BMCH2016-013978-495 CALLE TAMPICO
Twit 4 4 Q"
LA QUINTA, CALIFORNIA.92253 COMMUNITY DEVELOPMENT DEPARTMENT
Applicant:
IE INC
31225 LA BAYA
WESTLAKE VILLAGE, CA 91362
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.: 686310
Date: S 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.).
(_)1, as owner of the property, am exclusively contracting with licensed contractors
to construct 6e 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:
My OI'
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 5/2/2016
NC DBA GENERAL AIR
THOUSAND PALMS, CA 92276
(760)343-7488
Llc. No.: 686310
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 the work for which this permit is issued.
1 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.
Date: S ZL 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 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: S 2 it Signature (Applicant or Agent):
BUILDING PERMIT
Application Number:
BMCH2O16-0139
Omer -
Property Address:
APN:
57475 SEMINOLE DR
762350026'
®
n THOM� RA
(/}L'l,\1 57475 MII
Application Description:
RAYC RAFT RESIDENCE / HVAC CHANGE OUT
hli�QtHTA°"
Property Zoning:
F
0 2 20016
Application Valuation:
$12,948.00
MAY
Applicant:
IE INC
31225 LA BAYA
WESTLAKE VILLAGE, CA 91362
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.: 686310
Date: S 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.).
(_)1, as owner of the property, am exclusively contracting with licensed contractors
to construct 6e 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:
My OI'
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 5/2/2016
NC DBA GENERAL AIR
THOUSAND PALMS, CA 92276
(760)343-7488
Llc. No.: 686310
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 the work for which this permit is issued.
1 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.
Date: S ZL 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 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: S 2 it Signature (Applicant or Agent):
=FINANCIAL IIdFORIVIATION �`�z;�*� ;,�
Y
r, DESCRIPTION��
�� '�A000UNT>;��y �QTY�AMOUNT:
PAIDf sPA1D DATE��
a
BSAS 5131473 FEE
'101-0000-20306 0
$1.00
$0.00
W: PAID BY, <;: +
' METHOD <.^� RECEIPT #s
CHECK #
' OLTD 13Y
�� r,a:'- »h. 1 o >'.+.. �;'
y
...�-.. � :Ai: .Z _. .. .� .s ,�"`
]•. `�a C,Z�.
Yvfn' ra r aG!a
Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $1.00 $0.00 ,
g
DESCRIPTIONK
`ACCOUNTS $tl,
'QTYx
AMOUNT* 3.9
> `q�;'PAID—
PAID DATE
„
HVAC CHANGEOUT - SPLIT -SYSTEM
101-0000-42402
0
$72.52
$0.00 ,
` PAID BY. ` E
'' �
s.:: METHOD,'
"'IRE
-CHECK#,
�
� ���
7 ; trx*
•t DESCRIPTION
Y ti "ACCOUNT 'r
roQ
TY
AMOUNT;
PAID `
'PAID DATE':
a '�
HVAC CHANGEOUT - SPLIT -SYSTEM PC
101-0000-42600
0
$36.26
$0.00
g 'PAID BY £
METHOD
a- RECEIPT # µ'+CHECK
#�
�' CLTD BY.`
a
Total Paid for CHANGEOUT: $108.78 $0.00
x `€.i:. .�,. Y ., , n •i”. S
DESCRIPTION �
ea>; •,x, - s'"'Y Q<-'
K, F 'ACCOUNTS
QTY
AMOUNT„
z .`;
a
PAID t�'
4
PAID DATE,
„�
x
k �, ,
PERMIT ISSUANCE
101-0000-42404
0
$91.85
$0.00
r1,METHOD
RECEIPT #`'
i CHECK #' .w
`CLTD BY; >X
Total Paid for PERMIT ISSUANCE: $91.85 $0.00
TOTALS:00
=FINANCIAL IIdFORIVIATION �`�z;�*� ;,�
• L .
Description: RAYCRAFT RESIDENCE / HVAC CHANGE OUT
Type: MECHANICAL Subtype: Status: APPROVED Applied: 5/2/2016 MFA
Parcel No: 762350026 Site Address: 57475 SEMINOLE DR LA QUINTA,CA 92253 Approved: 5/2/2016 MFA
Subdivision: TR 29147-2 Block: Lot: 37 Issued:
Lot.Sq Ft: 0 Building Sq Ft: 0 Zoning: Finaled:
Valuation: $12,948.00 Occupancy Type: Construction Type: Expired:
No. Buildings: 0 No. Stories: 0 No. Unites: 0
Details: HVAC CHANGE OUT - 16 SEER/80AFUE.SPLIT SYSTEM [2008 ENERGY] CARBON MONOXIDE ALARM(S) TO BE INSTALLED PRIOR TO
FINAL INSPECTION. PER 2013 CALIFORNIA BUILDING CODES. r
FINANCIAL INFORMATION
Printed: Monday, May 02, 201612:35:26 PM 1 of 2 S
��
SYSTEM
;n DESCRIPTION-
c
CITY.
