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BMCH2015-0241. 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 Clas • C20 License No.: 92006 Date: Contra 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 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: (760)770-4357 Llc. No.: 920062 WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of tie following declarations: I have and will maintain a certificate :)f 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 perforrrBnce 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 &l work for which this permit is issued, I shall not employ any person in'any manner so ai to become subject to the workers' compensation laws of California, and agree.that, if I should become subject to the workers' cam ensation provisions of Section 3700 o e Labor Code, I sh rthwith comply with osepr isions. Date: s Applicant: WARNIN :.FAILURE TO SECURE WORKERS' C PENSATION COILAGE 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 ACKNO%A LEDGEMENT 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 applicztion 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 sta-e 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 representat'ves of this- ' to enter upon the a mention g prop y f�spection purposes. D / Signature (Applicant or Ag �� •c(/ r 4 VOICE (760) 777-7125 7.9-495 CALLE TAMPICO D FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 COMMUNITY DEVELOPMENT DEPARTMENT INSPECTIONS (760) 777-7153 BUILDING PERMIT Date: , 6/30/2015 Application Number: BMCH2O15-0241 Owner: Property Address: 48655 PASEO TARAZO SHERYL HARTMAN APN: 646082054. 2255 E VERMONT AVE Application Description: HVAC CHANGE OUT Property Zoning: ANAHEIM, CA 92253 Application Valuation: $11,823.00 3 0 2015Applicant: fCorMMUNITy Contractor: TIMO'S AIR CONDITIONING &HEAT OF LA QUINTA TIMO'S AIR CONDITIONING& HEAT' 72-067 NORTHSHORE STREET STE A VELOPMENTDEPARTNIENT 72-067 NORTHSHOIRE STREET STE A THOUSAND PALMS, CA 92276 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 Clas • C20 License No.: 92006 Date: Contra 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 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: (760)770-4357 Llc. No.: 920062 WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of tie following declarations: I have and will maintain a certificate :)f 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 perforrrBnce 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 &l work for which this permit is issued, I shall not employ any person in'any manner so ai to become subject to the workers' compensation laws of California, and agree.that, if I should become subject to the workers' cam ensation provisions of Section 3700 o e Labor Code, I sh rthwith comply with osepr isions. Date: s Applicant: WARNIN :.FAILURE TO SECURE WORKERS' C PENSATION COILAGE 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 ACKNO%A LEDGEMENT 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 applicztion 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 sta-e 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 representat'ves of this- ' to enter upon the a mention g prop y f�spection purposes. D / Signature (Applicant or Ag �� •c(/ r FINANCIAL t 5 ;QTY AMOUNTrt PAID #PAID.DATE srA00OUNT BSAS SB1473 FEE 101-0000-20306 0 $1.00 $0.00 � �4 F "� w= r ;,METHOD RECEIPT #' ;, z. BY, BV:� # C sPAID ' :t� ss <� ;CHECK 1 ­ Total Paid for BUILDING STANDARDS ADMINISTRATION BSA $1.00 $0.00 . T DESCRIPTION; QTYI� =,AMOUNT r PAID "r � PAIUVDATE z.. V:: Yl jACCOUNT�!'4 ." ` HVAC CHANGEOUT - SPLIT -SYSTEM 101-0000-42402 0 $72.52 $0.00 AID ax' P,BY* METHOD -RECEIPT # CHECK # _z CLTD BYf wry, _• DESCRIPTIONY f s ACCOUNTS _ rAINI0UNT '- „ �PAID>DATE ,PAID �a� HVAC CHANGEOUT - SPLIT -SYSTEM PC 101-0000-42600 0 $36.26 - $0.00 PAIDBY, �`"'� a 'METHOD �� 'RECEIPT#� t wd CHECK# �`;. CLTDBY aa.33" Total Paid forCHANGEOUT: $108.78 $0.00 ` `.z..:pDESCRIPTION v �LLACCOUNT�f; >QTY, ? AMOUNT „�� PAID q j'. €PAID DATE PERMIT ISSUANCE 101-0000-42404 0 $91.85 $0.00 PAIQ BY , ` t METHOD?RECEIPT } # e 4 CHECK # z CODBYa Total Paid for PERMIT ISSUANCE: $91.85 $0.00 TOTALS: $201.63 00 •i Iain #_ Permit # Project Address: W4-7�� A. P. Number: Legal Description: Contractor,<— Address: City, ST, Zip. I-TuC;t'9+;t) Telephone: 161C-- 7 76.. `f' ) State Lic. # : Arch., Engr., Designer: Address: City., ST, Zip: City of La Quinta -Building 8z Safety Division P.O. Box 1504; 78-495 Calle Tampico . La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and'' Tracking Sheet Z� Owner'sName: `7e AddrZip ess•.�t^�' ` City, ST, ��JCd>I �T ➢ L% I.V Telcphl Project ell- City Lic. #t �� .......° sr < <' Construction Type: ccupancy: Teleph :... ":.: il:i!:ii-:Av"l -f: iii!:j;.v!,-ii'..: r.• •;:Sv,.;. project type (circle one) New Addt n Alter Repair Demo Sate Lic. ..... Name of Contact Person: Sq. Sq. Ft.:t5 t� #Stories: # Units: Telephone # of Contact Person: ` l© ,_ ��j Estimated Value of Proj L� • APPLICANT: DO NOT WRITE BELOW THIS LINE #1 Submittal Req'd Reed TRACKING PERMIT FEES. Plan Check submitted Reviewed, ready for corrections Called Contact Person Plans irked up P Plans resubmitted 2•' Review, read for corrections/issue y Called Contact Person picked icked u P Plans resubmitted Rcview, ready for correctionslissue Called Contact Person Date of permit issue Item Amount Plan Check Deposit Plan Check Balance. Construction Mechanical Electrical Plumbing S.M.L Grading Plan Sets Structural Cala. Truss Cala. Title 24 Cales. Flood plain plan Grading plan Subcontactor List . Grant Deed H.O.A. Approval Developer Impact Fee IN IiOUSE•- A.I.P.P. - Planning Approval Pub. Wks. Appr School Fccs • . Total Permit Fees Description: HVAC CHANGE OUT CONTACTS Type: MECHANICAL Subtype: _ Status: APPROVED Applied: 6/30/2015 EVA Approved: 6/30/2015 EVA Parcel No: 646082054 Site Address: 48655 PASEO TARAZOLA QUINTA,CA 92253 Subdivision: TR 20052-4 Block: Lot: 54 Issued: Lot Scl Ft: 0 Building Scl Ft: 0 Zoning: Finaled: Valuation: $11,823.00 Occupancy Type: Construction Type: Expired: No. Buildings: 0 No. Stories: 0 No. Unites: 0 Details:. HVAC CHANGE OUT - 20 SEER / .80AFUE SPLIT SYSTEM [2008 ENERGY] CARBON MONOXIDE ALARM(S) TO BE E INSTALLED PRIOR TO FINAL INSPECTION. 2013 CALIFORNIA BUILDING CODES. APPLICANT TIMO'S AIR CONDITIONING & HEAT AUU FINANCIAL CONTACTS INFORMATION �F -NAME TYPE `` NAMEP �;° ADDRESSl CITY STATERZIP PHONEK FAX $ EMAIL , APPLICANT TIMO'S AIR CONDITIONING & HEAT 72-067 NORTHSHORE THOUSAND CA •92276 (559)284-5247 STREET STE A PALMS CONTRACTOR TIMO'S AIR CONDITIONING & HEAT 72-067 NORTHSHORE THOUSAND CA 92276 (559)284-5247 STREET STE A PALMS . OWNER SHERYL HARTMAN 2255 E VERMONT AVE ANAHEIM CA 92253 (559)284-5247 FINANCIAL INFORMATION Printed: Tuesday, June 30, 2015 3:05:28 PM 1 of 2' CffW"YSTCMS BOND INFORMATION , Phnted:Tuesday, June 30,2O15]lB:Z8Pm1 . 2ofZ Total Paid for BUI LDING'STANDARDS ADMINISTRATION $1.00 $0.00 HVAC CHANGEOUT - 101-0000-42402 01 $72.52 $0.00 HVACCHANGEOUT- 101-0000-42600 a $36.26 $0.00 SPLIT -SYSTEM PC Total Paid forCHANGEOUT: $108.78 $0.00 Total Paid for PERMIT ISSUANCE: $91.85 $0.00 BOND INFORMATION , Phnted:Tuesday, June 30,2O15]lB:Z8Pm1 . 2ofZ CERTIFICATE OF COMPLIANCE CFIR-ALT-02-E Alterations to Space Conditioning Systems (formerly CF -IR -ALT -HVAC) (Page 1 of 3 ) Project Name: Steve Hartman Date Prepared: 2015-0630 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 Steve Hartman 02 Date Prepared 2015-06-30 03 Project Location 48655 Paseo Tarazo 04 Building Type Single family 05 CA City p CERTIFICATE OF COMPLIANCE CFIR-ALT-02-E Alterations to Space Conditioning Systems (formerly CF -IR -ALT -HVAC) (Page 1 of 3 ) Project Name: Steve Hartman Date Prepared: 2015-0630 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 Steve Hartman 02 Date Prepared 2015-06-30 03 Project Location 48655 Paseo Tarazo 04 Building Type Single family 05 CA City La Quinta 06 Dwelling Unit Name Steve Hartman 07 Zip Code 92253 08 Dwelling Unit Conditioned 2000 'FIs the SCS` ` `Installing a Floor Area (ft2) ir° f as art Number of space conditioning 09 Climate Zone 15 10 (SC) systems in this dwelling 1 'CFA served "4 ystem a unit. B. Space Conditioning (SC) System Informationy AW -10"_ 01 02 C X03 0405£ 06 07 w ` 08 09 10 'FIs the SCS` ` `Installing a +s€< ir° f as art '"Installing SC System SC System 'CFA served "4 ystem a refrigerant rinstalling newSC installing I €ldsialling Identification or Location or Area by this SC ducted containing system more than 40 ent elyen w entirely new Name Served System (ft2) system? component? components? feet of ducts? duct system? SC system? Alteration Type System 1 Location 1 2000 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-A0177874A-000000000-0000 CA Building Energy Efficiency Standards - 2013 Residential Compliance is Registration Date/rime: 2015-06-30 12:26:49 Report Version: 2014-03-31 Schema Version: 0.555SDD HERS Provider: CaICERTS Report Generated: 2015-06-30 12:26:58 - CERTIFICATE OF COMPLIANCE CF1R-ALT-02-E Alterations to Space Conditioning Systems (formerly CF -IR -ALT -HVAC) (Page 2 of 3 ) D. Altered Space Conditioning System (Sections 15O.2(b)lE and F) O1 02 03 04 05 06 07 08 09 _0 11 12 Heating Cooling System Heating Altered Heating Minimum Altered Cooling Minimum Reglired 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 T -pe Duct Length R -Value All new All new This field or This field or System 1 Central gas heating AFUE 0.8 Central split cooling SEER 20 Setback section isnot section is not furnace components AC components applicable applicable Required Documentation: CF2R-MCH-01-E -Space Conditioning Systems Ducts and Fans - -Duct Insulation requirement for new plenums: R6. . )-A CF2R-MCH-20-H & CF311-10CH-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: 5 1596, or 5 30% leakage to outside or.seal all accessible leaks. CF2R-MCH-25-H & CF3R-MCH-25-H Refrigerant Charge.Veinfrcation?required.when-refrigerant containing components are Installed or altered (applicable in CZ 2, 8-15). CF2RCF3R-MCH-23 & CF3R-MOH-23 Air FIow,2 300 CFM/ton required when MCH -25 Is required. " Exceptions: -Duct systems registered with HERS provider as previously sealed are exempt fr MCH 2,Duct leakage Testing rq�uuementz systems and Air Handler/Furnace changes do not require verification of Air FII w~MCH 23or RetngemnTCharge T2,.;-. -Heating-only are from MCH 20«Duct Leakage Testlng requiie"me�nts ' -Existing duct systems constructed, insulated or sealed with asbestos exempt f5E. EntirelyNew or Complete Replacement Duct System, withor w hout+E a ment Cangout (_ctins15p.2 _)bDnaa nd0.2(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-A0177874A-000000000-0000 Registration Date/Time: 2015-06-30 12:26:49 HERS Provider: CaICERTS CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2014-03-31 'teport Generated: 2015-06-30 12:26:58 Schema Version: 0.555SDD CERTIFICATE OF COMPLIANCE : CFIR-ALT-02-E Alterations to Space Conditioning Systems (formerly CF -IR -ALT -HVAC) (Page 3 of 3 ) V Documentation Author's Declaration Statement 1.1 certify that this Certificate of Compliance documentation is accurate and complete. Documentation Author Name: Documentation Author Signature: ) _/,1/0L Timo , Joseph C/� r Company: Signature Date: TIMO'S AIR CONDITIONING & HEATING INC 2015-06-30 12:26:49 Address: CEA/ HERS Certification Identification (if applicable): 72-067 NORTHSHORE STREET STE A City/State/Zip: Phone: THOUSAND PALMS CA 92276 (760) 770-4357 Responsible Person's Declaration statement I certify the following under penalty of perjury, under thd6,ws of the State of California: 1. The information provided on,this Certificate"of ComplianceAs true a^nd correct. 2. 1 am eligible under Division 3 of the Businessend Professions Code}to a ccept7esponsibllity for the building design or system design identified on this Certificate of Compliance (responsible designer). 3. That the energy features and performance specifications, materlalrcomponents, and manufactured devices for the building design or. system design Identified on this Certificate of Compliance conform to the requirements of Title 24, Part 3 and Part 6pf the Cahfornia'.Code of g la`tlons.11 P 4. The building design features or system design features aidentified ontthis Certificate,of Compliance are } consistentwith the monformatibn.prowded an of cappliii bf-,-dmpliance documents, worksheets, calculations, plans and specifications submittedtothe e4orcemenmtzagencyfor5p',rocvaeltwith this bu(Idirgpermj'plicatiav S. I that copy this Certifirate�of C, mpliance shall he'rnade,ayad@ble wkh tfto building'permn(sj:jssued f.6the,:Wilding, and__made available.tothe enforcement agency for all applicable will ensure a registered of iheabuilder to,the building inspections. I understand that a registered copy of this Ceacate of Complliancep required to b,e,,jnduded with theddgHcumWtaattion p4oyides owner at occupancy. Responsible Designer Name: w 1 Lo.. TX Responsible Designer 5 gnattre: V f Timo , Joseph 0 t(/N Company: Date Signed: TIMO'S AIR CONDITIONING & HEATING INC 2015-06-30 12:26:49 Address: License: 72-067 NORTHSHORE STREET STE A 920062 City/State/Zip: Phone: THOUSAND PALMS CA 92276 (760) 770-4357 Digitally signed by CaICERTS. This digital signature is provided in order to secure the content of this registered document and in no way implies Registration Provider responsibility for the accuracy of the information. Registration Number: 215-A0177874A-000000000-0000 Registration Datefrime: 2015-06-30 12:26:49 HERS Provider: CaICERTS CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2014-03-31 Report Generated: 2015-06-30 12:26:58 Schema Version: 0.555SDD