BMCH2015-034878-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
4.4 Qumr(u
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING PERMIT
Application Number:
BMCH2O15-0348
Property Address:
79160 BIG HORN TRAIL
APN:
776030016
Application Description:
BIERSACK / CHANGE OUT (1) 14SEER CONDENSOR AND COIL
Property Zoning:
x
Application Valuation:
$3,000.00
Applicant:
NJO
DOVE AIR INC
C.7'I
68-749 RISUENO ROAD
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 70001 of Division 3 of the Business and Professions Code,
and my License is in full force and effect.
License Class: C20 License No.: 794315
Dat ` f 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 ) 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 Name:
Lender's
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Owner:
KEVIN BIERSACK
1290 CAMPEON CIR
PALM SPRINGS, CA 92253
Contractor:
DOVE AIR INC
68-749 RISUENO ROAD
CATHEDRAL CITY, CA 92234
(760)327-1890
Llc. No.: 794315
Date: 9/3/2015
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 WCRKERS' 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.
j,f�'
Date: .3Signature (Applicant or Agent):
z
Uj
o�
x
M rJ
o2
rn y
NJO
n
C.7'I
M
M
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 WCRKERS' 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.
j,f�'
Date: .3Signature (Applicant or Agent):
FINANCIAL .
DESCRIPTION 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 - CONDENSER ONLY
101-0000-42402
0
$36.26
$0.00
PAID BY
METHOD.
RECEIPT #
CHECK #
CLTD BY
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
HVAC CHANGEOUT - CONDENSER ONLY PC
101-0000-42600
0
$24.17
$0.00
PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
HVAC CHANGEOUT - REPAIR/ALTERATION
101-0000-42402
0
$12.09
$0.00
PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
HVAC CHANGEOUT - REPAIR/ALTERATION
PC
101-0000-42600
0
$4.83
$0.00
PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY
Total Paid forCHANGEOUT: $77.35 $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
• 1 • $0.00
Description: BIERSACK / CHANGE OUT (1) 14SEER CONDENSOR AND COIL
Type: MECHANICAL Subtype: Status: UNDER REVIEW
Applied: 9/3/2015 SKH
Approved:
Parcel No: 776030016 Site Address: 79160 BIG HORN TRAIL LA QUINTA,CA 92253
Subdivision: TR 25429 Block: Lot: 24
Issued:
Lot Sq Ft: 0 Building Sq Ft: 0 Zoning:
Finaled:
Valuation: $3,000.00 Occupancy Type: Construction Type:
Expired:
No. Buildings: 0 No. Stories: 0 No. Unites: 0
NAME TYPE
Details: HVAC CHANGE OUT - (1) 14SEER CONDENSOR AND COIL [2013 ENERGY] CARBON MONOXIDE ALARM(S) TO BE INSTALLED PRIOR TO
FINAL INSPECTION. 2013 CALIFORNIA BUILDING CODES.
ADDITIONAL SITES
CHRONOLOGY
CONDITIONS
CONTACTS
NAME TYPE
NAME
ADDRESSI
CITY
STATE
ZIP
PHONE
FAX
EMAIL
APPLICANT
DOVE AIR INC
68-749 RISUENO ROAD
CATHEDRAL
CITY
CA
92234
CONTRACTOR
DOVE AIR INC
68-749 RISUENO ROAD
CATHEDRAL
CITY
CA
92234
OWNER
KEVIN BIERSACK
1290 CAMPEON CIR
PALM SPRINGS I
CA
I 92253
Printed: Thursday, September 03, 2015 2:54:19 PM 1 of 2
SYSTEMS
ATTACHMENTS
Printed: Thursday, September 03, 2015 2:54:19 PM 2 of 2
R�SYSTEMS
CLTD
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
RECEIPT #
CHECK #
METHOD
PAID BY
BY
BSAS SB1473 FEE
101-0000-20306
0
$1.00
$0.00
Total Paid forBUILDING STANDARDS ADMINISTRATION $1.00 $0.00
BSA:
HVAC CHANGEOUT -
101-0000-42402
0
$36.26
$0.00
CONDENSER ONLY
HVAC CHANGEOUT -
101-0000-42600
0
$24.17
$0.00
CONDENSER ONLY PC
HVAC CHANGEOUT -
101-0000-42402
0
$12.09
$0.00
REPAIR/ALTERATION
HVAC CHANGEOUT -
101-0000-42600
0
$4.83
$0.00
REPAIR/ALTERATION PC
Total Paid forCHANGEOUT: $77.35 $0.00
PERMIT ISSUANCE
101-0000-42404 1
0
$91.85
$0.00
Total Paid forPERMIT ISSUANCE: $91.85 $0.00
TOTALS:00
ATTACHMENTS
Printed: Thursday, September 03, 2015 2:54:19 PM 2 of 2
R�SYSTEMS
IT #14-r AIPA t 40�---S
Bin #
City of La Quinta
Building SZ Safety Division
78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
Project Address: -3 �362—
Owner's Name:
A. P. Number:
Address: 5'U 2 PCtl E/ r.
