BMCH2015-0252Applicant:
HARRISON ENTERPRISES INC DBA D
31170 RESERVE DRIVE
THOUSAND PALMS, CA 92276
'/�pV\t1S pPPSMENj
CVIN
m p��DpMEN} DE
GDMMUN�
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.: 968141
r
Date: % )5 Contractor. & sL
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 Name:
lender's Address:
Z
Contractor:
HARRISON ENTERPRISES INC DBA D
31170 RESERVE DRIVE
THOUSAND PALMS, CA 92276
(760)343-5562
Llc. No.: 968141
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.
S� 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.
1
Date: '$ � 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 actor 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: 1T Signature (Applicant or Agent):�-�^^�L
VOICE (760) 777-7125
78-495 CALLE TAMPICO
D
LA QUINTA, CALIFORNIA
92253
FAX (760) 777-7011COMMUNITY
DEVELOPMENT DEPARTMENT
INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 7/8/2015
Application Number:
BMCH2O15-0252
Owner:
Property Address:
79633 POMO
GERRY OLMA
APN:
776180019
79633 POMO
Application Description:
OLMA RESIDENCE HVAC CHANGE OUT
LA QUINTA, CA 92253
Property Zoning:
Application Valuation:
$17,048.00
n
Applicant:
HARRISON ENTERPRISES INC DBA D
31170 RESERVE DRIVE
THOUSAND PALMS, CA 92276
'/�pV\t1S pPPSMENj
CVIN
m p��DpMEN} DE
GDMMUN�
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.: 968141
r
Date: % )5 Contractor. & sL
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 Name:
lender's Address:
Z
Contractor:
HARRISON ENTERPRISES INC DBA D
31170 RESERVE DRIVE
THOUSAND PALMS, CA 92276
(760)343-5562
Llc. No.: 968141
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.
S� 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.
1
Date: '$ � 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 actor 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: 1T Signature (Applicant or Agent):�-�^^�L
FINANCIAL INFORMATION
` ;* .,17�;DESCRIP.TION:�p s �t'.:� � ,ry '"'ACCOUNT �ti' QTY r�`AMO,UNT=`rf' PAID PAID DATE
BSAS SB1473 FEE 101-0000-20306
0
$1.00 $0.00
,:PAID BY t' z :METHOD r.
, ~RECEIPT #� CHECK # ` CLTD BYs'
Total Paid forBUILDING STANDARDS ADMINISTRATION BSA $1.00 $0.00
- "..,.DESCRIPTION" "`
: r`« �� #ACCOUNT `"
fQTYs
,4 ,AMOUNT
PAID.
rPAIDDATE
HVAC CHANGEOUT - SPLIT -SYSTEM
101-0000-42402
0
$72.52
$0.00
JiAID 'BY ��
`z METHOD ` E
RECEIPT # .k .�:
CHECK #
a JCLTD BY-,'
'.'DESCRIPTION
ACCOUNT 4 ``
'CITY
s ' 'AMOUNT y
PAID •'
"PAID DATE-
HVAC CHANGEOUT - SPLIT -SYSTEM PC -
101-0000-42600 ,
0
$36.26
$0.00
' q PAID BY "' p
i j, METHOD
Y ;RECEIPT;# c„� -
CHECK #
CLTD BY
Total Paid forCHANGEOUT: $108.78 $0.00
DESCRIPTION i`"'`
k ACCOUNT x ,'
QTYa
`y' AMOUNTy
'yt .yu FPAID.
,PAID DATE';
PERMIT ISSUANCE
101-0000-42404
.0
$91.85
$0.00
PAID BY =:
'` 4`-t» >METHOD 'y
u ; a€RECEIPT.# K ti .t
s CHECK # e
CLTD BY •,
Total Paid forPERMIT ISSUANCE: $91.85 $0.00
TOTALS:$0.00
B1n. #
.
