BMCH2015-016178-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: BMCH2O15-0161
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COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING PERMIT
Property Address:
50165 MOUNTAIN SHADOWS RD RD
APN:.
776011004
Application Description:
HANOVER / CHANGE OUT (1) 14SEER/8AFUE SPLIT SYSTEM
Property Zoning:
Application Valuation:
$12,550.00
Applicant:
DESERT AIR CONDITIONING
INC
590 WILLIAMS ROAD
Q
¢w
o
PALM SPRINGS, CA 92264
N
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: C20. C43 License No.: 276586
Dte� —1 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).:
(J I, as owner of the property, or my employees with wages as their sole
compensatiori, 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 orimproves 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 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:
VOICE (760) 777-7125.
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
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'
compen ation, as provided for by Section 3700 of the Labor Code, for the performance
of the rk r which this permit is issued.
ImI 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: _ 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 3700 of the Labor Code, I shall forthwith
comply with those provisions. - -
Date; ,,5`- / 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 l 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: ' "101Signature (Applicant or Agent):
Date: 5/7/2015
Owner: "
GEORGE HANOVER
50165 MOUNTAIN SHADOWS RD'�J
W
LA QUINTA, CA 92253
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Contractor:
®
LCD w
DESERT AIR CONDITIONING
INC Qit
9
590 WILLIAMS ROAD
PALM SPRINGS, CA 92264
�
o
(760)323-3383
U
Llc. No.: 276586
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'
compen ation, as provided for by Section 3700 of the Labor Code, for the performance
of the rk r which this permit is issued.
ImI 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: _ 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 3700 of the Labor Code, I shall forthwith
comply with those provisions. - -
Date; ,,5`- / 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 l 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: ' "101Signature (Applicant or Agent):
FINANCIAL INFORMATION
'DESCRIPTION 'nr F r sM xy s�+ACCOUNT yy,.i s :'QTYW
r' » AMOUNTS M. t ,,PAID �PAID-DATE
BSAS SB1473 FEE 101-0000-20306' 0
$1.00 $0.00
. i
t �yrl•.Eri - !. ...,� � iT I�p . �„IM � q�,?Tf'I�f * G :. �j'� �-
ti?°PAID BY” :,: ,��.� METHOD 4 t ;!r yfftECEIPT # ,,s f' `CHECK # y'
�CLTD.BY"
Total Paid for BUILDING STANDARDS ADMINISTRATION BSA $1.00 $0.00
_ � ... . 1 C..j. -. L Yf.-..w
ps , DESCRIPTION
5:., i�,: _: ::•.. L rS`
ACCOUNT s-
t. s
Y C
4QTY,
-
'J.^` 4 •. 4 -�'4. 1
., AMOUNT
.. ��..-: ..-, t _
_ PAID . ; `
-.. _ -'.
`PAID DATE
HVAC CHANGEOUT - SPLIT -SYSTEM
101-0000-42402
0
$72.52
$0.00
�,.t.PAID BY z" :..` 3 r
, k2 METHOD w _ L .t 'r
s'' RECEIPT # ; =-ex-
_:,'CHECK #� 3 ;.'
CLTD BY''
DESCRIPTION a'_ 4
`. �� r A000UNTt{r4
QTY,
AMOUNT,
+. i1 PAID 3
PAID DATE
HVAC CHANGEOUT - SPLIT -SYSTEM PC
101-0000-42600
0
' $36.26
$0.00
,f PAID BY ';
METHOD,-;
fr
;,a v ;RECEIPT #
.', CHECK #r
CLTD BY `'
Total Paid forCHANGEOUT: $108.78 $0.00
Y e }y DESCRIPTION �',` _n �i
r °? ir,ACCOUNT', }
zQTY
% •AMOUNT;
r PAID 3 `,
PAIDIDATE
PERMIT ISSUANCE
101-0000-42404
0
$91.85
$0.00
,
PAID BY,.aT,
1
::-IIMETHOD x,
'_ RECEIPT•# "�
¢ 43":� CHECK #
CLTD BY
Total Paid for PERMIT ISSUANCE: $91.85 $0.00
TOTALS:•
t
Description: HANOVER / CHANGE OUT (1) 14SEER/8AFUE SPLIT SYSTEM
Type: MECHANICAL Subtype: - Status: UNDER REVIEW
Applied: 5/7/2015 SKH
Approved:
Parcel No: 776011004 - Site Address: 50165 MOUNTAIN SHADOWS RD RD LA QUINTACA
92253
CONTACTS
Subdivision: TR 25429 Block: Lot: 04
Issued:
Lot Scl Ft; 0 Building Sq Ft: 0 Zoning:
Finaled:
Valuation: $12,550.00 Occupancy Type: Construction Type:
Expired:
No. Buildings: 0 No. Stories: 0 No. Unites: 0
S P
Details: HVAC CHANGE OUT - (1)14SEER/8AFUE SPLIT SYSTEM [2013 ENERGY] CARBON MONOXIDE ALARM(S) TO BE INSTALLED PRIOR TO
FINAL INSPECTION. 2013 CALIFORNIA BUILDING CODES.
