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BMCH2016-0272LICENSED 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 andeff License Class: C20 Licens o.: 924785 Dat , ` 1 P& C�ra 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 l ($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, 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 (760)567-0748 Llc. No.: 924785 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 k for which this permit is issued. a e and will maintain workers' compensation insurance, as required by Se ion 0 of the Labor Code, for thprformance of the work for which this permit is issue . y workers' compensation, nsu rance carrier and policy number are: Carrier: STATE COMPENSATION INSURANCE FUND Policy Number: 9115056 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,o ection 700 of the Labor Cod I shall forthwith comply lith those provisions. Dat 1 � I (0 nNir�CV)it 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 author' a repr entatives of this city to enter upon the above/m)en/t/jio�nfed^/pr perty for inspection urposes. / U / P.6-ivnn al- n— Anon •r : -i�'. 78-495 CALLE TAMPICO ' U VOICE (760) 777-7125 LA QUINTA, CALIFORNIA 92253 FAX (760) 777-7011. DESIGN & DEVELOPMENT DEPARTMENT INSPECTIONS (760) 777-7153 BUILDING PERMIT Date: 7/27/2016 Application Number: BMCH2O16-0272 Owner: Property Address: 79305 DESERT CREST DR DONALD JOHNSTON"' APN: 604332026 /ra D n Application Description: JOHNSTON DONALD / HVAC CHANGE OUT 92253 Property Zoning: Application Valuation: $6,000.00 JUL 2 7 2016 Applicant: Contractor: Qli;tVTA FRAGUZ A/C & HEATING FRAGUZ A/C & H ATIIN -- ?13L�_Ak71VEENT P 0 BOX 1243 P 0 BOX 1243 _ DESERT HOT SPRINGS, CA 92240 DESERT HOT SPRINGS, CA 92240 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 andeff License Class: C20 Licens o.: 924785 Dat , ` 1 P& C�ra 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 l ($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, 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 (760)567-0748 Llc. No.: 924785 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 k for which this permit is issued. a e and will maintain workers' compensation insurance, as required by Se ion 0 of the Labor Code, for thprformance of the work for which this permit is issue . y workers' compensation, nsu rance carrier and policy number are: Carrier: STATE COMPENSATION INSURANCE FUND Policy Number: 9115056 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,o ection 700 of the Labor Cod I shall forthwith comply lith those provisions. Dat 1 � I (0 nNir�CV)it 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 author' a repr entatives of this city to enter upon the above/m)en/t/jio�nfed^/pr perty for inspection urposes. / U / P.6-ivnn al- n— Anon •r : -i�'. Date: 7/27/2016 Application Number: BMCH2016-0272 Owner: Property Address: 79305 DESERT CREST DR DONALD JOHNSTON APN: 604332026 Application Description: JOHNSTON DONALD / HVAC CHANGE OUT 92253 Property Zoning: Application Valuation: $6,000.00 Applicant: Contractor: FRAGUZ A/C & HEATING FRAGUZ A/C & HEATING P 0 BOX 1243 P 0 BOX 1243 DESERT HOT SPRINGS, CA 92240 DESERT HOT SPRINGS, CA 92240 (760)567-0748 Llc. No.: 924785 ------------------------------------------------------------=-------------------------------- Detail: HVAC CHANGE OUT - 16.5SEER/80AFUE SPLIT SYSTEM [2013 ENERGY] CARBON MONOXIDE ALARM(S) TO BE INSTALLED PRIOR TO FINAL INSPECTION. 2013 CALIFORNIA BUILDING CODES. y FINANCIAL INFORMATION .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 - SPLIT -SYSTEM 101-0000-42402 0 $72.52 DESCRIPTION ACCOUNT QTY AMOUNT HVAC CHANGEOUT - SPLIT -SYSTEM PC 101-0000-42600 0 $36.26 Total Paid for CHANGEOUT: $108.78 DESCRIPTION ACCOUNT QTY AMOUNT PERMIT ISSUANCE 101-0000-42404 0 $91.85 Total Paid for PERMIT ISSUANCE: $91.85 Description: JOHNSTON DONALD / HVAC CHANGE OUT Type: MECHANICAL Subtype: Status: UNDER REVIEW Applied: 7/27/2016 RSE Approved: Parcel No: 604332026 Site Address: 79305 DESERT CREST DR LA QUINTA,CA 92253 Subdivision: TR 23935-6 Block: Lot: 24 Issued: Lot Sq Ft: 0 Building Sq Ft: 0 Zoning: Finaled: Valuation: $6,000.00 Occupancy Type: Construction Type: Expired: No. Buildings: 0 No. Stories: 0 No. Unites: 0 NAME TYPE Details: HVAC CHANGE OUT - 16.5SEER/80AFUE SPLIT SYSTEM [2013 ENERGY] CARBON MONOXIDE ALARM(S) TO BE INSTALLED PRIOR TO FINAL INSPECTION. 