AMOUNT
ID:
NT DATE'
1 4
CHECK #'
METHOD
PAIDBYBSAS
TLT7
DATE
.. . ... .... . ...... . ... .... ... ....... . ... ...... .
...... ... .. ... . ..............
i7.,
. . .. ....... .. .. ... .. .......... ....
...... .... .... . .
.. ... .. . ...... .. INFORMATION
--ATTACHME T
N
SB1473 FEE
101-6000-20306
0-
$1.00
$0.00
Total Paid for BUILDING STANDARDS ADMINISTRATION $1.00 $0.00.
BSA:
HVACCHANGEOUT-
101-0000-42402
0-
$72.52
$0.00
SPLIT -SYSTEM
HVAC CHANGEOUT-
lol-0000-42600
0.
$36.26
$0.00
SPLIT -SYSTEM PC
Total Paid for CHANGEOUT: $108.78 $0.00
PERMIT ISSUANCE SUANCE
101-0000-42404 -F--07
$41.85
$0.00
Total Paid for PERMIT ISSUANCE: 01.85 $6.00
INSPELTIC
...... . ...... .
WENT PRO
Printed: Monday, May 02, 2016 12:35:26 PM 2of2 CRewSYSTEMS ,
'RETURN t� STATUS
Tu
','REMARKS-
:REVIEWTYPE�' REVIEWER
NT DATE'
',NOTES,
DATE
.. . ... .... . ...... . ... .... ... ....... . ... ...... .
...... ... .. ... . ..............
i7.,
. . .. ....... .. .. ... .. .......... ....
...... .... .... . .
.. ... .. . ...... .. INFORMATION
--ATTACHME T
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. ...... ....... . . . . ...... ........... ............
. .......
.. . .. . ... .. .... ... ... . . ..... ............... .. . . . ........ ..
Printed: Monday, May 02, 2016 12:35:26 PM 2of2 CRewSYSTEMS ,
#
City Of La QUJih�
• 'Building 8r Safety Aivision
P.O. Box 1504, 7B-495 Calle Tampico
La.Quinta, CA 92253 - (760) 777-7012
Building Permit' Application and Tracking Sheet.
Permit #
Project Address: 5.7475 Seminole Drive
Owner'sName:. Thomas Raycraft
A. P. Number.
Address:. 57475 Seminole Drive
Legal Description:
City, ST, Zip: La Quinta, CA 92253
Contractor. General Air Conditioning
Telephone: 760-777-1719 K -11
IM -
Address: 31170 Reserve Drive
Project Description: Replace 4ton A/C, Coil, & 80,000 BTU. .
City, ST, Zip: Thousand Palms, CA 92276
Furnace
Telephone: 760-343-7488
State Lie. #': 686310Y
Lie. #;
Arch., Engr, Designer
Address:
City, ST, Zip:
Telephone: Y. `�^ •.
Construction Type:. Occupancy:
Project type (circle one):. New Add'a Alter Repair Demo
Sq. Ft.:#Stories: #Units:,
State Lic. #:
Name of Contact Person: Steven Schnierer
Telephone # of Contact Person: 8.18-73577876
Estimated Value of Project: $.12,948.00 .
APPLICANT: DO NOT WRITE BELOW THIS UNE .
#
Submittal
Req'd
'Reed
TRACKING
PERMIT FEES
Plan Sets
Pian Check submitted
Item Amount
Structural CaIes.
Reviewed, ready for corrections
Plan Check Deposit. .
Truss Cala.
Called Contact Person
Plan Check Balance.
Tide 24 Calce.
Plans picked up
Construction
Flood plain plan
Plans resubmitted..
Mechanical
Giading plan
2iQ Review, ready for correctionsrasue
Electrical
Subeontactor Ila
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.L
H.O.A.'Approval
Plans resubmitted
Grading
IM HOUSE:-
7i° Review, ready for correctionslissue
Developer Impact Fee
Planning Approval
Called Contact Person
A I P.P.
Pub. Wks. Appr '
Date of permit lssue
Scho61 Fees .
Total Permit Fees
CERTIFICATE OF COMPLIANCE CF1R-ALT-02-E
Alterations to Space Conditioning Systems (formerly CF-iR-ALT HVAC) (Page 1 of 3 )
Project Name: THOMAS RAYCRAFT Date Prepared: 2016-04-27
A. General Information
MR -ALT -02 is applicable to multiple space conditioning systems contained within a single dwelling unit. When multipledwelling units must be documented,.
use one MR -ALT -02 document for each dwelling unit.
