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BMCH2016-0156T-ih 78-495 CALLE TAMPICO 0 D 4 Qum LA QUINTA, CALIFORNIA 92253 COMMUNITY DEVELOPMENT DEPARTMENT II BUILDING PERMIT Application Number: BMCH2O16-0156 Owner: Property Address: 78770 CABRILLO WAY BOLTHOUSE APN: 646410027 78770 CABRILLO WY Application Description: BOLTHOUSE / COIL AND CONDESOR LA QUINTA, CA 92253 Property Zoning: Application Valuation: $3,500.00 Applicant: ADAM SIMMONS P 0 BOX 314 LA QUINTA, CA 92247 Contractor: ADAM SIMMONS P 0 BOX 314 LA QUINTA, CA 92247 (760)564-7525. Llc. No.: 780534 VOICE (760) 777-7125 FAX (760) 777-7011 MONS (760."',-X7044749 Date:___57_11/2016 C_,_1 3; WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter I hereby affirm under penalty of perjury one of the following declarations: O I have and will maintain a certificate of consent to self -insure for workers' and my License is in full force and effect. compensation, as provided for by Section 3700 of the Labor Code, for the performance fJ � oft the work for which this permit is issued. C rV 1 have and will maintain workers' compensation insurance, as required by ;M_ O Section 3700 of the Labor Code, for the performance of the work for which this permit LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter I hereby affirm under penalty of perjury one of the following declarations: 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, I have and will maintain a certificate of consent to self -insure for workers' and my License is in full force and effect. compensation, as provided for by Section 3700 of the Labor Code, for the performance License Class: C20 License No.: 780534 oft the work for which this permit is issued. �- - 1 have and will maintain workers' compensation insurance, as required by Date: Contractor. - 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: - OWNER -BUILDER DECLARATION Carrier: _ Polity Number: I hereby affirm under penalty of perjury that I am exempt from the Contractor's State I certify that in the performance of the work for which this permit is issued, I License Law for the following reason (Sec. 7031.5, Business and Professions Code: Any shall not employ any person in any manner so as to become subject to the workers' city or county that requires a permit to construct, alter, improve, demolish, or repair compensation laws of California, and agree that, if. I should become subject to the any structure, prior to its issuance, also requires the applicant for the permit to file a workers' compensation provisions of Section 3700 the Labor Code, I shall forthwith signed statement that he or she is licensed pursuant to the provisions of the comply with those provisions. 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 Date: S� Applicant: 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 WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, ($500).: AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO (_) I, as owner of the property, or my employees with wages as their sole ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION TO THE COST OF compensation, will do the work, and the structure is not intended or offered for sale. COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, (Sec. 7044, Business and Professions'Code: The Contractors' State License Law does not INTEREST, AND ATTORNEY'S FEES. apply to an owner of property who builds or improves thereon, avid who does the work himself or herself through his or her own employees, provided that the improvements APPLICANT ACKNOWLEDGEMENT are not intended or offered for sale: If, however, the building or improvement is sold IMPORTANT: Application is hereby made to the Building Official for a permit subject to within one year of completion, the owner -builder will have the burden of proving that the conditions and restrictions set forth on this application. he or she did not build or improve for,the purpose of sale.). 