BMCH2015-033678-495 CALLS- AMPICO -
LA QUINTA, CALIFORNIA 92253
Tiht 4 4 Qu�u&
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING PERMIT
Application Number:
BMCH2O15-0336
Property Address:
57545 BLACK DIAMOND
APN:
762340015
Application Description:
HUMPHREYS RESIDENCE / COIL REP
Property Zoning:
Application Valuation:
$1,500.00
Applicant:
IE INC
31225 LA BAYA
WESTLAKE VILLAGE, CA 91362
D0
T
ENT AUG 31 2015 LA
CITY OF LA QUINTA
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: 6 31 ) 5 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).:
U 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
Lender's Address:
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 8/31/2015
HUMPHREYS
ACK DIAMOND
fA, CA 92253
Contractor:
HARRISON ENTERPRISES INC DBA GENERAL AIR
CONDITIONING
31-170 RESERVE DRIVE STE A
THOUSAND PALMS, CA 92276
(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
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: _ 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.
t
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 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. c
Date: Signature (Applicant or Agent): J"rL
y
l 1 . l •
EDED SCRIPTIOIV "AkCCOUNT' Y
r.
QTY AMOUNTPAID PAID DATE=
esus .>.�. w. 4 ,.�_- . ?''� - �iN .r, fisc = 1z,rsza r-z,,r., :t
BSAS 561473 FEE 101-0000-20306 0
$1.00 $1.00 8/31/15
IE INC CHECK R8828 25672 MFA
Total Paid forBUILDING STANDARDS ADMINISTRATION BSA $1.00 $1.00
1OUDESCRIPTION:.F
PAID. DATE;
.,;�
ACCOUNT.• , x
4N
Z.xN.s�PD
.��ar ;..__�
HVAC CHANGEOUT - CONDENSER ONLY
101-0000-42402.
0
$36:26
$36.26
8/31/15
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IE INC
CHECK
R8828
25672
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DESCRIPTION s
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DATE
, .
Yytr
n�
kQrTYK��AMOUNT
PAID
HVAC CHANGEOUT - CONDENSER ONLY PC
101-0000-42600
0
$24.17
$24.17
8/31/15
.. WE
METHOD.' �
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CHECK #
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rRECEIRT
IE INC
CHECK
118828
25672
MFA
Total Paid forCHANGEOUT: $60.43 $60.43
r SDESCttIPTION
ACO NT'
TY
A(VIO NST r sok
k-111 s`�PAD V
PAIDDATE
i
PERMIT ISSUANCE
101-0000-42404
0
$91.85
$91.85
8/31/15
,d',� ""'F &�4 `' ' H yF•;w v!-.�, S,S�r^ w i
°5 PAID BY
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METHOD
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,RECEIPT n
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IE INC
CHECK
118828
25672
MFA
Total Paid for PERMIT ISSUANCE: $91.85 $91:85
•
Description: HUMPHREYS RESIDENCE/ COIL REPLACEMENT
Type: MECHANICAL Subtype: Status: ISSUED
Applied: 8/31/2015 MFA
Approved: 8/31/2015 MFA
Parcel No: 762340015 Site Address: 57545 BLACK DIAMOND LA QUINTA,CA 92253
Subdivision: TR 29147-1 Block: Lot: 45
Issued: 8/31/2015 MFA
Lot Sq Ft: 0 Building Sq Ft: 0 Zoning:
Finaled:
Valuation: $1,500.00 Occupancy Type: Construction Type:
Expired: 2/27/2016 MFA
No. Buildings: 0 No. Stories: 0 No. Unites: 0
ADDRESS1
Details: REPLACES TON EVAP COIL 16 SEER SPLIT SYSTEM [2008 ENERGY] CARBON MONOXIDE ALARM(S) TO BE INSTALLED PRIOR TO FINAL
INSPECTION. 2013 CALIFORNIA BUILDING CODES.
__j Applied to Approved
Approved to Issued
Printed: Monday, August 31, 2015 12:22:35 PM 1 of 2 r#? ..
SYSTEti1S
CONTACTS
NAME TYPE
NAME
ADDRESS1
CITY
STATE
ZIP
PHONE
FAX
EMAIL
APPLICANT
IE INC
31225 LA BAYA
WESTLAKE
CA
91362
(212)851-6795
VILLAGE
CONTRACTOR
HARRISON ENTERPRISES INC DBA
31-170 RESERVE DRIVE
THOUSAND
CA
92276
(212)851-6795
GENERAL AIR CONDITIONING
STE A
PALMS
OWNER
THOMAS HUMPHREYS
57545 BLACK
LA QUINTA
CA
92253
(212)851-6795
DIAMOND
Printed: Monday, August 31, 2015 12:22:35 PM 1 of 2 r#? ..
SYSTEti1S
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
RECEIPT #
CHECK #
METHOD
PAID BY
CLT
BY
BSAS SB1473 FEE
101-0000-20306
0
$1.00
$1.00
8/31/15
R8828
25672
CHECK
IE INC
MFA
Total Paid forBUILDING STANDARDS ADMINISTRATION
$1.00 $1.00
BSA:
HVAC CHANGEOUT -
101-0000-42402
0
$36.26
$36.26
8/31/15
R8828
25672
CHECK
IE INC
MFA
CONDENSER ONLY
HVAC CHANGEOUT -
101-0000-42600
0
$24.17
$24.17
8/31/15
R8828
25672
CHECK
IE INC
MFA
CONDENSER ONLY PC
Total Paid forCHANGEOUT: $60.43 $60.43
PERMIT ISSUANCE
101-0000-42404
1 0
$91.85
$91.85
8/31/15
R8828
25672
CHECK
IE INC
MFA
Total Paid for PERMIT ISSUANCE: $91.85 $91.85
TOTALS:
Printed: Monday, August 31, 2015 12:22:35 PM 2 of 2 C
SYS TEti1S
Bfn.#
Inta
Of Ld Quo:
Building & Safety Divislon
P.O. Box 1504,78-495 Calle Tampico
fa.Qulnta, CA 92253 - (760) 777-7012
Building Permit Application'and Tracking Sheet
Permit #
Project Address: 57545 Black Diamond
Owner's Name:. Tom Humphreys
A. P. Number:
Address: 57545 Black Diamond
Legal Description:
City, ST, Zip: La Quinta, CA 92253
Contractor: g
General Air Conditioning
p
Telephone:
Address: 31170 Reserve Drive
ProjectDescription: Replace Ston Evaporative Coil
City, ST, Zip: Thousand Palms, CA 92276
Telephone: 760-343-7488
4
State Lic. # : 686310
City Lie. M
Arch., Engr., Designer:
Address;
City., ST, Zip:
Telephone:
^y'...5�,.•�y%u`?�..'. • .
Construction Type:. Occupancy:
State Lic. #:'
Project type (circle one): New Add'n Alter Repair Demo
Name of Contact Person: Steven Schnierer
Sq.*Ft.; #Stories:
#Unit:
Telephone # of Contact Person: 818-735-7876 X 1
Estimated Value of Project: $1,500 .
APPLICANT: DO NOT WRITE BELOW THIS UNE
#
Submittal
Req'd
Recd
TRACFOTIG
PERMIT FEES
Pian Sets
Plan Check submitted
Item Amount
Structural Coles.
Reviewed, ready for corrections
Plan Check Deposit. .
Truss Cates.
Called Contact Person
Plan Check Balance.
Title 24 Cates.
Plans picked up
Construction
Flood plain plan
Pians resubmitted, .
Mecharilcal
Grading plan
2'! Review, ready for correctionstissue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.L
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
Alterations to Space Conditioning Systems (formerly CF -1R -ALT -HVAC)
Project Name:
TOM HUMPHREYS I Date Prepared:
CF111-ALT-02-E
(Page 1 of 3 )
2015-08-30
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 MR -ALT -02 document for each dwelling unit.
