Loading...
BMCH2016-0012A I I�IIII IIT fill ll�l aw ,5 78-495 CALLE TAMPICO � 4VOICE (760) 777-7125 LA QUINTA, 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 Section 7000) of Division 3 of the Business and Professions Code, and my License is in full force and effect. License Class: C36, C10. C20 • License No.: 765074 (Date: Contractor: F - I g k� T I %►ne 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).: (1 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.). (1 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 I am exempt under Sec. . BAP.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. Q. Lender's Name: Lender's Address: (951)276-9744 Llc. No.: 765074 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 Se67on'37700 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: _w 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. ' 'p � e: L� 1 Applicant:/ 1,J � �­Pd � r WARNING: FAILURE TO SECURE WORKERS' COMPENSAT ON 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 uponthe above-mentioned property for inspection purposes. Date: 2— 2` Signature (Applicant or Agent)f� C') `; e: . Application Application Number: BMCH2O16-0012 Owner: 1�!;,D -i Property Address: 54160 AVENIDA VALLEJO LUIS CERVANTES o r >, APN: 774213009 54160 AVENIDA VALLEJO. Application Description: CERVANTEZ / CHANGE OUT (2) MINI SPLITS AND DUCT REPLACEMENT LA QUINTA, CA 92201 C Property Zoning: m o Application Valuation: $15,150.00 0 cN� D 32 473 M Applicant: Contractor: ARCHON ENERGY SOLUTIONS A R S AMERICAN RESIDENTIAI ,Fm OUTSIDE CITY LIMITS 965 RIDGE LAKE BLVD SUITE 201 MEMPHIS, TN 38120 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: C36, C10. C20 • License No.: 765074 (Date: Contractor: F - I g k� T I %►ne 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).: (1 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.). (1 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 I am exempt under Sec. . BAP.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. Q. Lender's Name: Lender's Address: (951)276-9744 Llc. No.: 765074 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 Se67on'37700 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: _w 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. ' 'p � e: L� 1 Applicant:/ 1,J � �­Pd � r WARNING: FAILURE TO SECURE WORKERS' COMPENSAT ON 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 uponthe above-mentioned property for inspection purposes. Date: 2— 2` Signature (Applicant or Agent)f� FINANCIAL 1 • DESCRIPTION ACCOUNT' QTY AMOUNT PAID PAID DATE BSAS S81473 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 101-0000-02402 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 DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE HVAC CHANGEOUT - SPLIT -SYSTEM 101-0000-42402 0 $145.04 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY DESCRIPTION ACCOUNT QTY., AMOUNT PAID PAIDJDATEHVAC CHANGEOUT - SPLIT -SYSTEM PC 101-0000-02600 0 $72.52 $0.00 PAID BY METHOD RECEIPT # CHECK # CLT Total Paid for CHANGEOUT: $234.48 $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:00 Description: CERVANTEZ / CHANGE OUT (2) MINI SPLITS AND DUCT REPLACEMENT Type: MECHANICAL Subtype: Status: UNDER REVIEW Applied: 2/2/2016 SKH Approved: Parcel No: 774213009 Site Address: 54160 AVENIDA VALLEJO LA QUINTA,CA 92253 Subdivision: SANTA CARMELITA VALE LA QUINTA Block: 283 Lot: 17 Issued: UNIT 26 Lot Sq Ft: 0 Building Sq Ft: 0 Zoning: Finaled: Valuation: $15,150.00 Occupancy Type: Construction'Type: Expired: No. Buildings: 0 No. Stories: 0 No. Unites: 0 STATE Details: HVAC CHANGE OUT - (2)14SEER/78AFUE SPLIT SYSTEMS AND DUCT RUNS [2013 ENERGY] CARBON MONOXIDE ALARM(S) TO BE INSTALLED PRIOR TO FINAL INSPECTION. 