BMCH2016-0184Applicant: Contractor:
COMMUNITYDECITYC'TYC ppMQN DT_ EP` NT
IE INC VOTTA ENTERPRISES INC DBA COMFORT -MR
31225 LA BAYA 72248 NORTHSHORE ST STE 101
WESTLAKE VILLAGE, CA 91362 THOUSAND PALMS, CA 92276
(760)320-5800
Llc. No.: 763937
---------------------------------------------------------------------------------------------
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 License No.: 763937
Da s ?Q 1 to 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, 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 Address:
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 th,ork for which this permit is issued.
cr 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.
A
p��-S Zi 1LQ AppIG t
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.
S 27 1
Dater Signature (Applicant or Agen�
Qum&
Ti,&t
VOICE (760) 777-7125
78-495 CALLE TAMPICO
D
FAX (760) 777-7011COMMUNITY
LA QUINTA, CALIFORNIA 92253
DEVELOPMENT DEPARTMENT
INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 5/27/2016
Application Number:
BMCH2O16-0184
Owner:
Property Address:
78800 SAN ITA DR
604163005
RICHARD GASIEWSKI
DAPN:
Application Description:
GASIEWSKI / HVAC CHANGE
OUT 92253
Property Zoning:
l
MAY � % 2016 l
Application Valuation:
$9,500.00
Applicant: Contractor:
COMMUNITYDECITYC'TYC ppMQN DT_ EP` NT
IE INC VOTTA ENTERPRISES INC DBA COMFORT -MR
31225 LA BAYA 72248 NORTHSHORE ST STE 101
WESTLAKE VILLAGE, CA 91362 THOUSAND PALMS, CA 92276
(760)320-5800
Llc. No.: 763937
---------------------------------------------------------------------------------------------
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 License No.: 763937
Da s ?Q 1 to 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, 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 Address:
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 th,ork for which this permit is issued.
cr 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.
A
p��-S Zi 1LQ AppIG t
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.
S 27 1
Dater Signature (Applicant or Agen�
••
A6CO..: • : vaL�FrA, D pm
R
BSAS SB1473 FEE 101-0000463,06. j- 0` $1.00...
$0:00
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CHECK.#�� �3CLTUfBYk
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,
Total Paid for BUILDING STANDARDS ADMINISTRATIONI.,BSA: $1:00 .$0.00
.,ONONIONRktiY.:fi'w.ti<&. , ,. ,r,..
ION SCRIPTIONmIkN ��
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PAID ;
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SPA D UATE;k
HVAC CHANGEOUT - SPLIT -SYSTEM
101-0000-42402
0
s72.52
$0.00
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�uF:rDESCRIPTION�r�a�
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101 0000=42600. �.
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$3616
$0.00
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METHOD
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Total Paid for CHANGEOUT: .$.108.78 $0.00
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0..
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Total Paid for PERMIT ISS4NCE$91 85 $0.00. .
• 1 1 11
Description: GASIEWSKI / HVAC CHANGE OUT
Type: MECHANICAL Subtype:
Status: UNDER REVIEW
Applied: 5/27/2016 SKH
Approved:
Parcel No: 604163005 Site Address: 78800.SANITA DR LA QUINTA,CA 92253
Subdivision: TR 23269 Block:
Lot: 105
Issued:
Lot Sq,Ft: 0 Building Sq Ft: 0
Zoning:
Finaled:
Valuation: $9,500.00 Occupancy Type:
Construction Type:
Expired:
No. Buildings: 0 No. Stories: 0
No. Unites: 0
Details: HVAC CHANGE OUT - 25SEER/80AFUE SPLIT SYSTEM [2013 ENERGY] CARBON MONOXIDE ALARM(S)
TO BE INSTALLED PRIOR TO
FINAL INSPECTION. 2013 CALIFORNIA BUILDING CODES.
