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BMCH2016-0190LICENSED 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 License No.: 968138 Daate-:� v /VfContractorr: �C V 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 Lender's 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 tfor which this permit is issued. shave 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. I . _ n Date: � 40 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 property for inspection purposes. Date: 06 Oz /`� Signature (Applicant or Agent):4IM— r 78.-495 CALLE TAMPICO VOICE (760) 777-7125 ,LA QUINTA, CALIFORNIA 92253 FAX (760) 777-7011 COMMUNITY DEVELOPMENT DEPARTMENT INSPECTIONS (760) 777-7153 BUILDING PERMIT Date: 6/2/2016 Application Number: BMCH2O16-0190 Owner: Property Address: 50485 GRAND TRAVERSE AVE AVE MARK JACOBS APN: 770320066 50485 GRAND TRAVERSE Application Description: JACOBS / HVAC CHANGE OUT LA QUINTA, CA 92253 Property Zoning:Application Valuation: $9,800.00Applicant: FIRST CHOICE A/C &HEATING INCFIRST Contractor: [T-Z4= CHOICE A / C & HEATIN79747 CASSIA ST 79-747 CASSIA STREETLA QUINTA, CA 92253 LA QUINTA, CA 92253(760)989-2369oLlc. No.: 968138`� 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 License No.: 968138 Daate-:� v /VfContractorr: �C V 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 Lender's 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 tfor which this permit is issued. shave 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. I . _ n Date: � 40 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 property for inspection purposes. Date: 06 Oz /`� Signature (Applicant or Agent):4IM— r FINANCIAL INFORMATION 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 for BUILDING STANDARDS.ADMINISTRATION BSA: .$1.00. $0.00 DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE HVAC CHANGEOUT - SPLIT -SYSTEM 101-0000-42402 0 $72.52 $0.00 PAID BY METHOD RECEIPT # -CHECK # CLTD BY DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE HVAC CHANGEOUT - SPLIT -SYSTEM PC 101-0000-42600 0 $36.26 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY. Total Paid for CHANGEOUT: $108.78 $0.00 DESCRIPTION ACCOUNT QTY AMOUNT ' PAID PAID DATE PERMIT ISSUANCE 101-0000-42404 0 $91.85 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY Total Paid for PERM IT- ISSUANCE: $91.85 $0.00 TOTALS:• • 0• i Permit Details PERMIT NUMBER City of La Quinta BMCH201'6=0190 Description: JACOBS / HVAC CHANGE OUT Type: MECHANICAL Subtype: Status: APPROVED Applied: 6/2/2016 SKH Approved: 6/2/2016 SKH Parcel No: 770320066 Site Address: 50485 GRAND TRAVERSE AVE AVE LA QUINTA,CA 92253 Subdivision: TR 25389-1 Block: Lot: 19 Issued: Lot Sq Ft: 0 Building Scl Ft: 0 Zoning: Finaled: Valuation: $9,800.00 Occupancy Type: Construction Type: Expired: No. Buildings: 0 No. Stories: 0 No. Unites: 0 Details: HVAC CHANGE OUT - 16SEER/80AFUE SPLIT SYSTEM [2013 ENERGY] CARBON MONOXIDE ALARM(S) TO BE INSTALLED PRIOR TO FINAL INSPECTION. 2013 CALIFORNIA BUILDING CODES. ADDITIONAL SITES Printed: Thursday, June 02, 2016 9:06:12 AM 1 of 2 C SYSTEMS CHRONOLOGY CONDITIONS ADDRESSI CONTACTS CITY STATE ZIP PHONE FAX EMAIL NAME TYPE NAME APPLICANT FIRST CHOICE A/C & HEATING INC 79747 CASSIA ST LA QUINTA CA 92253 CONTRACTOR FIRST CHOICE A / C & HEATING INC 79-747 CASSIA STREET LA QUINTA CA 92253 OWNER MARK JACOBS 50485 GRAND TRAVERSE LA QUINTA CA 92253 Printed: Thursday, June 02, 2016 9:06:12 AM 1 of 2 C SYSTEMS BOND INFORMATION Printed: Thursday, June 02, 2016 9:06:12 AM 2 of 2 c SYSTEMS CLTD DESCRIPTION ACCOUNT CITY AMOUNT PAID PAID DATE RECEIPT # CHECK # METHOD PAID BY BY HVAC CHANGEOUT - 101-0000-42402 0 $72.52 $0.00 SPLIT-SYSTEM HVAC CHANGEOUT - 101-0000-42600 0 $36.26 $0.00 SPLIT-SYSTEM PC Total Paid for CHANGEOUT: '$108.78 $0.00 PERMIT ISSUANCE 101-0000-42404 0 $91.85 $0.00 Total Paid for PERMIT ISSUANCE: $91.85 $0.00 TOTALS:00 BOND INFORMATION Printed: Thursday, June 02, 2016 9:06:12 AM 2 of 2 c SYSTEMS CERTIFICATE OF COMPLIANCE Alterations to Space Conditioning Systems (formerly CF -IR -ALT -HVAC) Project Name: MARK JACOBS I Date Prepared: CF111-ALT 02-E (Page 1 of 3 ) 2016-06-02 A. General Information MR -ALT -02 is applicable to multiple space conditioning systems contained within a single dwelling unit. When multiple dwelling units must be documented, use one MR -ALT -02 document for each dwelling unit. 01 Project Name MARK JACOBS i• 02 Date Prepared 2016-06-02 03 Project Location 50485 GRAND TRAVERSE 04 Building Type Single family 05 CA City La Quinta 06 Dwelling Unit Name MARK JACOBS 07 Zip Code 92253 08 Dwelling Unit Conditioned 3000 Installing Installing> Installing Floor Area (ft2) Location or Area by this SC ducted containing system Number of space conditioning ent ri ely a 09 Climate Zone 15 10 (SC) systems in this dwelling 1 component? components? feet of ducts? I duct system? unit. Alteration Type B. Space Conditioning (SC) System Information ' ' `r1l RF 'T 01 02 03, 04kl( f�=I 05 k� I f-061 11 07 U$ _09 10 ti. '�' ,...... Nis the SC ! ! °.