2013 CALIFORNIA BUILDING CODES. ADDITIONAL SITES CHRONOLOGY CONDITIONS CONTACTS NAME'TYPE NAME • ADDRESS1- -CITY STATE ZIP PHONE FAX EMAIL APPLICANT ARCHON ENERGY SOLUTIONS OUTSIDE CITY LIMITS CONTRACTOR A R S AMERICAN RESIDENTIAL SERVICES OF C 965 RIDGE LAKE BLVD SUITE 201 MEMPHIS TN 38120 OWNER L LUIS CERVANTES . 54160 AVENIDA . I VALLEJO LA QUINTA T CA 92201 FINANCIAL INFORMATION Printed: Tuesday, February 02, 2016 3:55:41 PM 1 of 2 ff?uff SYSTEMS INSPECTIONS PARENT PROJECTS Printed: Tuesday, February 02, 2016 3:55:41 PM 2 of 2 rp SYSTEMS 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: 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 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: $234.48 $0.00 PERMIT ISSUANCE 101-0000-42404 0 $91.85 $0.00 Total Paid for PERMIT ISSUANCE: $91.85 $0.00 TOTALS:00 INSPECTIONS PARENT PROJECTS Printed: Tuesday, February 02, 2016 3:55:41 PM 2 of 2 rp SYSTEMS STATE OF CALIFORNIA ALTERATIONS - HVAC Ml- CEC-CF1 R -ALT -04-E Revised 06/14 CALIFORNIA ENERGY COMMISSION CERTIFICATE OF COMPLIANCE CF1R-ALT-04-E Alterations - HVAC CZ 2, and 8-15 (formerly CF -IR -ALT -HVAC) (Page 1 of 1) Site Address: / du va Enforcement Agency: D�aatte Pnp r d: Permit#: / ( Equipment Type Equipment Efficiency New Ducting, Plenums, Lineset: Con Itioned Thermostat Required R -value Floor Area (sq ft) ❑ Packaged System ❑ Evaporator Coil ; %9AFUE COP ❑ R-6 (CZ 1, 8-13) Ducting Served by system ❑ Setback ❑ Split System ❑ Condensing Unit �1 ❑ R-8' (CZ 11, 14, 15) Ducting sgft (if not already WMini Split ❑ Compressor (l SEER ��HSPF ❑ R-6 (all CZ's) Plenums present, must ❑ Furnace ❑ Lineset _EER 4 13R-5 or R7.5) Lineset° be installed) ❑ TXV HERS VERIFICATION SUMMARY Installer determines work to be completed and matches to one of the options below. At permit application this form is allowed to be filled out by hand. For final inspection all forms are to be registered (no hand filled forms allowed) and a copy left on site. C Chan eou Required Compliance Documents to be left on site for Final: All Equipment, CF111-ALT-02-E Condenser Unit, Evaporator Coil, CF2R: MECH-01, MECH-20-HERS, MECH-(23 or 24)Z -HERS, MECH-25-HERSZ Compressor, TXV, Lineset, CF3R: MECH-20-HERS, MECH-(23 or 24)-HERSZ, MECH-25-HERSZ Air Handler/FurnaceZ (Can include new ducting) Installer Requirement: Duct leakage (< 1S%, or < 10% to outside, or seal all accessible leaks), Air Flow 2 300 CFM/ton, Refrigerant Charge. Exempted from duct leakage testing if: ❑ 1. Duct system registered with HERS provider as previously sealed, or ❑ 2. There is less than 40 linear feet of duct in unconditioned space, or ❑ 3. Existing duct systems are constructed, insulated or sealed with asbestos (list manufacture date of building ....... 2. New HVAC System Required Compliance Documents to be left on site for Final: All new equipment and All New Ducts' including Mini Split CF111-ALT-02-E CF2R: MECH-01, MECH-20-HERS, MECH-22-HERS, MECH-(23 or 24)-HERS2, MECH-25-HERS2 CF3R: MECH-20-HERS, MECH-22-HERS, MECH-(23 or 24)-HERS2, MECH-25-HERS2 Mini Splits require CF111-ALT>02-E, CF2R-MECH-01, and (CF2R-CF3R) MECH-25-HERS Installer Requirement: Duct leakage < 6%, Fan Efficacy (.58W/CFM), Air Flow z 350 CFM/ton (or alternative), Refrigerant Charge ❑ 3. All New Ducts with Replacement Required Compliance Documents to be left on site for Final: All New Ducts' and one or more of the following CF1R-ALT-02-E replaced: Condenser Unit, Evaporator Coil, CF2R: MECH-01, MECH-20-HERS, MECH-(23 or 24) -HERS, MECH-25-HERS Compressor, TXV, Lineset, Furnace CF3R: MECH-20-HERS, MECH-(23 or 24) -HERS, MECH-25-HERS Installer Requirement: Duct leakage < 6%, Air Flow >_ 350 CFM/ton (or alternative), Refrigerant Charge Exempted from duct leakage testing if: ❑ 1: Existing duct systems are constructed, insulated or sealed with asbestos 4. New Ducting over 40 feet Required Compliance Documents to be left on site for Final: New ducting but less than All New Ducts' CF1R-ALT-02-E, CF2R: MECH-20-HERS, CF3R: MECH-20-HERS Installer Required to: Duct leakage L15% or, < 10% to outside or, or seal all accessible leaks) ❑ EXCEPTION: Existing duct systems constructed, insulated or sealed with asbestos. 