BMCH2016-0400LICENSED 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: C10, C20 License No.: 98866116
Date: / L 3= 1k, 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
($500).:
I ) 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.).
(1 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 Address:
(760)323-8786
Llc. No.: 986116
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: NORGUARD INSURANCE COMPANY Policy Number: DAWC700675
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/ovisions.
Dat t7 3 Applicar�tli�'=
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:
/'6 Signature (Applicant or Agent):
LI
]
� Q�i
a�
VOICE (760) 777-7125
78-495 CALLE TAMPICO D
FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253
DESIGN & DEVELOPMENT DEPARTMENT
INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 11/3/2016
Application Number: BMCH2O16-0400
Owner:
Property Address: 44700 CALLE SANTA BARBARA
VERONE TRYTTEN
APN: 604381002
44700 CALLE SANTA BARBARA
Application Description: VERONE / CHANGE OUT (1)CONDENSOR
LA QUINT, CA 92253
Property Zoning:
7'�C-:)
Application Valuation: $2,000.00
Applicant:
Contractor:
ERKIES ELECTRICAL HEATING AND AIR
ERKIES ELECTRICAL HEATING AN I 1 ZP
O BOX 1366
P O BOX 1366 R
��,
PALM SPRINGS, CA 92263
PALM SPRINGS, CA 92263 i
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: C10, C20 License No.: 98866116
Date: / L 3= 1k, 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
($500).:
I ) 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.).
(1 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 Address:
(760)323-8786
Llc. No.: 986116
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: NORGUARD INSURANCE COMPANY Policy Number: DAWC700675
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/ovisions.
Dat t7 3 Applicar�tli�'=
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:
/'6 Signature (Applicant or Agent):
Application Number: BMCH2016-0400
Property Address: 44700 CALLE SANTA BARBARA
APN: 604381002
Application Description: VERONE / CHANGE OUT (1)CONDENSOR
Property Zoning:
Application Valuation: $2,000.00
Applicant:
ERKIES ELECTRICAL HEATING AND AIR
P 0 BOX 1366
PALM SPRINGS, CA 92263
Date: 11/3/2016
Owner:
V ERON E TRYTTE N
44700 CALLE SANTA BARBARA
LA QUINT, CA 92253
Contractor:
ERKIES ELECTRICAL HEATING AND AIR
P 0 BOX 1366
PALM SPRINGS, CA 92263
(760)323-8786
Llc. No.: 986116
Detail: CHANGE OUT - (1) CONDENSOR [2013 ENERGY] CARBON MONOXIDE ALARM(S) TO BE INSTALLED PRIOR TO FINAL INSPECTION. 2013 CALIFORNIA
BUILDING CODES.
DESCRIPTION ACCOUNT QTY AMOUNT
BSAS SB1473 FEE 101-0000-20306 0 $1.00
Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $1.00
r DESCRIPTION
ACCOUNT
CITY
AMOUNT
HVAC CHANGEOUT - CONDENSER ONLY
101-0000-42402
0
$38.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
HVAC CHANGEOUT - CONDENSER ONLY PC
101-0000-42600
0
$25.33
Total Paid for CHANGEOUT: $63.33
DESCRIPTION
ACCOUNT
qTY
AMOUNT
PERMIT ISSUANCE
101-0000-42404
0
$96.27
Total Paid for PERMIT ISSUANCE: $96.27
Bin # City of Ja Quilita
Buitdin; 8i: Safety Division
Permit # . . 78-495 Calte Tampico
La Quinta, CA 92253 - (760) 777-701,2
Building Permit Application and Tracking Sheet
Project Address: ® Owner's Name: TRYTTEW0 i -
A. P. Number: Q ha bAkA
Address: S,AI�►�
Legal Description: o
popCity,
ST, Zip: t— A e
ontr
C act r•
o. 2t�S C:
Z c L
C C� L
T h n
ele o c:
P
Address: apa N 'PALM Ck,,/ DoJ
Project Description: Re, kcc AQ, ONafm r
City, ST, Zip: ezc lv/ N i11 QL,Q-L ,
Telephone: bo .3 d 3
State Lie. # : r(g(� I
City Lie. #:.
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone:
hon e:
. < z
aneY
C e:n Occupancy:
Type: :
S Lie. i . #:
PPe circle one): New Add'n Alter t Demo
ai Project ty o
Name of Contact Person: N ACL M -Q -JSq.
Ft.: aaga T#StoriT
I s:
Telephone # of Contact Person: 76o sa:3. 879(o
Estimated Value of Project: 1) 000
APPLICANT: DO NOT WRITE BELOW THIS LINE
9
Submittal
Req'd
Rcc'd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Cafes.
Called Contact Person
Plan Check Balance.
Title 24 Calcs.