.01
Project Name
THOMAS RAYCRAFT
02 '
Date Prepared
2016-04-27
03
Project Location
57475 SEMINOLE DRIVE
04
Building Type
Single family
05
CA City
La Quinta
06
Dwelling Unit Name
THOMAS RAYCRAFT
SC System
SC System i
CFA served
Dwelling Unit Conditioned
refrigerant t
07
Zip Code
92253
08
Floor Area (ft2)
3205
Location or Area
by this SC
'
containing
Number of space conditioning
more than 40
09
Climate Zone
15
10
(SC) systems in this dwelling
1
' system?
component?
_3x"t
feet of ducts?
unit.
SC system?
B. Space Conditioning (SC) System Information---..
t
.01
02
; . U3
04?
U5>
pp
1 1 06s,
07j
08
09
10
Is the SC
Installing a
SC System
SC System i
CFA served
"Ii'
system a
refrigerant t
``
nstallinginew SC
"
Installing i
Insfalling>
Installing
g
Identification or'
Location or Area
by this SC
ducted
containing
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
3205
Yes
Yes
Yes
No
No
No.
Altered space
conditioning system
C. Extension of Existing Duct System, Greater Than 40 Feet (Section 150.2(b)1Diib)
This section does not apply to this project.
Registration Number: 216-A0158355A-000000000-0000 Registration Date/Time: 2016-04-27 23:12:50 HERS Provider: CaICERTS
CA Building Energy Efficiency Standards.- 2013 Residential Compliance Report Version: 2013 Rev 1.007 Report Generated: 2016-04-27 23:12:53
Schema Version: 0.555SDD
CERTIFICATE OF COMPLIANCE CF1R-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
it
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
This field or
This field or
System 1
furnace
heating
AFUE
80
AC
cooling
SEER
16
Setback
section is not
section is not
components
components
applicable
applicable
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 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: 515%, or 510% leakage to outside, or seal all accessible leaks.
CF2R-MCH-25-H & MR -MCH -25-1-1 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 z 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
t akge MAC HH 25
-Heating-only systems and Air Handler/Furnace changes do not require verificat�ion`of Air Flow MCH -23, or RefrigeranCh
Ott 56
-Existing duct systems constructed, insulated or sealed with asbestos:are exempt from MCH 2O,Duct;Leakage Testing regwrements. ,
. i
E. Entirely New or Complete Replacement Duct.System, with' or without, Equipment Changeout (Sections l'50.2(b)1Diia-and 150.2(b)1E, 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-A0158355A-000000000-0000 Registration Date/Time: 2016-04-27 23:12:50 HERS Provider: CalCERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013 Rev 1.007 Report Generated: 2016-04-27 23:12:53
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..I certify that this Certificate of Compliance documentation is accurate and complete.
Documentation Author Name:
Documentation Author Signature: 15��'� A
Shanley, BarbaraOOy
Company:
Signature Date:
HARRISON ENTERPRISES INC dba GENERAL AIR CONDITIONING
2016-04-27 23:12:50
Address:
CEA/.HERS Certification Identification (if applicable): .
31-170 RESERVE DRIVE STE A
City/State/Zip:
Phone:
THOUSAND PALMS CA 92276
760-343-7488
Responsible Person's Declaration statement',',,
I certify the following under penalty of perjury, under the law's 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�Regulatlonw�,
4. The building design features or system design features identified on.this Certificate of Compliance are consistent with -the information,provided on'other applicatile�compliance documents, worksheets,
calculations, plans and specifications submitted to the enforcement agency for approval w,th_this building permit application.;
�'qs .. � C4 .r• $ . . �'Y�.
5. I will ensure that a registered copy of,thisCerfificate ofCompliance shall be made available with the bulldingspermit(s)issued forthe building, and made available tottie�,enfotcement agency for all applicable
ov des to the building owner at occupancy.
inspections. I understand that a registered copy of thisvCertiificate of Co�mpliance,is,requiir„edd to be included with the documentation &,builder p!
w
Responsible Designer Name: ' -�;l
Responsible Designer Signature:
Shanley, Barbara
Company:
Date Signed:
HARRISON ENTERPRISES INC dba GENERAL AIR CONDITIONING
2016-04-27 23:12:50
Address:
License:
31 -170 -RESERVE DRIVE STE A
686.310
City/State/Zip:
Phone:
THOUSAND PALMS CA 92276
760-343-7488
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-A0158355A-000000000-0000 Registration Date/Time: 2016-04-27 23:12:50 HERS Provider: CaICERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013 Rev 1.007 Report Generated: 2016-04-27 23:12:53
Schema Version: 0.5555DD