BMCH2016-018878-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 922531. t
Application Number:
Property Address:
APN:
Application Description
Property Zoning:
Application Valuation:
Applicant:
IE INC
BMCH2O16-0188
54315 ALYSHEBA DR
Tv�/ D 4 QuiRro VOICE (760) 777-7125
FAX (760) 777-7011
COMMUNITY DEVELOPMENT DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 6/2/2016
Owner:
ANGELOS THEODOSSIS
767780004
THEODOSSIS RESIDENCE / HVAC CHANGE OUT
$3,765.00
31225 LA BAYA
WESTLAKE VILLAGE, CA 91362
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, C36 License No.: 686310
i
Date: Z. I 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 orshe 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 N
Lender's A
s �
Contractor:
HARRISON ENTERPRISES INC D
31170 RESERVE DRIVE
THOUSAND PALMS, CA 92276
77)
(760)343-7488
Llc. No.: 686310
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
Df the work for which this permit is issued.
'QE:- 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.
Data�eo Z Ilo (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.
—
or.Agent): _
t
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
ACCOUNTQTY
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 CHANGEOUT: $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
t
Description: THEODOSSIS RESIDENCE./ HVAC CHANGE OUT
Type: MECHANICAL Subtype: Status: APPROVED
Applied: 6/2/2016 MFA
Approved: 6/2/2016 MFA
Parcel No: 767780004 Site Address: 54315 ALYSHEBA DR LA QUINTA,CA 92253
Subdivision: TR 32879 Block: Lot: 52
Issued:
Lot Sq Ft: 0 Building Sq Ft: 0 Zoning:
Finaled:
Valuation: $3,765.00 Occupancy Type: Construction Type:
Expired:
No. Buildings: 0 No. Stories: 0 No. Unites: 0
NAME TYPE
Details: COIL CHANGE OUT - 18 SEER/80AFUE SPLIT SYSTEM [2008 ENERGY] CARBON MONOXIDE ALARM(S) TO BE INSTALLED PRIOR TO
FINAL INSPECTION. PER 2013 CALIFORNIA BUILDING CODES.
ADDITIONAL
CHRONOLOGY
CONDITIONS
STATE
ZIP
PHONE
FAX
EMAIL
NAME TYPE
NAME
ADDRESSI.
CONTACTS
CITY
APPLICANT
IE INC
31225 LA BAYA
WESTLAKE
VILLAGE
CA
91362
(949)291-7683
CONTRACTOR
HARRISON ENTERPRISES INC DBA
GENERAL AIR
31170 RESERVE DRIVE
THOUSAND
PALMS
CA
92276
(949)291-7683
FRANCISCO@CALLTHE
GENERAL.COM
OWNER
ANGELOS THEODOSSIS
27791 GOLDEN RIDGE
LN
SAN JUAN CAPO
CA
92253
(949)291-7683
Printed: Thursday, June 02, 2016 7:55:35 AM 1 of 2 srsrenns
Printed: Thursday, June 02, 2016 7:55:35 AM 2 of 2 : " srsrEMs
'#
CLTD
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
RECEIPT #
CHECK
METHOD
PAID BY.
By '
BSAS SB1473 FEE
101-0000-20306
0
$1.00
$0.00
Total Paid for BUILDING STANDARDS ADMINISTRATION $1.00 $0.00
BSA:
HVACCHANGEOUT-
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:•• 00
Printed: Thursday, June 02, 2016 7:55:35 AM 2 of 2 : " srsrEMs
Bill #
City. Of La QUinta
Building a Safety Division
P.O. Box 1504,78-495 Calle Tampico
La.Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
ProjeccAddress: 54315 Alysheba Drive
Ownet'sName:.Angelos Theodossis
A. P. Number.
Address:
Legal Description:
City, ST, Zip.
Contractor: General Air Conditioning
Telephone: `
Address: 31170 Reserve Drive
Project Description:' Replace 4ton Coil
City, ST, Zip: Thousand Palms, CA 92276
Telephone: 760-343-7488"
M VMS
State Lic. # : 686310
City Lie. #.:
Arch., Engr., Designer:
Adder.
City., ST, Zip: -
Telephone:
State Lia #: �wj; r
Construction Type:. Occupancy:
Project type (circle one): New Add'n Alter Repan Demo
Name ofContact Person: Steven SchniererSq.
Ft.: #Stories: # Units:
Telephone # of Contact Person: 818-735'7876
Estimated value of project $3,765.00 .
APPLICANT: DO NOT WRITE BELOW THIS UNE
#
Submittal
Req'd
Recd
TRACIMG
PERMIT FEES
Plan Sets
Plan Check submitted
Item Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit. .
Truss Cates.
Called Contact Person
Plan Check Balance.
Title 24 Calci.
Plans picked up
Construction
Flood plain plan -
Plans resubmitted, .
Mechanical
Grading plan
20 Review, ready for correctionstissae
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
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
CERTIFICATE OF COMPLIANCE
CF111-ALT-024
Alterations to Space Conditioning Systems (formerly CF -111 -ALT HVAC) (Page 1 of 3 )
Project Name:
ANGELOS THEODOSSIS I Date Prepared:
2016-06-01
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
ANGELOS THEODOSSIS
02
Date Prepared
2016-06-01
03
Project Location
54315 ALYSHEBA DRIVE
04
Building Type
Single family
05
CA City
La Quinta
06
Dwelling Unit Name
ANGELOS THEODOSSIS
07
Zip Code
92253
013
Dwelling Unit Conditioned
5667
Installing
,installing
Installing
Floor Area (ft2)
Location or Area
by this SC
-*ducted
'
system
Number of space conditioning
entirely a
09
Climate Zone
15 ,` `
10
(SC) systems in this dwelling
1
component?
components?
s' t
I duct system?
unit.
Alteration Type
B. Space Conditioning (SC) System Information F=7 Fn n
01
02
03 r..
04��
,.- #
/ice 105 #
4�q
I f -06f f�t
I �7�'# {
y
i 68 11
09
10
the SC`"`°"
'Installing a`
SC System
SC System
'CFA served
"_N system a
refrigerant {
«installing new SC
Installing
,installing
Installing
Identification or
Location or Area
by this SC
-*ducted
c ntaining
system
more than 40
entirely 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
5667
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-A0202981A-000000000-0000
Registration Date/Time: 2016-06-01 19:26:01
HERS Provider: CaICERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013 Rev 1.007 Report Generated: 2016-06-01 19:25:50
1 Schema Version: 0.555SDD
CERTIFICATE OF COMPLIANCE CF1R-ALT-02-E
Alterations to Space Conditioning Systems (formerly CF -1R -ALT -HVAC) (Page 2 of 31
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
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
Fancoil AHU
SEER
18
Setback
section is not
section is not
altered
applicable
applicable
applicable
applicable
Reauired 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 & MR -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:
-Duct systems registered with HERS provider as previously sealed are exempt from MCH -20 Duct Leakage' Testing requirements.,4
Air
-Heating-only systems and Air Handler/Furnace changes do not require verification of Flow MCH-23rRefrigerant Charge MECH"25 C
Existing duct systems constructed, insulated or sealed with asbestos are exempt from MCH=20 Duct Leakage Testing requirements.
q
10%%L. 1 t k�. 1 11 r F t f T V „ 1 1 ... 1 t 1 4 1 1 I t 1 1 1 E r ►, a
E. Entirely New or Complete Replacement Duct System, with or without. Equipment Changeout (Sections,150.2(b)1Diia,and 150.2(b)1E, 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: 216-A0202981A-000000000-0000 Registration Date/Time: 2016-06-01 19:26:01 HERS Provider: CaICERTS
CA Building Energy Efficiency Standards'- 2013 Residential Compliance Report Version: 2013 Rev 1.007 Report Generated: 2016-06-01 19:25:50
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:
/ /J
Documentation Author Signature: ��-/!1??I:G
Shanley, Barbara
O
Company:
Signature Date:
HARRISON ENTERPRISES INC dba GENERAL AIR CONDITIONING
2016-06-01 19:26:00
Address:
CEA/ HERS Certification Identification (if applicable):
31-170 RESERVE DRIVE STE A
City/State/Zip:
Phone:
THOUSAND PALMS CA 92276 �',
760-343-7488
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 of is true and correct.
2. I 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.'" i f��
4. The building design features or system design features 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 enforcemeni agency for approval with this building permit application.
'� t t
Xdlhg,
jo-,. k �. F e e v w,,`t e i[ r
S. I will ensure that a registered copy of this Certificate of,Compliance shall be -made available with the building permit(s) issued forthe 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 prov ddees to the building owner at occupancy.
Responsible Designer Name: 1 ... 9 -1! J
Responsible Dgner Signature: V 0 %w
Shanley, Barbara
Company:
Date Signed:
HARRISON ENTERPRISES INC dba GENERAL AIR CONDITIONING
2016-06-01 19:26:01
Address:
License:
31-170 RESERVE DRIVE STE A
686310
City/State/Zip:
Phone:
THOUSAND PALMS CA 92276
760-343-7488
Digitally signed by Ca10ERTS. This digital signature is provided in order to secure the content of this registered documen4 and in noway implies Registration Provider responsibility for the accuracy of the information.
Registration Number: 216-A0202981A-000000000-0000 Registration Date/Time: 2016-06-01 19:26:01 HERS Provider: CaICERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013 Rev 1.007 Report Generated: 2016-06-01 19:25:50
Schema Version: 0.5555DD