FINANCIAL INFORMATION
Printed: Friday, May 27, 2016 1:00:14 PM 1 of 2 CRWSYSTEMS
Printed: Friday, May Z7,IOz61l0:14nm 2ofZ CRWYSTEMS
.77
_Ofy
NT
BSAS SB1473 FEE
101-0000-20306
0
$1.00
$0.00
Total Paid for B . UILDING STANDARDS ADMINISTRATION $1.00 $0.00
HVACCHANGEOUT-
101-0000-42402
0
$72.52
$0.00
HVACCHANGEOUT-
101-0000-42600
0
$36.26
$0.00
SPLIT -SYSTEM PC
Total Paid for CHANGEOUT: $108.78 $0.00
PERMIT ISSUANCE
101-0000-42404
0
$91.85
$0.00
Total Paid for PERMIT ISSUANCE: $91.85 $0.00
TOTALS: $201.63 $0.00
Printed: Friday, May Z7,IOz61l0:14nm 2ofZ CRWYSTEMS
Bin. #
Permit #
Project Address: 78800 Sanita Drive
City. Of La Quivhta
Building 8L Safety Division
P.O. Box 1504,78-495 Calle Tampico
14.Quinta,.CA 92253 - (760) 777-7012
Building Permit Application'and Tracking Sheet
Owner's Name:. Cheryl Gasiewski
A. P. Number.
Address: 78800 Sanita Drive
Legal Description:
City, ST, Zip: La Quinta, CA 92253
Contractor: Comfort Air
Telephone: 310-990-2300
.` "sg{`�'.
,,'..�a��..3•;:,��',a^,<;x.,�,�`�'...
Address: 4803 E Sunny Dunes Road
Project Description: Replace 3ton A/C, Coil, & 70,000 BTU
City, ST, Zip: Psalm Springs, CA 92264.
Furnace
telephone: 760-320-5800
% H` ,.• ``' �n;• ;;i
:� � �1,'�;; ��' •-"
State Lic. # : 763937
City Lie'.
Arch., Engr., Designer:
Address:
City., ST. Zip:
Telephone: v Y `�
State Lie. #: �, •y �V
Name of Contact Person: Steven Schnierer
Construction Type-,. Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
Sq. it.:
# Stories:
# Units:
Telephone # of Contact Person: $18-735-7876
Estimated Value of Project: $9,500.00 .
APPLICANT: DO NOT WRITE BELOW THIS LINE
# Submittal Req'd'Rec'd TRACKING PERMIT FEES
Plan Sets Plan Check submitted Item Amount
Structural Cales.
Reviewed, ready for corrections
Plan Check Deposit. .
Truss Cates.
Called Contact Person
Plan Check Balance
Title 24 Calcd.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
r4 Review, ready for correctionstissue
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 correctionsfissue
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
Alterations to Space Conditioning Systems (formerly CF -1R -ALT -HVAC)
Project Name:
CHERYL GASIEWSKI I Date Prepared:
CF1R-ALT 02-E
(Page 1 of 3 )
2016-05-26
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 CHR -ALT -02 document for each dwelling unit.
Ol
Project Name
CHERYL GASIEWSKI
02
Date Prepared
2016-05-26
03
Project Location
78800 Sanita Drive
04
Building Type
Single family
05
CA City.
La Quinta
06
Dwelling Unit Name
CHERYL GASIEWSKI
07
Zip Code
92253
08
Dwelling Unit Conditioned
1300
Floor Area (ft2)
SCS stem
Y
CFA servedq�ls
, stem al -7'
d i
r f i er nt
g: a. �.
�.Instalh new SC
a� �
Number of space conditioning
In tallin
1�
09
Climate Zone
15
10 _
,(SC) systems in this.dwelling -
:1
containing
bg
system
more than 40
entirely new
unit.
Name
Served
System (ft2)
system?
component?
components?
