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BMCH2016-0120-aw 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 COMMUNITY DEVELOPMENT DEPARTMENT BUILDING PERMIT Application Number: BMCH2O16-0120 Owner: Property Address: 45230 COLDBROOK LN LN THOMAS APN: 604412026 Application Description: HVAC CHANGE OUT/ THOMAS MADDOX 92253 Property Zoning: Application Valuation: $3,500.00 Applicant: THOMAS MADDOX , 92253 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: _ License No.::CONV:140528101254089654 Date: 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 e44($50 ).: 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.). ( 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.). _W'I am exempt under Sec. B.&P.C. for this reason ,Oa�t� �� — �lA, Owne ' 7-72),,11- CONSTRUCTION -7OwLGCONSTRUCTION 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 Contractor: THOMAS M , 92253 VOICE (760) 777-7125 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 4/22/2016 )OX ------------- D Q APR 22 2C;b -�E CITYOFLA QUINTA Llc. No.::CONV:140528101254089654 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 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. 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: Signature (Applicant or Agent): FINANCIAL • • DESCRIPTION ACCOUNTQTY AMOUNT PAID PAID -DATE' BSAS SB1473 FEE 101-0000-20306 0 $1.00 $1.00 4/22/16 PAID BY METHOD RECEIPT # CHECK # CLTD BY THOMAS MADDOX DEBIT R14977 BMCH2O16-0120 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 $72.52 $72.52 4/22/16 PAID BY METHOD RECEIPT # CHECK # CLTD BY THOMAS MADDOX DEBIT R14977 BMCH2O16-0120 RSE DESCRIPTION -` ACCOUNT" QTY AMOUNT PAID PAID DATE HVAC CHANGEOUT - SPLIT -SYSTEM PC 101-0000-42600 0 $36.26 $36.26 4/22/16 PAID BY METHOD RECEIPT # CHECK # CLTD BY THOMAS MADDOX DEBIT 1114977 BMCH2O16-0120 RSE Total Paid for CHANGEOUT: .$108.78 $108.78 DESCRIPTION. ACCOUNT QTY AMOUNT PAID PAID DATE PERMIT ISSUANCE 101-0000-42404 0 $91.85 $91.85 4/22/16 PAID BY METHOD RECEIPT # CHECK # CLTD BY THOMAS MADDOX DEBIT, R14977 BMCH2O16-0120 RSE Total Paid for PERMIT ISSUANCE: $91.85 $91.85 TOTALS: Description: HVAC CHANGE OUT / THOMAS MADDOX ADDITIONAL Type: MECHANICAL Subtype: Status: ISSUED Applied: 4/22/2016 RSE Approved: 4/22/2016 RSE Parcel No: 604412026 Site Address: 45230 COLDBROOK LN LN LA QUINTA,CA 92253 Subdivision: TR 23995-5 Block: Lot: 8 Issued: 4/22/2016 RSE Lot Scl Ft: 0 Building Sq Ft: 0 Zoning: Finaled: Valuation: $3,500.00 Occupancy Type: Construction Type: Expired: 10/19/2016 RSE No. Buildings: 0 No. Stories: 0 No. Unites: 0 92253 Details: Printed: Friday, April 22, 2016 9:58:25 AM 1 of 2 C SYS TEh1S ADDITIONAL CHRONOLOGY CONDITIONS CONTACTS N.AME,TYPE; ::.. NAME :..: ADDRE551 CITY STATE ZIP PHONE FAX EMAIL APPLICANT THOMAS MADDOX 92253 CONTRACTOR THOMAS MADDOX 92253 OWNER THOMAS MADDOX 92253 Printed: Friday, April 22, 2016 9:58:25 AM 1 of 2 C SYS TEh1S INSPECTIONS PARENT PROJECTS Printed: Friday, April 22, 2016 9:58:25 AM 2 of 2 CM sysrrrns CLTD DESCRIPTION ACCOUNT CITY AMOUNT PAID PAID DATE RECEIPT # CHECK # METHOD PAID BY BY HVAC CH T - 101-0000-42402 0 $72.52 $72.52 4/22/16 R14977 B DEBIT THOMAS MADDOX RSE SPLIT -SYSTEM SYSTEM -012O16 -0120 HVAC.CHANGEOUT - 101-0000-42600 0 $36.26 $36.26 4/22/16 R14977 BMCH2O16 DEBIT THOMAS MADDOX RSE SPLIT -SYSTEM PC -0120 Total Paid for CHANGEOUT: $108.78 $108.78 PERMIT ISSUANCE 101-0000-42404 0 $91.85 $91.85 4/22/16 R14977 BMCH2O16 DEBIT THOMAS MADDOX RSE -0120 Total Paid for PERMIT ISSUANCE: $91.85 $91.85 TOTALS: INSPECTIONS PARENT PROJECTS Printed: Friday, April 22, 2016 9:58:25 AM 2 of 2 CM sysrrrns CERTIFICATE OF COMPLIANCE Alterations to Space Conditioning Systems (formerly CF -1R -ALT -HVAC) Project Name: T.Maddox I Date Prepared: CF1R-ALT 02-E I (Page 1 of 3 ) 2016-04-20 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 T.Maddox 02 Date Prepared 2016-04-20 03 Project Location 45230 Coldbrook lane 04 Building Type Single family 05 CA City La Quinta 06 Dwelling Unit Name House .07 Zip