BMCH2016-0222LICENSED 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:
1'�Tw
C20 C3License No.: 9066111�5�//�
Dat Contractor:
OWNER -BUILDER CIECLAVTION
I hereby affirm under penalty of perjury that I am a mpt 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 11, 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. 30971 -Civ. C.).
Lender's Name:
Lender's
(760)360-2202
Llc. No.: 906115
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 pr visions.
' f i
Date: ' Applicant:
WARNING: FAILURE TO SECURE WORKERS' COMP SA N 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.
Date: lJ 4 6 Signature (Applicant or Agent .
1P
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
U -`
COMMUNITY
COMMUNITY DEVELOPMENT DEPARTMENT___
VOICE (760) 777-7125
JUN 2 1 2016 � �� (760) 777-7011
INS S (760) 777-7153
BUILDING PERMIT
CITYOFOPMENTDA late:
COMMUNITY DEVELOPMENT DEPARTMENT
6/21/2016
Application Number: BMCH2O16-0222
Owner:
Property Address: 48575 CAPISTRANO WAY
RICHARD WEST
APN: 646390030
Application Description: RICHARD WEST / HVAC CHANGE OUT
92253
Property Zoning:
Application Valuation: $11,000.00
Applicant:
Contractor:
CERTIFIED COMFORT SYSTEMS INC DBA HYDES
CERTIFIED COMFORT SYSTEMS INC DBA HYDES
42-949 MADIO STREET
42-949 MADIO STREET
INDIO, CA 92201
INDIO, CA 92201
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:
1'�Tw
C20 C3License No.: 9066111�5�//�
Dat Contractor:
OWNER -BUILDER CIECLAVTION
I hereby affirm under penalty of perjury that I am a mpt 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 11, 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. 30971 -Civ. C.).
Lender's Name:
Lender's
(760)360-2202
Llc. No.: 906115
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 pr visions.
' f i
Date: ' Applicant:
WARNING: FAILURE TO SECURE WORKERS' COMP SA N 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.
Date: lJ 4 6 Signature (Applicant or Agent .
DESCRIPTION.
FINANCIAL UNFORIVIATION
ACCOUNT
QTY AMOUNT
PAID PAID DATE
BSAS SB1473 FEE
101-0000-20306
0 $1.00
$1.00 6/21/16
PAID BY
METHOD
RECEIPT #
CHECK # CLTD BY
CERTIFIED COMFORT SYSTEMS INC
CHECK
R16449
20480 RSE
Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $1.00. $1.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
HVAC CHANGEOUT - SPLIT -SYSTEM
101-0000-42402
0
$145.04
$145.04
6/21/16
PAID BY
METHOD -
RECEIPT #
CHECK #
CLTD BY
CERTIFIED COMFORT SYSTEMS INC
CHECK
R16449
20480
RSE
DESCRIPTION
ACCOUNT
QTY
AMOUNT
- PAID
PAID DATE
HVAC CHANGEOUT --SPLIT-SYSTEM PC
101-0000-42600
0
$72.52
$72.52
6/21/16
PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY
CERTIFIED COMFORT SYSTEMS INC
CHECK
R16449
20480
RSE
Total Paid for CHANGEOUT: $217.56 $217.56
DESCRIPTION
ACCOUNT -
QTY
AMOUNT
PAID
PAID DATE
PERMIT ISSUANCE
101-0000-42404
0
$91.85
$91.85
6/21/16
PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY
CERTIFIED COMFORT SYSTEMS INC
CHECK
R16449
20480
RSE
Total Paid for PERMIT ISSUANCE: $91.85 $91.85
TOTALS: $310.41 $310.41
Description: RICHARD WEST / HVAC CHANGE OUT
CONDITIONS
NAME TYPE
Type: MECHANICAL Subtype:
Status: UNDER REVIEW
Applied: 6/21/2016 RSE
Approved:
Parcel No: 646390030 Site Address: 48575 CAPISTRANO WAY LA QUINTA,CA 92253
Subdivision: TR 27840 Block:-
Lot: 113
Issued:
Lot Sq Ft: 0 Building Sq Ft: 0
Zoning:
Finaled:
Valuation: $11,000.00 Occupancy Type:
Construction Type:
Expired:
No. Buildings: 0 No. Stories: 0
No. Unites: 0
Details: HVAC CHANGE OUT (2).- 16.5SEER/80AFUE SPLIT SYSTEM [2013 ENERGY] CARBON MONOXIDE ALARM(S) TO BE INSTALLED PRIOR TO
FINAL INSPECTION. 2013 CALIFORNIA BUILDING CODES.