ADDITIONAL SITES I
CHRONOLOGY
CONDITIONS
CONTACTS
E -TYP
I •7--ITNAI VI E
611 ESSfe"*
J" -
S P
�,�'PHONE"--
EIV14ki'� i,� 1',77
APPLICANT
DESERT AIR CONDITIONING INC
590 WILLIAMS ROAD
PALM SPRINGS CA
92264
(760)564-4150,
CONTRACTOR
DESERT AIR CONDITIONING INC
590 WILLIAMS ROAD
PALM SPRINGS CA
92264
(760)564-4150
OWNER
GEORGE HANOVER
I . .
50165 MOUNTAIN
SHADOWS RD
LA QUINTA CA
1�
92 253
(760)564-4150
Printed: Thursday, May 07, 2015 11:57:28 AM 1of2
ClewlYSTEMS
PARENT PROJECTS
INSPECTIONS
__RETURNED
SENT DATE DUE DATE
DATE
;STATUS'OffMAR6,
INSPECTION -TYPE-' INSPECTORex SCHEDULED COMPLETED
RESULTt�,, ';#r .,,7REMARKS TES
74DAT
�s.
DAfE7 i
INFORMATION
CL
..'DESCRIPTION
A CCOUNT
;;-QTY.'
_.'�AM OUNT,
-kibr,�
PA ID DATE'
RECEIPT!#,,
i-CHEC,K #-'
METHOD,
PAID BY �'- 1
:2
x�
'BY;'
HVAC CHANGEOUT -
101-0000-42402
0
$72.52
$0.00
SPLIT -SYSTEM
HVACCHANGEOUT-
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 forPERMIT ISSUANCE: $91.85 $0.00
TOTALS: $201.63 $0.00
PARENT PROJECTS
INSPECTIONS
__RETURNED
SENT DATE DUE DATE
DATE
;STATUS'OffMAR6,
INSPECTION -TYPE-' INSPECTORex SCHEDULED COMPLETED
RESULTt�,, ';#r .,,7REMARKS TES
74DAT
�s.
DAfE7 i
INFORMATION
. . . . . . . . . .
_t. ,
MECHANICAL FINAL BU)_
PARENT PROJECTS
Printed: Thursday, May 07, 2015 11:57:28 AM 2 of 2 CRWSYSTEMS
REVIEWTYPE EVIEI�
__RETURNED
SENT DATE DUE DATE
DATE
;STATUS'OffMAR6,
-
-NOTES1"
BOND
INFORMATION
ATTACHMENTS
Printed: Thursday, May 07, 2015 11:57:28 AM 2 of 2 CRWSYSTEMS
B14#
Citiy Of Quintaj
Building at Safety Division
P.O. Box 1504,78-495 Calle Tampico
La.Qulnta, C4 92253 -:(760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
Project Address: 50165 MOUNTAIN SHADOWS RD.
Owner's Name:. M. HANOVER
A P. Number.
Address: 50165 MOUNTAIN SHADOWS RD.
Legal Description:
Contractor. Desert Air Conditioning., Inca
City, ST, Zip: I -A QUINTA,,. CA 92253
Telephone 760-564-4150 _... 'a
Address: 590 Williams Rd.
Project Description: replace one 5 ton spit system on
City, ST, Zip: Palm Springs, CA 92264.
round like for like
Telephone: 760-323-3383
yStateLic.#:
; 363
n
276586
Arch., Engr., Designer. N/A
Address:
City., ST, Zip:
Telephone:
State Lic. #: ti04
m.. G4�
Name of Contact Person: Keri Skov
Construction Type: , Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
Sq. Ft :# Stories: #Units:.
Telephone # of Contact Person: 760-323-3383
Estimated Value of Project: $12,550.00
APPLICANT: DO NOT WRITE BELOW THIS UNE
#
Submittal
Req'd
'Reed
TRACIMG
PERMIT FEES
Plan Sets
Plan Check submitted
Item Amount ,
Structural Calm
Reviewed, ready for corrections
Plan Check Deposit. .
Truss Calcs,
. Called Contact Person
Plan Check Balance
Tide 24 Calcs.
Plans picked up
Construction '
Flood plain plan
Plans resubmitted.'.
Mechanical
Grading plan
V Review, ready for corrections/iissue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M,L
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE;.
'"' Review; ready for correctionsAssue
Developer Impact Fee
Planning Approval.
