216 NORTH SHORE ST #101
72216 NORTH SHORE ST #101
THOUSAND PALMS, CA 92276
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 P fessions Code,
and my License is in full force and effect.
License Class: C20, Cj36 License No.: 7777
Date: l Z ' l 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 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:
(760)328-8096
Llc. No.: 777794
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
1 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 wor 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: MIDWEST EMPLOYERS CASUALTY COMPANY Polity 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 37 of the Labor Code, I shall forthwith
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 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 peimit 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 stat aws relating to building
construction, and hereby authorize representatives oft is cit to enter upon the
above-mentioned property for inspection purposes.
Date: / Signature (Applicant or Age ).
i -
i
Date: 1/12/2017
Application Number: BMCH2017-0003
Owner:
Property Address: 78273 SCARLET CT
MC CLAIN
APN: 604024056
78273 SCARLET CT
Application Description: MCCLAIN / HVAC CHANGE OUT
LA QUINTA, CA 92253
Property Zoning:
Application Valuation:
Applicant:
Contractor:
J ANTHONY PLUMBING HEATING & AIR CONDITI
J ANTHONY PLUMBING HEATING & AIR CONDITI
72216 NORTH SHORE ST #101
72216 NORTH SHORE ST #101
THOUSAND PALMS, CA 92276
THOUSAND PALMS, CA 92276
(760)328-8096
---------------------------------,-----------------.---------------------
Llc. No.: 777794
Detail: HVAC CHANGE OUT - 14SEER/81AFUE SPLIT SYSTEM [2013 ENERGY] CARBON MONOXIDE ALARM(S) TO BE INSTALLED PRIOR TO FINAL INSPECTION.
2013 CALIFORNIA BUILDING CODES.
i
Total Paid for PERMIT ISSUANCE: $96.27
TOTALS: $210.27
C
FINANCIALINFORMATION
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
TOTALS: $210.27
C
Bin #
Qty of La Quinta
Building 8T 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: ` Z� 3ek
Owner's Name:,
A. P. Number:
Address:
Legal Description:
City, ST, Zip:
Contractor:—
�
•'r`»<>>'«><><?><N>'
:. ,..w,:.�.::>.;� :::-•::.:;,.:::: v�: ,,.
Address: 72.216 NORTH SHORE ST STE 101
Project Description:
CA 9022 7 u
City, ST, Zip:
fes, l� )4A4
Telephone:
cv
State Lic. #
City Lic. #.-.t
Arch., Engr., Designer:
Address:
City., ST, Zip:
Telephone:
t •.''•"?%'pis?;'>`2"#�:>•.`:'`'E>�>`
<'<«<::?«: ;::>::>:?:::>>:%1s<>:>`:<>:>:
Construction T e: Occu anc :
YP p Y
State Lic. #:
Project a circle one): New Add'n Alter
type ( ) Repair Demo
Name of Contact Person: ATO
Sq. Ft.:#
Sto ' s:
# Units:
Telephone # of Contact Person:
Estimated Value of Project:?
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Rec'd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance
Title 24 Cales.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
god Review, ready for corrections/issue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
'^' Review, ready for correctionstissue .
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees
CERTIFICATE OF COMPLIANCE
Alterations to Space Conditioning Systems (formerly CF -IR -ALT -HVAC)
Project Name:
MCCLAIN I Date Prepared:
CF1R-ALT-02-E
(Page 1 of 3)
2017-01-12
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
CF1R-ALT-02 document for each dwelling unit.
01
Project Name
MCCLAIN
02
Date Prepared
2017-01-12
03
Project Location
78273 SCARLET CT
04
Building Type
Single family
05
CA City
La Quinta
06
Dwelling Unit Name
MCCLAIN
SC System
SC System
08
Dwelling Unit Conditioned
refrigerant
07
Zip Code
92253
Installing
Floor Area (ft)1200
Identification or
Location or Area
by this SC
ducted
containing
Number of Space
more than 40
09
Climate Zone:
15 < '-., - _ _.,._.;..
10
Conditioning (SC) Systems in
1
system?
component?
a
feet of ducts?
this Dwelling Unit:
SC system?
Alteration Type
B. Space Conditioning (SC) System Ihf6rmaticP) J
01
02
h
_ %' 03
+max''
04
`'„laJf ti+yi!'
05 ,
.#'t+w*..e...•:-S
06
,,
!4 0.y{
07"
08
`v.
0 9
10
'
"Is the Str
I stall g a
Vol
SC System
SC System
CFA served
system a
refrigerant
Installing new SC
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?
dud system?
SC system?
Alteration Type
Altered space
System 1
Location 1
1200
,Yes
Yes
Yes
No
No
No
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: 217-A020001224A-000-000-0000000-0000
Registration Date/Time
2017-01-12 09:10:34
HERS Provider: CaICERTS
CA Building Energy Efficiency Standards - 2016 Residential Compliance Report Version: 2016.1.005 Report Generated: 2017-01-12 09:11:00
crhom2 Vorcinn• row 1n/1F
CERTIFICATE OF COMPLIANCE
Alterations to Space Conditioning Systems (formerly CF -1R -ALT -HVAC)
CF111-ALT 02-E
(Page 2 of 3)
D. Altered Space Conditioning System (Sections 250.2(b)IE 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
Outdoor
This field or
This field or
System 1
Central gas
Gas furnace
AFUE
81
Central split
condensing
SEER
14
Setback
section is not
section is not
furnace
AHU
AC
unit
applicable
applicable
Reouired Documentation:
CF2R-MCH-01-E - Space Conditioning Systems
- Duct insulation requirement for the new portions of supply -air and return -air ducts or plenums: R6 (CZ 1-10, 12 and 13) and R8 (CZ 11 and 14-16)
CF2R and CF311-MCH-20-H - Duct Leakage Test 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% 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 MCH 25.
Heating -only systems and Air Handler Furnace changes do not require verification of Air Flow MCH�23, ar'Refngerant`ch 0—
-Existing duct systems constructed, insulated or sealed withasbestos=are exemptsfrom MCH -20 DuCtLeakage Testing regwremer�45
-Wr h 4 .7 E 8 V. �'*C. a 2 i y m i -:. :a. r.• n. . 4 , —
"w...ti '9 as� +..k. t. .✓ �".
E. Entirely New or Complete Replacement Duct System, with or without,Equipment Changeout (Sections,150.2(b)1Diia.and,150.2(b)lE, F)
This section does not apply to this project.
F. Entirely New or Complete Replacement Space Conditioning System (Section 150.2(b)IC)
This section does not apply to this project.
Registration Number: 217-A020001224A-000-000-0000000-0000
Registration Date/Time
2017-01-12 09:10:34
HERS Provider: CaICERTS
CA Building Energy Efficiency Standards - 2016 Residential Compliance Report Version: 2016.1.005 Report Generated: 2017-01-12 09:11:00
Crhomn \/orcin— —, 10/1f+
CERTIFICATE OF COMPLIANCE CF111-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:
Mascarenas, Brannon
Company:
Signature Date:
SANDERSON & SON'S INC
2017-01-12 09:10:34
Address:
CEA/ HERS Certification Identification (if applicable):
72216 NORTHSHORE ST #101
City/State/Zip:
Phone:
THOUSAND PALMS CA 92276 j'
760-343-2121 X123
Responsible Person's Declaration statement"t.
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, co�mponnents, and manufactured devices for the buildmg_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 othertapphcatile°compliance documents, worksheets,
F nt „�Cu*r - � — u- r e
for this building
calculations, plans and specifications submitted,to`the enforcement agency approval with permit application'.
5. I will ensure that a registered copy of tliis Certificate of,Compliance shall be,made,available with --the buitdirig permit(s)sissued forzthe buildlt g, and;made available,to the enforcement agency for all applicable
inspections. I understand that a registered copy of this.drtificate of Complliance requi dd to b�e,included itch the,documentaation tthe..buildderprovides to -the building owner at occupancy.
Responsible Designer Name: Responsible Desi ner Signature ,ateJr
�Z��IfrdXi�R4C��
Mascarenas, Brannon
Company:
Date Signed:
SANDERSON & SON'S INC
2017-01-12 09:10:34
Address:
License:
72216 NORTHSHORE ST #101
1018962
City/State/Zip:
Phone:
THOUSAND PALMS CA 92276
760-343-2121 X123
Digitally signed by CaICERTS. This digital signature is provided in order to secure the content of this registered document, and in noway implies Registration Provider responsibility for the accuracy of the information.
Registration Number: 217-A020001224A-000-000-0000000-0000
Registration Date/Time:
2017-01-12 09:10:34
HERS Provider: CalCERTS
CA Building Energy Efficiency Standards - 2016 Residential Compliance Report Version: 2016.1.005 Report Generated: 2017-01-12 09:11:00
Crhomn Vnrcinn • r— 1n11r