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BMCH2015-001678-495 CALLE TAMPICO - LA QUINTA, CALIFORNIA 92253 Application Number: Property Address: APN: Application Description Property Zoning: Application Valuation: BMCH2O15-0016 54961 TANGLEWOOD 775152082 HVAC CHANGE OUT 16 SEER $5,968.00 Applicant: EFFICIENT AIR CONDITIONING INC P 0 BOX 1043 THOUSAND PALMS, CA 92276 4 4v Q": LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of C iapter 9 {commencing with Section 7000) of Division 3 of the Business and Professions =ode, and my License is in full force and effect. License Class: B. C20 License No.: 881926 (Date: / �T> '-(j Contractor: �. OWNER -BUILDER DECLARATION I hereby.affirm under penalty of perjury that I am exempt from the ContractIs 5tate License Law for the following reason (Sec. 7031.5, Business and Professions Cod -2: 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 anc the basis for the alleged exemption. Any violation of Section 7031.5 by any applicart for a permit subjects the applicant to a civil penalty of not more than five hundred ddlars ($500).: ( ) I, as owner of the property, or employees with wages as their sole compensation, will do the work, and the structure is not intended or offered forsale. (Sec. 7044, Business and Professions Code: The Contractors' State License Law cibes 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 provirg 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 Contra=tors' State License Law does not apply to an owner of property who builds or, improves thereon, and who contracts for the projects with a contractors) licensed pursuant to the Contractors' State License Law.). (_) I am exempt under Sec. . B.&P.C. for this reason Date: Owner: CONSTRUCTION LENDING AGENCY Idiereby affirm under penalty of perjury that there is a construction lending age icy for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.). Lender's Name: Lender's Address: VOICE (760) 777-71125 FAX (760) 777-7311 INSPECTIONS (760) 777-7153 Date: 1/15/2)15 ITA KUSKIKE TANGLEWOOD INTA, CA 92253 Contractor: EFFICIENT AIR CONDITIONING INC P 0 BOX 1043 THOUSAND PALMS, CA 92276 (760)343-5335 Llc. No.: 881926 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 thew rk for which this permit is issued. 1I 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 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 worker' 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.fP11UL, . Date: _— I lApplicant: J` WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNAND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVILFINES 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 subjE•.:t 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 orpursuant to any permit issued as a result of this application , the owner, and the applicant, each agrees tc, and shall defend, indemnify and hold harmless the City of La Quinta, its officers, agent::, 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 worn 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 ccrrect. I agree to comply with all city and county ordinances and state laws relating to bulding construction, and hereby authorize representatives of this cityto enter u n above mentioned property for inspection purposes. Date: — �� Signature (Applicant or Agent): Simplified PrescriF Climate Zones 10 to 15 Certificate of Compliance: 2008 Residential HVACAIterations CF -IR -ALT -HV Site Address: Enforcement Agency: Date: Permit 4: - Equipment T,Xpe List Minimum Efficiency' Duct insulation requirement Conditioned Floor Area Thermostat ❑ Packaged Unit Fumace ❑ AFUE (bT© ❑ Cop Over 40 ft of ducts added or XSetback Indoor Coil ❑SEER ❑ HSPF replaced in unconditioned space Served by system (lfnot already Condensing Unit ❑ EER ❑ Resistance 13R 6 (CZ 10-13) sf present, must be ❑ other ❑ R 8 (CZ 14-15) installed) 1. Equipment Type: Choose the equipment being installed; if more than one system, use another CF -IR -ALT -HVAC for each system. 