Legal Description:
City, ST, Zip: 0 " C_ -5'b
Contractor: / v
Telephone:
hone:
Address: t YA l)
Project Description:
ULl A, V
I
City, ST, Zip:
c�
Telephone: / 'SS
State Lic. # :
City Lie. #.
Arch., Engr., Designer:
Address:
City., ST, Zip:
Telephone:
-
.
Construction n TY Pe: aneY
Occupancy:
:
ic. #•
Project hPa (circle le one • New Add'n Alter Repair
Demo
Name of Contact Person: p
Sq. Ft.:
# Stories:
# Units:
Telephone # of Contact Person: L/!3 —113 "
Estimated Value of Project:
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 Cates.
Called Contact Person
Plan Check Balance
Title 24 Cafes.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2nd Review, ready for-corrections/issue
Electrical
Subeontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
II.O.A. Approval
Plans resubmitted
Grading
IN ROUSE:-
'"! Review, ready for corrcctionsfissue
Developer Impact Fee
Planning Approval
Called Contact Person
A.1.P.P.
Pub. Wks. Appr
Date of permit issue
scho6l Fees,
Total Permit Fees
WX
CERTIFICATE OF COMPLIANCE
Alterations to Space Conditioning Systems (formerly CF -1R -ALT -HVAC)
Project Name:
Kevin Biersack I Date Prepared:
CF1R-ALT 02-E
(Page i of 3 )
2015-09-01
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
Kevin Biersack
02
Date Prepared
2015-09-01
03
Project Location
79160 Big Horn TH.
04
Building Type
Single family
05
CA City
La Quinta
06
Dwelling Unit Name
Kevin Biersack
SC System
SC System
CFA served
08
Dwelling Unit Conditioned
1200
07
Zip Code
92253
Floor Area (ft2)
Location or Area
by this SC
ducted
, a .
containing
system
Number of space conditioning
entirely new
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 Ito. M ir
01
02
03
c 04 kv
05.
06
07 "� _f
08 -
09
10
..
��Is the SC
i 9i ..4 "'n �wtl
< Installing a
Y
bL IFM K
"MA�.IY W
SC System
SC System
CFA served
`'tis�ystem a
refrigerant
4..
,Installing,new SC
{ + a .
Installing I
w
Installing=
1 ..+ *.-
Installing
Identification or
Location or Area
by this SC
ducted
, a .
containing
system
more than 40
entirely new
entirely new
Name
Served
System (ft2)
system?
component?
components?
feet of ducts?
duct system?
I SC system?
Alteration Type
Altered space
System 1
Office &Bedroom
1200
Yes
Yes
Yes
No
No
No
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-A6309967A-000000000-0000
CA Building Energy Efficiency Standards - 2013 Residential Compliance
Registration Date/Time:
Report Version: 2014-03-31
Schema Version: 0.555SDD
2015-09-01 08:13:24
HERS Provider: CaICERTS
Report Generated: 2015-09-01 08:13:23
CERTIFICATE OF COMPLIANCE
Alterations to Space Conditioning Systems (formerly CF -1R -ALT HVAC)
CF1R-ALT-02-E
(Page 2 of 3 )
D. Altered Space Conditioning System (Sections 150.2(b)1E and F)
rN
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
No heating
This field or
This field or
Central split
All new
This field or
This field or
System 1
Central gas
component
section is not
section is not
AC
cooling
SEER
14
Setback
section is not
section is not
furnace
altered
applicable
applicable
components
applicable
applicable
Reauired 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: 515%, or 510% 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:'
-Duct systems registered with HERS provider as previously sealed are exempt from 'MCH-20,DDuucct Leakage,Testing ke{gwrements.
-Heating-only systems and Air Handler/Furnace changes do not require verification of Air Flow+MCH-23, or Refrigerant Charge MECH-2
nr-
insulated or sealed with asbestos are exemptf�rom MCH 20 Duct Leakage Testing requirements.
-Existing duct systems constructed,
�.,
E. Entirely New or Complete Replacement Duct System, with or w thout Equipment Changeout (Sections 150.2(b)1Diia an J150.2(b)1E, F)
This section does not apply to this project.
F. Entirely New or Complete Replacement Space Conditioning System (Section 150.2(b)iC)
This section does not apply to this project.
i
Registration Number: 215-A6309967A-000000000-0000
CA Building Energy Efficiency Standards - 2013 Residential Compliance
Registration Date/Time: 2015-09-01 08:13:24
Report Version: 2014-03-31
Schema Version: 0.555SDD
HERS Provider: CalCERTS
Report Generated: 2015-09-01 08:13:23
CERTIFICATE OF COMPLIANCE CFiR-ALT 02-E
Alterations to Space Conditioning Systems (formerly CF -1R -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:
Laster, Gary
Company:
Signature Date:
DOVE AIR INC
2015-09-01 08:13:24
Address:
CEA/ HERS Certification Identification (if applicable):
68-749 RISUENO ROAD
City/State/Zip: •
Phone:
1(760)
CATHEDRAL CITY CA 92234
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 R egula ons. �� � � � ��
Certificate of Compliance are the information -provided on other applicable ompliance documents, worksheets,
4. The building design features or system design features identified on this �connistent.with
and specifications submitted to the enforcement agency for approval with this building permit application.
calculations, plans
P P 't1 4.4 �i.y� � vk �. k6! , %
5. I will ensure that a registered copy of this Certificate of,Compliance shall,be'made:available witl] the buIIdingtpermit(s),issued for,the building,and,made available,to,the4enforcement agency for all applicable
�,ia.
inspections. I understand that a registered copy of this Certificate of Compliance is_requiired to be included with the.,documeentationApwl�thepuilder provides to the buvilding owner at occupancy.
,ice, v v ie—
Responsible Designer Name: i� .- Responsible Designer Signature:`
G(lbiXJ(i
Laster, Gary
Company: Date Signed:
DOVE AIR INC 2015-09-01 08:13:24
Address:
License:
68-749 RISUENO ROAD
794315
City/State/Zip:
Phone:
CATHEDRAL CITY CA 92234
(760) 327-1890
Digitally signed by Ca10ERTS. 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-A6309967A-000000000-0000
CA Building Energy Efficiency Standards - 2013 Residential Compliance
Registration Date/Time:
Report Version: 2014-03-31
Schema Version: 0.555SDD
2015-09-01 08:13:24
HERS Provider: CaICERTS
Report Generated: 2015-09-01 08:13:23
Bin #
City of La Quinta
Building a 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: , o
Owner's Name: e- -1 'M t Q
A. P. Number:
Address:
Legal Description:
City, ST, Zip:
Contractor:
Telephone: e hone:
P
Address: v
Project Description: A
City, ST, Zip:
Telephone:
hone:
State Lic. # :
City Lic. #.: 103 5 cl
Arch., Engr., Designer:
Address:
City., ST, Zip:
Telephone:
n
Co tructi
s on Type: Occupancy:
P
to
Ste Lic. #
Project ect h'P e one): circle e . New Add' n Alter r ReA ai r Demo
Name of Contact Person:
Sq. Ft.:
# Stories:
# Units:
Telephone # of Contact Person:
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
N
Submittal
Req'd
Rec'd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Cafes.
Reviewed, ready for corrections
Plan Check Deposit
Truss Cafes.
Called Contact Person
Plan Check Balance
Title 24 Cafes.
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 r
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
W