BMCH2015-000679195 Mandarina
BMCH2015-0006
Ji J
,. A,
OMMUNITY DEVELOPMENT DEPARTMENT
BUILDING PERMIT
Application Number: BMCH2O15-0006
Property Address: 79195 MANDARINA
APN: 776280012
Application Description: AC CHANGEOUT 1 TON 13 SEER
Property Zoning:
Application Valuation: $6,800.00
Applicant:
HYDES
0 OUTSIDE CITY LIMITS
LA QUINTA, CA 92253
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Owner:
DENNIS MOGENSEN "
5251 N QUAIL SUMMIT WAY
BOISE, ID 92253
H or:
YDES
0 OUTSIDE CITY LIMITS
O LA QUINTA, CA 92253
G
PMa O cONo6-22000
LI :LIC -0004822
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: License No.: :LIC -0004822
Xat-.M/ ntractor:
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 fond'
permit subjects the applicant to a civil penalty of not more than five hundred dollars
($500).:
(_ ) 1, 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:
Date: 1/9/2015
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
of 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 t ose p ovisions.
,esteplicant:
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•
mentio ned/pr pert for inspection purposes.
D ' Si ature (Applicant or Agent):
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 MR -ALT 02 document for each dwelling unit.
01
Project Name
79-195 Mandarina
02 .
Date Prepared
2015-01-08
03
Project Location
79-195 Mandarina
04
Building Type
Single family,
05
CA City
La Quinta -
06
Dwelling Unit Name
79-195 Mandarina
07
Zip Code
92253
08
Dwelling Unit Conditioned'
2577 '
Installing new SC.
Installing
Installing
Installing
Floor Area (ft2)
-
• Location or Area
by this SC
ducted
containing
Number of space conditioning
more than 40
09
Climate Zone
15 -
30
(SC) systems in this dwelling
1 , ;' ,•
system?'
component?
+
feet of ducts?
unit.
SC system?
t• i
e,
• :ni y'x'rt•.-g - y-+ +'t'r••y +-7 ++r'^' . `4. J' "`:y 'C'i J ' ,' - 1 k .. ..
B. Space Conditioning (SC) System'InformationytJ
01
02
03;
X05i
06
? 07
r ,08 ., •
_ ,c '09
_ 10.
Is the SC
Installing a
` SC System
-'SC System
CFA'served
y 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?
duct system?
SC system?
Alteration Type
System l
Living Area
800
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.
Ff
44
Registration Number: 215 A0012153A-000000000 0000 Registration Date/Time: 2015-01-08 13:32:57 HERS Provider: CalCERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2014-03-31 Report Generated: 2015-01-08 13:34:05
Schema Version: 0.551SDD
CERTIFICATE OF COMPLIANCE CF111-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)1E and F)
01
02
03
04
05
06
07
08
09
10
it
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
All new
Less than or
System 1
furnace
heating
AFUE
0.78
packaged AC
cooling
SEER
13
Setback
equal to 40
R-8
components
components
feet
Required Documentation:
CF2R-MCH-01-E - Space Conditioning Systems Ducts and Fans
-Duct insulation requirement for new plenums: R6.
CF2R-MCH-20-H & MR -MCH -20-H — Duct Leakage testing 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.
CF211-MCH-25-H & CF3R-MCH-25-H Refrigerant Charge Verification required when refrigerant containing components'are installed or altered (applicable
in CZ 2, 8-15). ,
CF2RCF3R-MCH-23 & CF3R-MCH-23 Air Flow z 300 CFM/ton required when MCH -25 is required.
Exceptions: i
-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 MCH -23, or Refrigerant Charge MECH-25.
Existing duct systems constructed, insulated or sealed with asbestos are exempt from MCH -20 Duct Leakage Testing requirements.
E. Entirely New or Complete Replacement Duct System, with or without Equipment Changeout (Sections 150.2(b)lDiia 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: 215-A0012153A-000000000-0000 Registration Date/Time: 2015-01-08 13:32:57
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2014-03-31
Schema Version: 0.551SDD
HERS Provider: CalCERTS
Report Generated: 2015-01-08 13:34:05
CERTIFICATE OF COMPLIANCE
CFiR-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:
Hyde, Mark
Company:
Signature Date:
CERTIFIED COMFORT SYSTEMS INC
2015-01-08 13:32:57
Address:
CEA/ HERS Certification Identification (if applicable):
42949 Madio
City/State/Zip:
Phone:
Indio CA 92201
(760) 360-2202
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 Ceriificate 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 land Part 6 of the California Code of Regulations. t —
4. The building design features or system design feature"s 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 agency for approval with this building permit application.
1
S. I will ensure that a registered copy of this Certificate of Compliance shall be made available with the building permit(s) issued 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 be included with the documentation the builder provides to the building owner at occupancy.
Responsible Designer Name:
Responsible Designer Signature:
Hyde, Mark
Company:. -
Date Signed: -
CERTIFIED COMFORT SYSTEMS INC
2015-01-08 13:32:57
Address:
License: '
42949 Madio
906115
City/State/Zip:
Phone:
Indio CA 92201
(760) 360-2202
Digitally signed by CaICERTS. 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-A0012153A-000000000-0000 Registration Date/Time: 2015-01-08 13:32:57 HERS Provider: CaICERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2014-03-31 Report Generated: 2015-01-08. 13:34:05
Schema Version: 0.551SDD
FINANCIAL INFORMATION
" DESCRIPTJON"ACCOUNT 4QTYAMOUNTS SPAID PAID DATE
BSAS SB1473 FEE 101-0000-20306 0 $1.00 $0.00
PAIDBYy _ f METHODS' z .RECEIP;T # ; CHECK # z CLTD BY
Total Paid forBUILDING STANDARDS ADMINISTRATION BSA $1.00 $0.00
z ' aDESCRIPTI*.
