BMCH2017-011978-495 CALLE TAMPICO
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LA QUINTA, CALIFORNIA 92253 DESIGN & DEVELOPMENT DEPARTMENT
BUILDING PERMIT
Application Number: BMCH2O17-0119
Property Address: 54371 SHOAL CREEK
APN: 775061052
Application Description: BRUCKNER /CHANGE OUT (1)17SEER/81AFUE SPLIT SYSTEM
Property Zoning:
Application Valuation: $10,000.00
Applicant:
CERTIFIED COMFORT SYSTEMS INC DBA HYDES
42-949 MADIO STREET
INDIO, CA 92201
I
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: C 0 C3 License No.: 906115 (�
Date:Contractor:_fflay4.9 1�1/
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.).
(_) 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 Address:
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
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.
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 permit
is issued. My workers' compensation insurance carrier and policy number are:
Carrier: EVEREST NATIONAL INSURANCE COMPANY Policy Number: 7600015264
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 thoseovsions.
Date:III 7i17'
Applicant:'
pplicant: �U'
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 tc
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 correc:.
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 -me ioneci operty for inspection purposes. oil
I toDate: Signature (Applicant or Agent):
Date: 4/6/2017
Owner:
RON BRUCKNER
54371 SHOAL CREEK ,
LA QUINTA, CA 92253
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Contractor:
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CERTIFIED COMFORT SYSTEMS INC D YDES
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42-949 MADIO STREET
INDIO, CA 92201
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(760)360=2202
Llc. 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 performance
of the work 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 permit
is issued. My workers' compensation insurance carrier and policy number are:
Carrier: EVEREST NATIONAL INSURANCE COMPANY Policy Number: 7600015264
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 thoseovsions.
Date:III 7i17'
Applicant:'
pplicant: �U'
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 tc
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 correc:.
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 -me ioneci operty for inspection purposes. oil
I toDate: Signature (Applicant or Agent):
Date: .4/6/2017
Application Number: BMCH2O17-0119 d Owner:
Property Address: 54371 SHOAL CREEK RON BRUCKNER .
APN: 775061052 54371 SHOAL CREEK
Application Description: BRUCKNER / CHANGE OUT (1)17SEER/81AFUE SPLIT SYSTEM LA QUINTA, CA 92253
Property Zoning: _
Application Valuation: $10,000.00
-Applicant: Contractor:
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
i
s
(760)360=2202.
Llc. No.: 906115
•------------------------------------------------------------------------------------=-------
Detail: HVAC CHANGE OUT (1)17SEER/81AFUE SPLIT.SYSTEM. CARBON MONOXIDE ALARM(S) TO BE INSTALLED -PRIOR TO FINAL INSPECTION. 20161
CALIFORNIA BUILDING CODES. f
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FINANCIAL INFORmATION
DESCRIPTION ACCOUNT QTY AMOUNT
BSAS SB1473 FEE 101-0000-20306 0 $1.00
Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $1.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
HVAC CHANGEOUT- PACKAGED UNIT
101-0000-42402
0
$38.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
HVAC CHANGEOUT - PACKAGED UNIT PC
101-0000-42600
0
$25.33
Total Paid for CHANGEOUT: $63.33
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PERMIT ISSUANCE
101-0000-42404
0
$96.27
Total Paid for PERMIT ISSUANCE: $96.27
DESCRIPTION
ACCOUNT
QTY
AMOUNT
TECHNOLOGY ENHANCEMENT FEE
502-0000-43611
0
$5.00
Total Paid for TECHNOLOGY ENHANCEMENT FEE:. $5.00 -
TOTALS:.•
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CERTIFICATE OF COMPLIANCE CF1R-ALT 02-E
Alterations to Space Conditioning Systems (formerly CF -IR -ALT -HVAC) (Page 1 of 3)
Project Name: 54371 Shoal Creek Date Prepared: 2017-04-05
A. General Information
CF1R-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
54371 Shoal Creek
02
Date Prepared
2017-04-05
03
Project Location
54371 Shoal Creek
04
Building Type
Single family
05
CA City
La Quinta
06
Dwelling Unit Name
54371 Shoal Creek
r0%1�
V I
L.J*
Dwelling Unit Conditioned
SC System
07
Zip Code
92253
08
Floor Area (ft)
1627
Installing
Installing
Identification or
Number of Space
by this SC
09
Climate Zone
15
10
Conditioning (SC) Systems in
1
Name
Served
System (ft2)
this Dwelling Unit:
component?
r�— [ r•-•-- 7 i .'-%, r--- f" i i
B. Space Conditioning (SC) System Informatn)
l on �
11
it' ((-
—
I I
01
02
03
04
. a
07�
a 08 «�
`"� -69
10
�- s the SCS
Installi g a-
r0%1�
V I
L.J*
SC System
SC System
CFA served
system a
refrigerant
Installing new SC
Installing
Installing
Installing
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
1600
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: 217-A020109583A-000-000-0000000-0000 Registration Date/Time: 2017-04-05 12:06:13 HERS Provider: CaICERTS
('A Ri 01ding FnPrgy FffiriPnry Standards - 2016 Residential Comollance Report Version: 2.016.1.005 Report Generated: 2017-04-05 12:06:25
Schema Version: rev 10/16
6
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
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
81
AC
cooling
SEER
17
Setback
section is not
section is not
components
components
applicable
applicable
Reouired Documentation:
CF2R-MCH-01-E - Space Conditioning Systems
- Duct insulation requirement for the new portions of supply -air and return -air ducts or plenums: R6 (CZ 1-10, 12 and 13) and R8 (CZ 11 and 14-16)
CF2R and CBR -MCH -20-H - Duct Leakage Test 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 <= 10% leakage to outside, or seal all accessible leaks.
