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BMCH2015-018678-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: Property Address: APN: Application Description: Property Zoning: Application Valuation: Applicant: ADAM SIMMONS P 0 BOX 314 LA QUINTA, CA 92247 Twit 4 COMMUNITY DEVELOPMENT DEPARTMENT BUILDING PERMIT BMCH2O15-0186 79720 RANCHO LA QUINTA DR 602210013 COLEMAN / CHANGE OUT (2)13SEER/78AFUE SPLIT SYSTEMS $10,500.00 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 DivisioA3of he Business and Professions Code, and my License is in full force and effect. License Class: C20 License No.: 780534n,'e`I Q Date: J /��T/�d Contractor 902�4q� 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.). (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 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 Na Lender's Address: VOICE (760) 777-7125 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 5/28/2015 Owner: JACK COLEMAN 79720 RANCHO LA QJINTA LA QUINTA, CA 92253 C C 0 c 2 z �C-) D Contractor: o < ADAM SIMMONS m P 0 BOX 314! LA QUINTA, CA 92247 zp m v r,St (760)564-7525 Uc. No.: 780534 WORKER'S COMPENSATIOA 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 ofthe Labor Code, for the performance of he 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 so become subject to the workers' compensation laws of California, and agree that, i:" I should become subject to the workers' compensation provisions of Section 3700 qF 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 NAIding Official for a permit subject to the conditions and restrictions set forth on this application. 1. Each person upon whose behalf this applicaton 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 applicatian 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 cancellaton. 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 ws relating to building construction, and hereby authorize representatives of this city enter upon the above• mentioned property for inspection purposes. Date: Signature (Applicant or.Agent FINANCIAL INFORMATION 'DESCRIPTION'ACCOUNT'AMOUNT _ ' PAID vPAIDrDATE' BSAS SB1473 FEE' 101-0000-20306 0 $1.00 • $0.00 PAID BYr } METHOD RECEIPT # #, CLTD BY r µ� .CHECK , Total Paid forBUILDING STANDARDS ADMINISTRATION BSA- $1.00 $0.00 DESCRIPTION •;4. ' : ACCOUNT QTY T AMOUNT };.' PAID PAID DATE. << . -,x , HVAC CHANGEOUT - SPLIT -SYSTEM -101-0000-42402 0 $145.04 $0.00 METHOD RECEIP.T:# �� .r.� CHECK i`,',7,, � CLTD BY }'' ' t: DESCRIPTION�aJAMOUNT;•P "PAID° ` '_ . PAID DATE` HVAC CHANGEOUT - SPLIT -SYSTEM PC 101-0000-42600 0 $72.52 $0.00. �.. ;,� .'. .. [, :�� yR.Ylt PAID"BY .. N' .� .' .. ,•«..a., "METHOD fi Y" .''� Si RECEIPT # 'CHECK # CLTD BY ' t„ .. , • t Total Paid forCHANGEOUT: $217.56 ` $0.00 '•� {DESCRIPTION 'ACCOUNT ,' QTY AMOUNT "PAID ° PAID DATE ..L• .fYm 4 - ,1 . PERMIT ISSUANCE 101-0000-42404 0 $91.85 $0.00 1' METHODS .i* RECEIPT# r t 7 i` tCHECK# : z ""CLTD BY: 4 Total Paid for PERMIT ISSUANCE: $91.85 $0.00 TOTALS:• •• Description: COLEMAN / CHANGE OUT (2)13SEER/78AFUE SPLIT SYSTEMS Type: MECHANICAL Subtype: _ Status: APPROVED Applied: 5/28/2015 SKH Approved: 5/28/2015 SKH Parcel No: 602210013 Site Address: 79720 RANCHO LA QUINTA DR LA QUINTA,CA 92253 Subdivision: TR 29457-1 Block: Lot: 12 Issued:' Lot Sq Ft: 0 Building Sq Ft: 0- Zoning: Finaled: Valuation: $10,500.00 Occupancy Type: Construction Type: Expired: No. Buildings: 0 No. Stories: 0 No. Unites: 0 - * PAID Details: HVAC CHANGE OUT - (2)13SEER/80AFUE SPLIT SYSTEMS [2013 ENERGY] CARBON MONOXIDE ALARM(S) TO BE INSTALLED PRIOR TO FINAL INSPECTION. 