City. of La Quanta
Building 8L Safety Division
P.O. Box 1504,78-495 Calle Tampico
14.Quinta, CA 92253 - (760) 777-7012
0252— Building Permit Application,and Tracking Sheet
Permit #
Oak 2-0 (15
Project Address: 79633'Pomo
Owner's Name:. Gerry Olma
A. P. Number.
Address: 79633 Pomo
Legal Description:
City, ST, Zip: La Quinta, CA 92253
Contractor: DCS Air Conditionings
Telephone:
s'•ti' ~w= >. "<
-z' a �•''^"
Address: 31170 Reserve Drive
Project Description:
City, ST, Zip: Thousand Palms, CA 92276
Replace Ston A/C, 5ton Coil, & 90,000 BTU Furnace
Telephone: 760-343-7488'
State Lie. #: 968141 City Lie'. #.:
Arch., Engr., Designer
Address:
City., ST, Zip:
Telephone: W'Project
., � State Lie. #: " cf • ;
Name of Contact Person: Steven Schnierer
truction Type: Occupancy:
type (circle one): New Add'n Alter Repair Demo
Sq. Ft.: #Stories: #Units:
Telephone # of Contact Person: 8.18-735-7876 X 1
Estimated Value of Project: $17,048.00.
APPLICANT: DO NOT WRITE BELOW THIS, LINE
N
Submittal
Req'd
Recd
TRACKING
PERMIT FEES'
Plan Sets
Plan Check submittedItem
Amount
Structural Cales.
Reviewed, ready for corrections
Plan Check Deposit. .
Truss Calcs.
Called Contact Person
Plan Check Balance
Tide 24 Ca1cs.
Pians picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
r! Review, ready for corrections/issue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
'"' Revlew', 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
Description: OLMA RESIDENCE HVAC CHANGE OUT
Type: MECHANICAL Subtype: Status: UNDER REVIEW
Applied: 7/8/2015 EVA
Approved:
Parcel No: 776180019 Site Address: 79633 POMO LA QUINTA,CA 92253
Subdivision: TR 24890-6 Block: Lot: 45
Issued:
Lot Sq Ft: 0 Building Sq Ft: 0 Zoning:
Finaled:
Valuation: $17,048.00 Occupancy Type: Construction Type:
Expired:
No. Buildings: 0 No. Stories: 0 No. Unites: 0
Details: HVAC CHANGE OUT - 16 SEER / .80AFUE SPLIT SYSTEM [2013 ENERGY] CARBON MONOXIDE ALARM(S) TO BE INSTALLED PRIOR TO
FINAL INSPECTION. 2013 CALIFORNIA BUILDING CODES.
Printed: Wednesday, July 08, 2015 9:10:37 AM, 1 of 2 Cff
SYSTEMS
• • • •
CONDITIONS
CONTACTS
NAMEJYPE'`
NAME„ z
''ADDRESS1
CITY
STATE ..
•ZIP_
.'PHONE FAX
APPLICANT
HARRISON ENTERPRISES INC DBA D
31170 RESERVE DRIVE
THOUSAND
CA
92276
(760)296-1193
PALMS
CONTRACTOR
HARRISON ENTERPRISES INC DBA D
31170 RESERVE DRIVE
THOUSAND
CA
92276
(760)296-1193
PALMS
OWNER
GERRY OLMA
79633 POMO
LA QUINTA
CA
j 92253
j (760)296-1193
Printed: Wednesday, July 08, 2015 9:10:37 AM, 1 of 2 Cff
SYSTEMS
"DESCRIPTION,
ACCOUNT .'
QTY'
,+AMOUNT '}
,F, b �,
:µPAID DATE
'RECEIPT#,
_-CHECK #'
METHOD E`
PAID BY - ,ry
.+�--�++w
CLTD
i u i
-PAID
BSAS SB1473 FEE
101-0000-20306
0
$1.00
$0.00
- Total Paid forBUILDING STANDARDS ADMINISTRATION
$1.00 $0.00
BSA:
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 forCHANGEOUT: $108.78 $0.00
PERMIT ISSUANCE
101-0000-42404
0
$91.85
$0.00
Total Paid for PERMIT ISSUANCE: $91.85 $0.00
TOTALS: $201.63
Printed: Wednesday, July 08, 2015 9:10:37 AM 2 of 2 C
SYSTEMS
CERTIFICATE OF COMPLIANCE CF1R-ALT-02-E
Alterations to Space Conditioning Systems (formerly CF -IR -ALT -HVAC) (Page 1 of 3 )
Project Name: GERRY OLMA Date Prepared: 2015-07-03
-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 CF1R-ALT-02 document for each dwelling unit.
01
Project Name
GERRY OLMA
02
Date Prepared
2015-07-03
03
Project Location
79633 POMO
04
Building Type
Single family
05
CA City
La Quinta
06
Dwelling Unit Name
GERRY OLMA
07
Zip Code
92253
08
Dwelling Unit Conditioned
3200
Cnstalling a
tfA91i�1F
gMs.'.xea'Ad
Floor Area (ft2)
SC System
SC System
CFA served
''system al --4
Number of space conditioning
Installing 'new'.,SC
09
Climate Zone
15
10
(SC) systems in this dwelling
1
by this SC
ducted
containing
system
unit.
entirely new
B. Space Conditioning (SC) System' Information
_.._ P, ^4N dO��
01 ..
02
03
04
05
:06''"�'�
_
07"
08
09
10
a
�,,
�':`�Is the SC
Cnstalling a
tfA91i�1F
gMs.'.xea'Ad
SC System
SC System
CFA served
''system al --4
r frigera t t
Installing 'new'.,SC
lristalling
I'ns talli g
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 1
Location 1
3200
Yes
Yes
Yes
No
No
No
Altered space
conditioning system
C. Extension of Existing Duct System, Greater Than 40 Feet (Section150.2(b)iDiib)
This section does not apply to this project.
1
Registration Number: 215-AO18227OA-000000000-0000
Registration Date/Time: 2015-07-03 13:48:21
HERS Provider: CalCERTS
CA Building Energy, Efficiency Standards - 2013 Residential Compliance Report Version: 2014-03-31 Report Generated: 2015-07-03 13:27:48
Schema Version: 0.555SDD
CERTIFICATE OF COMPLIANCE CFiR-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)lE 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
16
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 & 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: 5 15%, or:5 10% leakage to outside, or seal all accessible leaks.
MR -MCH -25-H & CF311-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 Flow2 300 CFM/ton required when MCH -25 is required.
Exceotions: `
-Ductm registered with HERS provider as previously sealed are exempt from MCH 20 Duct Leaka a Testis r wrements..
systemsP P Y P e, r g eq
-Heating-only systems and Air Handler/Furnace changes do not require verification of Air FI�MCH-23 or RefrigerantwCha�g CH 25:S_
Existing duct insulated are MCH=20 Duct€Leakage Testing a ts.
niM
systems constructed, or sealed with asbestos exemptIrrom require
.; llr:"` fi"""t 1 ;If 9
E. Entirely New or Complete Replacement Duct System, with'or wlthout�Equipment ChangeouV(Sections 150.2(b)1Dn 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)lC)
This section does not apply to this project.
Registration Number: 215-A0182270A-000000000-0000
Registration Date/Time:
2015-07-03 13:48:21
HERS Provider: CalCERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2014-03-31 Report Generated: 2015-07-03 13:27:48
Schema Version: 0.555SDD
CERTIFICATE OF COMPLIANCE CF1R-ALT-02-E
Alterations to Space Conditioning Systems (formerly CF-lR-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: �f
Jacoby, Ian
cyan �aco Jr
Company:
Signature Date:
Stratz Permit Service
2015-07-03 13:34:23
Address:
CEA/ HERS Certification Identification (if applicable):
5858 Dovetail Drive
City/State/Zip:
Phone:
Agoura Hills CA 91301
818-735-7876
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 o egulat ons ,/fi "�/"""
4. The building design features or system design features identified on this Certificate of Compliance are bonssissten t wrthh+the inform aation provided on oth& applicable`compliance documents, worksheets,
4 9calculations, plans and specifications submitted to the enforcement agency for approval .witA this bwldmg permit application. `
,. „<4 kF.' �." _ It .•4. It r, >
5. 1 will ensure that a registered copy of this Certificate of Compliance shall be made available with the buildlrigpermit(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 Compl ance� s_required to be -included with the -the po vides to_the build ng owner at occupancy.'
a
Responsible Designer Name:
Respons"idle Designer Signature: ,y
ROGAN, LESLIE
Company:
Date Signed:
HARRISON ENTERPRISES INC
2015-07-03 13:48:21
Address:
License:
72078 CORPORATE WAY #101
968141
City/State/Zip:
Phone:
THOUSAND PALMS CA 92276
(760)343-5566
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-AO18227OA-000000000-0000 Registration Date/Time: 2015-07-03 13:48:21 HERS Provider: CaICERTS
CA Building Energy Efficiency Standards- 2013 Residential Compliance Report Version: 2014-03-31 Report Generated: 2015-07-03 13:27:48
Schema Version: 0.555SDD