..,. .t, . x .La
ACCOUNTi,
. ,', - , `?
'QTY
AMOUNT S
%PATO < n
4;DATE
.. six
`PAID
HVAC CHANGEOUT - PACKAGED UNIT
101-0000-42402
0
$36.26
$0.00
PAtD`BY
r r,.' -METHOD;
h<
S RECEIPT# '<'
CHECK #
CLTD BY,
h . DESCRIPTION>i},.ti:;w
ACCOUNT ,QTY
..
AMOUNT ':,
f ;
PAID
z
PAID`DATE
HVAC CHANGEOUT - PACKAGED UNIT PC
101-0000-42600
0
$24.17
$0.00
PAID BYE{'
METHOD
p RECEIPT #
;' iCHEGK #
CLTD By
Total Paid forCHANGEOUT: $60.43 $0.00
s °§ DESCRIPTION } _ x
' -ACCOUNT "
QTY
> "AMOUNT k t
PAID h
PAID(DATE}
PERMIT ISSUANCE
101-0000-42404
0
$91.85
$0.00
PAID BY
METHOD
zM REIPT # . <
EC
CHECK # '
CLTD BY
I.
Total Paid forPERMIT ISSUANCE: $91.85 $0.00
TOTALS:00
k
r
s
Description: AC CHANGEOUT 1 TON 13 SEER
Type: MECHANICAL
Subtype: Status: APPROVED
Applied: 1/9/2015 KHE
Approved:
Parcel No: 776280012 Site Address: 79195 MANDARINA LA QUINTA,CA 92253
Subdivision: TR 28447
Block: Lot: 30
Issued:
Lot Sq Ft: 0
Building Sq Ft: 0 Zoning:
Finaled:
Valuation: $6,800.00
Occupancy Type: Construction Type:
Expired:
No. Buildings: 0
No. Stories: 0 No. Unites: 0
Details: AC CHANGE -OUT - 2 TON, 13 SEER, .78 AFUE HEAT PUMP & AIR HANDLER, 2013 CODES.
ACCOUNT QTY AMOUNT PAID PAID
DESCRIPTION
DATE CLTD" ,
RECEIPT # CHECK #` r METHOD " PAID
BSAS SB1473 FEE 101-0000-20306 0 $1.00 $0.00
Total Paid forBUILDING STANDARDS ADMINISTRATION$1.00 $0.00
BSA:
Printed: Friday, January 09, 2015 9:27:06 AM 1 of 2
SYSTEMS
;DESCRIPTION
ACCOUNT
^,CITY
V:AMOUNT
PAID -
PAID DATE
RECEIPT.#
CHECK #,;
METHOD
PAID BY'_
CLTC
HVAC CHANGEOUT -
101-0000-42402
0
$36.26
$0.00
PACKAGED UNIT
HVAC CHANGEOUT -
101-0000-42600
0
$24.17
$0.00
PACKAGED UNIT PC
Total Paid forCHANGEOUT: $60.43 $0.00
PERMIT ISSUANCE 7
101-0000-42404
0
$91.85
$0.00
Total Paid for PERMIT ISSUANCE: $91.85 $0.00
TOTALS
. , PARENT,I'ROJImCTS....... .... . .. . . ............
BOND INFORMATION
_.ATTACHMENTS
Printed: Friday, January 09, 2015 9:27:06 AM 2 of 2
SYSTEMS
Bin #
Permit# a 0 y _D
f C
Project Address:'
A. P. Number.
L
tractor:ress: ( 'ZI LI c''
, ST, Zip:
/O
Tele ho
ity Of La Quinta
Building . 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: l
Address:
City, s'T, Zi.* . I\_ n / rV ) nr
" 4.,
C A cjZ.Zd
Project Description:
P IIe 6a -2.zez
- r
State Lic. # : q ('7r 1.
City Lic. #: Z Z
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone:
State Lic. #:
Construction Type:
Occupancy:
cy:
Name of Contact Person:
PrOject type (circle one):
New Add'n Alter Repair'' Demo
Telephone # of Contact Person:.
Sq. Ft : 2
# Stories: # Units:
Estimated Value Of Project: 6
APPLICANT: DO NOT WRITE BELOW THIS UNE
# Submittal Req'd Reed
TRACBIlYG
Plan Sets
Plan Check submitted
PF,RMIT FEES
Structural Calcs.
Reviewed, ready for
Item Amount
Truss Cales.
corrections
Plan Check Deposit
Called Contact Person
Energy Calcs.
Plan Check Balance
Pians picked up
Flood plain plan f
Construction
Plans resubmitted
Grading plan
Mechanical
Subcontactor List
2A Review, ready for corrections/issue
-
Electrical
Called Contact Person
Grant Deed
Plumbing
Plans picked up
ILO.A. A
Approval
S-M.L
Plans resubmitted
IN ROUSE:
Grading '
Planni. A
Planning pproval
3,d Review, ready for corrections/issue
DeveloperImpact Fee
,
Called Contact Person
Pub. Wks. APpr
A.LP.P.
Date of permit issue
School Fees
Total Permit Fees