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BMCH2015-0101LICENSED 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:: 8Lic nse No.: 885220/ Dated !/ /no-c'ontractor.% 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 permitGto 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' 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 ,k rk for which this permit is issued. .,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 C e, I s I forthwith. comply.with those provisions. Da��2 te: 3 Applicant: 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 withal.] city and county ordinances and state laws g building construction,. and hereby authorize representatives of this er up a above• mentionedropert for inspection purposes. Date:4nature (Applicant Si A � • g ( pp 'LU 1 LU LL, 0 C3z C3 U-1 g� �o o� U z 0 U VOICE (760) 777-7125 78-495 CALLE TAMPICO D FAX (760) 777-7011 FAX LA QUINTA, CALIFORNIA 92253 COMMUNITY DEVELOPMENT DEPARTMENT (760) 777-7153 BUILDING PERMIT Date: 3/27/2015 Application Number: BMCH2O15-0101 Owner: Property Address: 5116GAVENIDA VELASCO FRANCISCO ESPINOZA APN: 773065007 P 0 BOX 1464 Application Description: ESPINOZA/REPLACE SPLIT SYSTEM MECCA, CA 92253 Property Zoning: Application Valuation: $4,500.00 ? o (Ni Applicant: Contractor: DAVID STARRETT CONSTRUCTION DAVID STARRETT CONSTRUCTION Cal n` 27636 YNEZ ROAD L-7 -177 27636 YNEZ ROAD L-7 -177 TEMECULA, CA 92591 TEMECULA, CA 92591 (951)514-9133 --------------------------------------------------------------------=------------------------ Llc. No.: 885220 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:: 8Lic nse No.: 885220/ Dated !/ /no-c'ontractor.% 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 permitGto 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' 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 ,k rk for which this permit is issued. .,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 C e, I s I forthwith. comply.with those provisions. Da��2 te: 3 Applicant: 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 withal.] city and county ordinances and state laws g building construction,. and hereby authorize representatives of this er up a above• mentionedropert for inspection purposes. Date:4nature (Applicant Si A � • g ( pp 'LU 1 LU LL, 0 C3z C3 U-1 g� �o o� U z 0 U FINANCIAL INFORMATION DESCRIPTION ; , 4` `-"'AaOUNT `W. CQ • BSAS SB1473 FEE 101-0000-20306 0 MI D" METHOD z; t Total Paid forBUILDING'STANDARDS ADMINISTRATION'BS DESCRIPTION : �x �'c;'- w„ ACCOUNT;.., _§ Q HVAC CHANGEOUT - SPLIT -SYSTEM 101-0000-42402 0 PAID BYE,° ° '*s �� METHOD a' .RECEIPT# 4.* .�GHECK#. CLTD BY r, .°;DESCRIPTION 4 . ,� ACCOUNT :f 4 = QTY b : AMOUNT, , : _ '•PAID PAID DATE HVAC CHANGEOUT - SPLIT -SYSTEM PC 101-0000-42600 .0 $36.26 $0.00 ,PAID;BY, RECEIPT# CHECK# CLTDBY: J' Total Paid forCHANGEOUT: $108.78 $0.00 DESCRIPTION :, AC000NT a QTY. x - „ ..AMOUNT• : �" r PAID, ' , PAID DATE- PERMIT ISSUANCE 101-0000-42404 0 $91.85. $0.00 'PAID METHOD r,RECEIPT # CHECK # .CLTO BY,' Total Paid forPERMIT ISSUANCE: $91.85 $0.00 TOTALS:�� TY,; ? AMOUNT 4. '.PAID xPAID DATE.; $1.00 $0.00 t RECEIPT BY�� •' k $1.00 , $0.00 • ' '. TY; AMOUNT ._. .,... PAID ''PAID DATE $72.52 • $0.00 "- , - A • i • t j i A • i • t j i i Description: ESPINOZA/REPLACE SPLIT SYSTEM V Type: MECHANICAL Subtype: Status: UNDER REVIEW Applied: 3/27/2015 SKH Approved: Parcel No: 773065007 Site Address: 51160 AVENIDA VELASCO LA QUINTA,CA 92253 Subdivision: SANTA CARMELITA VALE LA QUINTA Block: 69 Lot: 7 Issued: UNIT 9 Lot Sq Ft:.0 Building Sq Ft: 0 Zoning: Finaled: Valuation: $4,500.00 Occupancy Type: Construction Type: Expired: . No. Buildings: 0 No. Stories: 0 No. Unites: 0 Details:. HVAC CHANGE OUT - 13SEER/780AFUE SPLIT SYSTEM [2013 ENERGY] CARBON MONOXIDE ALARM(S) TO BE INSTALLED PRIOR TO FINAL INSPECTION. -2-013 CALIFORNIA BUILDING CODES. .i a „.,.. ..,.,. .,,.. ADDITIONAL SITES .............. a.... FINANCIAL INFORMATION Printed: Friday, March 27, 2015 10:02:15 AM 1 of 2 C SYSTEMS DESCRIPTION ACCOUNT QTY" AMOUNT PAID PAID DATE RECEIPT #; CHECK # METHOD= PAID BY * CLTD BY BSAS SB1473 FEE 101-0000-20306 0 $1.00 $0.00 Total Paid forBUILDING STANDARDS ADMINISTRATION $1.00 $0.00 BSA: HVAC CHANGEOUT - 101-0000-42402 0 $72.52. $0.00 SPLIT -SYSTEM HVAC CHANGEOUT - • 101-0000-42600 