B. Space Conditioning -(SC) System 5rfformation,
Aow
01
02
7 03
04
b5
--06M
07
088
09
10
r.,,a�,
the sC
? �m-'�"a� ai '+�
Installing a_SCS
ham-
Y stem
SCS stem
Y
CFA servedq�ls
, stem al -7'
d i
r f i er nt
g: a. �.
�.Instalh new SC
a� �
Installiri
gar g
In tallin
1�
Installin g
Identification or
Location or Area
by this SC
ducted
containing
bg
system
more than 40
entirely new
entirely new
Name
Served
System (ft2)
system?
component?
components?
feet of ducts?
duct system?
SC system?
Alteration Type
System 1
Location 1
--r
1300
Yes
Yes
Yes
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-A0196263A-000000000-0000
Registration Date/Time: 2016-05-26 13:31:04
HERS Provider: CalCERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013 Rev 1.007 Report Generated: 2016-05-26 13:30:55
Schama Varcinn• n.SSSCnn
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)IE 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
25
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.
CFZR-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: <_ 15%, or <_ 10% leakage to outside'or seal all accessible leaks.
CUR -MCH -25=H.& CF3R-MCH 25-H Refrigerant Charge-Vificaton•repuired'when refrigerant containing components are installed or altered (applicable in CZ 2, 8-15).
CF2RCF3R-MCH-23 & CF3R-MCH23 Air Flow > 300;CFM/ton required:,when MCH -25 is required.
-s
Exceptions-.
-Duct systems registered with HERS provider as previously sealed are exempt from MCH -20 Duct Leakage Testing requirements...
MCH!
-Heating-only systems and Air Handler/Furnace changes do not require verification of Air Flow MCH=23, or Refrigerant Charge
°
Existing duct systems constructed; insulated or sealed with as6estos�are exemp from MC Du Leakage Test g;requi re"mmeWntss yi
I
> 'fit az ^tett rr�u m wA +as -Har cW
p wr wa Asn as
E.'.Entirely New or Complete Replacement Duct,System, with or without Equipment Changeout (Sections 150.2(b)1Diia.and 150.2(b)1E, F)
PK I I) 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-A0196263A-000000000-0000
Registration Date/Time: 2016-05-26 13:31:04
HERS Provider: CalCERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013 Rev 1.007 Report Generated: 2016-05-26 13:30:55
Cchpma Varcinn• n.SSSCnn
CERTIFICATE OF COMPLIANCE CF1R-ALT-02-E
Alterations to Space Conditioning Systems. (formerly CF -1R -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: �
Jan
Jacoby, Ian
C7acob
Company:
Signature Date:
i PERMIT E RATERS
2016-05-26 13:31:04
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,lawsof 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 Busiiiess'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 Reg lations.
4. The building design features or system design features identified on this Certificate of C mpliance arer[onsis�tent,witMthe in formation provided on otI. her" r applicable compliance documents, worksheets,
to for building
calculations, plans and specifications submitted the enforce ment=agency approval with this permit application.
5. 1 will ensure that a registered copy of this,Certificaa to of Compliance shalf;_be;maade available with Wia build hg.pemit(s);issued for the building, and ade availabl f9_the enforcement agency for all applicable
w Y04,.
inspections. I understand that a registered copy of this-6ertificate of Compliance is required to be included with the documentation the builder provides to the building owner at occupancy. -
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Responsible Designer Name: = .Z
Responsible Designer Signature: V 11
Jan
Jacoby, Ian
acobJr
Company:
Date Signed:
VOTTA ENTERPRISES INC
2016-05-26 13:31:04
Address:
License:
4803 E SUNNY DUNES ROAD
763937
City/State/Zip:
Phone:
PALM SPRINGS CA 92264
760-320-5800
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-A0196263A-000000000-0000 Registration Date/Time: 2016-05-26 13:31:04 HERS Provider: C6ICERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013 Rev 1.007 Report Generated: 2016-05-26 13:30:55
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