Plans picked up
Construction
Flood plain plan
Plans 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 Permit Fees
CERTIFICATE OF COMPLIANCE CFiR-ALT 02-E
Alterations to Space Conditioning Systems (formerly CF -IR -ALT -HVAC) (Page 1 of 3 )
Project Name: TRYTTEN Date Prepared: 2016-10-20
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 CHR -ALT -02 document for each dwelling unit.
01
Project Name
TRYTTEN
02
Date Prepared
2016-10-20
03
Project location
44700 CALLE SANTA BARBARA
04
Building Type
Single family
05
CA City
La Quinta
06
Dwelling Unit Name
HOUSE
07
Zip Code
92247
08
Dwelling Unit Conditioned
2292
$stem'
Floor Area (ft2)
compon�erit?
Meetducts ?
duct system?
SC system?
Alteration Type
Number of space conditioning
5
09
Climate Zone
15
16''(SC)
systems in this dwelling
1
Altered's ace
unit.
B. Space.Conditioning:(SC) System Information
01
02
03'
0,4.
05, 06
07
68
09
10
SC System
SC Sys
SFA
e'SC- "
I stat nig,_(
Identification or n
Name
t
`Location o A ea
Serve
served
isduc
y ^)
systema
e`d .
m?
refner, g - t Instarling news
contaiin s stem
rl .,g y_
i components:?.
; ;Installing
rrrthan 40
-
Installing
entirely new
Y
Installing
entirely new
Y
$stem'
syst
compon�erit?
Meetducts ?
duct system?
SC system?
Alteration Type
System 1
5
9
Ye�>
' Y�e� Yg
.�N9,� a
No
No
Altered's ace
conditioning system
w.v.. �e parr s ��'G1 a7 1"�►.7.7.Vi..'6[At1V11
C: Extension of Existing Duct System, Greater Than 40 Feet (Section 150.2(b)10iib)
This section does not apply to this project.
Registration Number: 316-A1035454A-000000000-0000 Registration Date/Time:.2016-10-20 16:50:43 HERS Provider: USERA
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013 Rev 1.b07
Report Generated: 2016-10-20 16:51:16
Schema Version: 0.555SDD
CERTIFICATE OF COMPLIANCE CFiR-ALT 02-E
Alterations to Space Conditioning Systems (formerly CF -IR -ALT -HVAC) (Page 2 of 3 )
D. Altered Space Conditioning System (Sections.150.2(b)1E 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 gasCentral
No. heating
split
All new
-
Greater than
"System 1
furnace
component
AFUE
.78
AC
cooling
SEER
14
Setback
40 feet
R-8
altered
components
'
RequiredDocumentation:
CF211-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 1'5%, or15 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.
-Heating-only systems and Air Handler/Fu mace. 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-A1035454A-000000000-0000
Registration Date/Time: 2016-10-20 16:50:43
HERS Provider: USERA
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013 Rev 1.007 Report Generated: 2016-10-20 16:51:16
Schema Version: 0.555SDD
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:
Dane Feldman
Documentation Author Signature A
�t
q's
w, yr11111
Signature Dater
Company:
Erkies Electrical heating -and air
2016-10-20
Address:
CEA/ HERS Certification Identification (if applicable):
202 N,P.alm Canyon
986116
City/State/Zip:,
Phone:
Palm Springs CA 92262
.760-323-8786
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 componenti,-and manufactured devices for the building design or system design identified on this Certificate of Compliance conform to the
requirements of.Title 24, Part,l and Part, 6:6f 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 a'rovalwith this building permit application.
S. I will ensareitlt a registe d=e V py of is Certfi"caf of Com lceishalldbe;mad'e ava'lablew,ith thebuilding permit(s),ssued'for the building, and made available to the enforcement agency for all applicable
>. `�Y 0..e+IAi��? ' .�+5'i}iwiig
inspedio WIZ CRIA�Fgistered
r Aderstand this?. a
sr tl copy o ertrf to ofiComphan is requlredkto:be#Included with the docu= me action the builder provides to the building owner at occupancy.
Responsible.Desig"ner a '
4 No,
0Resp9nable Desig}rler Signature: Q�dM
Dane.Feldman
Dane Feldman Oct 20. 2016
Company : 4
01�Signecl:
Erkies Electrical he�4nppar(i�Lf F. _ {�
�E '. A;.-.
6 10- 0 M1
X18-.ctt4.K4:aR1� uY1�'
Address: U.Sicense.
202,N.PaIm Canyon : LJs7. �� r�.1®-asoCi1on
-i��}
. .
City/State/Zip:.
Phone:
Palm Springs CA 92262
760-323-8786
RA
`7'his'digital signature is provided, in order to secure
' the content of this registered document, and in no
way implies Registration Provider responsibility for
U.S. Energy Raters AssodaUori,
the accuracy of the information. ^
Registration Number: 316-A1035454A-000000000-0000 Registration Date/Time: 2016-10-20 16:50:43
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013 Rev 1.007
Schema Version: 0.555SDD
HERS Provider: USERA.
Report Generated: 2016-10-20 16:51:16