2013 CALIFORNIA BUILDING CODES. CHRONOLOGY CONDITIONS ZIP PHONE FAX EMAIL NAME TYPE NAME ADDRESSI CONTACTS CITY STATE APPLICANT FRAGUZ A/C & HEATING P O BOX 1243 DESERT HOT SPRINGS CA 92240 CONTRACTOR FRAGUZ A/C & HEATING P O BOX 1243 DESERT HOT SPRINGS CA 92240 OWNER DONALD 1OHNSTON 92253 Printed: Wednesday, July 27, 2016 3:15:01 PM 1 of 2 srsrrrns Printed: Wednesday, July 27, 2016 3:15:01 PM 2 of 2 sysrrnns CLTD DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE RECEIPT # CHECK # METHOD PAID BY BY FRAGUZ A/C & BSAS SB1473 FEE 101-0000-20306 0 $1.00 $1.00 7/27/16 R17434 DEBIT HEATING RSE Total Paid for BUILDING STANDARDS ADMINISTRATION $1.00 $1.00 BSA: HVAC CHANGEOUT - 101-0000-42402 0 $72.52 $72.52 7/27/16 R17434 DEBIT FRAGUZ A/C & RSE SPLIT -SYSTEM HEATING HVAC CHANGEOUT - 101-0000-42600 0 $36.26 $36.26 7/27/16 R17434 DEBIT FRAGUZ A/C & RSE SPLIT -SYSTEM PC HEATING Totat Paid for CHANGEOUT: $108.78 $108.78 FRAGUZ A/C & PERMIT ISSUANCE 101-0000-42404 0 $91.85 $91.85 7/27/16 R17434 DEBIT HEATING RSE Total Paid for PERMIT ISSUANCE: $91.85 $91.85 TOTALS:i Printed: Wednesday, July 27, 2016 3:15:01 PM 2 of 2 sysrrnns Bin Permit # Project Addressr -r City of La Quinta Buifding U Safety Division 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet - - A. P. Number. Address: -7 Legal ,Mscription: - t, ST, Zt II -- l,c�_ ( 2— S3 Contrattor; TGletil5otic: �r .:� �,��.�;,4�t � ���� .i:EA, .��',. i cy.: :.3 .......l�F+�.%Ti Address: Project DeseriptiorrCkLn�C_ City ST, Zip Telephone \ '♦''' Mhk J/ ` Cj } City.Lic. #f.: Arch., Engr., Designer: Address: City, ST, Zip: Telephone: _ State Lic. #: a E f, Construction Type: Occupancy: YP Project type circle one): New Add'n Alter Repair Demo Name of Contact Person: Sq. Ft.; 4 Stories:: N. Units: Telephone i# of Contact Person: �] Estimated Value of Project: - APPLICANT: DO NOT WRITE BELOW THIS LINE f# Submittal Rcq'd Rcc'd 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 Cates. Plans picked up Construction Flood plain plan Plans resubmitted Mechanical Grading plan 2" Review, read for corrections/issue Y Electrical Subcontactor List Called Contact Person Plumbing Gran( Deed Plans picked up S.M.1, II.O.A. Approval Plans resubmitted Grading IN HOUSE:- 3'° 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 reel, Total Permit Fees CERTIFICATE OF COMPLIANCE Alterations to Space Conditioning Systems (formerly CF -1R -ALT -HVAC) Project Name: JOHNSTON I Date Prepared: RECEIVED CF1R-ALBA' E7 2016 AR457 offfQUINTA 2016-07-27 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 CF1R-ALT-02 document for each dwelling unit. 03 Project Name JOHNSTON 02 Date Prepared 2016-07-27 03 Project Location 79305 DESERT CREST DR. 04 Building Type Single family 05 CA City La Quinta " ' 06 Dwelling Unit Name JOHNSTON 07 Zip Code 92253 08 Dwelling Unit Conditioned 1700 ' i stalIIin'g #In��stalli g installing Floor Area (ft2) Location or Area. by this SC ducted - - 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 .� 04'46, AIMCOS 06 074 08 I t 09 10 #Is the SCIntilling a`°` SC System SC System CFA servedystem a r frige nt 4 Installing neva �c i stalIIin'g #In��stalli g 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 01 OS 1700 No Yes No No No No Altered space - 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: 216-A0280075A-000000000-0000 CA Building Energy Efficiency Standards - 2013 Residential Compliance Registration Date/Time: 2016-07-27 10:17:51 Report Version: 2013 Rev 1.007 Schema Version: 0.555SDD HERS Provider: CaICERTS Report Generated: 2016-07-27 10:38:36 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: guzman, rosa 'OIL��f2lfllLlf/ Company: Signature Date: FRAGUZ A/C & HEATING 2016-07-27 10:17:51 Address: CEA/ HERS Certification Identification (if applicable): P 0 BOX 1243 924785 City/State/Zip: Phone: desert hot springs CA 92240 760-567-0748 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. I 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 ttie California Code of Reg la�tlons. 4. The building design features or system design features identified on this Certifica a of Comglia e:consistent,wit ^the informat rovided oro therm p(jcablel mpliance documents, worksheets, yEy calculations, plans and specifications submitted to the af�forcement:agency forapprovaUwitfi this building permit application. S. I that Certificat Compliance beimadgkayailable farthe'buling, will ensure a registered copy of this of shall withrthe bullding permit(s),Issued and,made avallabletq,the�enforcement agency for all applicable {a.�.. ic,=.. inspections. I understand that a registered copy of thisCertlficate of Compl anceyls_requiired to be Included "with the documentatio%hepmlder p�rovydes to-tbe bu, ilding owner at occupancy. Responsible Designer Name: ` i '� Responsible Deslgrfer Signature: V 1 L-,# . guzman, rosa Company: Date Signed: FRAGUZ A/C & HEATING 2016-07-27 10:17:51 Address: License: P 0 BOX 1243 • 924785 City/State/Zip: Phone: desert hot springs CA 92240 760-567-0748 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-A0280075A-000000000-0000 Registration Date/Time: 2016-07-27 10:17:51 HERS Provider: CaICERTS CA Building Energy Efficiency Standards -.2013 Residential Compliance Report Version: 2013 Rev 1.007 Report Generated: 2016-07-27 10:38:36 Schema Version: 0.555SDD I