CF2R and CF3R-MCH-25-H Refrigerant Charge verification required when refrigerant containing components are installed or altered (applicable in CZ 2, 8-15).
CF2R and CF3R-MCH-23 Airflow Rate >= 300 CFM per ton required when MCH -25 is required.
Exceptions:
Duct systems registered with HERS provider as previously sealed are exempt from MCH -20 Duct Lea kagTesting r equiremenntts. p .
Heating -only systems and Air Handler Furnace changes do not require verification of Air Flow MCH -23, or"Refrigerant Charge MCH -25.
R
•'��ds
Existing duct systems constructed, insulated or sealed with asbestosaare exempt�from MCH -20 Duct{Leakage Testwng requi}ements.C
Pl iS fI
E. Entirely New or Complete Replacement Duct;System, with or without.Equipment Changeout (Sections 150.2(b)1Diia-and 150.2(b)lE, F)
`�,1 � Its ''�,�•»�' i[ � �,/� II � �
v 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: 217-A020109583A-000-000-0000000-0000 Registration Date/Time: 2017-04-05 12:06:13 HERS Provider: CaICERTS
CA Buildim Enerev Efficiencv Standard5 - 2016 k5ldtntip.l Compliance Report Version: 2016.1.005 Report Generated: 2017-04-05 12:06:25
Schema Version: rev 10/16
CERTIFICATE OF COMPLIANCE CF1R-ALT-02-E
Alterations to Space Conditioning Systems (formerly CF -IR -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
2017-04-05 12:06:13
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 ofd egulations F' t t ° � d
s �3 �
s
4. The buildingdesign features or stem design features identified on this Certificate of Compliance are consistent -with the information rovid d n th r.- li
g y g p e o o a app c le compliance documents, worksheets,
r.{ v i s
calculations, plans and specifications submitted to the enforcement agency for approval with this building permit application. "`� f
lt.�{ 4k sr it �. t� 7fE'
5. 1 will ensure that a registered copy of this CertificateofCompliance shall be_ mad%available with .the building permit(s) issued forithe building, and made available tgthe enforcement agency for all applicable
inspections. I understand that a registered copy of this Certificate of Compliance -is -required to be -included with the documeentationQthe builder provides to the b wilding owner at occupancy.
Responsible Designer Name: ,. —A
Responsible Designer Signature: V' it 7'r-,-0
Hyde, Mark
Company:
Date Signed:
CERTIFIED COMFORT SYSTEMS INC
2017-04-05 12:06:13
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: 217-A020109583A-000-000-0000000-0000 Registration Date/Time: 2017-04-05 12:06:13 HERS Provider: CaICERTS
GA Dv.ilding Energy Efficiency Standards - 2016 Residential Compliance_ Report Version: 2016.1.005 Report Generated: 2017-04-05 12:06:25
k. Schema Version: rev 10/16
Bin. #
City of.La Quinta
Building 8t Safety Division
P.O. Box 1504,78-495 Calle Tampico
9 1.a.Quinta, CA 92253 - (760) 777-7012
1 Building Permit Application'and Tracking Sheet
Permit #
,%O* Q'
Project Address: Owner'sNeme:. �..�,
No
A. P. Number: Address:
Legal Description:City, ST, Zip:
Contractor. MIOi �tly� Telephone: 'S Fah`
Address: - /�
j� Project Description:
Q
.- -N
City, ST, Zip:l D / �U� Ll 13
Telephone: -2-w2 . �ti
V
�
State Lie. # : City Lie', #:
Arch, Engr., Designer.
Address:
City., ST, Zip:
-
Telephone:� •,;.,.�,'. •
Y : ^ Construction Type:. Occupancy:
State Lic. #: ,, , . .:.• Project type (circle one): New Add'n Alter Repair Demo
Name of Contact Person:Sq. Ft : #Stories: 1 # Units:
Telephone # of Contact Person: Estimated Value of Project`0 O .0
APPLICANT: DO NOT WRITE BELOW THIS UNE
#
Submittal
Req'd
Recd
TRACMG
PERMrP FEES
Plan Sets
Plan Cheek submitted
Item
Amount
Structural Cales.
Reviewed, ready for corrections
Plan Check Deposit.
Truss Calcs.
Called Contact Person
Plan Check Balance.
Title 24 Calce.
Plans picked up
Construction
Flood plain plan
Plans resubmitted,' .
Mechanical
Grading plan
P' Review, ready for corrections/issue
Electrical
Subcontactor 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 corrections/issue
Developer Impact Fee
Planning Approval
CTed Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees