BMCH2016-0204LICENSED 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.: 1008665
r `
Dater/S .' 6 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.).
(_J 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
(760)397-3438.
Llc. No.: 1008665
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 th work for which this permit is issued.
01 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 oft Labor Code, I shall forthwith
comply with those provisions.
Date: —4170lApplicant:
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 ASPROVIDED 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 u on the
above-mentionedproperty for inspection purposes.
Date: _ r r I I Signature (Applicant or Agent):
78-495 CALLE TAMPICO
Q�i
U l4P
VOICE (760).777-7125
LA QUINTA, CALIFORNIA 92253
; FAX (760) 777-7011
COMMUNITY DEVELOPMENT DEPARTMENT
INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 6/15/2016
Application Number:
BMCH2O16-0204
Owner:
o
Property Address:
79297 LIGA ST
WALTER NARAJOWSKI
AP N:
Application Description:
776130024
NARAJOWSKI / CHANEOUT COIL
z n L
C:: p�
Property Zoning:
Application Valuation:
$3,100.00
t -r
C21,
Applicant:
Contractor:
C)z
rn D t
AIR EXPERTS AIR CONDITIONING &HEATING
AIR EXPERTS AIR CONDITIONING'& HE TIN
84-160 MEADOWS LANE
84-160 MEADOWS LANE
m
COACHELLA, CA 92236 ..
COAGHELLA, CA.92236
-'
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.: 1008665
r `
Dater/S .' 6 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.).
(_J 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
(760)397-3438.
Llc. No.: 1008665
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 th work for which this permit is issued.
01 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 oft Labor Code, I shall forthwith
comply with those provisions.
Date: —4170lApplicant:
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 ASPROVIDED 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 u on the
above-mentionedproperty for inspection purposes.
Date: _ r r I I Signature (Applicant or Agent):
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 - REPAIR/ALTERATION
101-0000-42402
0
$12.09
$0.00
PAID BY
METHOD
RECEIPT # :
CHECK #
CLTD BY
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
HVAC CHANGEOUT - REPAIR/ALTERATION
PC
101-0000-42600
0
$4.83
$0.00
PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY
Total Paid for CHANGEO.UT: $16.92 $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 PERMIT ISSUANCE: $91.85 $0.00
TOTALS:0• 00
Description: NARAJOWSKI / CHANEOUT COIL
Type: MECHANICAL Subtype: Status: UNDER REVIEW
Applied: 6/15/2016 SKH
Approved:
Parcel No: 776130024 Site Address: 79297 LIGA ST LA QUINTA,CA 92253
Subdivision: TR 24890-6 Block: Lot: 66
Issued:
Lot Sq Ft: 0 Building Sq Ft: 0 Zoning:
Finaled:.
Valuation: $3,100.00 Occupancy Type: Construction Type:
Expired:
No. Buildings: 0 No. Stories: 0 No. Unites: 0
84-160 MEADOWS
LANE
Details: HVAC CHANGE OUT -COIL [2013 ENERGY) CARBON MONOXIDE ALARM(S) TO BE INSTALLED PRIOR TO FINAL INSPECTION. 2013
CALIFORNIA BUILDING CODES.
ADDITIONAL SITES
CHRONOLOGY
CONDITIONS
NAME TYPE""
NAME ADDRESS1
CONTACTS
CITY STATE
ZIP
PHONE
FAX
EMAIL
APPLICANT
AIR EXPERTS AIR CONDITIONING &
HEATING
84-160 MEADOWS
LANE
COACHELLA CA
92236
CONTRACTOR
AIR EXPERTS AIR CONDITIONING &
HEATING
84-160 MEADOWS
LANE .
COACHELLA CA
92236
OWNER
WALTER NARAJOWSKI
13186 SHALIMAR
DEL MAR CA
1 92253
FINANCIAL INFORMATION
Printed:. Wednesday, June 15, 2016 2:05:29 PM 1 of 2 O
srsrrnns
Permit Details PERMIT NUMBER
City of a Quinta
BMCH20�6=024
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
RECEIPT #
CHECK #
:METHOD
PAID BY
CLTD
BY
BSAS SB1473 FEE
101-0000-20306.
0
$1.00
$0.00
Total Paid for BUILDING STANDARDS ADMINISTRATION $1.00 $0.00
BSA:
HVAC CHANGEOUT -
101-0000-42402
0
$12.09
$0.00
REPAIR/ALTERATION
HVAC CHANGEOUT -
101-0000-42600
0
$4.83
$0.00
REPAIR/ALTERATION PC
Total Paid for CHANGEOUT: $16.92 $0.00
PERMIT ISSUANCE
101-0000-42404
0
$91.85
$0.00
Total Paid for PERMIT ISSUANCE: $91.85 $0.00
TOTALS:0900
INSPECTIONS
- PARENT PROJECTS
BOND INFORMATION
Printed: Wednesday, June 15, 2016 2:05:29 PM 2 of 2bq
SYSTEMS
Bin
Permit #
Project Address:
City of La Quin to
Building 8t Safety Division
78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
` e Owner's Name: pcq(-3g Je
A. P. Number:
Address: 2 ��
Legal Description:
City, ST, Zip:�j 225
Contractor:
v S \
h n e.