CERTIFIED COMFORT SYSTEMS INC
DBA HYDES
42-949 MADIO STREET
ADDITIONAL SITES
CHRONOLOGY
CONDITIONS
NAME TYPE
NAME
ADDRESSI
CONTACTS
CITY
STATE
ZIP
PHONE
FAX
EMAIL .
APPLICANT•
CERTIFIED COMFORT SYSTEMS INC
DBA HYDES
42-949 MADIO STREET
INDIO
CA
92201
CONTRACTOR
CERTIFIED COMFORT SYSTEMS INC
DBA HYDES
42-949 MADIO STREET
INDIO
CA
92201
OWNER
RICHARD WEST
92253
FINANCIAL INFORMATION
Printed: Tuesday, June 21, 2016 8:47:52 AM 1 of 2
SYSTEMS
BOND INFORMATION
Printed: Tuesday, June 21, 2016 8:47:52 AM 2 of 2
SYS7F.MS
CLTD
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
RECEIPT #
CHECK #
METHOD
PAID BY
_
BY
BSAS SB1473 FEE
101-0000-20306
0
$1.00
$1.00
6/21/16
R16449
20480
CHECK
CERTIFIED COMFORT
RSE
SYSTEMS INC
Total Paid for BUILDING STANDARDS ADMINISTRATION
$1.00 $1.00
BSA:.
HVAC CHANGEOUT -
101-0000-42402
0
$145.04
$145.04
6/21/16
R16449
20480
CHECK
CERTIFIED COMFORT
RSE
SPLIT -SYSTEM
SYSTEMS INC
HVAC CHANGEOUT -
101-0000-42600
0
$72.52
$72.52
6/21/16
R16449
20480
CHECK
CERTIFIED COMFORT
RSE
SPLIT -SYSTEM PC
SYSTEMS INC
Total Paid for CHANGEOUT: .$217.56 $217.56
PERMIT ISSUANCE
101-0000-42404
0
1 1
$91.85
T
$91.85
6/21/16
R16449
20480
CHECK
CERTIFIED COMFORT
RSE
SYSTEMS INC
Total Paid for PERMIT ISSUANCE: $91.85 $91.85
TOTALS:• .41
BOND INFORMATION
Printed: Tuesday, June 21, 2016 8:47:52 AM 2 of 2
SYS7F.MS
Bin. #
City, of U Quinta
Buiiding a Safety Division
P.O. Box 1504,78-495 Calle Tampico
La.Quinta, C.4 92253 - (760) 777-7012
- C am Building Permit Application and Tracking Sheet
Permit #
g ro o4 0-41
Project Address: 5
Owner's Name:.
A. P. Number.
Address:48
Legal Description:
Contractor: ;
City, ST, Zip;
M
' . �•;=g;�:¢i�;�::s
Address: _
Project Description:
City, ST, Zip:
Telephone: �_ 3 ,� —"� i
State Lic. #: City:Lic. #;
-
Arch:, Engr., Designer
Address:
City., ST, Zip:
Telephone:
State Lic. #: r~`'
Name of Contact Person:
Construction Type:. Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
Sq. Ft.:
#Stories:
#Units:
Telephone # of Contact Person:
Estimated Value of Project
APPLICANT: DO NOT WRITE BELOW THIS UNE
#
Submittal
Plan Sets
Req'd
Recd
TRACKIPII IG
Plan Check submitted
PERMIT FEES
hent Amount
Structural Cales.
Reviewed, ready for corrections
Plan Check Deposit. .
'buss Calcs.
Called Contact Person
Plan Check Balance
Title 24 Cates'.
Pians picked up
Construction
Flood plain plan
Plans resubmitted..
Mechanical
Grading plan
2a° Review, ready for corrections/'issue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Pians picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
'i° Review, ready for correctionsftue
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 -IR -ALT -HVAC) (Page 1 of 3 )
Project Name: 48575 Capistrano Way Date Prepared: 2016-06-16
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 CF111-ALT-02 document for each dwelling unit.
01
Project Name
48575 Capistrano Way
02
Date Prepared
2016-06-16
03
Project Location
48575 Capistrano Way
04
Building Type
Single family
05
CA City
La Quinta
06
Dwelling Unit Name
48575 Capistrano Way
07
Zip Code
92253
08
Dwelling Unit Conditioned
3200
Floor Area (ft2)
SC System
SC System
CFA served
' system a�
r`efrigerant
Number of space conditioning
C Instilling "'
09
Climate Zone
15
10
(SC) systems in this dwelling
2
`ducted
containing
~ system �'
o e than 40
unit.
entirely new
B. Space Conditioning SCS stem Information
p g( ) Y
01
02
03
04, '�
05 1 ',
': 06 ,� �t
` w,
} ; 08
4 09
10
h
t
tls the SC --
Installing a"
SC System
SC System
CFA served
' system a�
r`efrigerant
Installing newBC
C Instilling "'
Installing
�- Installing
Identification or
Location or Area
by this SC
`ducted
containing
~ system �'
o e than 40
entirely new
entirely new
Name
Served
System (ft2)
system?
component?
components?
feet of ducts?
duct system?
SC system?
Alteration Type
System 1
living room
1600
Yes
Yes
Yes
No
No
No
Altered space
conditioning system
System 2
bedrooms
1600
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-A0223833A-000000000-0000 Registration Date/Time: 2016-06-17 14:26:53 HERS Provider: CaICERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013 Rev 1.007 Report Generated: 2016-06-16 16:01:38
Schema Version: 0.555SDD
CERTIFICATE OF COMPLIANCE
CF1R-ALT 02-E
I Alterations to Space Conditioning Systems (formerly CF -1R -ALT -HVAC) (Page 2 of 3 ) I
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 split
All new
Central split
All new
This field or
This field or
System 1
HP
heating
AFUE
78
AC
cooling
SEER
18
Setback
section is not
section is not
components
components
applicable
applicable
Central split
All new
Central split
All new
This field or
This field or
System 2
HP
heating
AFUE
78
AC
cooling
SEER
18
Setback
section is not
section is not
components
components
applicable
applicable
Reouired 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: 5 15%, or 510% leakage to outside, or seal all accessible leaks. n --._.. - I-�
t r--- -. t----
CF2R-MCH-25-H & CF3R-MCH-25-H Refrigerant Charge Verification required wheri 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: S / / + '
1
Exceptions: � S �� i j� { } j} i -Duct
HERS exempt
C
systems registered with provider as previously sealed are from MCH -20 DuctLeakage Testing requirements..y
-Heating-only systems and Air Handler/Furnace changes do not require verification of Air Flow MCH -23, or Refrigerant Charge MECH-25
1!
-Existing duct systems constructed, insulated or sealed with asbestos are exempt from MCH -20 Dud eL akage,Testing requirements.,
E. Entirely New or Complete Replacement Duct System, with or without Equipment Changeout (Sections 150.2(b)lDiia and 150.2(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: 216-A0223833A-000000000-0000
Registration Date/Time: 2016-06-17 14:26:53
HERS Provider: CaICERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013 Rev 1.007 Report Generated: 2016-06-16 16:01:38
Schema Version: 0.555SDD
CERTIFICATE OF COMPLIANCE CFiR-ALT-02-E I
Iterations to Space Conditioning Systems (formerly CF -1R -ALT -HVAC) (Page 3 of 3 ) I
Documentation Author's Declaration Statement
1. 1 certify that this Certificate of Compliance documentation is accurate and complete.
Documentation Author Name:
Documentation Author Signature:
Hyde, Mark
le�7�
Company:
Signature Date:
CERTIFIED COMFORT SYSTEMS INC
2016-06-17 14:26:53
Address:
CEA/ HERS Certification Identification (if applicable):
42949 Madio
City/State/Zip:
Phone:
Indio CA 92201
760-360-2202
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 on this Certificate of Compliance are consistent with the information provided on other applicable compliance documents, worksheets,
calculations, plans and specifications submitted to the enforcement agency for approval with this building permit application.
5. 1 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 docum_entation.the builder provides to the building owner at occupancy.
Responsible Designer Name: ` j _ :
Hyde, Mark
Responsible Designer Signature: U �`j� �L t
w�vr..� 7 all ;
O
Company:
Date Signed:
CERTIFIED COMFORT SYSTEMS INC
2016-06-17 14:26:53
Address:
License:
42949 Madio
906115
City/State/Zip:
Phone:
Indio CA 92201
760-360-2202
Digitally signed by CaICERTS. 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-A0223833A-000000000-0000 Registration Date/Time: 2016-06-17 14:26:53 HERS Provider: CaICERTS
' CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013 Rev 1.007 Report Generated: 2016-06-16 16:01:38
Schema Version: 0.555SDD