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BMCH2015-0459l I I Illlll Illll I'll Illi -�' 27 ceutv/ D 78-495 CALLE TAMPICO �i % -"" " VOICE (760) 777-7125 LA QUfNTA, CALIFORNIA 92253 FAX (760) 777-7011COMMUNITY DEVELOPMENT DEPARTMENT INSPECTIONS (760) 777-7153 BUILDING PERMIT LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Seaton 7000) of Division 3 of the Business and Professions Code, and my License is In full force and effect. License Class: C License No.: bat : W 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-bullder 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 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. _ 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:- Pollcy 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 rovisions of Sectlon 3700 of the Labo Cod I s II forthwith compI with tho pro slops, FJ )Z Appllcant:. 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 Qulnta, Its officers, agents, and employees for any act or omisslon related to the work being performed under or ng 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 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 t building construction, and h reby authorize representatives of this city to enter u on e ab v mentl ed roperty for inspection purposes. Date: 12 ( Signature (Applicant or Agent): )--- Application Number: BMCH2O15-0459 Owner: Property Address: 80175 VIA MIRASOL FRANK KOZZLE APN: 777090043 80175 VIA MIRASOL m Application Description: KOZZLE / CHANGE OUT (2) 16SEER/78AFUE SPLIT SYSTEMS LA QUINTA, CA 92253 Property Zoning: r ' Application Valuation: $1,400.00 ) ry 4'1 r G. Applicant: Contractor: v c.n ANTHEM MECHANICAL ANTHEM MECHANI li! 53-800 POLK STREET 53-800 POLK STREET COACHELLA, CA 92236 COACHELLA, CA 92236 (760)469-2525 Llc. No.: 1001659 LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Seaton 7000) of Division 3 of the Business and Professions Code, and my License is In full force and effect. License Class: C License No.: bat : W 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-bullder 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 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. _ 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:- Pollcy 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 rovisions of Sectlon 3700 of the Labo Cod I s II forthwith compI with tho pro slops, FJ )Z Appllcant:. 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 Qulnta, Its officers, agents, and employees for any act or omisslon related to the work being performed under or ng 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 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 t building construction, and h reby authorize representatives of this city to enter u on e ab v mentl ed roperty for inspection purposes. Date: 12 ( Signature (Applicant or Agent): k `F h4 x ,E2 F`4 :f.ate, y;?4;h DESCRIPTIONya ; ACCOUNTsQTYzAMOUNT PAIDyDATE t` �� x PAIDX BSAS SB1473 FEE 101-0000-20306 = 0 $1.00 $0.00 4 PAID 8Y ` F4METHOD` Q� RECEIPT #' " CHECK # CLTD BY' r h aME'w>.n.u% �`m�$,.._ Total Paid for BUILDING STANDARDS ADMINISTRATION' BSA: $1.00 $0.00 ,. r ESCRIPTION "` 3 b &:�� Y:'r "3''b > *' i" F r 000UNT "1 u t QTY j; »sy ,iEe.a �+"EacE.. ,:..r -. AMOUNT l..a.' ._ swy.is.e.* x..,;�� PAID r: PAID DATE „ x "I ; E , r..;,.E. HVAC CHANGEOUT - SPLIT SYSTEM 101-0000-42402 0 $145.04 $0.00 _ J e a PAID BY METHOD , Tq rM RECEIPT # l CHECK # r CLTD BY z � . u.. t .,. �. g ,�� ,i ... :�Yaiv::23L,z�i:, E +,�,; r—gyy3Y.'ti#, .s,4 $#.�;. vT - DESCRIPTION -. <c"'xr'..EX f 619 f , ,b„ ACCOUNT .''Y;n ,Yf Y'9 E,i,:a.ft` P > AID ' P �, k.: PAID DATE r < .. ..: ..... a .a.. {< � z ti Vie.. QTYAMOUNTE' rb HVAC CHANGEOUT - SPLIT -SYSTEM PC 101-0000-42600 0 $72.52 $0.00 4s 5 x- GN 1 ' k .x �, "# "fib 3 �ERECEIPT # P, BY s s>y�s��METHOD�rn :c :. .-..., -a2 rn� ..>..YH.`i,+%u!< , .! :s:� ..,,. ,.n .'. _aO .. ,�.-�✓.�;.m^. `s..,...z _ n. ro�'Y H %s ..., ,4'e"�.. uJ .v _., >-_ CCTD Y ,12n7. }:.: Total Paid for CHANGEOUT: $217.56 $0.00 4 R.4m SMOa 'PAID SPA DA DESCRIPTION `y Fys° ACCOUNTr QTLY:�gA;UNTO D PERMIT ISSUANCE 101-0000-42404 0 $91.85 $0.00 .b. ,..e(� k.3r`ite,." }iS:,,'_a.e 3+4 . .:..4. "^:n.r BY, y.. - 0 ` d Z CLT.. DR BEFd Y 1" VP_$ ....� X ,;% 6•} _*.d '.y.r,,v r ,.._..,.. a ro-a�h om":n :. Total Paid for PERMIT ISSUANCE:' $91.85, $0.00 • 0� �0• Description: KOZZLE / CHANGE OUT (2) 16SEER/78AFUE SPLIT SYSTEMS Type: MECHANICAL Subtype: Status: UNDER REVIEW Applied: 12/10/2015 SKH Approved: Parcel No: 777090043 Site Address: 80175 VIA MIRASOL LA QUINTA,CA 92253 Subdivision: TR 29894-2 AMEND NO 2 Block:. Lot: 10 Issued: Lot Scl Ft: 0 Building Sq Ft: 0 Zoning: Finaled: Valuation: $1,400.00 Occupancy Type: Construction Type: Expired: No. Buildings: 0 No. Stories: 0 No. Unites: 0. ZIP PHONE FAX EMAIL Details: HVAC CHANGE OUT - (2)16SEER/78AFUE SPLIT SYSTEM [2013 ENERGY] CARBON MONOXIDE ALARM(S) TO BE INSTALLED PRIOR TO FINAL INSPECTION. 2013 CALIFORNIA BUILDING CODES. Printed: Thursday, December 10, 2015 11:32:23 AM 1 of 2 C SYS TEti1S. CHRONOLOGY CONDITIONS NAME TYPE NAME ADDRESSI CONTACTS CITY STATE ZIP PHONE FAX EMAIL APPLICANT ANTHEM MECHANICAL 53-800 POLK STREET COACHELLA CA 92236 CONTRACTOR ANTHEM MECHANICAL 53-800 POLK STREET COACHELLA CA 92236 OWNER FRANK KOZZLE 80175 VIA MIRASOL I LA QUINTA CA 92253 Printed: Thursday, December 10, 2015 11:32:23 AM 1 of 2 C SYS TEti1S. DESCRIPTION ACCOUNT QTY AMOUNT PAID-. PAID DATE RECEIPT # CHECK #., METHOD. PAID BY CLTD BY HVAC CHANGEOUT - 101-0000-42402 0 $145.04' $0.00 SPLIT -SYSTEM HVAC CHANGEOUT - 101-0000-42600 0 $72.52 $0.00 SPLIT -SYSTEM PC Total Paid for CHANGEOUT: $217.56 $0.00 PERMIT ISSUANCE 101-0000-42404 0 $91.85 $0.00 Total Paid for PERMIT ISSUANCE: $91.85- $0.00 TOTALS:0,40•0 PARENT PROJECTS ATTACHMENTS Printed: Thursday, December 10; 2015 11:32:23 AM 2 of 2 CN?WYSTFMS' Bin # Qty of % Quintd.. Building & Safety Division 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Permit # Project Address: D V; A &L4 ' C, I Owner's -Name: f � n � xo •� 1 � . A. P. Number: Address: �D 1 `% S V1 I' I l' s C>) Legal Description: City, ST, Zip:tiO t n .�/O� (/ Contract r• N� fvi rC �ohc Z I Telephone: ione:`7 »�1 2 Address: 0PC2 L S'f Project Description: - City, ST, Zip: 1� G� P Z VA S" ✓lit le h ne• Telephone: e P State Lic. # Arch., Engr., Designer: Address: City, ST, Zip: Telephone: ................................................... Cs ruction TYe: Occupancy: .on P State ic. Pro P (circle one): Neww A dd'n Alter Repair Demo Name of Contact Person: Sq. Ft.: # Stories: # Units: Telephone # of Contact Persofi: Estimated Value of Project: APPLICANT: DO NOT WRITE BELOW THIS LINE # ' Submittal Req'd Rec'd 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 Calcs. Plans picked up Construction Flood plain plan Plans resubmitted Mechanical Grading plan. 2nd Review, ready for corrections/issue Electrical Subcontactor List Called Contact Pcrson Plumbing Grant Deed Plans picked up S.M.I. Ii.O.A. Approval Plans resubmitted Grading IN Ii0I1SE:- 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 1 - CERTIFICATE OF COMPLIANCE Alterations to Space Conditioning Systems (formerly CF -1R -ALT -HVAC) Project Name: KOZZLE, FRANK I Date Prepared: CF1R-ALT-02-E (Page 1 of 3 ). 2015-12-04 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 KOZZLE, FRANK 02 Date Prepared 2015-12-04 03 Project Location 80175 Via Marisol 04 Building Type Single family 05 CA City. La 4uinta 06 Dwelling Unit Name KOZZLE, FRANK 07 Zip Code 92253 08 Dwelling Unit Conditioned 1600 aso ►' tac � ea Floor Area (ft2) SC System ` CFA'servedstem kJls aF, r{{e.rf igerant f Installing new;SC Number of space conditioning {Installing 09 Climate Zone 15 10 (SC) systems in this dwelling 2 containing system more than 40 entirely new unit. B. Space Conditioning (SC) Systeminformation. ,. = 01 02 03 04 05*4 Ik V06 07 Of8 09 10' 41 the SC t '�' � `moi Installing aSC � � aso ►' tac � ea System SC System ` CFA'servedstem kJls