0 $36.26 $0.00 ` SPLIT -SYSTEM PC Total Paid forCHANGEOUT: $108.78 $0.00 PERMIT ISSUANCE 101-0000-42404 0 $91.85 $0.00 Total Paid for PERMIT ISSUANCE: $91.85 $0.00 TO BOND INFORMATION - ATTACHMENTS Printed: Friday, March 27, 2015 10:02:15 AM 2 of 2 SYSTEMS CERTIFICATE OF COMftIANCE CF1R-ALT 02-E Alterations to Space Conditioning Systems (formerly CF -IR -ALT -HVAC) (Page 1 of 3 ) Project Name: Espinosa Date Prepared: 2015-03-05 I Registration Number: 215-A0061796A-000000000-0000 CA Building Energy Efficiency Standards - 2013 Residential Compliance 10 Alteration Type Altered space. conditioning system r, Registration Date/Time: 2015-03-05 17:33:21 HERS Provider: CalCERTS Report Version: 2014.03-31 Report Generated: 2015-03.05 17:33:21 Schema Version: 0.555SDD Information LA�.General LT -02 is applicable to multiple space conditioning systems contained within a single dwelling unit. When multiple dwelling units must be ented, use one CFIR-ALT-02 document for each dwelling unit. oject Name Espinosa 02 Date Prepared 2015-03-05 01 03 05 Project Location CA City 51160 Avenida Velasco La Quinta 04 06 Building Type Dwelling Unit Name Single family ` Espinosa 07 Zip Code 92253 08 Dwelling Unit Conditioned Floor Area (ft2) 1320 09 Climate Zone 15 10 Number of space conditioning (SC) systems In this dwelling 1 SC System Identification or SC System Location or Area CFA served by this Se system a ducted unit. Installing new SC I Registration Number: 215-A0061796A-000000000-0000 CA Building Energy Efficiency Standards - 2013 Residential Compliance 10 Alteration Type Altered space. conditioning system r, Registration Date/Time: 2015-03-05 17:33:21 HERS Provider: CalCERTS Report Version: 2014.03-31 Report Generated: 2015-03.05 17:33:21 Schema Version: 0.555SDD B. Space Conditioning (SC) System Information 01 02 03 04 05 06 07 --.08 09 Is the SC Installing a SC System Identification or SC System Location or Area CFA served by this Se system a ducted refrigerant Installing new SC Installing Installing Installing Name Served System (ft2) system? containing component? system components? more than 40 feet of ducts? entirely new duct system? entirely new SC system? System 1 Location 1 1320 Yes Yes Yes No No No C. Extension of Existing Duct System, Greater Than 40 Feet (Section150.2(b)1Diib) This section does not apply to this project. I Registration Number: 215-A0061796A-000000000-0000 CA Building Energy Efficiency Standards - 2013 Residential Compliance 10 Alteration Type Altered space. conditioning system r, Registration Date/Time: 2015-03-05 17:33:21 HERS Provider: CalCERTS Report Version: 2014.03-31 Report Generated: 2015-03.05 17:33:21 Schema Version: 0.555SDD CERTIFICATE OF COMFiIANCE rn CFIR-ALT-02-E Cn Alterations to Space Conditioning Systems (formerly CF -1R -ALT -HVAC) o (Page 2of3) N • N r Cn D. Altered Space Conditioning System (Sections 150.2(b)IE and F) OS 02 03 04 05 06. 07 08 09 10 11 12 < ` System Heating Identification System Altered Heating Heating Minimum Altered Cooling Cooling Minimum Required New or or. Name Type Heating Components Efficiency Type Efficiency Value Cooling Cooling I Efficiency Efficiency Thermostat Replaced New Duct m System Type Components Type I Value Type Duct'Length R -Value n 0 Central split System 1 All new heating AFUE 0 78 Central split All new Less than or Hp components HP cooling SEER 13 Setback equal to 40 R-8 c components feet o Beguired 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 required when heating or cooling components a Leakage 'rate compliance: < 1re.installed inducted systems, or when more than 40 ft of duct length is replaced. 5%, 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). F CF2RCF3R-MCH-23 & CF3R-MCH•23 Air Flow 2! 