BMCH2016-0147LICENSED 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 and effect.
License Class: C20, C36 License No.: 8274200
Date:
"10 l(e Con2ractor�OWNER-BUILDER DECLARATION,.
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 Add
WORKER'S COMPEMSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
I have and will maintain a certViicate 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
c=-1:ft-I have and will maintain worke-s' 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 performanm 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 agre that, if I should become subject to the,
workers' compensation provisions of Sectbn 3700 of the Labor Code, l shall forthwith
comply with those provisions.
10 lc. Applicant:
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL,
AND SHALL SUBJECT AN EMPLOYER TO Cit MINAL PENALTIES AND CIVIL FINES UP TO
ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION TO THE COST OF
COMPENSATION, DAMAGES AS PROVIDES FOR IN SECTION 3706 OF THE LABOR CODE, .
INTEREST, AND ATTORNEY'S FEES.
APPLICANT ACh NOWLEDGEMENT'
IMPORTANT: Application is hereby made to the Building Official for a permit subject to
the conditions and restrictions set forth or this application.
1. Each person upon whose behalf this application is made, each person at whose
request and for whose benefit work is perormed 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 harmlessthe 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 ai-d state that the above information is correct. .
I agree to comply with all city and county xdinances and state laws relating to building
construction, and hereby authorize representatives of this city to enter upon the
above-mentioned property for inspection purposes.
(d
Date:'S )L0 Signature (Appl_ _ _ ieant-drA'gent): Jc/wsrz—��
4aw
VOICE (760) 777-7125
78-495 CALLS TAMPICO
FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253
COMMUNITY DEVELOPMENT DEPARTMENT
• INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 5/10/2016
Application Number: BMCH2O16-0147
D
Owner:
Property Address: 79347 CALLE PALMETO
JOANN LANE
APN: 604382030
PAY 10 2016
79347 CALLE PALMETO
Application Description: LANE RESIDENCE / HVAC
CHANGE OUT
LA QUINTA; CA 92253
Property Zoning:
CITYOFIAQU)MA
Application Valuation: $9,406.00
MM
�U+1'OFU�Op;,gEfJTIJ�g+7
Applicant:
Contractor:
IE INC
ALL SEASONSAIR CONDITIONING PLUMBING &
31225 LA BAYA
73605 DINAH SHORE DR STE 1310M
WESTLAKE VILLAGE, CA 91362.
PALM DESERT, CA 92211
(760)568-26613
Llc. No.: 827420
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 and effect.
License Class: C20, C36 License No.: 8274200
Date:
"10 l(e Con2ractor�OWNER-BUILDER DECLARATION,.
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 Add
WORKER'S COMPEMSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
I have and will maintain a certViicate 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
c=-1:ft-I have and will maintain worke-s' 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 performanm 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 agre that, if I should become subject to the,
workers' compensation provisions of Sectbn 3700 of the Labor Code, l shall forthwith
comply with those provisions.
10 lc. Applicant:
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL,
AND SHALL SUBJECT AN EMPLOYER TO Cit MINAL PENALTIES AND CIVIL FINES UP TO
ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION TO THE COST OF
COMPENSATION, DAMAGES AS PROVIDES FOR IN SECTION 3706 OF THE LABOR CODE, .
INTEREST, AND ATTORNEY'S FEES.
APPLICANT ACh NOWLEDGEMENT'
IMPORTANT: Application is hereby made to the Building Official for a permit subject to
the conditions and restrictions set forth or this application.
1. Each person upon whose behalf this application is made, each person at whose
request and for whose benefit work is perormed 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 harmlessthe 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 ai-d state that the above information is correct. .
I agree to comply with all city and county xdinances and state laws relating to building
construction, and hereby authorize representatives of this city to enter upon the
above-mentioned property for inspection purposes.
(d
Date:'S )L0 Signature (Appl_ _ _ ieant-drA'gent): Jc/wsrz—��
INFORMATION
M 4 _.4"!
DESCRIPTION: ��
QTY
�
:a AMOUNTT� PAID DATE;
,ACCOUNTn,�'
z,. ?PAID€ s
•BSAS SB1473 FEE 101-0000-20306
0
$1.00
0.00
PAID BYr`' METHODe�f$
RECEIPT #
' CHECK #• ` `CLTD BY ,X
,
Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $1.00 $0.00
s� tDESCRIPTION �
;` ACCOWNT 'X
QTY
r AMOUNTr
«
PAIDDATE-i
a;*
.PAID
HVAC CHANGEOUT - SPLIT -SYSTEM
101-0000-42402
0
$72.52
$0.00
YPAID�BY
RECEIPT # '�
CHECK #'CLTD
BY
}�
FDESCRIPTION 4'' "� i
' «'-ACCOUNT` `,R �x , y
QTY
` ; AMOUNT,
PAID,,
PAID DATE'.
kap
X$
HVAC CHANGEOUT - SPLIT -SYSTEM PC
101-0000-42600
0
$36.26
$0.00
;PAID BY "� " `
` ` aMETHOD€:,
#1
CHECK #
LTD,B71 w
3
..RECEIPT
Total Paid for CHANGEOUT: $108.78 $0.00'
'ME SCRIPT,ION,;
AC CO
QTY
AMOUNT';
PAID ,
PAID DATE
a �.. _,,...
