BMCH2016-013378-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
�r �f •f�Q,e,�rw
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING PERMIT
Application Number: BMCH2O16-0133
Property Address: 55530 ROYAL ST GEORGE
APN: 767522003
Application Description: SERVAIS RESIDENCE / HVAC
Property Zoning:
Application Valuation: $12,312.00
Applicant:
IE INC
31225 LA BAYA
WESTLAKE VILLAGE, CA 91362
V A d D
2 r,.
CITYOFLAQUINTA
Y DEVELOPMENT DEPARTMENT
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: C20, C36 License No.: 977333
Date:Z ) Contractor: Z
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, 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
Lender's Address:
VOICE (760) 777-.7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 5/2/2016
'Owner:
MICHAEL SERVAIS
735 1ST ST NO 202
KIRKLAND, WA 92253
Contractor:
A#1 SERVICES HEATING & AIR CONDITIONING
78206 VARNER ROAD #D-189
PALM DESERT, CA 92211
(760)342-3610
Llc. No.: 977333
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.
`� 1 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: _ Polity 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: !J Z ((. Applicant:vL
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: 3 ' V Signature (Applicant or Agent): wy
FINANCIAL INFORMATION
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 for BUILDING STANDARDS ADMINISTRATION BSA: $1.00 $0.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
HVAC CHANGEOUT - SPLIT -SYSTEM
101-0000-42402
0
$72.52
$0.00
PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY
DESCRIPTION
'ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
HVAC CHANGEOUT - SPLIT -SYSTEM PC
101-0000-42600
0
$36.26
$0.00
PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY
Total Paid for CHANGEOUT: $108.78 $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
TOTALS: $201.63 00
Description: SERVAIS RESIDENCE / HVAC CHANGE OUT
Type: MECHANICAL Subtype: Status: APPROVED Applied: 5/2/2016 MFA
Parcel No: 767522003 Site Address: 55530 ROYAL ST GEORGE LA QUINTA,CA 92253 Approved: 5/2/2016 MFA
Subdivision: TR 29348-1 Block: Lot: 17 Issued:
Lot Sq Ft: 0 Building Sq Ft: 0 Zoning: Finaled:
Valuation: $12,312.00 Occupancy Type: Construction Type: Expired:
No. Buildings: 0 No. Stories: 0 No. Unites: 0
Details: HVAC CHANGE OUT - 21 SEER/80AFUE SPLIT SYSTEM [2008 ENERGY] CARBON MONOXIDE ALARM(S) TO BE INSTALLED PRIOR TO
FINAL INSPECTION. PER 2013 CALIFORNIA BUILDING CODES.
ADDITIONAL SITES
FINANCIAL INFORMATION
Printed: Monday, May 02, 2016 11.35:14 AM 1 of 2 CN?WlYSTEMS
CONTACTS
NAME TYPE
'NAME
ADDRESSI
CITY
STATE
ZIP
PHONE
FAX
EMAIL
APPLICANT
IE INC
31225 LA BAYA
WESTLAKE
CA
91362
VILLAGE
CONTRACTOR
A#1 SERVICES HEATING & AIR
78206 VARNER ROAD
PALM DESERT
CA
92211
CONDITIONING
#D-189
OWNER
MICHAEL SERVAIS
735 IST ST NO 202
1 KIRKLAND
WA
92253
FINANCIAL INFORMATION
Printed: Monday, May 02, 2016 11.35:14 AM 1 of 2 CN?WlYSTEMS
Printed: Monday, May 02, 2016 11:35:14 AM 2 of 2 sYSTEMs
REVIEWS
REVIEW TYPE REVIEWER SENT DATE DUE DATE RETURNED
DATE
STATUS REMARKS NOTES
BOND
INFORMATION
CLTD
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
RECEIPT #
CHECK #
METHOD
PAID BY .
BY
BSAS S81473 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
$72.52
$0.00
SPLIT -SYSTEM
HVAC CHANGEOUT -
101-0000-42600
0
$36.26
$0.00
SPLIT -SYSTEM PC
Total Paid for CHANGEOUT: $108.78 $0.00
PERMIT ISSUANCE
101-0000-42404
1 0
$91.85
$0.00
Total Paid for PERMIT ISSUANCE: $91.85 $0.00
TOTALS:00
Printed: Monday, May 02, 2016 11:35:14 AM 2 of 2 sYSTEMs
REVIEWS
REVIEW TYPE REVIEWER SENT DATE DUE DATE RETURNED
DATE
STATUS REMARKS NOTES
Printed: Monday, May 02, 2016 11:35:14 AM 2 of 2 sYSTEMs
BOND
INFORMATION
ATTACHMENTS
Printed: Monday, May 02, 2016 11:35:14 AM 2 of 2 sYSTEMs
Bin.#
.0ty of LQ Quints
80ding 8r Safety Division :. .
�3 P.O. Box 1504,78-495 Calle Tampico
La.Quinta, CA 92253 -:(760) 777-7012
Building pp Permit A lication and TrackingSheet
Permit #
u I C
Projectaddress: 55530 Royal Saint George
Owner's Name:. Susan Servais
A P. Number
Address: 55530 Royal Saint George
Legal Description:
City, ST, Zip: La Quinta, CA 92253
Contractor: A#1 Services Heating & A/C
Telephone:
Address: 78206'Varner Road #D-189
Project Description: Replace 4ton A/C, Coil, & FAU
City, ST, Zip: Palm Desert, CA 92211
Telephone: 760-342-3610
IN
::,'''
State Lic. # : 977333
City Lie'. #,;
Arch, Engr., Designer.