300 CFM/ton required when MCH -25 is required. Exceotlonsi -Duct systems registered with HERS provider as previously sealed are exempt from MCH -20 Duct Leakage Testing requirements. -Heating-only systems and Air Handler/Furnace changes do not require verification of Air Flow MCH -23, or Refrigerant Charge MECH-25. - -Existing duct system's constructed, insulated or sealed with asbestos are exempt from MCH -20 Duct Leakage Testing requirements, E. Entirely New or Complete Replacement Duct System, with or without Equipment Changeout (Sections 150.2(b)1DIla and 150:2(b)lE, F) This section does not apply to this project. F. Entirely New or"Complete Replacement Space Conditioning System (Section 150.2(b)iC) This section does not apply to this project. Registration Number:215-A0061796A-000000000-0000 CA Building Energy Efficiency Standards - 2013 Residential Compliance Registration Date/Time: 2015-03-05 17:33:21 Report Version: 2014=03-31 Schema Version: 0.555SDD HERS Provider: CaICERTS Report Generated: 2015-03-05 17:33:21 0) W 0) CERTIFICATE OF-COMRLIANCE CF111-ALT-02-E Alterations to Space Conditioning Systems (formerly CF -IR -ALT -HVAC) (Page 3 of 3 ) C Documentation Author's Declaration Statement 1. 1 certify that this Certificate of Compliance documentation is accurate and complete. Documentation Author Name: Documentation Author Signature: Starrett, David Company: Signature Date: DAVID D STARRETT 2015-03-05 17:33:21 Address: CEA/ HERS Certification Identification (if applicable): 27636 Ynez Road L7177 - City/State/Zip: Phone: TEMECULA CA 92591 (951) 514-9133 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 forlhe.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. 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 approval'with this building permit application.'. , 5. 1 will ensure that a registered copy of this Certificate of Compliance shall be made available with the building permits) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a registered copy of this Certificate of Compliance is required to be included with the documentation the builder provides to the building owner at occupancy. Responsible Designer Name: Responsible Designer Signature: Starrett, David Company: Date Signed: DAVID D STARRETT 2015-03-05 17:33:21 Address: License: 27636 Ynez Road L7177 885220 City/State/Zip: Phone: TEMECULA CA 92591 (951) 5147-9133 Digitally signed by CaICERTS. 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: 215-A0061796A-000000000-0000 Registration Date/Time: 2015-03-05 17:33:21 HERS Provider: CalCERTS CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2014-03-31 Report Generated: 2015-03-05 17:33:21 Schema Version: 0.555SDD - Mar 26 15 02:25p David Starrett Construct 951 694 3649 p.2 Litt # Qty of La Quin ta. B uilding $r Safety DA ision Permit # N.O. Box 1504, 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 �A'?�� / 7 Building Permit Application and Tracking -Sheet 70 i i. Project Address; Sdeo Owner's Mame: A. P.1Jumbta-: Address: S/ ( d vt✓ v� ��JG c Legal Description: City, ST, Zip; �a �u'N .L, e a Tye s-3 Con',raclor:d, o cs%.Q/t/e� f T Tcicphonc: 7 G L o 9. 8 3 9 r- Address 'a2 3 % IVe2 � L7 /2) Project Description: C-'ty, ST, Zip: I GN7rGv/eqg Telephone:�jS/— St.atcLic.€t City Lic. k; Arch., Engr., Designer Address: City" ST, Zip: Telephone: EsLmatcd Value of Project: Construction Type. Occupancy: APPLICANT: DO NOT WRITE BELOW THIS LINE State Lie. 4: rER'N11T FEES Plan Sets Plan Ch,ecksubmittcel Structural Calks. IteviaYcd, ready for corrections Item Amount P1an'Chcck Deposit Truss Calks. Callcd Contact Person Project typc (circle one): New Add'n Re air Demo Tille24 Calks. Plans picked up Name of Contact Person: Flood plair. plan Plans resubmitted Mechanical Grading plan 2" Review, ready for corrections/issue Electrical Subcon(actor List Called Contact Pers' oil Sq. Fc: j3Z0 #1 Stories: Grant Deed flans picked up , 11 Units: Tcicphonc t1,of Contact Person: Grading IN 1i0i1SE:- Reyiew, ready for cors-cctionsolissuc• DevcloperImpact Fee Planning Approval Called Contacf Person . Putr. Wks. Appr Date of permit issue EsLmatcd Value of Project: APPLICANT: DO NOT WRITE BELOW THIS LINE K Submittal Rcq'd Rcc'd TRACICLNG ' rER'N11T FEES Plan Sets Plan Ch,ecksubmittcel Structural Calks. IteviaYcd, ready for corrections Item Amount P1an'Chcck Deposit Truss Calks. Callcd Contact Person Plan Check Balance Tille24 Calks. Plans picked up ConstruCllun, Flood plair. plan Plans resubmitted Mechanical Grading plan 2" Review, ready for corrections/issue Electrical Subcon(actor List Called Contact Pers' oil Plumbing Grant Deed flans picked up , S.M.I. H.O.A. Approval Plans resubmitted Grading IN 1i0i1SE:- Reyiew, ready for cors-cctionsolissuc• DevcloperImpact Fee Planning Approval Called Contacf Person A.I.P.P. Putr. Wks. Appr Date of permit issue Schcol Fees Total Permit Fees