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BMCH2015-018778-495 CALLE TAMPICO Ta�/ 4 Qumr(v VOICE (760) 777-7125 D FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 COMMUNITY DEVELOPMENT DEPARTMENT. INSPECTIONS (760) 777-7153 BUILDING PERMIT Date: 5/28/2015 Application Number: BMCH2O15-0187 Owner: Property Address: 77360 CAMINO QUINTANA PATRICK GARVIN APN: 658250064 Property Zoning: Application Valuation: $6,000.00 ^—r_ Applicant: Contractor: ADAM SIMMONS ADAM SIMMONS N P O BOX 314 P 0 BOX 314 LA QUINTA, CA 92247 LA QUINTA, CA 92247' (760)564-7525 Llc. No.: 780534 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.: 780534 / / /t Date: )� /Z K// 'S 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).: (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. . 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 Address: 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 S ction 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 37 of the Labor Code, I shall forthwith comply with those provisions. 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/gnter upon the above- mentioned property for inspection purposes. n/1 X, Date: Signature (Applicant or Agent) DESCRIPTION FINANCIAL • 1• 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 forBUILDING STANDARDS ADMINISTRATION BSA: $1.00 $0.00 DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE HVAC CHANGEOUT - PACKAGED UNIT 101-0000-42402 0 $36.26 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE HVAC CHANGEOUT - PACKAGED UNIT PC 101-0000-42600 0 $24.17 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY Total Paid forCHANGEOUT: $60.43 $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 • •i 78-495 CALLE TAMPICO T4ht 4 Qu � VOICE (760) 777-7125 D FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 COMMUNITY DEVELOPMENT DEPARTMENT INSPECTIONS (760) 777-7153 BUILDING PERMIT Date: 5/28/2015 Application Number: BMCH2O15-0187 Owner: Property Address: 77360 CAMINO QUINTANA PATRICK GARVIN APN: 658250064 Property Zoning: Application Valuation: $6,000.00 Applicant: ADAM SIMMONS P 0 BOX 314 LA QUINTA, CA 92247 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.: 780534 Date: 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 -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 contractors) licensed pursuant to the Contractors' State License Law.). ( I 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 Contractor: ADAM SIMMONS P 0 BOX 314 LA QUINTA, CA 92247 (760)564-7525 Uc. No.: 780534 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. 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. Date: Signature (Applicant or Agent): PAID PAID DATE FINANCIAL INFORMATION DESCRIPTION ACCOUNT QTY AMOUNT BSAS SB1473 FEE 101-0000-20306 0 $1.00 $0.00 . PAID BY METHOD RECEIPT # CHECK # CLTD BY Total Paid forBUILDING STANDARDS ADMINISTRATION BSA $1.00 $0.00 DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE HVAC CHANGEOUT - PACKAGED UNIT 101-0000-42402 0 $36.26 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE HVAC CHANGEOUT - PACKAGED UNIT PC 101-0000-42600 0 $24.17 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY Total Paid forCHANGEOUT: $60.43 $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 CERTIFICATE OF COMPLIANCE Alterations to Space Conditioning Systems (formerly CF -IR -ALT HVAC) Project Name: Parricia Garvin I Date Prepared: CF1R-ALT-02-E (Page 1of3) 2015-05-18 A. General Information CF111-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 Parricia Garvin 02 Date Prepared 2015-05-18 03 Project Location 77360 Camino Quintana 04 Building Type Single family 05 CA City La Quinta 06 Dwelling Unit Name Parricia Garvin 07 Zip Code 92253 08 Dwelling Unit Conditioned 2000 Cnstalling 1, 4lnstalling Installing Floor Area (ft2) Location or Area by this SC ducted ; containing system Number of space conditioning ent rely w 09 Climate Zone 15 10 (SC) systems in this dwelling 1 component? components? feet of ducts? 'duct system? unit. Alteration Type B. Space Conditioning (SC) System Information ,r Ol 02 03 t 04 U5' d'�06 07 Orb; 09 10 1. :.. yA s the SC's Install ng a c,.•»`'" SC System SC System CFA served Ystem refrigerant f Installing ew C Cnstalling 1, 4lnstalling Installing Identification or Location or Area by this SC ducted ; containing system more than 40 ent rely w entirely new Name Served System (ft2) system? component? components? feet of ducts? 