'All new ducting R-8 required when more than 40 ft installed and R-6 when less than. 40 ft installed. This includes in walls, between floors etc. 2 Heating only systems and Air Handler/Furnace changes do not require Air Flow MECH-(23 or 24), or Refrigerant Charge verification MECH-25 ' All New Ducts is when at least 75 percent of the duct system is new duct material, and up to 25 percent may consist of reused parts from the dwelling unit's existing duct system (e.g., registers, grilles, boots, air handler, coil, plenums, duct material) R-5 (1" thick insulation) for linesets 1" and less. R-7.5 (1.5" thick insulation) for linesets over 1 inch. Most mfg will require Suction line Diameter with insulation as the following 1.5-2T-25/8", 2.5-.3T-2%", 3.5 to 4T-2%", 5T -4'/e" Contractor (Documentation Author's /Responsible Designer'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 California Business and Professions Code to accept responsibility for the information on this document. 3. That the energy features and performance specifications for the design identified on this Certificate of Compliance conform to the Title 24, Parts 1 6 the California Code Regulations requirements of and of of (CCR). 4. 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 CCR. 5. 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 enforcement agency for approval with this building permit application. Respons' Ie DesiggerName, t p ll Responsible Designer Signature: Date Signed:�'� / (� License: 7� 60 7 compa I 1NMS, Address: X036s Phone: ate/Zip: ���5 ' ie at: 1-800-772-3300 2, S6 STATE OF�CALIFORNIA ALTERATIONS - HVAC CEC-CF1 R -ALT -04-E Revised 06114 CALIFORNIA ENERGY COMMISSION CERTIFICATE OF COMPLIANCE CF1R-ALT-04-E Alterations - HVAC CZ 2, and 8-15 (formerly CF -IR -ALT -HVAC) (Page 1 of 1) Site Address: 1�' 1/ 4T—€nforcement Agency: Date PTeepare : Permit#: 16 DA Equipment Type Equipment Efficiency New Ducting, Plenums, Lineset: Conditioned Thermostat Required R -value Floor Area (sq ft) ❑ Packaged System ❑ Evaporator Coil AFUE COP ❑ R-6 (CZ 2, 8-13) Ducting Served by system ❑ Setback ❑ Split System -1��Mlnl Split ❑ Condensing Unit ❑Compressor SEER ❑ R-8' (CZ 11, 14, 15) Ducting sgft (If not already must ❑ R-6 (all CZ's) Plenums present, ❑ Furnace ❑ Lineset I LEER O R-5 or R7.5) Lineset4 be installed) ❑ TXV HERS VERIFICATION SUMMARY Installer determines work to be completed and matches to one of the options below. At permit application this form is allowed to be filled out by hand. For final inspection all forms are to be registered (no hand filled forms allowed) and a copy left on site. ❑ 1. HVAC Changeout/Repair Required Compliance Documents to be left on site for Final: All Equipment, CF1R-ALT-02-E Condenser Unit, Evaporator Coil, CF2R: MECH-OS, MECH-20-HERS, MECH-(23 or 24)' -HERS, MECH..25-HERSZ Compressor, TXV, Lineset, CF3R: MECH-20-HERS, MECH-(23 or 24) -HERS', MECH-25-HERS' Air Handler/Furnace' (Can include new ducting) Installer Requirement: Dud leakage (S.15%, or < 10% to outside, or seal all accessible leaks), Air Flow Z 300 CFM/ton, Refrigerant Charge. Exempted from dud leakage testing if: ❑ 1. Dud system registered with HERS provider as previously sealed, or ❑ 2. There is less than 40 linear feet of dud in unconditioned space, or ❑ 3. Existing dud systems are constructed, insulated or sealed with asbestos (list manufacture date of building ....... 