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BMCH2017-0212LICENSED 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: C220 License No.: 794315 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 permii 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).: (_j 1, 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 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 tothe Contractors' State License Law.). U 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: (760)327-1890 Llc. No.: 794315 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: EXEMPT Polity Number: _ ertify 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 l should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, 1 shall forthwith comply with those provisions. L ( wr. D e.-6 Applicanti � 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. 1 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 (Applica �A,gent). VOICE (760) 777-7125 78-495 CALLE TAMPICO FAX FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 DESIGN & DEVELOPMENT DEPARTMENT (760) 777-7153 BUILDING PERMIT Date: 6/6/2017 Application Number: BMCH2O17-0212 Owner: �. z Property Address: 79810 RANCHO LA QUINTA DR EUGENE SBARBARO APN: 602220001 Application Description: SBARBARO / HVAC CHANGE OUT - (1)14SEER COIL 92253 © a z Property Zoning:Cy W Application Valuation: $1,000.00 p �LL o � d Z it Applicant: Contractor: z DOVE AIR INC DOVE AIR INC 68-749 RISUENO ROAD . 68-749 RISUENO ROAD o U CATHEDRAL CITY, CA 92234 CATHEDRAL CITY, CA 92234 . 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: C220 License No.: 794315 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 permii 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).: (_j 1, 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 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 tothe Contractors' State License Law.). U 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: (760)327-1890 Llc. No.: 794315 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: EXEMPT Polity Number: _ ertify 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 l should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, 1 shall forthwith comply with those provisions. L ( wr. D e.-6 Applicanti � 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. 1 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 (Applica �A,gent). Date: 6/6/2017 Application Number: BMCH2O17-0212 Owner: Property Address: 79810 RANCHO LA QUINTA DR EUGENE SBARBARO APN: 602220001 Application Description: SBARBARO / HVAC CHANGE OUT - (1)14SEER COIL 92253 Property Zoning: Application Valuation: $1,000.00 Applicant: Contractor: DOVE AIR INC DOVE AIR INC .68-749 RISUENO ROAD 68-749 RISUENO ROAD CATHEDRAL CITY, CA 92234 CATHEDRAL CITY, CA 92234 (760)327-1890 Ll c. Nd.: 794315 Detail: HVAC CHANGE-OU7 - (1)14 SEER COIL. CARBON MONOXIDE ALARM(S) TO BE INSTALLED. PRIOR TO FINAL INSPECTION: 2016 CALIFORNIA BUILDING CODES. FORMAT • DESCRIPTION ACCOUNT QTY AMOUNT BSAS SB1473 FEE 101-0000-20306 0 $1.00 Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $1.00. DESCRIPTION ACCOUNT QTY AMOUNT HVAC CHANGEOUT- REPAIR/ALTERATION .101-000042402 0 $12.67 DESCRIPTION ACCOUNT QTY AMOUNT HVAC CHANGEOUT - REPAIR/ALTERATION PC 101-0000-42600 0 $5.07 DESCRIPTION PERMIT ISSUANCE DESCRIPTION TECHNOLOGY ENHANCEMENT FEE Total Paid.for CHANGEOUT: $17.74 ACCOUNT QTY AMOUNT 101-0000-42404. 0 $96.27 Total Paid for PERMIT ISSUANCE: $96.27 ACCOUNT QTY AMOUNT 502-0000-43611 0 $5.00 Total Paid for TECHNOLOGY ENHANCEMENT FEE: • $5.00 r'n # Qty- of. La Quinta Building 8t Safety Division 78-495 Calle Tampico y,�� l La Quinta, CA 92253 - (760) 777-7012 V �ilding Permit Application and Tracking Sheet Permit # n LU Project Address: 0 &Vth 0 - C.G ; Owner's Name: r0' '. A. P. Number: Address: -7� 6 (O Legal Description: City, ST, Zip: �21 CA 6 s3 Contractor: 6 � Tele h n — o e. ""'•' Address: r Y\A ' Project Description: City, ST, Zip: �Jc 1 C— �` Tele Pne h o .7 "b 3 7 State Lic. # City Lie. #.:01.03:.Sir Arch., Engr., Designer: Address: City., ST, Zip: Telephone: e one: ' Construe tion TYP Occupancy: Type-. O P Y: State te Lic. Project hPa (circle le ne • New Add'n Alter Repairair Demo Name of Contact Person: Sq. Ft.: # Stories: # Units: Telephone # of Contact Person: ,� ��—�� D Estimated Value of Project: 0 0 V eA APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Req'd Recd TRACKING PERMIT FEES Plan Sets Plan'Check submitted Item Amount Structural Cafes. 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 correctionslssue Electrical Subcontactor List Called Contact Person Plumbing Grant Deed Plans picked up S.M.I. II.O.A. Approval Plans resubmitted Grading IN 110USE:- '"! Review, ready for correct ionstissue -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 CF111-ALT-02-E Alterations to Space Conditioning Systems (formerly CF -1R -ALT -HVAC) (Page 1 of 3) Project Name: Gene SbarbaroDate Prepared: 2017-06-06 L 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 CHR -ALT -02 document for each dwelling unit. 01 Project Name Gene Sbarbaro 02 Date Prepared 2017-06-06 03 Project Location 79810 Rancho LaQuinta Dr. 04 Building Type Single family 05 CA City La Quinta 06 Dwelling Unit Name G6ne Sbarbaro Dwelling Unit Conditioned Installing,a 07 Zip Code 92253 - 08 Floor Area (W) 3.000 SC System CFA.served system a' refrigerant Number of Space Installing 09 Climate Zone 15 10 Conditioning (SC-) Systems in 1 ducte4 containing system more than 40 this Dwelling Unit: entirely new Name Served System (ft 2) system? component? " UP r B. Space Conditioning (SC) System Information ,e F 01 02 03 04 08 69 10 "Is the SC Installing,a SC System SC System CFA.served system a' refrigerant Installing new SC Installing Installing Installing Identification or Location or Area by this SC ducte4 containing system more than 40 entirely new entirely new Name Served System (ft 2) system? component? I components? feet of ducts? duct system? SC system? Alteration Type Altered space System 1 Bedrooms ( 2 1400 Yes Yes Yes No No No conditioning system C. Extension of Existing. Duct System, Greater Than 40 Feet (Section 150.2(b) 1 Dii b) This section does not apply to this project. Registration Number: 217-A020188785A-000-.000-0000000-0000 Registration Date/Time: 2017-06-06 07:37:54 CA Building Energy Efficiency Standards - 2016 Residential Compliance Report Version: 2016.1.005 Schema Version: rev 10/16 HERS Provider: CalCERTS Report Generated: 2017-06-06 07:3.8:16 CERTIFICATE OF COMPLIANCE CF111-ALT.02-E Alterations to Space Conditioning Systems (formerly CF-iR-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 No heating N This field or This field or Central split This field or This field or System 1 gas component section is not section is not AC Indoor coil SEER 14 Setback section isnot section is not furnace -altered applicable applicable applicable applicable Required Documentation: CF2R-MCH-01-E - Space Conditioning Systems - Duct insulation requirement for the new portions of supply -air and return -air ducts or plenums: R6 (CZ 1-50, 12 and 13) and R8 (CZ 11 and 14-16) CF2R and CF3R-MCH-20-H - Duct Leakage Test 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 and MA -MCH -25-H Refrigerant Charge verification required when refrigerant containing components are installed or altered (applicable in CZ 2, 8-15). CF2R and CF3R-MCH-23 Airflow Rate >= 300 CFM per ton required when MCH -25 is required. Exceptions: Duct systems registered with HERS provider as previously sealed are exempt from MCH -20 Duct Leakage Testing requirements. Heating -only systems and Air Handler Furnace changes do not require verification of Air Flow MCH-23„or Refngerant Charge M"H-25.1,,-� !"Duct -Existing duct systems constructed;insulated or sealed with asbestos are exempt'frorri MC' 1_e51kage Test ing;regwrements. ,. ?s is xt E. Entirely New or Complete Replacement Duct System, with or without Equipment Changeout (Sectionsj,50.2(b)1Dna-.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)1C) This section does not apply to this project. Registration Number: 217-A020188785A-000-000-0000000-0000 Registration Date/Time: 2017-06-06 07:37:54 HERS Provider: CaICERTS CA Building Energy Efficiency Standards 2016 Residential Compliance Report Version: 2016.1.005 Report Generated: 2017-06-06 07:38:16 Schema Version: rev 10/16 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: ga6t21& Laster, Gary ay Company: Signature Date: DOVE AIR INC 2017-06-06 07:37:53 Address: CEA/ HERS Certification- Identification (if applicable): 68-749 RISUENO ROAD City/State/Zip: Phone: CATHEDRAL CITY CA 92234 760-327-1890 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 4. The building design features or system design features identified ori this Certificate of Compliance are consistent with the information. provided on therapp,licable compliance documents, worksheets, calculations, plans and specifications submitted to the eriforcement agency for approvalwith this building permit application. l x' 5. 1 will ensure that a registered copy of this Certificate of Compliance sfia11 be'made.�available with.,the building.permit(s) issued forthe,buildirig, and[made availabletoahe enforcement agency for all applicable inspections. I understand that registered copy of this Certificate of Compliance is required to be,included with the documentation the.builder provides to, he building owner at occupancy. Responsible Designer Name: ' 4 4 Responsible De4igrier Signature: sR^ Laster, Gary Company: Date Signed: DOVE AIR INC 2017-06-06 07:37:54 Address: License: 68-749 RISUENO ROAD 794315 City/State/Zip: Phone: CATHEDRAL CITY CA 92234 760-327-1890 Easy to Verify M. 51 at CaICERTS.com 16 Digitally signed by Ca10ERTS. This digital signature is provided in order to secure the content of this registered document and in no way implies Registration Provider responsibilityf the accuracy of the inforr�t Registration Number: 217-A020188785A-000-000-Ob00000-0000 Registration Date/Time: 2017-06-06 07:37:54 HERS Provider: CaICERTS CA Building Energy Efficiency Standards - 2016 Residential Compliance Report Version: 2016.1.005 Report Generated: 2017-06-06 07:38:16 Schema Version:.rev 10/16