Code 92253 08 Dwelling Unit Conditioned 2008 Identification or Location oar Areay this SC-� Floor Area (ft2) containing----ystem / more;�than 40 entirely new entirely new Number of space conditioning Served 09 Climate Zone 15 10 (SC) systems in this dwelling 1 Alteration Type unit. t i' k A B. Space Conditioning (SC) System Information 01 02 03 04 05 06 07 08 09 10 r Is the SC Installing a SC System SC Syste m CSA served systema refrigerant Installing new SC Installing Installing Installing Identification or Location oar Areay this SC-� ducted containing----ystem / more;�than 40 entirely new entirely new Name Served System,(ft2) '1 system?— component?– components? =feet ofld�ucts? duct system? SC system? Alteration Type S F t i' k A i - System 1 L 2008 Yes Yes Yes No No No Altered space shouse I ; ,, conditioning system C. Extension of Existing Duct System, Greater Than 40 Feet (Section1S0.2(b)1Diib) .Cf APR � 2 2016 F ►A QrU,1N��pp{A{��►►ENT Registration -000000000-0000 CpNIMU CA Building Energy Efficiency Standards - 2013 Residential Compliance This section does not apply to this project. Registration Date/Time: 2016-04-20 18:13:46 Report Version: 2013 Rev 1.007 Schema Version: 0.555SDD HERS Provider: USERA Report Generated: 2016-04-20 18:13:56 CERTIFICATE OF COMPLIANCE CFiR-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)3E 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 gas All new Central split All new Less than or System 1 furnace heating AFUE 80.00 AC cooling SEER 14 Setback equal to 40 R-8 components components feet 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 <_ 10% 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 a 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. -Heating-only systems and Air Handler/Furnace changes do not require verification of Air Flow MCH -23, or Refrigerant Charge MECH-25. -Existing duct systems constructed, insulated or sealed with asbestos are exempt from MCH -20 Duct Leakage Testing requirements. Registration Number: 316-A1023909C-000000000-0000 Registration Date/Time`' 2016-04-20 18:13:46 HERS Provider: USERA CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013 Rev 1.007 Report Generated: 2016-04-20 18:13:56 Schema Version: 0.5555DD CERTIFICATE OF COMPLIANCE CFiR-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: Dana Nicol Signature. Date: Company: Nicol Construction Inc 2016-04-20' Address: CEA/ HERS Certification Identification (if applicable): 67851 Ocotillo trl 878070 City/State/Zip: Phone: Desert Hot Springs CA 92241 1760-567-0397 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. S. I will ensure -that a registered -copy of thirC&tifltate of Compliance•shalFbe•made availabl"ith•the•building permit(s),Issued°for the building, and made available to the enforcement agency for all applicable inspections. I understand that a �egistered,copl-of,tthis , rtificatetof Compliance�is required.1 k.to.be..inchdcdrith the documentation the builder provides to the building owner at occupancy. Responsible Designer Name: Dana Nicol � � � � Responsible Designer S gnature: � Company: ,DatOt igned-/ Nicol Constructiolp�c►/ 2016-04 0 Address:�+. 67851 Ocotillo trl U.S. Enemy Rai License: &,§ ioAssociation City/State/Zip: Phone: Desert Hot Springs CA 92241 760-567-0397 TM °This digital signature>it provided it order to secure, the'content of ttes `registered document and in no 'i ay implies Registration Provider responsibility for - - the accuracy, of the information.?: U.S Energy Raters Assoclation Registration Number: 316-A1023909C-000000000-0000 Registration Date/Time: 2016-04-20 18:13:46 HERS Provider: USERA CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013 Rev 1.007 Report Generated: 2016-04-20 18:13:56 Schema Version: 0.555SDD Din # City Of La Quinta 'Building a Safety Division P.O. Box 1504, 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 0 IZ-0 Building Permit Application and Tracking Sheet Permit,# �V\ -H 20 ( Project Address: Owner's Name: 8ry G S a 0 