� Installing a . k _ - j 40 .l U SC System SC System ! 'CFA served ystem a refrigerant t:Installing,new _ SC Installing Installing> Installing Identification or Location or Area by this SC ducted containing system more th n 40 ent ri ely a entirely new Name Served System (ft2) system? component? components? feet of ducts? I duct system? I SC system? Alteration Type System 1 Location 1 1800 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: 216-A0203232A-000000000-0000 Registration Date/Time: 2016-06-02 08:34:19 HERS Provider: CalCERTS CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013 Rev 1.007 Report Generated: 2016-06-02 08:34:20 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 Gas furnace Central split All new This field or This field or System 1 furnace AHU AFUE 0.8 AC cooling SEER 16 Setback section is not section is not 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 & CF3R-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%, or15 10% leakage to outside, or seal all accessible leaks. CF2R-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 t 300 CFM/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 - > w Y .a... 3 ,Q"g+....+ h3_ Heating -only systems and Air Handler/Furnace changes do not require verification of Air Flow MCH lC'Ref�igerq nt Chakrge ME � H=25.` Existing duct systems constructed, insulated or sealed with asbestos are exempt»�from MCH=26DuMtLeakage Testing;reguipeme its." '�"�,� "rP..�' ti+.. -rte i►o "�...,e� +ar �M ses .r'- f td,r •+.,.,.'+1 E. Entirely New or Complete Replacement Duct -System, with or without Equipment Changeout Sections 1f50.2(b)1Diia-ancl 150.2(b)lE, F) r l 4 1 P This section does not apply to this project. F. Entirely New or Complete Replacement Space Conditioning System (Section 150.2(b)lC) This section does not apply to this project. Registration Number: 216-A0203232A-000000000-0000 Registration Date/Time: 2016-06-02 08:34:19 HERS Provider: CaICERTS CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013 Rev 1.007 Report Generated: 2016-06-02 08:34:20 Schema Version: 0.555SDD 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: //� SOth% Both, Atila V Lti6 Company: Signature Date: FIRST CHOICE A / C & HEATING INC 2016-06-02 08:34:19 Address: CEA/ HERS Certification Identification (if applicable): 79-747 CASSIA STREET City/State/Zip: Phone: LA QUINTA CA 92253 760-989-2369 Responsible Person's Declaration statements; 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; 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 ofR regulations � 4. The building design features or system design features identified on this Certificate, of Compliance are consistent.wit�hlihe information,provided o other applica,l le`compliance documents, worksheets, calculations, plans and specifications submitted to the enforcement agency fora pr'oval with this buildingpermit plication. 5. I will ensure that a registered copy of this Certificate of.ompliance shall berms e.a_vailable withthe building<permit(s)assued forthe buildidng, andmade available to fhe.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 pr to the building owner at occupancy. -oxides +. fe w a°' Br._ig a9ko .en �f+--- ,r-yc Responsible Designer Name: C-1 C. rA Responsible Dess g er S gnature: V v t�� 'r V AM Both, Atila cgtila Company: Date Signed: FIRST CHOICE A / C & HEATING INC 2016-06-02 08:34:19 Address: License: 79-747 CASSIA STREET 968138 City/State/Zip: Phone: LA QUINTA CA 92253 760-989-2369 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: 216-A0203232A-000000000-0000 Registration Date/Time: 2016-06-02 08:34:19 HERS Provider: CaICERTS CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013 Rev 1.007 Report Generated: 2016-06-02 08:34:20 Schema Version: 0.555SDD B'n # City of La Quinta Building 8I• Safety Division 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Permit#{. Project Address:071 O o 5 lAAL& f Owner's Name: M.A Q �s A. P. Number: Address: 5- Legal Description: City, ST, Zip:A Q/A - Contractor: % ° 1 �N hone• Telephone: Address: ................. Project Description: C City, ST, Zip: A Ul 3 Wl Telephone: Q 0 '^ �7 QQ J State Lic. #: tcy 38 City Lic. Arch., Engr., Designer: Address: City., ST, Zip: Telephone: h one: Construction YP ucti n T o e Occupancy: Oecu Y: Sta tois L . #: Alter Demo hPa (circle one): New Add'n `)Repair Name of Contact Person: Sq. Ft.: sC7t7 # Stories: I # Units: Telephone # of Contact Person: Estimated Value of Project: APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Req'd Recd TRACKING PERMIT FEES Plan Sets Plan Check submitted Item Amount Structural Cales. 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 2nd Review, ready for corrections/issue Electrical Subcontactor List Called Contact Person Plumbing Grant Decd Plans picked up S.M.I. H.O.A. Approval Plans resubmitted Grading IN HOUSE:- '"! Review, ready for corrections/issue Developer Impact Fee Planning Approval Called Contact Person A.I.P.P. Pub. Wks. Appr Date of permit issue School Fees, Total Permit Fees