2. Minimum Equipment Efflciencies: 13 SEED 78% AFUE, 7.7HSPF for typical residential systems. HERS VERIFICATION SUMMARY Listed below are four HVAC alteration Options. The installer decides what work is being done and picks one of the appropriate Options. Each Option lists the HERS measures that must be conducted. A copy of the forms shall be left on site for final inspection and a copy given to the homeowner. At final, the inspector verifies that the work listed on this form was in fact the work completed by the installer. The inspector also verifies that each appropriate CF -6R and registered CF4R forms (no hand filled CF-4Rs allowed) are filled and .out Beginning October 1, 2010, a registered copy of the CF -1R and CF -6R shall also be on site for final ins ection. Msigned. I.HVAC Changeout Required Forms: • All HVAC Equipment replaced CF -6R forms: MECH-04, MECH-2I-HERS and (for split systems) MECH- 25 -HERS CF -4R forms: MECH- 21 and fors lit stems MECH-25 • Condenser Coil and /or • Indoor Coil and /or CF -6R forms: MECH-2I-HERS and (for split systems) MECH- 25 -HERS • Furnace CF -4R forms: MECH- 21 and (for split systems) MECH-25 For Split Systems: Duct leakage < 15 percent; RC, CCA 2:300 CFM/ton(Minimum Air Flow Requirement), TMAH For Packaged Units: Duct leakage < 15 percent Exempted from duct leakage testing if: ❑ 1. Duct system was documented to have been previously sealed and confirmed through HERS verification, or ❑ 2. Duct systems with less than 40 linear feet in unconditioned space, or ❑ 3. Existing ducts stems are constructed, insulated or sealed with asbestos ❑ 2. New HVAC System Required Forms: , • Cut in or Changeout with new ducts: (all new ducting and all CF -6R forms: MECH-04, MECH-20-HERS,and (for split systems) MECH-22-HERS, and MECH-25-HERS new equipment) CF -4R fomes: MECH 20-, and fors lit stems MECH-22, and MECH 25 ( P sY ) For Split Systems: Duct leakage < 6 percent; RC, CCA >: 350 CFM/ton, FWD, TMAH, STMS, and either HSPP or PSPP. For Packaged Units: Duct leakage < 6 percent ❑ 3. New Ducts with Replacement Required Forms: • Includes replacing or installing all new ducting CF -611 forms: MECH-04, MECH-20-HERS,and (for split systems) MECH-25-HERS and/or outdoor condensing unit and/or indoor CF -4R forms: MECH-20 and (for split systems) MECH-25 coil and/or furnace. Not all equipment changed. For Split Systems: Duct leakage < 6 percent, RC, CCA >_ 300 CFM/ton, TMAH For Packaged Units: Duct leakage < 6 percent ❑ 4. New Ducting over 40 feet Required Forms: • Includes adding or replacing more than linear feet of duct in unconditioned space. CF-6R forms: MECH-04, MECH-2I-HERS CF -4R forms: MECH-21 For split system or packaged units: Duct leakage < 15 percent ❑ EXCEPTION: Existing duct systems constructed, insulated or sealed with asbestos. Contractor (Documentation Author's /Responsible Designer's Declaration Statement) • I certify that this Certificate of Compliance documentation is accurate and complete. • I am eligible under Division 3 of the California Business and Professions Code to accept responsibility for the design identified on this Certif cate.of Compliance. • 1 certify that the energy d4tures and performance specifications for the design identif ed on this Certificate of Compliance conform to the requirements of Title 24, Parts 1 and 6 of the California Code of Regulations. • The design features identified on this Certificate of Compliance are consistent with the information documented on other applicable compliance fonns, worksheets, calculations, and plans specifications submitted to the enforcement enc forapproval with the permit application. Name: lalva Signature: Company 1 F6MIZ, - IAIVL!