A. P. Number. Address: $ 3 D b �� Legal Description. ntraciorj City, ST, Zip: CA. Z_ s 3 Telephone: ` , . Address: Project Description: -5— rcnt— City, ST, Zip: Item Telephone. Structural Coles. State Lic. # : _ _ _ _ City Lie. #; Reviewed, ready for corrections Engr., Designer: Plan Check Deposit Address: City., ST, Zip: Tele ho >. ;,;.. �. P r > t State Lie. #: Name of Contact Person: Construction Type: Occupancy: Project type (circle one): New Add'n Alter Repair Demo Sq. Ft : 02 pp # Stories: #Units: Telephone#,OfContact Person: �. - Z2--9_5--'lEstimated Valueo-fProjc&.QD 17' APPLICANT: DO NOT WRITE REI nW TNIS I WF I N Submittal Req'd Reed TRACMG PERMIT FEES Plan Sets Plan Check submitted Item Amount Structural Coles. Reviewed, ready for corrections Plan Check Deposit Truss Coles. . Called Contact Person Plan Check Balance Title 24 Coles, Plans picked up Coastruetion Flood plain plan Plans resubmitted Mechanical Grading plan 2w Review, ready for eorrectionsfissue Electrical Subcontactor Llst Called Contact Person Plumbing Grant Deed Plans picked up S.M.I. H.O.A. Approval Plans resubmitted Grading IN HOUSE:- 7rd Reyiew, ready for correctionsAssue Developer Impact Fee Planning.APproyliL _Called Conlactrerson _Ad.iz:E. Pub. Wks. APPr — Date of permit issue Schodl Fees Total Permit Fees P.O. Box 1504 LA QUINTA, CALIFORNIA 92247-1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT PROPERTY OWNER'S PACKAGE (760)777-7012 FAX (760) 777-7011 Disclosures & Forms for Owner -Builders Applying for Construction Permits IMPORTANT! NOTICE TO PROPERTY OWNER Dear Property Owner: An application for a building permit has been sub a ourme listing yourself as the builder of the property improvements specified at oL 10 ZO 4L11y1;a. We are providing you with an Owner -Builder Acknowledgment and Information Ve 'fication Porm to make you aware of your responsibilities and possible risk you may incur by having this permit issued in your name as the Owner -Builder. We will not issue a building permit until you have read, initialed your understanding of each provision, signed, and returned this form to us at our official address indicated. An agent of the owner cannot execute this notice unless you, the property owner, obtain the prior approval of the permitting authority. OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION DIRECTIONS: Read and initial each statement below to signi you understand or verify this information. 1. I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner -Builder" building permit that erroneously implies that the property owner is providing his or her own labor and material personally. I, as an Owner -Builder, may be held liable and subject to serious financial risk for any injuries sustained by an unlicensed person and his or her employees while working on my property. My homeowner's insurance may not provide coverage for those injuries. I am willfully acting as an Owner -Builder and am aware of the limits of my insurance coverage for injuries to workers on my property. e2. I understand building permits are not required to be signed by property owners unless they are responsible for the construction and are not hiring a licensed Contractor to assume this responsibility. 3. I understand as an "Owner -Builder" I am the responsible party of record on the permit. I understand that I may protect myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my own. 4. I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on permits and contracts. 