2013 CALIFORNIA BUILDING CODES. Printed: Thursday, May 28, 20154:42:19 PM 1 of 2 C SYSTEMS - }METHOD "{LTD=' b _ IACCOUNT 'QTY .. AMOUNT; .' - * PAID .PAID DATE RECEIPT#, CHECK# ; PAID BY : t . �DESCRIPTIONs. _ . .a •. ._....... } „' •.i r .. a 'n.. '.. S Lr.-' .. ... ,-}k. ; BSAS SB1473 FEE - 101-0000-20306 0 $1.00 $0.00 Total Paid forBUILDING STANDARDS ADMINISTRATION $1.00 $0.00 - BSA: Printed: Thursday, May 28, 20154:42:19 PM 1 of 2 C SYSTEMS b y . L j F ° N r r - Tab i DESCRIPTION; m +� ACCOUNT .. "CITY z ;,. `AMOUNT AID PAID. DATE RE EIPT' C #' ,CHECK #: METHOD PAID BY " BY µ HVAC CHANGEOUT - 101-0000-42402 0 $145.04 $0.00 SPLIT -SYSTEM HVAC CHANGEOUT - 101-0000-42600 0 $72.52 $0.00 SPLIT -SYSTEM PC Total Paid forCHANGEOUT: $217.56 $0.00 PERMIT ISSUANCE 101-0000-42404 0 $91.85 $0.00 Total Paid forPERMIT ISSUANCE: $91.85 $0.00 TOTALS:• i0 PROJECTSPARENT REVIEWS r r ¢ a - . RETURNED STATUS .,''� . . , REMARKS �� . ;REVIEW TYPE° _REVIEWER ^SENT DATE, ;.DUE DATE; �, ' ;.. NOTES," r gsa "DATE, Printed: Thursday,' May 28, 2015 4:42:19 PM 2 of 2 C srsrenns Qin # City of La Quinta Building 81: 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: Z � A, Owner's Name: 1r2 A. P. Number: Address: 7`1.- . Legal Legal Description: City, ST, Zip: L4 Z Z 5- 3 Contractor: Grl'!.fs Telephone: hone: Address: Project Description: 1 City, ST, Zip: T pone: h n,Xa- P o �! .5� S . State Lie. # : City Lie. #; Arch., Engr., Designer: Address: City., ST, Zip: Telephone: Co�nstru t on TYPe• O ccu etcY State Lie. #• Project type (circle one): "'New Add' n Alter Re P air Demo Name of Contact Person: Sq. Ft.: # Stories: # Units: Telephone # of Contact Person: 7� ' ' Estimated Value of Project:. APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Req'd Rcc'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 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 Fess A. General Information T . CHR -ALT -02 is applicable to multiple space conditioning systems contained within a single dwelling unit. When multiple dwelling units must be r ,- documented, use one_CFiR-ALT-02 document for each dwelling unit..— nit..' "01" Or Project Name ;+ Coleman ,0 2 Prepared. Date Pr red'. - _ ' ` , 2015`05 19 • "` 03 Project Location. • 79720 Rancho, La.Qui'nta Dr T, 04 Building Type Single family '05 : CA City . La Quints -� 06 Dwelling Unit Name Coleman 07 - Zip Code " tDwelling 92253 ,_ 08 Unit Conditioned Floor Area (ft2) { s 3200 � nstalling new SC Installing • ot apply this project.Ths section does n Number of space conditioning Identification or 09 Climate Zone 15 E 10 (SC) systems in this dwelling • 2 entirely new duct system? entirely new SC system? • unit �• . , 11't,�. .�c i "•:1 . % '_ . r ♦ * ; f •Y .. i-+ e,." B. Space Conditioning (SC) System Information - - - Ol,03 - 04 05 I 06 07 08. 09 _. 