01
Project Name
TOM HUMPHREYS
02
Date Prepared
2015-08-30
03
Project Location
57545 BLACK DIAMOND
04
Building Type
Single family
OS
CA City
La Quinta
06
Dwelling Unit Name
TOM HUMPHREYS
07
Zip Code
92253
08
Dwelling Unit Conditioned
4600
ai vyJ j/
�J 4i VJ�j
Floor Area (ft2)
SC System
CFA served
",%s�ystem +—
refrige nt t
Installing ew SSC
Number of space conditioning
h tall+ g
09
Climate Zone
15
10
(SC) systems in this dwelling
1
containing
system
more than 40
entirely new
unit.
B. Space Conditioning (SC) System Information n [f, Fn)� n �
�1
�I �f0
01
02
03
04�`
U5 I ki
6 M
11 07
1169 11
09
10
.`
IIsthe St—
.+Installinga'�
r`' W Y
ai vyJ j/
�J 4i VJ�j
SC System
SC System
CFA served
",%s�ystem +—
refrige nt t
Installing ew SSC
Clnstall`ng
h tall+ 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
4600
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: 215-A6308230A-000000000-0000
Registration Date/Time
2015-08-30 09:40:30
HERS Provider: CalCERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2014-03-31 Report Generated: 2015-08-30 09:40:12
Schema Version: 0.555SDD
CERTIFICATE OF COMPLIANCE CF1R-ALT-02-E
Alterations to Space Conditioning Systems (formerly CF-lR-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
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
Indoor coil
SEER
16
Setback
section is not
section is not
altered
applicable
applicable
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 <_ 10% leakage to outside, or seal all accessible leaks.
CF2R-MCH-25-H & CF3R-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: te"
-Duct systems registered with HERS provider as previously sealed are exempt from-MCH-20,Duct LeakagerTesting requirements. ,�•
Air Handler/Furnace do Air Flow MCH X23, or Refrigerant MECH-257�
-Heating-only systems and changes not require verification of Charge
Existing duct systems constructed, insulated or sealed with asbestos are exempt from MCH 20 Duct Leakage Testing require em nLs.
� �l
E. Entirely New or Complete Replacement Dud System, with"or withoutl�Equipment Changeout (Sections 150.2(b)1Diia�and'0.2(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: 215-A6308230A-000000000-0000
Registration Date/Time:
2015-08-30 09:40:30
HERS Provider: CaICERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2014-03-31 Report Generated: 2015=08-30 09:40:12
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: n
Jacoby, Ian
cyan loco Jt
Company:
Signature Date:
Stratz Permit Service
2015-08-30 09:40:18
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 ofiRegulat onss.. '� � �" 11 �
4. The building design features or system design features identified on this Certificate of Compliance are consistent with the information -provided on other,applicatile compliance documents, worksheets,
calculations, plans and specifications submitted to the enforcement agency for approval with this building permit application. �
5. 1 will ensure that a registered copy of this Certificate bf.Coompliance shall be.made.available with the building permit(s) issued for the buildirig, and made ava table 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 provides to the building owner at occupancy.
Y
Responsible Designer Name: I "� [, _ Y .:
Responsible Designer Signature: V
Shanley, Barbara
Company:
Date Signed:
HARRISON ENTERPRISES INC dba GENERAL AIR CONDITIONING
2015-08-30 09:40:30
Address:
License:
31-170 RESERVE DRIVE STE A
686310
City/State/Zip:
Phone:
THOUSAND PALMS CA 92276
(760) 343-7488
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 accuracy of the information.
Registration Number: 215-A6308230A-000000000-0000 Registration Date/Time: 2015-08-30 09:40:30 HERS Provider: CaICERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2014-03-31 Report Generated: 2015-08-30 09:40:12
Schema Version: O.S55SDD