BMCH2015-022778-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING PERMIT
Application Number:
BMCH2O15-0227
Property Address:
77435 CALLE COLIMA
APN:
774114001
Application Description:
BRUDVIK RESIDENCE HVAC C
Property Zoning:
Application Valuation:
$13,500.00
Applicant:
J ANTHONY PLUMBING HEATING & A
72216 NORTH SHORE ST #101
THOUSAND PALMS, CA 92276
JUN 26 2015
CITY OF LA QUINTA
COMMUNITY DEVELOPMENT DEPARTMENT
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, C36 License No.: 7777 4
Y /Contractor:
Date: 6L
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 ) 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 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:
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 6/26/2015
Owner:
SUSAN BRUDVIK
77435 CALLE COLIMA
LA QUINTA, CA 92253
Contractor:
J ANTHONY PLUMBING HEATING & A
72216 NORTH SHORE ST #101
THOUSAND PALMS, CA 92276
(760)343-2121
LIC. No.: 777794
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
o7fof a worwhich 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: Polity 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 Sectio 70 of the Labor Code, I shall forthwith
;ate:
mp) ith those provisions.
y4i a J 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 la • s relating to building
construction, and hereby authorize rep sentatives of this city t enter upon the above-
mentio property for inspection rposes.
Date (� Signature (Applicant or Agent):
DESCRIPTION
FINANCIAL INFORMATION
ACCOUNT QTY -AMOUNT PAID PAID DATE
BSAS SB1473 FEE
101-0000-20306 0
$1.00 $1.00 6/26/15
PAID BY
METHOD RECEIPT # CHECK # CLTD BY
J ANTHONY PLUMBING HEATING & A
CHECK R7346 40947 AZA
Total Paid forBUILDING STANDARDS ADMINISTRATION BSA $1.00 $1.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
HVAC CHANGEOUT - SPLIT -SYSTEM
101-0000-42402
0
$72.52
$72.52
6/26/15
PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY
1 ANTHONY PLUMBING HEATING & A
CHECK
R7346
40947
AZA
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
HVAC CHANGEOUT - SPLIT -SYSTEM PC
101-0000-42600
0
$36.26
$36.26
6/26/15
PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY
J ANTHONY PLUMBING HEATING & A
CHECK
R7346
40947
AZA
Total Paid forCHANGEOUT: $108.78 $108.78
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
PERMIT ISSUANCE
101-0000-42404
0
$91.85
$91.85
6/26/15
PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY
J ANTHONY PLUMBING HEATING & A
CHECK
R7346
40947
AZA
Total Paid forPERMIT ISSUANCE: $91.85 $91.85
TOTALS:
Description: BRUDVIK RESIDENCE HVAC CHANGE OUT
Type: MECHANICAL Subtype: Status: ISSUED Applied: 6/26/2015 AZA
Parcel No: 774114001 Site Address: 77435 CALLE COLIMA LA QUINTA,CA 92253 Approved: 6/26/2015 AZA
Subdivision: SANTA CARMELITA AT VALE LA QUINTA Block: 189 Lot: 24 Issued: 6/26/2015 AZA
UNIT 19
Lot Sq Ft: 0 Building Sq Ft: 0 Zoning: Finaled:
Valuation: $13,500.00 Occupancy Type: Construction Type: Expired: 12/23/2015 AZA
No. Buildings: 0 No. Stories: 0 No. Unites: 0
Details: HVAC CHANGE OUT - 14 SEER/80AFUE SPLIT SYSTEM [2008, ENERGY] CARBON MONOXIDE ALARM(S) TO BE INSTALLED PRIOR TO
FINAL INSPECTION. 2013 CALIFORNIA BUILDING CODES.
ADDITIONAL SITES
Printed: Friday, June 26, 2015 12:28:18 PM 1 of 2 Cm
SYSTEMS
CONDITIONS
CONTACTS
NAME TYPE
NAME
ADDRESSI
CITY
STATE
ZIP
PHONE FAX EMAIL
APPLICANT
J ANTHONY PLUMBING HEATING &A
72216 NORTH SHORE
THOUSAND
CA
92276
(
Printed: Friday, June 26, 2015 12:28:18 PM 1 of 2 Cm
SYSTEMS
INSPECTIONS
SEQID INSPECTION TYPE INSPECTOR SCHEDULED COMPLETED
DATE DATE
RESULT REMARKS NOTES
MECHANICAL FINAL" BLD
CLTD
DESCRIPTIONS
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
RECEIPT #
CHECK #
METHOD
PAID BY
-
BY
J ANTHONY
BSAS SB1473 FEE
101-0000-20306
0
$1.00
$1.00
6/26/15
R7346
40947
CHECK
PLUMBING HEATING
AZA
&A
Total Paid forBUILDING STANDARDS ADMINISTRATION
$1.00 $1.00
BSA:
J ANTHONY
HVAC CHANGEOUT -
101-0000-42402
0
$72.52
$72.52
6/26/15
R7346
40947
CHECK
PLUMBING HEATING
AZA
SPLIT -SYSTEM
&A
J ANTHONY
HVAC CHANGEOU-
101-0000-42600
0
$36.26
$36.26
6/26/15
R7346 .
40947
CHECK
PLUMBING HEATING
AZA
SPLIT -SYSTEM PCC
&A
Total Paid forCHANGEOUT: $108.78 $108.78
J ANTHONY
PERMIT ISSUANCE
101-0000-42404
0
$91.85.