Called Contact Person
Pub. Wks. Appr
Date of permit Issue
School Fees
Total Permit Fees
CERTIFICATE OF COMPLIANCE
Alterations to Space Conditioning Systems (formerly CF -1R -ALT -HVAC)
Project Name:
50165 MOUNTAIN SHADOWS RD. I Date Prepared:
CF111-ALT-02-E
(Page 1 of 3 )
2015-04-13
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
50165 MOUNTAIN SHADOWS RD.
02
Date Prepared
2015-04-13
03
Project Location
50165 MOUNTAIN SHADOWS RD.
04
Building Type
Single family
05
CA City
La Quinta
06
Dwelling Unit Name
50165 MOUNTAIN SHADOWS RD.
07
Zip Code
92253
08
Dwelling Unit Conditioned
3400
*Installin new SC
,�� Insti'llin'
�� r g,.
Iln tallin
Installing
g
Floor Area (ft2)
Identification or
Location or Area
by this SC
ducted
r. 4 4
containing
Number of space conditioning
ar
more than 40
09
Climate Zone
15
10
(SC) systems in this dwelling
1
system?
component?
components?
feet of ducts?
unit.
SC system?
B. Space Conditioning (SC) System Information F1 0
01
02
03
04&
T t US ,k k�
1-661 \
1 6-7))
08
09
10
the k—Installing
a
4
�A�`
SCS stem
Y
SCS stem
Y
CFA served
s stem a+��
Y
r f i e ar nt t
F g
*Installin new SC
,�� Insti'llin'
�� r g,.
Iln tallin
Installing
g
Identification or
Location or Area
by this SC
ducted
r. 4 4
containing
�g a
system
ar
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
2000
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-A0096117A-000000000-0000
Registration Date/Time: 2015-04-13 16:54:44
HERS Provider: CaICERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2014-03-31 Report Generated: 2015-04-13 16:54:58
Schema Version: 0.555SDD
CERTIFICATE OF COMPLIANCE CFIR-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)1E 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
0.8
AC
cooling
SEER
14
Setback
section is not
section is not
components
components
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 & CF311-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: 5 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 >_ 300 CFM/ton required when MCH -25 is required.
Exceptions:,...,f ��.... .,.
-Duct systems registered with HERS provider as previously sealed are, exempt from,NICH-20 Duct Leakage Testing y quveme�ts.
-Heating-only systems and Air Handler/Furnace changes do not require verificati} n of Air Flow ,MCH -23, or Refrigerant Charge MECH-25
DuctjLeakage
n r
-Existing duct systems constructed, insulated or sealed with asbestos are exempt from MCH -20 Test}ng requirements. r§ F6q
._
-
E. Entirely New or Complete Replacement Duct System, with -or withoutLfqufpment Changeout (Sections 150.2(b)1Diia ancl�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)1C)
This section does not apply to this project.
Registration Number: 215-A0096117A-000000000-0000 Registration Date/Time: 2015-04-13 16:54:44 HERS Provider: CaICERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2014-03-31 Report Generated: 2015-04-13 16:54:58
Schema Version: 0.555SDD
CERTIFICATE OF COMPLIANCE CFIR-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:
Skov, Keri
Company:
Signature Date:
Desert Air Conditioning Inc.
2015-04-13 16:54:44
Address:
CEA/ HERS Certification Identification (if applicable):
590 Williams Road
City/State/Zip:
Phone:
Palm Springs CA 92264
760-323-3383
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, material's, 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 egulations��
4. The building design features or system design features identified on this Certificate of Compliance are consistent wthh,the information.provided on other,applicable-compliance documents, worksheets,
!r + F ! ,r.:a` Z 7 # n
calculations, plans and specifications submitted to the enforcement agency for.approval with this building permit application. }
�. r
!Ia
j#.lf t
S. I will ensure that a registered copy of this Certificate of�Compliance shall be matle.ayailable with the building permit(s)•issued forithe Building, an) made available o the enforcement agency for all applicable
io
inspections. I understand that a registered copy of this -Certificate of Compliance is required to be, with the documentation thebuillder provides to -the building owner at occupancy.
Responsible Designer Name: + r.1
Responsible Designer signature:' It.00� CA
Skov, Keri
Company:
Date Signed:
Desert Air Conditioning Inc.
2015-04-13 16:54:44
Address:
License:
590 Williams Road
276586
City/State/Zip:
Phone:
Palm Springs CA 92264
760-323-3383
Digitally signed by Ca10ERTS. 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: 215-A0096MA-000000000-0000 Registration Date/Time 2015-04-13 16:54:44 HERS Provider: CaICERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2014-03-31 Report Generated: 2015-04-13 16:54:58
Schema Version: 0.555SDD