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BMCH2016-0084LICENSED 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.: 906115 Date: l7 Contractor: OWNER -BUILDER 7/e:pt N I hereby affirm under penalty of perjury that mfrom the Contractor's State License Law for the following reason (Sec. 7 1.5,s 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 11, 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, 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: (760)360-2202 Lic. No.: 906115 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 performan[e of tk 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 perry it 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 forthwit comply with those provisions. Date: GApplicant: WARNING: FAILURE TO SECURE WORKERS' MP ATION.COVERAGE IS UNLAWFLL, 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 3766 OF THE LABOR COCE, 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, a nd 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 cf 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: Signature (Applicant or Agent): 78-495 CALLE TAMPICO 4 40" VOICE (760) 777-7125 LA CtUINTA, CALIFORNIA 92253 FAX FAX (760) 777-70].1 COMMUNITY DEVELOPMENT. DEPARTMENT (760) 777-703.1 BUILDING PERMIT Date: 4/6/2016 Application Number: BMCH2O16-0084 Property'Address: 80330 TORREON WAY Owner: MYRL NOF FR AA APN: 777330016 Application Description: MYRL NOFZIGER /HVAC CHANGE OUT 1738 W LIIS s Pl.A-,) I ) GOSHEN, 11192 53 Property Zoning: APR 06 2016 (J Application Valuation: Applicant: Crrf OF LA OUNTA Contractorl COMMUPTYDEVELOPMENTOEFAF( R'E?JTa CERTIFIED COMFORT SYSTEMS INC DBA HYDES CERTIFIED COMFORT SYSTEMS INC DBA HYDES 42-949 MADIO STREET 42-949 MADIO STREET INDIO, CA 92201 INDIO, CA 92201 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.: 906115 Date: l7 Contractor: OWNER -BUILDER 7/e:pt N I hereby affirm under penalty of perjury that mfrom the Contractor's State License Law for the following reason (Sec. 7 1.5,s 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 11, 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, 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: (760)360-2202 Lic. No.: 906115 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 performan[e of tk 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 perry it 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 forthwit comply with those provisions. Date: GApplicant: WARNING: FAILURE TO SECURE WORKERS' MP ATION.COVERAGE IS UNLAWFLL, 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 3766 OF THE LABOR COCE, 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, a nd 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 cf 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: Signature (Applicant or Agent): Description: MYRL NOFZIGER / HVAC CHANGE OUT Type: MECHANICAL Subtype: Status: APPROVED Applied: 4/6/2016 RSE Approved: 4/6/2016 RSE Parcel No: 777330016 Site Address: 80330 TORREON WAY LA QUINTA,CA 92253 Subdivision: TR 31349 Block:- Lot: 100 Issued: Lot Sq Ft: 0 Building Sq Ft: 0 Zoning: Finaled: Valuation: $0.00 Occupancy Type: Construction Type: Expired: No. Buildings: 0 No. Stories: 0 No. Unites:.O. Details: HVAC CHANGE OUT - 20.5SEER/80AFUE SPLIT SYSTEM [2013 ENERGY] CARBON MONOXIDE ALARM(S) TO BE INSTALLED PRIOR TO FINAL INSPECTION. 2013 CALIFORNIA BUILDING CODES. CONDITIONS CONTACTS .N A M E TYPE; NAME ` ADDRESSI CITY STATE ; ° ZIP " PHONEY FAX EMAIL " APPLICANT CERTIFIED COMFORT SYSTEMS INC 42-949 MADIO STREET INDIO CA 92201 DBA HYDES CONTRACTOR CERTIFIED COMFORT SYSTEMS INC 42-949 MADIO STREET INDIO CA 92201 DBA HYDES OWNER MYRL NOFZIGER 1738 W LINCOLN AVE GOSHEN IN 92253 Printed: Wednesday, April 06, 2016 9:38:26 AM 1 of 2 SYSTEMS, .;., y. h.� ,.... .. �= »= :. wDESCRIP,TION :o P .. .;- 5 tom,... ;:� ACCOUNT �; ClTY�sAMbUNT a_ F,..: —:RAIDfx;,a" ID DATE ,5'r" ....W.. :RECEIPT,# +..e. CHECK # - S ,i`- a S METHOD . K %} _12 PAID BYw„” : , . BY. 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 0 $91.85 $0.00 _ Total Paid for PERMIT ISSUANCE: $91.85 $0.00 INSPECTIONS PARENT PROJECTS BOND INFORMATION - XrrACHMEN'T5 Printed: Wednesday, April 06, 2016 9:38:26 AM 2 of 2, SYSTEMS Bin. # City. 0.T La Quinta Building 8L Safety Division P.O. Box 1504,•78-49S Calle Tampico P.Quinta, CA 92253 -:(760) 7774012 Building Permit Application and Tracking Sheet Permit # Project Address:Owner's Name:. 1` A. P. Number. Address: Legal Description: Contractor: City, ST, Zip: Telephone: Address: _ Project Description: City, ST, Zip: Telephone: 360 'ZZ�2 �. i �: �z, State Lic. #:,�b6f t 5 City Lie. #.. -20 4 Arch:, Engr., Designer. Address: City., ST, Zip: Telephone: State Lic. #:" ^� ;ice» Name of Contact Person: Construction Type: • Occupancy: Project type (circle one): New . Add'n Alter Repair Demo Sq. Ft.: # Stories: # Units: Telephone # of Contact Person: Estimated Value of Project am APPLICANT: DO NOT WRITE BELOW THIS UNE p Submittal Req'd Recd TRACKIIVG PERMiT FEES Plan Sets Plan Check submitted Item Amount Structural Caics. Reviewed, ready for corrections Plan Check Deposit, . Truss Cales. Called Contact Person Plan Check Balance Tide 24 Cold. Pians picked up Construction Flood plain plan i Plans resubmitted.. Mechanical Grading plan i i 2id Review, ready for correcfionsfissue Electrical Subcontactor List Called Contact Person Plumbing Grant Deed Plans picked up SALL H.O.A. Approval I Plans resubmitted Gradin g IN HOUSE:- 'i° Review; ready for correctionslissae Developer Impact Fee Planning Approval ` Called Contact Person A.LP: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 -1R -ALT -HVAC) - (Page 1 of 3 ) Project Name: 80-330 Torreon Way Date Prepared: 2016-03-30 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 80`330 Torreon Way 02 Date Prepared 2016-03-30 03 Project Location 80-330 Torreon Way 04 Building Type Single family 05 CA City La Quinta 06 Dwelling Unit Name 80-330 Torreon Way 07 Zip Code 92253 s 08 Dwelling Unit Conditioned . 