Address:
City, ST, Zap:
Telephone:
State Lia #:
Construction Type: , Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
Sq. Ft.: # Stories: # Units:
Name of Contact Per=: Steven Schnierer
Telephone # of Contact Person: 818-735-7876
Estimated Value of Project: $12,312,00.
APPLICANT: DO NOT WRITE BELOW THIS LIME
#
Submittal
ReVd
Recd
TRACKNG
PERMIT FEES
Plan Sets
Plan Check submitted
Item Amount
Strgdural Calcs.
Reviewed, ready for corrections
Plan Check Deposit. .
Truss C21cs•
Called Contact Person
Plan Check Balance
Title 24 Calci.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechatilcal
Giading plan
2'! Review, ready for correctionsrtssue
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
C led Contact Person
AIPY
Pub. Wks. Appr
Date of permit lssue
School Fees
Total Permit Fees
CERTIFICATE OF COMPLIANCE
Alterations to Space Conditioning Systems (formerly CF-lR-ALT-HVAC)
Project Name:
SUSAN SERVAIS I Date Prepared:
CF1R-ALT 02-E
(Page 1 of 3 )
2016-04-26
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.
01
Project Name
SUSAN SERVAIS
02
Date Prepared
2016-04-26
03
Project Location
55530 Royal Saint George
04
Building Type
Single family
05
CA City
La Quinta
06
Dwelling Unit Name
SUSAN SERVAIS
07
Zip Code
92253
08
Dwelling Unit Conditioned
4716
.' '�"". Ll
Floor Area (ft2)
SC System
CFA served
''*.,system a�
'- ge a t (
*Installing new SC
Number of space conditioning
iln talli g
09
Climate Zone
15
30
(SC) systems in this dwelling
1
containing
W it
system
more than 40
entirely a
unit.
B. Space Conditioning (SC) System Information
n= F
01
02
03
04&
US i�lt
J_-)�
11 67))
j 08,
09
'10
.661
is the SC—
'Installing ate`
� `' "`..� , `
.' '�"". Ll
SC System
SC System
CFA served
''*.,system a�
'- ge a t (
*Installing new SC
CInstalling
iln talli g
installing
Identification or
Location or Area
by this SC
~`ducted
containing
W it
system
more than 40
entirely a
entirely new
Name
Served
System (ft2)
system?
component?
components?
feet of ducts?
duct system?
SC system?
Alteration Type
System 1
Location 1
4716
Yes
Yes
Yes
No
No
No
Altered -space
conditioning system
C. Extension of Existing Duct System, Greater Than 40 Feet (Section1S0.2(b)iDiib)
This section does not apply to this project.
Registration Number: 216-A0156339A-000000000-0000
Registration Date/Time: 2016-04-26 16:11.:33
HERS Provider: CaICERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013 Rev 1.007 Report Generated: 2016-04-26 18:10:55
Schema Version: 0.555SDD
CERTIFICATE OF COMPLIANCE CF1R-ALT 02-E
Alterations to Space Conditioning Systems (formerly CF71R-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
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
0.8
AC
cooling
SEER
21
Setback
equal to 40
R-8
components
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.
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 Duct Leakage Testing requirements.
CH
-Heating-only systems and Air Handler/Furnace changes do not require verificatio of'Air Flow MCH -23; r Refrigerant Charge EM -25.
.
Existing duct systems constructed, insulated or sealed with asbestos are exempUrom MCH=20 DucULeakage Testing requir'emerits.
f iF 1C
SV1 .f t J t '," _ I1._.. I i I 11 1. 1 F I I 1 : I } iV, ..
E. Entirely New or Complete Replacement Duct,5ystem, with or without, Equipment Changeout(Sections150.2(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-A0156339A-000000000-0000
CA Building Energy Efficiency Standards.- 2013 Residential Compliance
Registration Date/Time: 2016-04-26 18:11:33
Report Version: 2013 Rev 1.007
Schema Version: 0.555SDD
HERS Provider: CaICERTS
Report Generated: 2016-04-26 18:10:55
CERTIFICATE OF COMPLIANCE CF111-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: �/
Jacoby, Ian
cyan Jacob'
Company:
Signature Date:
i PERMIT E RATERS
2016-04-26 18:11:33
Address:
CEA/ HERS Certification Identification (if applicable):
31225 La Baya Drive #213
City/State/Zip:
Phone:
West Lake Village CA 91362
818-735-7876
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 manuf..aacctured 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. ,� �" " { �"" " i�
4. The building design features or system design features identified on this Certificate of Compliance are consistent with.the information provided on otherapplicable compliance documents, worksheets,
,
calculations, plans and specifications submitted to the enforcement agency for approvalwiththis buildirng permit application. ' }
5. 1 will ensure that a registered copy of this Certificate of,Compliance shall be,maiie""available with the bUhdfng: permit(s); issued forahe building, and made available fo 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 tthe,bullder provides to,the building owner at occupancy.
a
Responsible Designer Name: " U .. IIIA w
Responsible Designer Signature: fid' -+* ./�
Jacoby, Ian
c..Qan acobJr
Company:
Date Signed:
A 1 SERVICES
2016-04-26 18:11:33
Address:
License:
74866 Lennon PI
977333
City/State/Zip:
Phone:
Palm Desert CA 92260
760-565-2269 1
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-A0156339A-000000000-0000 Registration Date/Time: 2016-04-26 18:11:33 HERS Provider: CaICERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013 Rev 1.007 Report Generated: 2016-04-26 18:10:55
Schema Version: 0.555SDD