aF, r{{e.rf igerant f Installing new;SC (��^'IJ�nwy.'stalliri°g {Installing nstalling 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 1 800 Yes Yes Yes No No No Altered space conditioning system System 1 Location 2 800 Yes Yes Yes No No No Altered space conditioning system C. Extension of Existing Duct System, Greater Than 40 Feet (Section150.2(b)1Diib) This section does not apply to this project. Registration Number: 215-A6440951A-000000000-0000 CA Building Energy Efficiency Standards - 2013 Residential Compliance Registration Date/Time: 2015-12-04 17:21:08 HERS Provider: CaICERTS Report Version: 2013-1.006 Report Generated: 2015-12-04 17:16:58 Schema Version: 0.555SDD CERTIFICATE OF COMPLIANCE CF111-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 hew This field or This field or System 1 furnace heating AFUE 0.78 AC cooling SEER 16 Setback section is not section is not components components applicable applicable Central gas All new Central split All new. This field or This field or System 1 furnace heating AFUE 0.78 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: < 15%, or 510% leakage -to outside, or seal all accessible leaks. i CF2R-MCH-25-H & CF3R-MCH-25-H Refrigerant Charge Verification o'e $rp in CZ!2; 8-15). required when refrigerant containing compohents`are CF2RCF3R-MCH-23 & CF3R-MCH-23 Air Flow 2 300 CFM/ton required when MCV25'is requ re Exceptions: installed;oe`altered,(applicable w. -Duct systems registered with HERS provider as previously sealedtare{t empt from MCH=20 Leakage,Testing rtents. �g `7F 1°hrsir,�. w..i+�. .:,r•9 .' -Heating-only systems and Air Handler/Furnace changes do not require, verification of Air Flow MCH -23, or Refrigerant Charge MECH-25. mF -Existing duct systems constructed, insulated or sealed with asbestos are exempt 06ACH O,Duc le-ftakage Testing requiremen[ t E. Entirely New•or Complete Replacement Duct System, with or without Equipment Changeout (Sections 150.2(b)1Diia 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-A6440951A-000000000-0000 Registration Date/Time 2015-12-04 17:21:08 HERS Provider: CalCERTS CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013-1.006 Report Generated: 2015-12-04 17:16:58 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: Solomon, Michael Company: Signature Date: ANTHEM MECHANICAL 2015-12-04 17:21:08 Address: CEA/ HERS Certification Identification (if applicable): 53-800 POLK STREET City/State/Zip: Phone: COACHELLA CA 92236 760-469-2525 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 of Regula ons. 10 4. The building design features or system design features identified o is'Certif a e of Compliance are consistent'with,the ipformatio�n provided ori.other applicableI mpliance documents, worksheets, calculations, plans and specifications submitted to the a iforcement-agency for approval With this building per appIicati.t. � W tit +d tIt 5. 1 will ensure that a registered copy of this Certificateo of Compliance shall be;made available with the. buildingjpermit(s) issuetl forhhe tiuild g, andxmade availabl o�the enforcement agency for all applicable inspections. I understand that a registered copy of thPsCetitificate of Compliance d equed to be included i thed�ocumentation �theabuil der provides tothe building owner at occupancy. Responsible Designer Name: $ X-- fA w� • Responsible Desig er Signattre: V I L /�GCrIiR�,�/��.B�irGBsfi Solomon, Michael Company: Date Signed: ANTHEM MECHANICAL 2015-12-04 17:21:08 Address: License: 53-800 POLK STREET 1001659 City/State/Zip: Phone: COACHELLA CA 92236 760-469-2525 Digitally signed by CaICERTS. This digital signature is provided in order to secure the content of this registered document, and in noway implies Registration Provider responsibility for the a Registration Number: 215-A6440951A-000000000-0000 CA Building Energy Efficiency Standards - 2013 Residential Compliance Registration Date/Time: 2015-12-04 17:21:08 Report Version: 2013-1.006 Schema Version: 0.555SDD Report Gene