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BMCH2016-026378-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 I COMMUNITY DEVELOPMENT DEPARTMENT BUILDING PERMIT Application Number: BMCH2O15-0263 Property Address: 53360 AVENIDA RUBIO APN: .774073006 Application Description: OSBJORSON HVAC CHANGE OUT Property Zoning: Application Valuation: $9,485.00 Applicant: HARRISON ENTERPRISES INC DBA G 31-170 RESERVE DRIVE STE A THOUSAND PALMS, CA 92276 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.: 686310 Date: % Contractor: S z VOICE (760) 777-7125 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 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: OWNER -BUILDER DECLARATION Date: 7/13/2015 Owner: I certify that in the performance of the work for which this permit is issued, I TANIA OSBJORNSON shall not employ any person in any manner so as to become subject to the workers' 53360 AVENIDA RUBIO compensation laws of California, and agree that, if I should become subject to the LA QUINTA, CA 92253, workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith signed statement that he or she is licensed pursuant to the provisions of the comply with those provisions. Contractor's State License Law (Chapter 9 (commencing with Section 7000) of Division 3 c of the Business and Professions Code) or that he or she is exempt therefrom and the z_ L nC ]I basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a m r— Contractor: WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, HARRISON ENTERPRISES INC HARRISON DBA ~` 31-170 RESERVE DRIVE STEAM 0 C.v THOUSAND PALMS, CA 9227 z � N 6� _ compensation, will do the work, and the structure is not intended or offered for sale. _o rn (Sec. 7044, Business and Professions Code: The Contractors' State License Law does not D LT1 (760)3.43-7488 Y' 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 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: OWNER -BUILDER DECLARATION Carrier: _ Policy Number: I hereby affirm under penalty of perjury that I am exempt from the Contractor's State I certify that in the performance of the work for which this permit is issued, I License Law for the following reason (Sec. 7031.5, Business and Professions Code: Any shall not employ any person in any manner so as to become subject to the workers' city or county that requires a permit to construct, alter, improve,. demolish, or repair compensation laws of California, and agree that, if I should become subject to the any structure, prior to its issuance, also requires the applicant for the permit to file a workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith signed statement that he or she is licensed pursuant to the provisions of the comply with those provisions. 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 Date: 1:9 LS Applicant: 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 WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, ($500).: AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO (1 I, as owner of the property, or my employees with wages as their sole ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION TO THE COST OF compensation, will do the work, and the structure is not intended or offered for sale. COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, (Sec. 7044, Business and Professions Code: The Contractors' State License Law does not INTEREST, AND ATTORNEY'S FEES. 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 APPLICANT ACKNOWLEDGEMENT are not intended or offered for sale. If, however, the building or improvement is sold IMPORTANT: Application is hereby made to the Building Official for a permit subject to within one year of completion, the owner -builder will have the burden of proving that . the conditions and restrictions set forth on this application. he or she did not build or improve for the purpose of sale.). 