�) Date:DO_ Address: -70 7 — License: City/State/Zip:. , R Phon e: FINANCIAL INFORMATION DESCRIPTION _'r �`;E `� ACCOUNTS r ; ;ryQTY AMOUNT x PAID r PAID DATE BSAS SB1473 FEE 101-0000-20306 0 $1.00 $1.00 1/15/15 `fir • ' � PAID`BY�°METHOD b . RECEIPT # x '; E "CHECKS# 'e CLTD BY Y.,t...n - .: %Yd= n • CARLOS CHAVARRIA DEBIT R3413 SKH Total Paid forBUILDING STANDARDS ADMINISTRATION BSA: $1.00 $1.00 `Ery DESCRIPTION ACCOUNT 'r QTY OUNT '�: PAID �PAIDrrDATE HVAC CHANGEOUT - SPLIT -SYSTEM 101-0000-42402 0 $72.52 $72.52 1/15/15 : PAID. BY! : ' � � 'METHOD ` ^y RECEIPT CHECK #r BY a i ya w> z�CLTD CARLOS CHAVARRIA DEBIT R3413 SKH shy;, + ACCOUN PADESCRIPTIOE PAID:DATEAMOUNT`:;N , . $ �..:. , ,rig. • ,• r�; .. �� - HVAC CHANGEOUT - SPLIT -SYSTEM PC 101-0000-42600 , 0 $36.26 $36.26 1/15/15 METHOD 'RECEIPT #� k HECK #�" t TD 1 *CLTD BY s , �. CARLOS CHAVARRIA DEBIT R3413 SKH Total Paid forCHANGEOUT: $108.78 $108.78 ter aDESCRIPTION`.' `?s�QTY}`: AMO UNTS;$ FrisPi41D ` PAID'DATE Y;�ACCOUNT �3 PERMIT ISSUANCE 101-0000-42404 0 $91.85 $91.85 ..... .. ...... 1/15/15 �<� PAID BY METHOD �.. F:+ "ksRECEIPT # y a ,° r; , r ` `CHECK #'b„�' E CLTD BYE CARLOS CHAVARRIA DEBIT R3413 SKH Total Paid forPERMIT ISSUANCE: $91.85 $91.85 TOTALS: V1 Description: HVAC CHANGE OUT 16 SEER Type: MECHANICAL Subtype: Status: APPROVED Applied: 1/15/2015 MFA, Approved: 1/15/2015 SKH Parcel No: 775152082 Site Address: 54961 TANGLEWOOD LA QUINTA,CA 92253 Subdivision: TR 21846-2 Block: Lot: 3 Issued: Lot Sq Ft: 0 Building Sq Ft: 0. Zoning: — Finaled: Valuation: $5,968.00 Occupancy Type: Construction Type: Expired: No. Buildings: 0 No. Stories: 0 No. Unites: 0 Details: HVAC CHANGE OUT - 5 TON 16 SEER/80AFUE SPLIT SYSTEM [2008 ENERGY] CARBON MONOXIDE ALARM(S) TO BE INSTALLED PRIOR TO FINAL INSPECTION. 2013 CALIFORNIA BUILDING CODES. FINANCIAL -INFORMATION L Printed: Thursday, January 15, 2015 12:02:10 PM 1 of 2 ' 0 SYSTEMS - h ~DESCRIPTION �°'^... ,. yea'. ' r - °„ACCOUNT�� i;1. ^. $�.". a' - r "--=• �.« _ ., _ 4:a PAID rrr."'r'^i.""w.'""'r PAIDDATE .""'- RECEIPT •�++ CHECK# METHO D� X . PAID BY - CLTD- 'AiMOUNT , r�j IL, _ BY ,'.BSAS SB1473 FEE ' 101-0000-20306 0' $1.00 $1.00 1/15/15 R3413 ' DEBIT CARLOS CHAVARRIA SKH. Total Paid for BUILDING STANDARDS ADMINISTRATION $1.00 $1.00 BSA: _HVAC CHANGEOUT - 101-0000-42402 0 $72.52 $72.52 1/15/15 R3413 DEBIT CARLOS CHAVARRIA SKH - : SPLIT -SYSTEM HVAC CHANGEOUT - 101-0000-42600 0 $36.26 $36.26 1/15/15 R3413 DEBIT CARLOS CHAVARRIA SKH SPLIT -SYSTEM PC Total Paid forCHANGEOUT: $108.78 $108.78 PERMIT ISSUANCE 101-0000-42404 0 $91.85 $91.85 1/15/15 R3413 DEBIT CARLOS CHAVARRIA SKH Total Paid for PERMIT ISSUANCE:. $91.85 $91.85 TOTALS:• ., Printed: Thursday, January 15, 2015 12:02:10 PM 2 of 2 SYSTEMS 0UflCYf.7�J��r'Do �� Bin .# Qty 0f La Qulnta Building 8T Safety Division P.O. Box 1504, •78-495 Calle Tampico Ia.Quinta, CA 92253 -:(760) 777-7012 Building Permit Application and Tracking Sheet Permit # Project Address: Owner's Name: ' A. P. Number. Address: Legal Description: City, ST, Zip: `` ►� �Ik TeI hone: Contractor: eP 10 Address: Project Description City, ST, Zip: Arc( 1, 1S M hvhA1X ceea Telepho A� , € 1 State Lic. # : LAij Lic. M. 5383 Arch., Engr., Designer: Address: City., ST, Zip: Telephone: Construction Type: , ccupancy: State Lia #:`, Project type (circle one): New Add'n Alter Repair Demo Name of Contact Person:Sq. Ft.: #Stories: # Units: Telephone # of Contact Person: Estimated Value of Project APPLICANT: DO NOT WRITE BELOW THIS LINE N Submittal - Req'd Recd TRACMG PERMTr FEES Plan Sets Plan Check submitted Item Amount Structural Cala. Reviewed, ready for corrections Plan Check Deposit. . Truss Cales. Called Contact Person Plan Check Balance Tide 24 Calci. Plans picked up Construction i Flood plain plan Plans resubmitted.. Mechanical Grading plan tad Review; ready for correctionsrwue Electrical Subcontactor List Called Contact Person Plumbing Grant Deed Plans picked up SMI. E.O.A. Approval Plans resubmitted Grading IN HOUSE:- 3" Review; ready for correcdonsAssue Developer Impact Fee Planning Approval Called Contact Person A.LP.P. Pub. Wks. Appr Date of permit issue School Fees Total Permit Fees