$91.85
6/26/15
R7346
40947
CHECK
PLUMBING HEATING
AZA
&A
Total Paid for PERMIT ISSUANCE: $91.85 $91.85
TOTALS: $201.63 $201.63
INSPECTIONS
SEQID INSPECTION TYPE INSPECTOR SCHEDULED COMPLETED
DATE DATE
RESULT REMARKS NOTES
MECHANICAL FINAL" BLD
PARENT PROJECTS
Printed: Friday, June 26, 2015 12:28:18 PM 2 of 2
Ormw SYSTEMS
Bin #
Qty of La Quinta
Building &r Safety Division l.A
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
Project Address: �'2 l (�� l d(,�
Owner's Name:
A. P. Number:
Address: -5h-,-4
Legal Description:
City, ST, Zip:
Contractor:
Telephone: , ±'`„s> y? >:< <> `?< v « .
Address: gaze vo 19wvd 4Nvsn0H1
101 gig 16 UNG I UNGN 919R City, ST, Zip: '8-01A83S ANOH1Nd f
Project Description:
�-C (per CF—T0.0
Telephone:
P
'S ”
� 5 S
State Lic. # : % ,,I"
C� —Lx, ,-* S
Arch., Engr., Designer:
Address:
City., ST, Zip:
Telephone:
Y:': ":::
State Lic. #: ;4j:.w:.:..w:
Construction T e: Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
Name of Contact Person:
Sq. Ft.:
# Stories:
# Units:
Telephone # of Contact Person:
Estimated Value of Project: X00•
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Rec'd
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 Calcs.
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 correctionslissue .
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 CF1R-ALT 02-E
Alterations to Space Conditioning Systems (formerly CF -1R -ALT -HVAC) (Page 1 of 3 ).
Project Name: BRUDVIK Date Prepared: 2015-06-26
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 CF1R-ALT 02 document for each dwelling unit.
01
Project Name
BRUDVIK
02
Date Prepared
2015-06-26
03
Project Location
77435 CALLE COLIMA
04
Building Type
Single family
05
CA City
La Quinta
06
Dwelling Unit Name
BRUDVIK
07
Zip Code
92253
08
Dwelling Unit Conditioned
1600
x,
Floor Area (ft2)
SC System
SC System
CFA served
`system a��`
refrigerant
Number of space conditioning
nstallir►g
09
Climate Zone
15
10
(SC) systems in this dwelling
1
~ducted
containing
r system I. a
more than 40
unit.
entirely new
B. Space Conditioning (SC) System Information
01
02
03
04
/'' ; 05 ` .� `t
"--d6�'-
07 ;
08 i ��
09
30
x`ls
the SC_w.
`Installing a
x,
SC System
SC System
CFA served
`system a��`
refrigerant
.Installing new SC
nstallir►g
I sn tailing
Installing
Identification or
Location or Area
by this SC
~ducted
containing
r system I. a
more than 40
er t ly new
entirely new
Name
Served
System (ft2)
system?
component?
components?
feet of ducts?
duct system?
SC system?
Alteration Type
No alterationperformed
System 1
Location 1
1600
No
No
No
No
No
No
C. Extension of Existing Duct System, Greater Than 40 Feet (Section150.2(b)iDiib)
This section does not apply to this project.
D. Altered Space Conditioning System (Sections 150.2(b)1E and F)
This section does not apply to this project.
Registration Number: 215-A0173816A-000000000-0000 Registration Date/Time: 2015-06-26 11:07:13 HERS Provider: CaICERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2014-03-31 Report Generated: 2015-06-26 11:07:30
Schema Version: 0.555SDD
CERTIFICATE OF COMPLIANCE CF1R-ALT 02-E
Alterations to Space Conditioning Systems (formerly CF -1R -ALT -HVAC) (Page 2 of 3 )
E. Entirely New or Complete Replacement Duct System, with or without Equipment Changeout (Sections 150.2(b)lDiia 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.
a CEP,,,TS, nc.
Registration Number: 215-A0173816A-000000000-0000 Registration Date/Time: 2015-06-26 11:07:13 HERS Provider: CaICERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2014-03-31 Report Generated: 2015-06-26 11:07:30
Schema Version: 0.5555DD
CERTIFICATE OF COMPLIANCE CF111-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:
Robinson, Kevin
/�P,!/Nf/%i0+OG1GOB�ff/
Company:
Signature Date:
J ANTHONY PLUMBING HEATING & AIR CONDITIONING
2015-06-26 11:07:13
Address:
CEA/ HERS Certification Identification (if applicable):
72216 NORTH SHORE ST #101
City/State/Zip:
ne:
THOUSAND PALMS CA 92276
F760_343-2121
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 of Regulations. l t �- _ '? t , c- t `
4. 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 en%rcement agency for prove( with this building per mif application. �� 1
5. I will ensure that a registered copy of this Certificate of,Compliance shall he,matle available wlth the bu(Iding.permit(s) issued for'the building, and,made avallable3.o 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.
Responsible Designer Name: ``� f# ._ I 14. V N , W
Responsible Designer Signature: ii 1 �j
K
Robinson, Kevin
Company:
Date Signed:
J ANTHONY PLUMBING HEATING & AIR CONDITIONING
2015-06-26 11:07:13
Address:
License:
72216 NORTH SHORE ST #101
777794
City/State/Zip:
Phone:
THOUSAND PALMS CA 92276
760-343-2121
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-A0173816A-000000000-0000 Registration Date/Time: 2015-06-26 11:07:13 HERS Provider: CaICERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2014-03-31 Report Generated: 2015-06-26 11:07:30
Schema Version: 0.555SDD