3000 . pit Floor Area (ft2) SCS stem Y SCS stem Y CFA served 'Number refri a nt ¢ g�. of space conditioning Installin g 09 Climate Zone 15 1',�, 10 (SC) systems in this dwelling 1 ducted ti � containing system sr more than 40 unit. entirely new B. Space Conditioning (SC) System`Iriformation r _ 01 02 ' ' 03 041I 05 k� q� "6n� 11 07�) g M$ 11 09 10 M. �� ii } f b � �Is the SC -tea > t .=�} An; InstallinIIg SCS stem Y SCS stem Y CFA served y stem a refri a nt ¢ g�. Installin new SC a• �g � Installin g - Installin installing g Identification or Location or Area by this SC ducted ti � containing system sr more than 40 entirely new entirely new Name. _._ _ ___.Served . --..-,-System. (ft2)_ ...__.system?, --- __component? ..components?---. -feet.of-ducts?- duct -system?• - SGsystem? • I Alteration-Type- lteration-Type -System System1, living area 2000 Yes Yes Yes No No No Altered space [conditioning system C. Extension of Existing Duct System, Greater Than 40 Feet (Section150.2(b)iDiib) This section does not apply to this project. Registration Number: 216-A0118765A-000000000-0000 CA Building Energy Efficiency Standards - 2013 Residential Compliance Registration Date/Time: 2016-03-30 10:30:31 HERS Provider: CalCERTS Report Version: 2013 Rev 1.007 Report Generated: 2016-03-30 10:27:12 Schema Version: 0.555S6D 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)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 split All new Central split All new This field or This field or System 1 HP heating AFUE 0.78 AC cooling SEER 20 Setback section is not section is not components components t applicable applicable Required Documentation: CF2R-MCH-01-E - Space Conditioning Systems Ducts and Fans -Duct insulation requirement for new plenums: R6. 4 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: <_ 15%, or 5 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.- equirements. ti -Heating-only.�� Ai H- � -Heating-only systems and Air Handler/furnace changes do not require verification Air Flow Charge IVIErcH=2�� ' of ,MCH:�29 _or"Refrigerarit rgel Existing duct systems constructed, insulated or sealed with asbestos are exemp from MCH`-20 Duct�Leakage Testing requirements. l - P W% /"-,:4 %1 » U of lit `1k. 11 $1 1; 91 )i — 11 Jf It Vk . ��b;� '-�n..r vi.,v.+ w.r -aatis.,N.. 4+...,.or � 4.► wr �,a..,+.' y� +.n+ rAe wa �,,,,.nr Sw E. Entirely New or Complete Replacement Duct System, with or without Equipment Changeout (Sections 150.2(b)lDiia and 150.2(b)1E, F) t i t r k J U1 It< Rip y. 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-A0118765A-000000000-0000 CA Building Energy Efficiency Standards - 2013 Residential Compliance Registration Date/Time: 2016-03-30 10:30:31 Report Version: 2013 Rev 1.007 Schema Version: 0.555SDD HERS Provider: CalCERTS Report Generated: 2016-03-30 10:27:12 .....r: - p CERTIFICATE OF COMPLIANCE CFIR-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: Hyde, Mark Company: Signature Date: CERTIFIED COMFORT SYSTEMS INC 2016-03-30 10:30:31 Address: CEA/ HERS Certification Identification (if applicable): 42949 Madio City/State/Zip: Phone: Indio CA 92201 760-360-2202 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 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 Regula ns. i R E al f •+ �f 4. The building design features or system design features identified on this Cemficate of Compliance are,consistentwtth�the inform ation.provided on other plicable•compliance documents, worksheets, calculations, plans and specifications submitted to the enforcement agency for approval with this building permit application. j� x ha 1 � .r. �. 04 � 4�. tr . S. I will ensure that a registered copy of this Certificate of ompliance shall'be;made available with,,th"e building pgrmit(s),issued forthe'building, and,made available to the enforcement agency for all applicable inspections. I understand that a registered copy of this Certificate of Compliance requKred to be included with the�documentation�the�builder p�royi#des to,, he building owner at occupancy. Responsible Designer Name: > Responsible Designer Signature: V Jr00 LC Hyde, Mark wows 77TH Company: Date Signed: CERTIFIED COMFORT SYSTEMS INC 2016-03-30 10:30:31 Address: License: 42949 Madio 906115 City/State/Zip: Phone: Indio CA 92201 760-360-2202 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-A0118765A-000000000-0000 Registration Date/Time: 2016-03-30 10:30:31 HERS Provider: CaICERTS CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013 Rev 1.007 Report Generated: 2016-03-30 10:27:12 Schema Version: 0.555SDD