:
,
PERMIT ISSUANCE
101-0000-42404
0
$91.85
$0.00
PAID; BY>
METH0D
RECEIPT # x `
# �
CLTD Blf3 s
y
;CHECK
Total Paid for PERMIT ISSUANCE: $91.85 $0.00
TOTALS:00
Description: LANE RESIDENCE / HVAC CHANGE OUT
Type: MECHANICAL Subtype: Status: APPROVED Applied: 5/10/2016 MFA
Parcel No: 604382030 Site Address: 79347 CALLE PALMETO LA QUINTA,CA 92253 Approved: 5/10/2016 MFA
Subdivision: TR 25953 Block: Lot:, 121 Issued:
Lot Scl Ft: 0 Building Scl Ft: 0 Zoning: Finaled:
Valuation: $9,406.00 Occupancy Type: Construction Type: Expired:
No. Buildings: 0 No. Stories: 0 No. Unites: 0
Details: HVAC CHANGE OUT - 14 SEER/80AFUE SPLIT SYSTEM [2008 ENERGY] CARBON MONOXIDE ALARM(S) TO BE INSTALLED PRIOR TO
FINAL INSPECTION. PER 2013 CALIFORNIA BUILDING CODES.
FINANCIAL INFORMATION
Printed: Tuesday, May 10, 2016 8:41:20 AM 1 of 2
- SYSTEMS
CONTACTS
�;;.,:^:..:
NAME TYPE . NAME
....:er tv .. v,. -
' ADDRESSi CITY STi4TE ZIP
,�. as
PHONE X
E L
' <.i.:F, ..�
r
3i -.,i-. _F v. -!ha -r-rt �'1«,S, ..,-i'.. .. _..'?.
e. s:. 't. .>-.+"i ,w a.. .. ,. F"'"ry
��C'
z x, s
{•�E�n
APPLICANT
IE INC
31225 LA BAYA
WESTLAKE
CA
91362
(760)360-9257
VILLAGE
CONTRACTOR
ALL SEASONS AIR CONDITIONING
73605 DINAH SHORE
PALM DESERT
CA
92211
(760)360-9257
PLUMBING &
DR STE 1310M
OWNER
JOANN LANE
79347 CALLE PALMETO
LA QUINTA
CA
92253
(760)360-9257
FINANCIAL INFORMATION
Printed: Tuesday, May 10, 2016 8:41:20 AM 1 of 2
- SYSTEMS
~INSPECTIONS v i
PARENT, PROJECTS T
Printed: Tuesday, May 10,'2016 8:41:20 AM 2 of 2
- SYSTEMS"
sin.#
CIt}/ Of La Quvhta
1 ' Building & Safety Division
O� "� P.O. Box 1504,78-495 Calle Tampico -
La.
La.Quinta, CA 92253 -:(760) 777-7012
Building Application and Tracking Sheet
Permit #
1rb�
A�" _
Project Address: 79347 Calle Palmeto
Owner's Name:-Joann Lane
A P: Number.
Address; 79347 Calle Palmeto
Legal Description:
City, ST, Zip: 'La Quinta, CA '92253
Contractor. All Seasons Air Conditioning, Plumbing & Heating
Telephone: 760-360-9257
Address: .73605 Dinah Shore Drive Suite 1310M
Project Description: Replace .4ton A/Q Coil, &,80.,000'BTU
City, ST, Zip: Palm Desert, CA 92211
Furnace
Telephone*
p . 760-568-2663
'
State Lic. # : 827420.
City Lie. M.
Arch., Eng., Designer
Address: r
City., ST, Zip:
Telephone: Y.
State Lia #:wy u
Name of Contact Person: Steven Schnierer
Construction Type:. Occupancy:
Project type (circle one): New Add'r_ Alter Repair Demo
Sq. Ft.: #.Stories:
#Units:
Telephone # of Contact Person: 818-735-7876
Estimated Value of Project $9,406.00
APPLICANT: DO NOT WRITE BELOW THIS UNE
#
Submittal
Req'd
Reed
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item Amount
Structnrai Calm
Reviewed, ready for corrections
Plan-Chcck Deposii. .
Truss Cates.
Called Contact Person
Plan Check Balance
Title 24 Calci.
Plans picked up
Construction.
Flood plain plan
Plans resubmitted
Mechafil"L
Giading plan
2 A Review, ready for correctionsliissue
Electrical
Subco tactor 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 correetionsfissue
Developer hnpact Fee
Planning Approval
Called Contact Person
Pub. Wks. Appr -
Date of permit issue
School Fees
Total Permit-Fees
CERTIFICATE OF COMPLIANCE CF111-ALT 02-E
Alterations to Space Conditioning Systems (formerly CF -1R -ALT HVAC) (Page 1 of 3 )
Project Name: JOANN LANE Date Prepared: 2016-05-09
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
JOANN LANE
02
Date Prepared
2016-05-09
03
Project Location
79347 Calle Palmeto
04
Building Type .
Single family
05
CA City
La Quinta
06
Dwelling Unit Name
JOANN LANE
.07
Zip Code
92253
08
Dwelling Unit Conditioned
1736
�
Installing new;SC
�
Installing
•
installing
Floor Area (ft2)
Identification or
Location or Area
by this SC
�4;.
containing
Number of space conditioning
more than 40
09
Climate Zone
15 , �`
10
(SC) systems in this dwelling
1
system?
component?
components?
feet of ducts?
unit.
SC system?
B. Space Conditioning (SC) System Information "
01
02
f 03. yrc
04
U56
07 �w
:>' 08
09
10
'VA
`.�,
is the SC
Installing a
SC System
SC System
`CFA served
ystem a
�--�
refrigerant t
�
Installing new;SC
�
Installing
rte -
Installing
installing
Identification or
Location or Area
by this SC
ducted
containing
a ,
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
1736
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-A0173265A-000000000-0000 Registration Date/Time: 2016-05-09 23:27:12 HERS Provider: CalCERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013 Rev 1.007 Report Generated: 2016-05-09 23:27:18.
Schema Version: 0.555SDD
CERTIFICATE OF COMPLIANCE CF1R-ALT-02-E.
Alterations to Space Conditioning Systems (formerly CF-lR-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
Ideiititication
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
heating
AFUE
0.8
AC
cooling
SEER
14
Setback
equal to 40
R-8
furnace
components
components
feet
Reauired 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$req'uired 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%, or 5 10% leakage to outside, or seal all accessible leaks.
CF2R-MCH-25-H & COR -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" 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.
s e
.,6'78-..6 ,�` fir."' Y ,'�.
qtr as£ sw;-�a«. .*.
r,r '�+ s. ,�! t 'em
Heating -only systems and Air Handler/Furnace changes do not require venfication of Air Flow MCH 23 or Refrigerant Charge MEC( C
9
-Existing duct systems constructed, insulated or sealed with asbestos are exemptEfrom MCH -20 Duct l.AgWe Testing requirements.
r+4. 1.i N ...._.._ t: .U:I21 Nl4.. R t _ .. ri 1k k 11 ;:.c" +.s 4R Ir ;.k iii,.
•,..i. Jay
E. Entirely New or Complete Replacement DuctiSystem, with or without,Equipment Charigeout (Sections 150.2(b)1Diia and 150.2(b)lE, F)
yid k lig
This section does not apply to this project.
F. Entirely New or Complete Replacement Space Conditioning System (Section 150.2(b)lC)
This section does not apply to this project.
Registration Number: 216-A0173265A-000000000-0000 Registration Date/Time: 2016-05-09 23:27:12 HERS Provider: CalCERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013 Rev 1.007 Report Generated: 2016-05-09 23:27:18
Schema Version: 0.555SDD
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:
4ar'n6Y
I�cohti�.lan
r.Yatr
Company:
Signature Date:
i PERMIT E RATERS
2016-05-09 23:27:12
Address:
CEA/ HERS Certification Identification (if applicable):
31225 Le Baya Drive #213
City/State/Zip:
Phone:.
West Lake Village CA 91362
818-735-7876
Responsible Person's Declaration statementk "
I certify the following under penalty of perjury, under the laws of the State of California:
r
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.
S - erj
4. The building design features or system design features identified on Certificate of Compliance are consistent withahe informatl`on=provided on othegapplicable compliance documents, worksheets,
-this
calculations, plans and specifications submitted to the enforcement<agency forapprovalwith this building permit applicatiiin. >
tx V a C >k 1 ` -,A �A KA �; 0 � .
.
S. I will ensure that a registered copy ofthis Cerfificat bf C shall be.made available withytfie bulldlrig:permtt(s) issued for the building, and made aval_lable to the"ehforcement agency for all applicable
k,mpliance
inspections. I understand that a regisie'red copy of thf 4;ii cate of Co�mpllance�.is,�requi�red to be,included with the documentattion�the bwlder p ov des tothe building owner at occupancy.
Responsible Designer Name: } Jr -1 UX
Responsible Designer Signature: V 1i
An
Jacoby, Ian
�acoC
Company:
Date Signed:
ALL SEASONS AIR CONDITIONING PLUMBING & HEATING INC
2016-05-09 23:27:12
Address:
License:
73605 Dinah Shore Drive, Suite 1310M
827420
City/State/Zip:
Phone:
Palm Desert CA 92211
760-568-2663
Digitally signed by Ca10ERTS. This digital signature is provided in order to secure the content of this registered document, and in no way implies Registration Provider responsibility for the accuracy of the information.
Registration Number: 216-A0173265A-000000000-0000 Registration Date/Time: 2016-05-09 23:27:12 HERS Provider: CaICERTS
CA Building Energy.Efficiency Standards - 2013 Residential Compliance Report Version: 2013 Rev 1.007 Report Generated: 2016-05-09 23:27:18
Schema Version: 0.555SDD