1. Each person upon whose behalf this application is made, each person at whose (1 1, as owner of the property, am exclusively contracting with licensed contractors request and for whose benefit work is performed under or pursuant to any permit to construct the project.. (Sec. 7044, Business and Professions Code: The Contractors' issued as a result of this application , the owner, and the applicant, each agrees to, and State License Law does not apply to an owner of property who builds or improves shall defend, indemnify and hold harmless the City of La Quinta, its officers, agents, and thereon, and who contracts for the projects with a contractor(s) licensed pursuant to employees for any act or omission related to the work being performed under or the Contractors' State License Law.). following issuance of this permit. (_ I I am exempt under Sec. . BAP.C. for this reason 2. Any permit issued as a result of this application becomes null and void if work is 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 i 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 Eertify 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 er upon the above-mentionedpropertyfor inspection purposes. - Date: A* //' Signature (Applicant or Agent): • j o• � o W. �kFr NDESCRIPTION r s� Yg+a> ACCOUNT$, 4 µay QT {AMOUNT$-� PAID ,PAIO4DATE - WAS SB1473 FEE, 101-0000-20306 £ 0 $1.00 $0.00 K _ YQL + £�;; ```r ., _>...u.:_c.'..'.£.Sw .a �.,". ..� £,ate sr•,X _ t, wn.. v*x fF> W : "` CHECK #xq CLTDgBY .... -., o :, .......{... 6 w w+ n cT✓. _ h a • :.Y n �X;.., Total Paid for BUILDING, STANDARDS ADMINISTRATION.BSA: $1.00 $0.00 }� , 7wY .fi .•i k.:. YS,,..S ] 1 72. 4 ! ,a }j'£ a �; DESCRIPTION ;. f � Y:� $ACCOUNT 23 QTY AMOUNT�t ; PAID '0AID DATE HVAC CHANGEOUT - CONDENSER ONLY 101-0000-42402 0 $36.26. $0.00 PAID'.BY ., SSS METHODX, „> t .z,R._. ". s,.,� RECEIPT -M— .:T J <h-xf.. �,�'.Y �'�Y f � ,��4 �.3 R CHECK # � ;n CLTD BY E,.i Ct, eln.... 5v ". )� Xe45fii.,�.S�'s}s ���. Z 'SP. ;sv,cS[ �� "��a �.•i 'n b� DESCRIPTION, �s • X�7 � {. ex ^�-f k�.'�•. ACCOUNT ' .. �� ... ?QTYt -. ,'4rt'£mihj'i� n,f AMOUNT ` PAID PAID DATE HVAC.CHANGEOUT - CONDENSER'ONLY'PC 101-0000-42600' 0 $24.17 $0.00 w _.. 5. _; : PAID BYE .,:?Y W '.: ,... t '_ € METHOD .fid „ . . :r -s, k'9r` RECEIPT # ? .Y� wx.. _. W:: :r a, ..; ._:a ,. rs. ,. ,e,:OR' . r \ 'yam, ,, £ "CHECK #� F."�.., , ,r',L 3 '" D[ U'.' "CLTD BYE " •y� {�` Y. "Y«t i'?;x4.JM?}"Fo45 "4n['• v:{ �,r-: '- k>r 'c{iL.Y"i�`•=: �.� ll..F� -.. DESCRIPTION �; ...x4 .w:nirc-t-•.-Eh E,pyY "ACCOUNT Sim Y'tt,'&'v R s i?I x :. i E -3>•>:( F, ACCOUNT',:'QTY .H-+>,k➢:.r.. e iCt,, u...;. E it.x c k4 �'ei ofd fxf 3 `i?a• ,. *PY•`v'f w R,'�' .'a"�✓'� ..�;AMOUNT.<. � ::a : v JE z L r_:i.un.,YV S» .f_ .atY ��'PAID t.r Sax�*k'.<1..:4.C'E4. ,. "_eco P.AID,:DATE ✓:::'E.}::ZY,tr4,: a:.; HVACCHANGEOUT-'REPAIR/ALTERATION. 101-0000-42402 0 $12.09 $0.00 .w Yom' ?`r. PAIVBY ,..:��.>a:r,,;i.s4sCLTDBY.a: METHOD , ,RECEIPT :a.£ " x`Ey'„^`"`_,:. <.tfi,'fm ti'.z*...�, ;a. '�;'�' ,£' Yx: ;�i.;d:...s�•`'n`.,;ar_•`s`1::..Si'"+3'�;�.: .aX:C "...v._.,.kA000UNTg r g, 44YEcF ,F^,.5' AMOUNT�x�' k s`'PAID 4F 0. PAID DAT. EI HVAC'CHANGEOUT - REPAIR/ALTERATION PC 101-0000-02600. 0 $4.83 $0.00 R;PAIWBY PTO,'�51106 CLT D BY ToFtal Paid CHANGEOUT:. $77:35 .$0.00 'y y� ="k rt,� fT.Yrt. ,y2L.345`"•',5 VDESCRIPTION, � ��4 '3.,➢t '.:. 