Telephone:
Address: _me G�ocjzz�• LN
Project Description: ` C
City, ST, Zip: CoG c.N\9(ACM-3c
Telephone: 76O " 3 1-( 3
C'73 ;3
State Lic. # : Jp S
City Lic. #:
Arch., Engr., Designer:
Address:
City., ST, Zip:
ele h
'Telephone:
one:
tructi Occu an cY:
Cons on Type: VA
State Lic. #
PtYPa circle one • New Add'n
Alter ea t Demo
0
Name of Contact Person: S
Sq. Ft.:�S
# Stories:
# Units:
Telephone # of Contact Person: O-
�
� -3�3 �
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
it
Submittal
Req'd
Rcc'd
TRACKING
PERMIT FEES
Plan Setr
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 Pcrson
Plumbing
Grant Deed
Plans picked up
S.M.I.
I{.O.A.-Approval
Plans resubmitted
Grading
IN ROUSE:-
'rd 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 CF1R-ALT 02-E
Alterations to Space Conditioning Systems (formerly CF -IR -ALT -HVA C) (Page 1 of 3 )
Project Name: Narajowski Walter & Deborah Date Prepared: 2016-06-15
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
Narajowski Walter & Deborah
02-
Date Prepared
2016-06-15
03
Project Location
79-297 Liga
04
Building Type
Single family
05
CA City
La Quinta
06
Dwelling Unit Name
Narajowski Walter & Deborah
07
Zip Code
92253
08
Dwelling Unit Conditioned
1985
Floor Area (ft2)
SC System
CFA served
`N systema
refrigerant t
installingnew-SCIristalling
Number of space conditioning
Nlnstallmg•
09
Climate Zone
15
30
(SC) systems in this dwelling
1
con taining
..-
- 3 `.
en rn ely new
unit.
B. Space Conditioning (SC) System Information'
03
02
03
04'�
OS
06
111 07
08 I ' :
09
10
i
!
+FIs
�,,
theSC
x R ,t ta,Slling a"
Ins
, .p a .. «-. i ada
SC System
SC System
CFA served
`N systema
refrigerant t
installingnew-SCIristalling
Nlnstallmg•
Installing
Identification or
Location or Area
by this SC
ducted
con taining
system
more than 40
en rn ely new
entirely new
Name
Served
System (ft2)
system?
component?
components?
feet of ducts?
duct system?
SC system?
Alteration Type
System 1
living room
1985
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-A0221985A-000000000-0000
CA Building Energy Efficiency Standards - 2013 Residential Compliance
Registration Date/Time: 2016-06-15 12:53:58
Report Version: 2013 Rev 1.007
Schema Version: 0.555SDD
HERS Provider: CalCERTS
Report Generated: 2016-06-15 12:54:21
CERTIFICATE OF COMPLIANCE CF1R-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
Dud Length
R -Value
Central gas
No heating
This field or
This field or
Central split
This field or
This field or
System 1
furnace
component
section is not
section is not
AC
Indoor coil
SEER
14
Setback
section is not
section is not
altered
applicable
applicable
applicable
applicable
Reouired 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: 515%, or 510% 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 2 300 CFM/ton required when MCH -25 is required.
Exceptions:
-Dud systems registered with HERS provider as previously sealed are exempt from MCH:20 Duct Leakage Testing requirements.,,
of Air -23 MECH-2
-Heating-only systems and Air Handler/Furnace changes do not require verification Flow MCH rRefrigerant`Cha�ge
Existing dud systems constructed, insulated or sealed with asbestos -are exempt from MCH=20 DucttiLeakage Testing requirements. .0
,
`� '+t1V ..,, "w:,►^,:, ice, ,,,.,,,�' *.++...w.' �..'.,.a a.' aw ',.� ti,....
E. Entirely New or Complete Replacement -Duct -System, with or without -Equipment Changeout,(Sections r150.2(b)1Diia;and 150.2(b)lE, F)
4 5 UZ lr
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: 2167A0221985A-000000000-0000 Registration Date/Time: 2016-06-15 12:53:58 HERS Provider: CaICERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013 Rev 1.007 Report Generated: 2016-06-15 12:54:21
Schema Version: 0.555SDD
CERTIFICATE OF COMPLIANCE CF1R-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:
Lira, Luis M
Company:
Signature Date:
Air Experts Air Conditioning
2016-06-15 12:53:58
Address:
CEA/ HERS Certification Identification (if applicable):
PO Box 94
City/State/Zip:
Phone:
La Quinta CA 92247 '
1760-777-1724
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, 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 of Regulat ons"
4. The building design features or system design features identified on this Certificate of Compliance are.consistent withfihe information -provided on other applicable compliance documents, worksheets,
n * ..p+ 5 s w .� R ti +
calculations, plans and specifications submitted to the ei f�rcement1, gency fotr(approval wtth this building permitapplication.
r4 �,
4i ti+a_ i ar re ¢
5. 1 will ensure that a registered copy of this Certificate of Compliance shall,be.made,available with the building permit(;).issued for the-buildi g, and. made available,to the enforcement agency for all applicable
inspections. I understand that a registered copy of this C rtificate of Compliance is,required to berincludedwith the..documentation.the �builder provides to,the building owner at occupancy.
ti
Responsible Designer Name: °°*
Respon3itile Oessigner Signature: `
Lira, Luis M��•
Company:
Date Signed:
Air Experts Air Conditioning
2016-06-15 12:53:58
Address:
License:
PO Box 94
1008665
City/State/Zip:
Phone:
La Quinta CA 92247 1760-777-1724
Digitally signed by Ca/CERTS. 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-A0221985A-000000000-0000 Registration Date/Time: 2016-06-15 12:53:58 HERS Provider: CalCERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013 Rev 1.007 Report Generated: 2016-06-15 12:54:21
Schema Version: 0.555SDD