1. Each person upon whose behalf this application is made, each person at whose (_j I, as owner of the property, am exclusively contracting with licensed contractors request and for whose benefit work is performed under or pursuant to any permit to construct the project. (Sec. 7044, Business and Professions Code: The Contractors' issued.as a result of this application , the owner, and the applicant, each agrees to, and State License Law does not apply to an owner of property who builds or improves' shall defend, indemnify and hold harmless the City of La Quinta, its officers, agents, and thereon, and who contracts for the projects with a contractors) licensed pursuant to employees for any act or omission related to the work being performed under or the Contractors' State License Law.). following issuance of this permit. (_) I am exempt under Sec. , B.&P.C. for this reason 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. 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: 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: %I13 .IS Signature (Applicant or Agent) FINANCIAL i• 1• `DESCRIPTION `' y ACCOUNT x ,,.:QTY . '-AMOUNT `= ,' PAID PAID DATE BSAS SB1473 FEE 101-0000-20306 0 $1.00 $0.00 - � PAID BYjj 4 $ s METHOD d � sw '`RECEIPT #° rt ,CHECK # , CLTD BY , Total'Paid for BUILDING STANDARDS ADMINISTRATION BSA $1.00 $0.00 DESCRIPTION;; ° $ w :,<ACCOUNT QTY r.E AMOUNTt F;,`�� PAID `� PAID DATE. HVAC CHANGEOUT - SPLIT -SYSTEM 101-0000-42402 0 $72.52 $0.00 4_ PAID BY METHODi RECEIPT #_ CHECK # , zH CLTD BY, DESCRIPTION {. k' ;ACCOUNT ' _A 'QTYt° AMOUNT x.-., PAID PAID DATE HVAC CHANGEOUT - SPLIT -SYSTEM PC 101-0000-42600 0 $36.26 $0.00 PAID BY ��- METHOD ; z°F RECEIPT #,�° „: CHECK # `CLTD BYE Total Paid forCHANGEOUT: $108.78 $0.00 DESCRIPTION ti �'' ' 1ACCO.UNT k QTY # ¢rAMOUNT i x J PAID PAID DATE' PERMIT ISSUANCE 101-0000-42404 0 $91.85 $0.00 • _r w. - ..f a 1 s Y,PAID BY ! r" ` _' .: •-, METHOD q . ,f;RECEIPT # " .. Y'CHECK #'• 'e,r, CLTD BY Total Paid for PERMIT. ISSUANCE: $91.85 $0.00 • 1LS: $201.63 $0.00 sin.# CQw Of b- Qulflta 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 Perinit # Projectaddress: 53360 Avenida Rubio Owner's Name:. Tania Osbjorson A. P. Number. Address: 53360 Avenida Rubio Legal Description: Contractor. General Air conditioning City, ST, Zip: La Quinta, CA 92253 Telephone: ....�:,,w Address: 31176 Reserve Drive Project Description: City, ST, Zip: Thousand Palms, CA 92276 Replace 3.5ton Package Unit Telephone: 760-343-7488. , City Lic, #; State Lic. # : 686310 Arch., Engr., Designer. Address: City., ST. Zip: Telephone V Y `� State. Lia #: � fw; ;, v `"' k� ,c Name of Contact Person: Steven Schnierer Construction Type:. Occupancy: Project type (circle one): New Add'n .Alter Repair Demo . ypp Sq. Ft.: # Stories: _T# -units: Telephone # of Contact Person: 818-735-7876 X 1 Estimated value of project: $9,485.00 . APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Req'd 'Reed TRACMG PERMIT FEES Plan Sets Plan Check submitted Item Amount Structural Cales. Reviewed, ready for corrections Plan Check Deposit, . Truss Cala. Called Contact Person Plan Check Balance. Title 24 Calcs. Plans picked up Construction Hood plain plan Plans resubmitted Mechanical Giading plan rd Review, ready for correctionsfissue Electrical Subeontactor List Called Contact Person Plumbing Grant Deed Plans picked up H.O.A. Approval Plans resubmitted Grading Iii HOUSE:- '^' Review, ready for correctionsfissue Developer Impact Fee Planning Approval Called Contact Person A.LP.P. Pub. Wks. Appr Date of permit Issue school Fees Total Permit Fees Description: OSBJORSON HVAC CHANGE OUT Type: MECHANICAL Subtype: Status: APPROVED Applied: 7/13/2015 EVA Approved: 7/13/2015 EVA Parcel No: 774073006 Site Address: 53360 AVENIDA RUBIO LA QUINTA,CA 92253 Subdivision: SANTA CARMELITA VALE LA QUINTA Block: 185 Lot: 19 Issued: UNIT 18 Lot Sq Ft: 0 Building Sq Ft: 0 Zoning- Finaled: Valuation: $9,485.00 Occupancy Type: Construction Type: Expired: No. Buildings: 0 No. Stories: 0 No. Unites: 0 Details: HVAC CHANGE OUT - 13 SEER / 80 AFUE SPLIT SYSTEM [2013 ENERGY) CARBON MONOXIDE ALARM(S) TO BE INSTALLED PRIOR TO - FINAL INSPECTION. 2013 CALIFORNIA BUILDING CODES. CONDITIONS Printed: Monday, July 13, 2015 9:14:28 AM 1 of 2 SYSTEtitS .Per ' it Detal�S PERMITNUMBER -City of LaaQuiifa BMCH2O1�50263 r M f DESCRIP.T.fON =fi,. �-'ACCOUNT CITY . >'.=AMOUNT%? PAID PAID DATE' 'RECEIPT# Kw CHECK PAID BYBY CLTD`, 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:i 06 PARENT PROJECTS BOND INFORMATION . Printed: Monday, July 13, 2015 9:14:28 AM 2 of 2 SYS7Eti1S STATE OF CALIFORNIA ALTERATIONS - HVAC CEC-CFIR-ALT-04-E Revised 06/14 CALIFORNIA ENERGY COMMISSION CERTIFICATE OF COMPLIANCE CFIR-ALT-04-E Alterations - HVAC CZ 2, and 8-15 (formerly CF -SR -ALT -HVAC) (Page 1 of 1) Site Address: Enforcement Agency: Dae Prepared: Permit#: !� 33(00 Avev�� c� 1�.�0: o - ") t --S- Equipment Type Equipment Efficiency New ducting, Plenums, Uneset: Conditioned Thermostat Required R -value Floor Area (sq ft) jKPackaged System ❑ Evaporator Coil 9�IAFUE COP ❑ R-6 (CZ 2,8-13) Ducting Served by system X..Setback ❑ Split System ❑ Condensing Unit ❑ R-8' (C711, 14,15) Ducting koS(3 sgft. (If not already ❑ Mini Split ❑ Compressor 13 SEER HSPF ❑ R-6 (all CZ's) Plenums presen4 must ❑ Furnace ❑ Unesetbe EER ❑ R-5 or R7.5) Uneset" installed) ❑ TXV HERS VERIFICATION SUMMARYInstaller 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. X1. HVAC Changeout/Repair Required Compliance Documents to be left on site for Final: All Equipment, CFIR-ALT-02-E Condenser Unit, Evaporator Coil, CF2R: MECH-01, MECH-20-HERS, MECH-(23 or 24)' -HERS, MECH-25-HERS' Compressor, TXV, Uneset, CF3R: MECH-20•HERS, MECH-(23 or 24) -HERS', MECH-25-HERS= Air Handler/Furnace 2 (Can include new ducting) Installer Requirement: Duct leakage LIS%, or < 10% to outside, or seal all accessible leaks), Air Flow z 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 Ducts3 CF111-ALT-02-E including Mini Split CF2R: MECH-01, MECH-20-HERS, MECH-22-HERS, MECH-(23 or 24) -HERS', MECH-25-HERS2 CF3R: MECH-20-HERS, MECH-22-HERS, MECH-(23 or 24) -HERS', MECH-25-HERS' 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 CFIR-ALT-02-E replaced: Condenser Unit, Evaporator Coil, CF2R: MECH-01; MECH-20-HERS, MECH-(23 or 24) -HERS, MECH-25-HERS Compressor, TXV, Uneset, Furnace' CF3R: MECH-Z0 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: ❑ 1. Existing ducts stems are constructed, insulated or sealed with asbestos ❑ 4. New Ducting over 40 feet Required Compliance Documents to be left on site fm Final: New ducting but less than All New Ducts' CFIR-ALT-02-E, CF2R: MECH-20-HERS, CF3R: MECH-20-HERS Installer Required to: Duct leakage L15% or, L10% 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 ' 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-2%', 2.5-3T-2%", 3.5 to 4T-2%", ST -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. 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. Designer Name: Responsible Designer Signature: Date Signed: Ucense: �R,�es;;PP°�nsible Jdearet��r 15 toS(,3l Company: Address: Cit State/Zip: Phone: Gev�1Xr 3100 b�.er.=,e l�r It,ouse,>.�l I�oiw. 92271. 7b0' 37qs8 For assistance or questions -regarding the Energy Standards; contact the Energy Hotline at: 1-800-772-3300