4,1 }:"YJ£..%S.roi k.';f.f .'. •k E _e ACCOUNT , n '.. QTY M :1='.:. d-..,k"�T#:..wY AMOUNT � 4,_::.�F .{oxx%s...xS;•� x Fw k lh PAID PAID DATE'. 'PERMIT ISSUANCE .301-0000-42404 0 $91.85 $0.00 PAID{'�BY°. `,� r.:: '�§'.'e,::-_7.<A�, t"v .:.�vM (i: .�.` _'. r t METHODS 4x tx,?RECEIPTY# Vii._ -. ,c .'!.. 9E.. .i•4•Ec.3 �: �. €. .:.rs k3 r y ° F'i.Y�Y.. . CHECK#f Y Nr>,x.F`h ��' CLTDB YE,,, Total Pad PERMIT _ISSUANCE: $91.85 $0.00 • •0 i Description: BOLTHOUSE / COIL AND CONDESOR Type: MECHANICAL Subtype: Status: UNDER REVIEW Applied: 5/17/2016 SKH Approved: Parcel No: 646410027 Site Address: 78770 CABRILLO WAY LA QUINTA,CA 92253 Subdivision: PM 20469 Block: Lot: 5 Issued: Lot Sq Ft: 0 Building Sq Ft: 0 Zoning: Finaled: Valuation: $3,500.00 Occupancy Type: Construction Type: Expired: No. Buildings: 0 No. Stories: 0 No. Unites: 0 Details: HVAC CHANGE OUT- (1) CONDENSOR AND (1) COIL [2013 ENERGY] CARBON MONOXIDE ALARM(S) TO BE INSTALLED PRIOR TO FINAL INSPECTION. 2013 CALIFORNIA BUILDING CODES. CHRONOLOGY CONTACTSCONDITIONS NAME TYPE NAME ADDRESSI CITY STATE ZIP PHONE FAX EMAIL APPLICANT ADAM SIMMONS P 0 BOX 314 LA QUINTA CA 92247 Simmonscda@yahoo.c om CONTRACTOR ADAM SIMMONS P 0 BOX 314 'I LA QUINTA CA I 92247 Iom Simmonscda@yahoo.c OWNER BOLTHOUSE 1 7$770 CABRILLO WY I LA QUINTA CA 1 92253 Printed: Tuesday, May 17, 201611:43:37 AM 1 of 2 C SYSTEMS Printed: Tuesday, May 17, 2016 11:43:37 AM 2 of 2 SYS TEti1S CLTD DESCRIPTION ACCOUNT CITY AMOUNT PAID PAID DATE RECEIPT # CHECK # METHOD PAID BY BY BSAS SB1473 FEE 101-0000-20306 0 $1.00 $0.00 Total Paid for BUILDING 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 for CHANGEOUT: $77.35 $0.00 PERMIT ISSUANCE 101-0000-42404 0 $91.85 $0.00 Total Paid for PERMIT ISSUANCE: $91.85 $0.00 TOTALS:00 Printed: Tuesday, May 17, 2016 11:43:37 AM 2 of 2 SYS TEti1S CERTIFICATE OF COMPLIANCE CFIR-ALT-02-E Alterations to Space Conditioning Systems (formerly CF -1R -ALT -HVAC) Project Name: VOLTHOUSE I Date Prepared: (Page 1 of 3 ) 2016-04-14 A. General Information MR -ALT -02 is applicable to multiple space conditioning systems contained within a single dwelling unit. When multiple dwelling units must be documented, use one MR -ALT -02 document for each dwelling unit. 01 Project Name HOLTHOUSE 02 Date Prepared 2016-04-14 03 Project Location 78770 Cabrillo Way 04 Building Type Single family 05 CA City La Quinta 06 Dwelling Unit Name BOLTHOUSE 07 Zip Code 92253 08 Dwelling Unit Conditioned 1000 OInstalling Installing `Installing Floor Area (ft2) Location or Area by this SC 'ducted y system Number of space conditioning entirely new 09 Climate Zone 15 10 (SC) systems In this dwelling 1 component? components? feet of ducts? dud system? unit. Alteration Type B. Space Conditioning (SC) System Information 01 02 03 04:,&05 06 07'�� _ 08 09 10 � • ti. lls the SCS-'` t '� '"�.. Installing a y.....--../ Awl #mS. 4i �/ / IJ R.i LF wy,.J �+/' SC System SC System CFA served "\system a� ce rf ige nt 'i .Installing new SC 1. OInstalling Installing `Installing Identification or Location or Area by this SC 'ducted containing system more than 40 entirely new entirely new Name Served System (ft2) system? component? components? feet of ducts? dud system? SC system? Alteration Type System 1 whole house 1200 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: 216-A0140223A-000000000-0000 Registration Date/Time: 2016-04-14 19:22:09 HERS Provider: Ca10ERTS CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013 Rev 1.007 Report Generated: 2016-04-14 19:22:37 Crhomn %larcinn• n: CCCCrNI CERTIFICATE OF COMPLIANCE CF1R-ALT-02-E Alterations to Space Conditioning