'I V� 5. I understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total value of my construction is at least five hundred dollars ($500), including labor and materials, I may be considered an "employer" under state and federal law. —Te6c I understand if I am considered an "employer" under state and federal law, I must register with the state and federal government, withhold payroll taxes, provide workers' compensation disability insurance, and contribute to unemployment compensation for each "employee." I also understand my failure to abide by these laws may subject me to serious financial risk. OA -7, I understand under California Contractors' State License Law, an Owner -Builder who builds singl structures cannot legally build them with the intent to offer them for sale, unless all work is perf D subcontractors and the number of structures does not exceed four within any calendar year, or all of the work is performed under contract with a licensed general building Contractor. APR 8;Z "T 3' CITY OF LA QU!Nt'A COMMUNITY ®EV§WRM§Nf 1 8. I understand as an Owner -Builder if I sell the property for which this permit is issued, I may be held liable for any financial or personal injuries sustained by any subsequent owner(s) that result from any latent construction defects in the workmanship or materials. �'% 9. 1 understand I may obtain more information regarding my obligations as an "employer" from the Internal Revenue Service, the United States Small Business Administration, the California Department of Benefit Payments, and the California Division of Industrial Accidents. I also understand I may contact the California Contractors' State License Board (CSLB) at 1- 800-321-CSLB (2752) or www.cslb.ca.gov for more information about licensed contractors. 11ri - 10. I am aware of and consent to an Owner -Builder building permit applied for in my name, and understand that I am the party legally and financr lly responsible for proposed construction activity at the following address: `45 2.30 �r0� `�il�C .� / U e -A 1 11. I agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by all applicable laws and requirements that govern Owner -Builders as well as employers. _-,�A/11112. I agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the information I have provided on this foam. Licensed contractors are regulated by laws designed to protect the public. If you contract with someone who does not have a license, the Contractors' State License Board may be unable to assist you with any financial loss ypu may sustain as a result of a complaint. Your only remedy against unlicensed Contractors may be in civil court. It is also ,-important for you to understand that if an unlicensed Contractor or employee of that individual or firm is injured while working ' on your property, you may be held liable for damages. If you obtain a permit as Owner -Builder and wish to hire Contractors, you will be responsible for verifying whether or not those Contractors are properly licensed and the status of their workers' compensation insurance coverage. Before a building permit can be issued, this form must be completed and signed by the property owner and returned to the agency responsible for issuing the permit. Note. A copy of the property owner's driver's license, form notarization, or other verification acceptable to the agency is required to be presented when the permit is issued to verify the property owner's signature. e Note: The following Authorization Form is required to be completed by the property owner only when designating an agent of the property owner to apply for a construction permit for the Owner -Builder. AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF Excluding the Notice to Property Owner, the execution of which I understand is my personal responsibility, I hereby authorize the following person(s)14 act as my agent(s) to apply for, sign, and file the documents necessary to obtain an Owner -Builder Permit for my project. Scope of Construction Project (or cription of Work): Project Location or Address: Name of Authorized Agent: Address of Authorized Agent: I declare under penalty of perjury that I am the property owner or the address liste ove and I personally filled out the above information and certify its accuracy. Note: A cop fthe owner's driver's license, form n ation, or other verification acceptable to the agency is required to b"pr ented when the permit is issued to verify the prop wner's signature. Property Owner's Signature: / Date: