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BMCH2014-1043 (BMCH)60282 Angora Ct III IIIII I lilii III 77 IE 78-495 CALLE TAMPICO LkQUII\Ii CALIFORNIA 92253 Application Number: Property Address: APN: Application Description: Property Zoning: Application Valuation: c&t,, 4 lwQatarw COMMUNITY DEVELOPMENT DEPARTMENT BUILDING PERMIT BMCH2O14-1043 60282 ANGORA CT CT 764400062 CHANGE OUT COMPRESSOR CONDENSING UNIT $1,000.00 Applicant: A & R HEATING AND COOLING SERV 15061 ZIEGLINDE DRIVE LAKE ELSINORE, CA 92530 LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 70001 of Division 3 of the Business and Professions Code, and my License is in full force and effect. License Class: C20 License No.: 905577 ate: - / — 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 alleg d exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the I 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 Lender's Address: VOICE (760) 777-7125 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 8/7/2014 Owner: FANNIE MAY 3900 WISCONSON AVE N.W. WASHINGTON, DC 20016 Contractor: A & R HEATING AND COOLING SERV 15061 ZIEGLINDE DRIVE LAKE ELSINORE, CA 92530 (951)818-9906 LIc. No.: 905577 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 o1 the 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 policy number are: Carrier: _ Policy 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 3700 of the Labor Code, I shall forthwith comply with those provisions. dike: f — i '_ 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 propertyforinspection purposes. Date: / Signature (Applicant or Age FINANCIAL •• 1, DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE BSAS SB1473 FEE 101-0000-20306 0 $1.00 $0.00 PAID BY METHOD,, RECEIPT# CHECK # CLTD BY Total Paid forBUILDING STANDARDS ADMINISTRATION BSA: $1.00 $0.00 DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE CONDENSER/COMPRESSOR 101-0000-42402 0 $35.75 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE CONDENSER/COMPRESSOR PC 101-0000-42600 0 $23.83 $0.00 PAID BY METHOD 'RECEIPT # CHECK # CLTD BY Total Paid for MECHANICAL: $59.58 $0.00 DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE PERMIT ISSUANCE 101-0000-42404 0 $90.57 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY Total Paid for PERMIT ISSUANCE: $90.57 $0.00 • •• Bin # 4 Permit # =ProjectAddress:Z City Of La Quinta Building Sl- Safety Division P.O.-Box 1504, 78-495 Calle Tampico . . La Quinta, CA 92253 - (760) 777-7012. Building Permit Application and Tracking Sheet .Owner's Name: �- A. P. Number: Address: • j Pet) 1'jcs' a')Sz /It/b R1 c.J Legal Description: -•City, ST, Zip: Gia 4t� ,e.i> C_ •Contractor A ..i(- ,s� ✓t Cex PC/?,// G6 "Tele hone: 'T f" — P 2— d� Address:�) U b Z e, Project Description:41 fl,� `City, ST, Zip: Tele h nc P o O - s€: - - N - Statc Lic. # : p s f City Lic. #, Arch., Engr., Designer- esignerAddress: Address: .. City., ST, Zip: Telephone: A _. -(circle- Construction Type: Occupancy: cY: to # S to Lic. Project ne) New Add'n Alter De m o Thine of Contact Person: 112b4/ _'f Gn f� Sq. Ft.: # Stories: # Units: Telephone #,of Contact Person: (/4/dl 9fC-16 [ Estimated Value of Project: _+e # Submittal Req'd APPLICANT: DO NOT WRITE BELOW THIS LINE,t'•_ Rec'd TRACKNG 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 Calcs. Plans picked up Construction Flood plain plan Plans resubmitted Mechanical Grading plan 2"" Review, ready for corrections/issue Electrical Subcontactor List Called Contact Person Plumbing Grant Decd flans picked up S.M.I. H.O.A. Approval Plans resubmitted Grading IN HOUSE:- Rcviciv, ready for corrcctionsfissue Developer Impact Fee Planning Approval Called Contact Person A.1-P.P. Pub. Wks. Appr Date of permit issue School Fees Total Permit Fees Simplified Prescriptive Certificate of Compliance: 2008 Residential HVAC Alterations CF -1R -ALT -HVAC Climate Zones 10 - 15 Site Address: Enforcement Agency: Date: Permit #: 60282 Angora Ct La Quinta, CA 92253 City of La Quinta Aug 7, 2014 Duct insulation Conditioned Floor Equipment Typel List Minimum Efficiency2 requirement Area Thermostat ❑ Package Unit ❑ Furnace []Indoor Coil ❑ AFUE ® SEER 13.0 ❑ COP ❑ HSPF ❑ R 6 (CZ 10-13) Served by system sf_ ® Setback If not already present, must be ® Condensing Unit ❑ EER [j Resistance ❑ R 8 (CZ 14-15) 2277 installed) ❑ Other 1. Equipment Type: Choose the equipment being installed; .if more than one system, use another CF -1R -ALT -HVAC for each system. 2. Minimum Equipment Efficiencies: 13 SEER; 78% AFUE, Z7HSPF for typical residential systems.. HERS VERIFICATION SUMMARY Listed below are FOUR HVAC alteration Options. The installer decides what work is being done and picks one of the appropriate Options. Each Option lists the HERS measures that must be conducted. A copy of the forms shall be. left on site for final inspection and a copy given to the homeowner. At final, the inspector verifies that the work listed on this foam was in fact the work completed by the installer. The inspector also verifies that each appropriate CF -611 and registered CF -411 forms (no hand filled CF-4Rs allowed) are filled out and signed. Beginning October 1, 2010, a registered copy of the CF -SR and CF -611 shall also be on site for final inspection. ® 1. HVAC Changeout Required Forms: . All HVAC Equipment CF -6R forms: MECH-04, MECH-2I-HERS and (for split systems) MECH-25-HERS replaced CF -4R forms: MECH-21 and (for split systems) MECH-25 . Condenser Coil and /or . Indoor Coil and /or CF -6R forms: MECH-04, MECH-2I-HERS and (for split systems) MECH-25-HERS . Furnace CF -4R forms: MECH-21 and (for split systems) MECH-25 For Split Systems: Duct leakage < 15 percent; RC, CCA <_ 300 CFM/ton (Minimum Air Flow Requirement), TMAH Exempted from duct leakage testing if: ❑ 1. Duct system was documented to have been previously sealed and confirmed through HERS verification, or ❑ 2. Duct systems with less than 40 linear feet in unconditioned space, or ❑ 3. Existing duct systems are constructed, insulated or sealed with asbestos ❑ 4. The system will not be Ducted (ie. Ductless Mini -Split System) (Also Exempt from Refrigerant Charge) ❑ 2. New HVAC System Required Forms: .Cut in or Changeout:with CF-6R'forms:�MECH-04; MECH-20-HERS and,(for (for MECH-22-HERS, and new ducts: (all new ducting and all new. MECH-25-HERS } s'. ' CF-Wforms: MECH-20, and (for,split systerris);MECH-22, erid MECH-25. equipment) •" For Split Systems: Duct leakage,< 6 percent; RC, CCA >_ 350 CFM/tonfFWD, TMAH, STMS, and either HSPP or PSPP. ;- For Packaged Uns` Duct leakage.< 6`percentri it ❑ 3. New Ducts with/or without` Required Forms: Replacement .Includes replacing or installing all new ducting and/or outdoor condensing unit CF -611 forms: MECH-04, MECH-20-HERS, and (for split systems) MECH-25-HERS and/or indoor coil and/or furnace. No or some CF -4R forms: MECH-20 and (for split systems) MECH-25 equipment changed. For Split Systems: Duct leakage < 6 percent; RC, CCA >_ 300 CFM/ton, TMAH For Packaged Units: Duct leakage < 6 percent 114. New Ducting over 40 feet Required Forms: .Includes adding or replacing more than 40 CF -6R forms: MECH-04, MECH-2I-HERS linear feet of duct in unconditioned space. CF -4R forms: MECH-21 For split system or packaged units: Duct leakage < 15 percent ❑ EXCEPTION: Existing duct systems constructed, insulated or sealed with asbestos. Contractor (Documentation Author's /Responsible Designer's Declaration Statement) . I certify that this Certificate of Compliance documentation is accurate and complete. . I am eligible under Division 3 of the California Business and Professions Code to accept responsibility for the design identified on this Certificate of Compliance. . I certify 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. . The design features identified on this Certificate of Compliance are consistent with the information documented on other applicable compliance forms, worksheets, calculations, plans and specifications submitted to the enforcement agency for approval with the permit application. Name: ROBERT GRZEGORCZYK Signature: ROBERT 6RZEGORCZYK Company: A & R HEATING AND COOLING SERVICE Date: Aug 7, 2014 Address: 15061 ZIEGLINDE DRIVE License: 905577 City/State/Zip: LAKE ELSINORE / CA / 92530 Phone: (951) 818-9906 Reg: 214-A0070367A-000000000-0000 2008 Residential Compliance Forms Registration Date/Time: 2014/08/07 11:05:32 HERS Provider: CalCERTS, Inc. July 2010