Systems (formerly CF -1R -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 30 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 System 1 Central gas All new AFUE 0.78 Central split All new cooling SEER 16 Setback Less than or equal to 40 R-8 furnace compo is AC components feet Required 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%, ors 10% leakage to outside, or seal all accessible leaks. CF211-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 Duct Leakage. Testing requirements. �s -. r_ -Heating-only systems and Air Handler/Furnace changes do not require verification of Air Flow MCH -23; or'Refrigerant Chaige MECE -Existing duct systems constructed, insulated or sealed with asbestos are exempt.from MCH=20 DuctrLeakage Testing requirements. h 11 �t if tE 11 1!, E. Entirely New or Complete Replacement Duct System, with or without Equipment Changeout (Sections,150.2(b)Wlia 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: 216-A0140223A-000000000-0000 Registration Date/Time: 2016-04-14 19:22:09 HERS Provider: CaICERTS CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013 Rev 1.007 Report Generated: 2016-04-14 19:22:37 Crhoma vareinn• n GCCCnr1 CERTIFICATE OF COMPLIANCE CF2R-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: �Bl��GNGXGdz1Gd� Simmons, Donna Company: Signature Date: ADAM SIMMONS 2016-04-14 19:22:09 Address: CEA/ HERS Certification Identification (if applicable): 54440 AVENIDA CARRANZA City/State/Zip: Phone: LA QUINTA CA 92253 760-564-7525 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 Regulatlons.r"� 4. The building design features or system design features identified on this Certificate of Compliance are cons�stentwith the information provided on other applicable oc mpliance documents, worksheets, calculations, plans and specifications submitted to the enforcement agency for approval'with this building permit application. '^� J � � ,. w r �� ,[ r�.�s ate_ i� r� �t S. I will ensure that a registered copy of this Certificate of,Compliance shall be made.available with the building permit(s).issued for the building, and made available to 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: ' li Lm t -N +w Responsible Designer Signature: V i L �B1la:l��f.�Yt��1L4� Simmons, Donna Company: Date Signed: ADAM SIMMONS 2016-04-14 19:22:09 Address: License: 54440 AVENIDA CARRANZA 780534 City/State/Zip: Phone: LA QUINTA CA 92253 760-564-7525 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: 216-A0140223A-000000000-0000 Registration Date/Time: 2016-04-14 19:22:09 HERS Provider: CaICERTS CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013 Rev 1.007 Report Generated: 2016-04-14 19:22:37 r,rhomn \/aminn• n rrrgn I Bin # City of La Quinta Building&• Safety Division 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Permit # Project Address: •77� �A �r G� Owner's Name: A. P. Number: Address: 70 Legal Description: City, ST, Zip: ZZ3 Contractor: P�f s< Address: Address: ,©, �� Project Description: e— City, ST, Zip: :- C� T TPele h o� State Lic. # : j�' City Lie. #.- tArch., Arch.,Engr., Designer: Address: City., ST, Zip: Telephone: �' [ n Co structi n T o e: P Y P v Occu ancY: Sta to Lic. # DemoProject hPa (circle one. New Add'nAlterRe air Name of Contact Person: �. Sq. Ft.: #Stories: # Units: Telephone # of Contact Perso : ? --,a Estimated Value of Project: 35cxam. APPLICANT: DO NOT WRITE BELOW THIS LINE 0 Submittal Req'd Recd TRACKING PERMIT FEES Plan Sets Plan Check submitted Item Amount Structural Cates. 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 Pians 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 Pcrmit Fees