'duct system? SC system? Alteration Type System 1 whole house 2000 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-A0131618A-000000000-0000 Registration Date/Time: 2015-05-18 10:10:00 HERS Provider: CaICERTS CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2014-03-31 Report Generated: 2015-05-18 10:05:52 CERTIFICATE OF COMPLIANCE CF1R-ALT 02-E Alterations to Space Conditioning Systems (formerly CF -1R -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 All new Central All new Less than or System 1 . packaged HP heating AFUE 0.78 packaged AC cooling SEER 13 Setback equal to 40 R-8 components components feet 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%, or15 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:. .dam r, '" " -Duct systems registered with HERS provider as previously sealed are exempt from MCH -20 Duct Leakage Testing regwremeents. -Heating-only systems and Air Handler/Furnace changes do not require verification of Air Flow MCH -23 -or Refrigerant Charge MECHH-2255 duct insulated from Duct Leakage Testing -Existing systems constructed, or sealed with asbestos are exempt .MCR -20 requirements. E. Entirely New or Complete Replacement Duct System, with or without Equipment C ng out (Sections 150.2(b Dii and 50.2(b)lE, F) This section does not apply to this project. F. Entirely New or Complete Replacement Space Conditioning System (Section 150.2 WC) This section does not apply to this project. Registration Number: 215-A0131618A-000000000-0000 Registration Date/Time: 2015-05-18 10:10:00 HERS Provider: CalCERTS CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2014-03-31 Report Generated: 2015-05-18 10:05:52 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: Bachus, Tom //�Y(/�� Company: Signature Date: MLC Building Performance 2015-05-18 10:05:54 Address: CEA/ HERS Certification Identification (if applicable): 77825 Delaware Place City/State/Zip: Phone: Palm Desert CA 92211 760-836-0066 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 th3.e_Business and Professions Code to; accept responsibility for the building design or system design identified on this Certificate of Compliance (responsible designer). ign or system design identified on this Certificate of Compliance conform to the 3. That the energy features and performance specifications materials components, and manufactured devices for the builTinorma requirements of Title 24, Part 1 and Part 6 of the Californial. Code of Regulations. , 4. The building design features or system design features identified on this Certifcate of Compliance are consistent with thtion provided on othe 'applicabfe compliance documents, worksheets, calculations, plans and specifications submitted to the enforcement agency for a p val with this buildi gn permit ap Iication. w. : „ea. 5. 1 will ensure that a registered copy of this Certificate of Compliance shall be made available with the building permits issued for the building, and made available to theenforcement agency for all applicable inspections. I understand that a registered copy of thisCertifiicate of Compliance is required to be included with the documentation the builder provides to the building owner at occupancy. Responsible Designer Name: Respons Desigrier Signature . s7R Simmons, Donna Company: Date Signed: ADAM SIMMONS 2015-05-18 10:10:00 Address: License: 54440 AVENIDA CARRANZA 780534 City/State/Zip: Phone: LA QUINTA CA 92253. (760) 564-7525 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-A0131618A-000000000-0000 Registration Date/Time: 2015-05-18 10:10:00 HERS'Provider: CaICERTS CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2014-03-31 Report Generated: 2015-05-18 10:05:52 Bin # City Of La Quinta Building 8I' Safety Division P.O. Box 1504, 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012. Building Permit Application and Tracking Sheet Permit # Project Address: _ wner's Name: M4 A. P. Number: Address: e, ceA 61 0 n -u Legal Description: City, ST, Zip: CAee-4 s-� 3 Contractor: lu�.CJ� Telephone: <na<><? <<> Address: Project Description: City, ST, Zip: ua low, Z Telephone: hone: State Lic. #: � City Lic. M. Arch., Engr., Designer: Address: City, ST, Zip: e. Telephone:hon aneY Ctrons ucoonTY Pe: Occupancy: State ic. # S to L Project a circle one): ew Add'n Alter Repair air Demo b'P P Name of Contact Person: 'ate Sq. Ft.: # Stories: # Units: Telephone # of Contact Person: 71cn 73 ;5ff Estimated Value of Project: APPLICANT: DO NOT WRITE BELOW THIS LINE t! Submittal Req'd Recd TRACKING PERMIT FEES Plan Sets Plan Check submitted Item Amount Structural Calcs. Reviewed, ready for corrections Plan Check Deposit Truss Calcs. Called Contact Person Plan Check Balance Title 24 Cales. Plans picked up Construction Flood plain plan Plans resubmitted Mechanical Grading plan 2'. Review, ready for corrections/issue 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