1 2. New HVAC System Required Compliance Documents to be left on site for Final: All new equipment and All New Duds3 CF1R-ALT-02-E including Mini Split CF2R: MECH-01, MECH-20-HERS, MECH-22-HERS, MECH-(23 or 24) -HERS', MECH-25-HERSZ CF3R: MECH-20-HERS, MECH-22-HERS, MECH-(23 or 24)-HERSZ, MECH-25-HERS' Mini Splits require CF1R-ALT-02-E, CF2R-MECH-01, and (CF2R-CF3R) MECH-25-HERS Installer Requirement: Duct leakage < 6%, Fan Efficacy (.58W/CFM), Air Flow 2 350 CFM/ton (or alternative), Refrigerant Charge ❑ 3. All New Ducts with Replacement Required Compliance Documents to be left on site for Final: All New Duds3 and one or more of the following CF1R-ALT-02-E replaced: Condenser Unit, Evaporator Coil, CF2R: MECH-01, MECH-20-HERS, MECH-(23 or 24) -HERS, MECH-25-HERS Compressor, TXV, Lineset, Furnace CF3R: MECH-20-HERS, MECH-(23 or 24) -HERS, MECH-25-HERS Installer Requirement: Duct leakage < 6%, Air Flow 2 350 CFM/ton (or alternative), Refrigerant Charge . Exempted from duct leakage testing if: 111. Existing duct systems are constructed, insulated or sealed with asbestos New Ducting over 40 feet Required Compliance Documents to be left on site for Final: New ducting but less than All New Ducts3 CF1R-ALT-02-E, CF2R: MECH-20-HERS, CF3R: MECH-20-HERS Installer Required to: Duct leakage (<.15% or, < 10% to outside or, or seal all accessible leaks) ❑ EXCEPTION: Existing duct systems constructed, insulated or sealed with asbestos. ' All new ducting R-8 required when more than 40 ft installed and R-6 when less than 40 ft installed. This includes in walls, between floors etc. 2 Heating only systems and Air Handler/Furnace changes do not require Air Flow MECH-(23 or 24), or Refrigerant Charge verification MECH-25 3 All New Ducts is when at least 75 percent of the duct system is new duct material, and up to 25 percent may consist of reused parts from the dwelling unit's existing duct system (e.g., registers, grilles, boots, air handler, coil, plenums, duct material) ` R-5 (1" thick insulation) for linesets 1" and less. R-7.5 (1.5" thick insulation) for linesets over 1 inch. Most mfg will require Suction line Diameter with insulation as the following 1.5-2T-2%", 2.5-3T-2%", 3.5 to 4T-2%", 5T-4'/" Contractor (Documentation -Author's /Responsible Designer'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 California Business and Professions Code to accept responsibility for the information on this document. 3. That the energy features and performance specifications for the design identified on this Certificate of Compliance conform to the requirements of Title 24, Parts 1 and 6 of the California Code of Regulations (CCR).. 4. 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 CCR. S. 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 enforcement agency for approval with this building permit application. Responsible Designer Name: Responsible Designer Signature: Date Signe 16 License: 77 ��� 7656 Company :Address: OZ M� 7 � 11, City/State/Zip: , JUI V Phone; For assistance or questions regarding the Energy Standards, contact the Energy Hotline at: 1-$00-772-3300 10 Qin # City of La Quinta Building &r Safety Division 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 Building Permit Application, and Tracking Sh/eeetVA Permit # Project Address: S l I n / Ler e: L (� S �V \ V A. P. Number: Address: e, " -e Legal Description: City, ST, Zip.- Contra tor: .I c Tele h one: P Address: 3 1' Q {'S S -f Project Description: G � e l A(I tf kI L' City, ST, Zip: X-,1 VCz Y -S /J e 03 . 4 P q J Telephone: ele h 0 1 I 3 -6 I 2- V e s s State Lic. # :74 021 City Lie. #.- :Arch., Arch.,Engr., Designer: Address: City., ST, Zip: Telephone:Co Occupancy: an :TYPe: struc ton cY State Lic. J cttYPec rete one : New Add'n Alter Repair Demo Name of Contact Person: Sq. Ft.: O �{ 3 # Stories: #Units: Telephone # of Contact Person: II Estimated Value of Project: APPLICANT: DO NOT WRITE BELOW THIS LINE tl Submittal Req'd Rcc'd TRACKING PERMIT FEES Plan Sets Plan Check submitted Item Amount Structural Cafes. 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/issu,e 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 Scbool Fees, Total Permit Fees