BMCH2015-031878-495 CALLE TAMPICO
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LA QUINTA, CALIFORNIA 92253 COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING PERMIT
Application Number: BMCH2O15-0318 Owner:
Property Address: 54912 SHOAL CREEK SCOTT LISSOY-
APN: 601790004 2922 DAIMLER ST
Application Description: JURGENSON / (1)18.5SEER/.8AFUE SPLIT SYSTEM SANTA ANA, CA 0
Property Zoning:
Application Valuation: $10,230.00
Applicant:
ESSER SERVICES INC DBA ESSER A •
P 0 BOX 1636
CATHEDRAL CITY, CA 92235
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter
9 (commencing with Section 7000) of Division 3 of the Business and Professions Code,
and my License is in full force and effect.
License Class: C20 License No.: 489046
,Dated c5 17 I$ 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 ofthe
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 Cede: 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
VOICE (760) 777-7125
FAX (760) 777=7011
INSPECTIONS (760) 777-7153
Contractor:
ESSER SERVICES INC DBA ESSER
P 0 BOX 1636
CATHEDRAL CITY, CA 92235
(760)324-0550
Llc. No.: 489046
Dates
� C
� C
t�
v 9 En
C
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: _ Policy Number: _
I certify that in the performance of the work for which this permit is issued,
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. EI—
Date: A17 Isr Applicant: 1__*_—ice
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, anc
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 abovc-
mentioned property for. inspection purposes.
Date: $ h (J Signature (Applicant or Agent): efl_�
FINANCIAL
AO•
:E T 7 9e1 .F ^b^ir.t'MATION
.% t i f* .: L Z'.p aw• II
�s , QTY AMOUNT `�
'; ACCOUNT, s PAID x� �PAID;DATE�'
,wDESCRIPTION r ,_ t ##+ , s
�' _ -,_
BSAS SB1473 FEE 101-0000-20306 0
$1.00 $0.00
PAID,BY� "; `.?" 'v, METHOD a +
`RECEIP,T # IS CHEEK #x r ; CLTD BY
Y�r
a
,tom`
Total Paid for.BUILDING STANDARDS ADMINISTRATION BSA $1.00 $0.00
DESCRIPTION: S
I` " "' 'ACCOUNTS
;QTY
#: '`AMOUNT��e
�. x`a PAID `
FPAIDDAT&
7
�.
_
HVAC CHANGEOUT - SPLIT -SYSTEM
101-0000-42402
0
$72.52
$0.00
J Y� PAID BYE' #
METHOD
` ' `RECEIPT #z
CHEEK #�
t CLTD BY
r
xt
. _
DESCRIPTION-
,fit, 'ACCOUNT S,<
QTY,
AMOUNT `
PAID
'PAID DATE
HVAC CHANGEOUT - SPLIT -SYSTEM PC
101-0000-42600
0
$36.26
$0.00
I t BY'i f< 'T
�'x °
L s
# ` s
- CHECK #CLTD
BY
2 APAID
1
~RECEIPT
,
Total Paid forCHANGEOUT: $108.78 $0.00
�` i '` DESCRIPTION s:
to
�a ACCOUNT¢ `
x,,
AMOUNTa�
PAID �e
,..
- .4
iQTY.._
��
.PAIDDATE':
PERMIT ISSUANCE
101-0000-42404
0
$91.85
$0.00
E' PAID BY
RECEIPT # r
• CHECK #;
"CLTD BYys
,METHOD
_�
.' �'.
L,
Total Paid forPERMIT ISSUANCE: $91.85 $0.00
TOTALS:• 0•
1
Description: JURGENSON / (1)18.5SEER/.8AFUE SPLIT SYSTEM
Type: MECHANICAL Subtype: Status: UNDER REVIEW
Applied: 8/17/2015 SKH
Approved:
Parcel No: 601790004 Site Address: 54912 SHOAL CREEK LA QUINTA,CA 922S3
Subdivision: TR 31562 Block: Lot: it
Issued:
Lot Scl Ft: 0 Building Sq Ft: 0 Zoning:
Finaled:
Valuation: $10,230.00 Occupancy Type: Construction Type:
Expired:
No. Buildings: 0 No. Stories: 0 No. Unites: 0
Details: HVAC CHANGE OUT-18.55EER/.8AFUE SPLIT SYSTEM 12013 ENERGY) CARBON MONOXIDE ALARM(S) TO BE INSTALLED PRIOR TO
FINAL INSPECTION. 2013 CALIFORNIA BUILDING CODES.