10 ,. Is the SC Installing a I .,� _ Installing ° r ti SC System SC System CFA served stem a refrigerant � nstalling new SC Installing ,stalling= ot apply this project.Ths section does n Identification or Location or Area by this SC System (ft2) ducted system? �;.,, containing component? ,system components? more than 40 feet of ducts? entirely new duct system? entirely new SC system? Alteration Type' Name Served �• . , 11't,�. .�c i "•:1 . % '_ . r ♦ * ; f •Y .. i-+ e,." .�.r 1. } ,'`a" System l LIVING AREA 1600 .,Yes �^ Yes: r Yes _ No' = No r, . k No Altered space . conditioning system System 2 Master and „1600 ..Yes Yes y Yes No �No No Altered space conditioning system rw y .. �.. _+r� !r" ,, ' - Bedrooms }. 1 f," i . ��l� a T. ` `` l"Report Version: 2014-03-31 y �- ,i Report Generated: 2015-05-19 -'+t 08'28:17 c ._ ,.. _ - .. .. .. ,�, ems^ ��n} c - • C. Extension of Existing Duct System; Greater Than 40 Feet (Section150.2(1b)1Diib) '7" . ot apply this project.Ths section does n `•' ` .• �` ' �• 11't,�. .�c i "•:1 . % '_ . r ♦ * ; f •Y .. i-+ e,." .�.r 1. } ,'`a" `J,. .� 4 t ,. 1. �+. ++. r 7 _,r a •. '."h, r. t- Sf _ r - •t '..yrrt � � 1 ,,.'4 .A "' S - i a• Z..t r. £A�g '' 261`5_05-19 08:28 24 '-• . H HERS Provider: CaICERTS , a: r ^Re istration Number;:"2i5-A0132975A-b00000000-0000 g„. ., ; t -., -Registration"Date/Time : rw y .. �.. _+r� !r" ,, ' - i� 't, �3 , •� }. 1 f," i . ��l� � t ' {r , T, T. ` `` l"Report Version: 2014-03-31 y �- ,i Report Generated: 2015-05-19 -'+t 08'28:17 '. .CA Building ;Ener Efficient .Standards -.2013 Residential Compliance g gY Y s ;` �' Y ,. z • �rharr1.iVarcinn'. n S��nn r r x rR¢. f , 4 A CERTIFICATE OF COMPLIANCE C fi FiR ALT 02 E (Page 2of3) Alterations to Space Conditioning Systems (formerly CF=1R-ALT HVAC) i D. Altered Space Conditioning System (Sections 150.2(b)lE and F) " 01 02 03 04 05 06 07 : `" 08 „ 09 10 �� ' •�0. } r, �1� �. t ,. - W f { .r "� h :{ -rJ '� ; t .�'.ia 4 w."♦ s +"r ,�' l .+. iI .. 'Heating Heating H . Cooling Yom"♦ .. ti ` System Heating Altered Minimum f '' Altered (.00lfng mmiilluiii Required Newor 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 System 1 - Central gas-, All new heating AFUE 0.78 Centrals lit P All new cooling SEER , 13 ,- Setback Less than or `equal t 40 R-8 ' furnace components AC com orients P feet System 2 Central gas: All new. heating 4 AFUE ` 0.78 Centralsplit" All new .cooling SEER 13 Setback'. Less than or equal to 40 -, R 8 furnace components, ` ; ;.componentsfeet AC `+ Required Documentation:, e CF2R-MCH-01-E - Space Conditioning Systems Ducts and Fans . r Duct insulation requirement for new plenums: R6. .' CF211-MCH-20-1-1 & CF3R-MCH-20-H — Duct Lea ge 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% leakag o outside, or seal all access le leaks., CF2R-MCH-25-H & CF3R-MCH-25-H Refrigerant Charge Veri�ficaationrequired when refrigerant containing components arIr'e installed or altered appliwble in C7 2, 8 15). required re wired ` CF2RCF3R-MCH-23 & CF3R-MCH-23 Air Flow >_ 300 CFM/ton when MCH -25 is F. n. Exceptions:, requirements. �+ age Testing -Duct systems registered with HERS provider as previously sealed are exempt from MCH -20 DuctrLeak- .:. s.,-. Heating and Air Handler/Furnace changes do not require verification of Air Flow MCH -23, or Refrigerant Charge MECH 25. - ' 4 -only systems ffi . m ,, s �: -Existing duct systems constructed, insulated or sealed with asbestos are exempt from MCHr20 Duct Leakage Testing requirements. ' Y� .« J iY..-: f f�; �' -� � ` '{; +.i �� `t yi , . � * .r. i J:' J,+s i' ;' • _ "j 7 �� ' •�0. } r, �1� �. t ,. - W f { .r "� h :{ -rJ '� ; t .�'.ia 4 w."♦ s +"r ,�' l .+. iI .. ,y,,. !t, "^� �� ) . r�;'� t Yom"♦ .. Registration Date/Time: 2015-05-1908:28:24 HERSvtr—.Provider CaICERTS Registration Numbed:_ 215=A0132975A-000000000-0000 .•` _. , 2013. Residential Compliance Report Version: 2014 03-31% Report Generated: 2015-05-19 08;28:17 . - CA Building Energy Efficiency Standards - ,'. - i.t .%c. r 4 n r ^ ,• . ..• .x• .Cr'hPma Vakinn' n SSgCllll + *�,. 4 �� F K'+ •� CERTIFICATE OF COMPLIANCE - + . CF1R-ALT 02-E Alterations to Space Conditioning Systems (formerly CF=1R-ALT-HVAC) : ; . ' +Y (Page 3 of 3 ) 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. ; Digitally signed by CaICERTS ;This digital g nature p i Y �•y'. �f:T i S 'ii •-y " 7Y i•y •..i. . f• _ !` by �f } +,: . �, 19 08:28:24', x 'HERS Provider: CaICERTS ' ReglstraUon Number: 215-A0132975A 000000000 0000 a ,, Registration Date/Tlme`'2015,05 Buildiri Energy Efficiency Standards - 2013_Residential Compliance F• i 4Report Version: 2014-03-31 i Re_ port Generated: 2015705-19 08:28:17 CA g+ Grhama Varcinn'..n SSSCr1tl -Documentation Author's Declaration Statement :. 1.•1 certify that this Certificate of Compliance documentation is accurate and complete. Documentation Author Name: Documentation Author Signature: Simmons, Donna -P Company:. Signature Date:, ADAM SIMMONS, 2015-05-19 08:28:24 Address: CEA/ HERS Certification Identification (if applicable): 54440 AVENIDA CARRANZA City/State/Zip: Phone: LA QUINTA CA 92253 (760) 564-7525 Responsible Person's Declaiationstatement, I certify the following under penalty of perjury, under' theulaws 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 ofthe 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 rt 6 of the California C e of Regulations.' _. requirements of Title 24, Part land P featyre�entified o this Certificates of are c s_istent with the information provided on other applicable compliance documents, worksheets, 4. The building design features or systemdesign Compliance specifications submitted to the enforcement agency for approval with this building permit application. calculations, plans and ' .,. as 5.; 1 will ensure that a registered copy of this Certificate of Compliance shall be made available with the building permit) issued for the building, and made available to.. .... forcement 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: (. Responsible Desi ner Signature '%�I��iS a r G��1�G6X.a Simmons, Donna Company: ADAM SIMMONS �+ Date Signed: ' r 2015-05-19 08:28:24 Address: ..t � � �+ License: - 54440 AVE NIDA CARRANZA 780534 City/State/Zip: Phone: ' LA QUINTA CA 92253 " t. {760) 564-7525 ,; F , ; , i;,., 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. ; Digitally signed by CaICERTS ;This digital g nature p i Y �•y'. �f:T i S 'ii •-y " 7Y i•y •..i. . f• _ !` by �f } +,: . �, 19 08:28:24', x 'HERS Provider: CaICERTS ' ReglstraUon Number: 215-A0132975A 000000000 0000 a ,, Registration Date/Tlme`'2015,05 Buildiri Energy Efficiency Standards - 2013_Residential Compliance F• i 4Report Version: 2014-03-31 i Re_ port Generated: 2015705-19 08:28:17 CA g+ Grhama Varcinn'..n SSSCr1tl