CONDITIONS
t„
FINAN,�lAL INFORMATION
Printed: Monday, August 17, 2015 2:02:27 PM 1 of 2 -
SYSTEMS
DESCRIPTION
ACCOUNT
QTY
AMOUNT.
".PAID
PAID DATE
RECEIPT #
CHECK #.
METHOD
PAID BY
CLTD..
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
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
•
rr;,
PARENT PROJECTS ,
BOND INFORMATION
.,,,,,,..ATTACHMENTS Z,
Printed: Monday, August 17, 2015 2:02:27 PM 2 of 2
SYSTEMS
Bfn.#
Crty 0f Let QuIntd
Butiding a Safety Division
P.O. Box 1504,78-495 Calle Tampico
ta.Qutnta, CA 92253 - (760) 777-7012
l Building Permit Application* and Tracking Sheet
Permit #
C�iI�jO ,
Project Address: 54912 Shoal'Creek
Owner's Name:. Robert Jurgenson
A. P. Number.
Address: 54912 Shoal Creek
Legal Description: ��
City, ST, Zip: La Quinta, CA 92253
Contractor: Esser Services Inc.
g ssz
Telephone: 503-292-6733 g'
Address: PO Box 1636
Project Description: Replace 4ton A/C On Roof & 50,000 .
City, ST, Zip: Cathedral City, CA 92235
BTU Furnace In Attic
Telephone: 760-324-0550MAI
State Lic. #: 489046
City Lic. M.
Arch., Engr., Designer.
Address:
City., ST, Zip:
Telephone: 1" ' ` `°
State Lic. #: `^as-y`iu
Construction Type: Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
Sq. Ft.: # Stories: # Unit;:
Name of Contact Person: Steven Schnierer
Telephone # of Contact Person: 818-735-7876 x 1
Estimated Value of Project: $10,230,00
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
"Reed
TRACMG
PERMrPFEES
Plan Sets
Plan Check submitted'
Item Amount
Structural Caies.
Reviewed, ready for corrections
Plan Check Deposit. .
Truss Calcs.
Called Contact Person
Plan Check Balance
Title 24 Cates.
Pians picked up
Construction
Flood plain plan
Plans resubmitted. ,
Mechanical
Grading plan
2'a Review, ready for corrcetionstissue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Pians picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
'^' Review, ready for corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees
CERTIFICATE OF COMPLIANCE
CF1R-ALT 02-E I
Alterations to Space Conditioning Systems (formerly CF -IR -ALT -HVAC) (Page 1 of 3 )
Project Name: ROBERTJURGENSON. Date Prepared: 2015-08-14
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 MR -ALT 02 document for each dwelling unit.
01
Project Name
ROBERTJURGENSON
02
Date Prepared
2015-08-14
03
Project Location
54912 SHOAL CREEK
04
.Building Type
Single family
05
CA City
La Quinta
06
Dwelling Unit Name
ROBERTJURGENSON
07
Zip Code
92253
08
Dwelling Unit Conditioned
1627
WX
Floor Area (ft2)
SC System
SC System
CFA served
systema
refrigerant
Number of space conditioning
Installir g
09
Climate Zone
15
10
(SC) systems in this dwelling
1
ducted
x,
containing
system
�, tx
more than 40
unit.
entirely new
B. Space Conditioning (SC) System Information "' ��-4
01
02
03
04
Sl
V 6
67%
i
08
09
10
a _
-.
~�
"
�, is the SC
J- 4.`3'�T'R`% 'i`.�{ "^Mii
Installing a
WX
SC System
SC System
CFA served
systema
refrigerant
_
Installing Pone SC
Installir g
Ina g
rMinstalling
Identification or
Location or Area
by this SC
ducted
x,
containing
system
�, tx
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
1.627
Yes
Yes
Yes
No
No
No
Altered space
conditioning system
C. Extension of Existing Duct System, Greater Than 40 Feet (Section 150.2(b)iDiib)
This section does not apply to this project.
Registration Number: 215-A0227613A-000000000-0000 Registration Date/Time:. . 2015-08-14 08:59:55 HERS Provider: CalCERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2014-03-31 Report Generated: 2015-08-14 08:58:45
5LIici6a Va345.,..0.5555DD
CERTIFICATE OF COMPLIANCE CF111-ALT 02-E
Alterations to Space Conditioning Systems (formerly CF -IR -ALT -HVAC) (Page 2 of 3 )
D. Altered Space Conditioning System (Sections 150.2(b)1E 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 lit
sp
All new
This field or
This field or
System 1
furnace
heating
AFUE
0.8
AC
cooling
SEER
18.5
Setback
section is not
section is not
components
components
applicable
applicable
Reouired 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, `orseal all accessible leaks.
CF2R-MCH-25-H & CF3R-MCH-25-H Refrigerant0arge 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 MCy-25is required.
Exceptions:
-Duct systems registered with HERS provider as previously sealed are exempt from-M"�CH-20 Du Le ka Testing r�eq�wremeents. Inr-
-Heating-only systems and Air Handler/Furnace changes do not require verification of Air Flow MCH=23 or Refrigerant_Charge.MECH 25.!'A
;
e>z ,W r4 testi c� Wes �-t-4-Existing duct systems constructed, insulated or sealed with asbestos:are exemtfram MCH-20:DuctlLeakage Testing requirements.11F'A. h�. -4 10 ' `__ R.+ a�1 I''
i
— I
•x PN
E. Entirely New or Complete Replacement Duct System, with br withou Equ pment C ang out`(S cti ns 150.2(b) Dii nd 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: 215-A0227613A-000000000-0000
Registration Date/Time: 2015-08-14:08:59:55
HERS Provider: CaICERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2014-03-31 Report Generated: 2015-08-14 08:58:45
3diema Veisiurn. 0.5555DD
CERTIFICATE OF COMPLIANCE CF1R-4LT-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: �/ a
Jacoby, Ian
cyan JacCC
Company:
Signature Date:
Stratz Permit Service
2015-08-14 08:58:35
Address:
CEA/ HERS Certification Identification (if applicable):
5858 Dovetail Drive
City/State/Zip:
Phone:
Agoura Hills CA 91301
818-735-7876
Responsible Person's Declaration statement°;:
I certify the following under penalty of perjury, under the laws!& the State of California:
1. The information provided on this Cerrtificate:of Compliance is true and correct.
2. 1 am eligible under Division 3 of the Business 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 an this Certificate of Compliance conform to the
F.
requirements of Title 24, Part 1 and Part:6 of the Cal,fotma Code of Regulations. i"
x7 �a
raAw
4. The building design features or system design features �dentif,ed ow his Certific6ate of Compliance arei�gs�iste t t the i ormatio rovided on other,applicabl ompliance documents, worksheets,
calculations, plans and specifications submitted t' io,�tYWh��e ehfforcement, agency foyr,}approva with_ this building permit application.
�-tl ". T'r 64 V1L '� 1' 4'+AI. 9rK -n—
.K.i r'r4�
m
S. I will ensure that a registered copy of th s,Certificate of Compliance sfiall be inade,available with:the bwldirig;permit(s)lissuetl for<the build- and made available,to,;the-enforcement agency for all applicable
inspections. I understand that a registered copy of this-Ceitificate of Compliance is required to be,,included with the documentation the binder to the building owner at occupancy.
provides
'„yt�::i it a i>t"" 41'`"^@ .9!"", "'_!n ,1.'Td.. '`"V s4 $ :H: kf".yiq .'Yr',t. Piilcl�
Responsible Designer Name: � w
Esser, Michael
Responsible Designer Signature: i yam
GCIlA%evC�3Plti
Company:
Date Signed:
ESSER SERVICES INC
2015-08-14 08:59:55
Address:.
License:
P O BOX 1636
489046
City/State/Zip:
Phone:
CATHEDRAL CITY CA 92235
(760, 324-0550
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: 215-A0227613A-000000000-0000 Registration Date/Time: 2015-08-1408:59:55 HERS Provider: CaICERTS
CA Bbilding Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2014-03-31 Report Generated: 2015-08-14 08:58:45
5ChE,-',6 Veesivii. 0.5555DD - - -- - -