BMCH2016-007778-495 CALLE TAMPICO
VOICE (760) 777-7125
LA QUINTA, CALIFORNIA 92253
FAX (760) 777-7011
COMMUNITY DEVELOPMENT DEPARTMENT
.,7V
INSPECTIONS (760) 777-7153
BUILDING PERMIT
<.. y n ti
01711
m
o016
Application Number: BMCH2016 0077
0r: 0
Em
Property Address: 55306 SHOAL CREEK
C fel IIE CROSS
APN: 775142017
55114 SHOAL CREE
nF�7
Application Description: CROSS / HVAC CHANGE OUT
LA QUINTA; CA 9225Property
Zoning:
rnCD
Application Valuation: $7,900.00cApplicant:
Contractor:
MAPLE LEAF PLUMBING HEATING AND AIR COND
MAPLE LEAF PLUM
l% HE
ING AND IR CON
P 0 BOX 3653
PALM DESERT, CA 92261
P 0 BOX 3653
PALM DESERT, CA 9
�i
AI
(760)346-6758
Llc. No.: 481393
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: C36, C20 License No.: 481393
Date:
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 f& a
permit subjects the applicant to a civilpenalty of not more than five hundred dollars
($500).:
(1 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
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 in 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: t
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: 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 forthon this application.
i. 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. I
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: Signature (Applicant or Agent)
FINANCIAL INFORMATION�_. c: — PAID _ PAID DATE
s DESCRIP.TION,_ �; gig'* y,'°ACCOUNT` eQTY �; ' :AMOUNT
r z �.
BSAS SB1473 FEE 101-0000-20306 0 $1.00 $0.00
E ' `PAID}BY # METHOD ,' a £ RECEIPT " , € . `CHECK # CLTD BY`!
,
Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $1.00 $0.00'
zt,DESCRIPTION .nr""
x ACCOUNT 1 ri
QTY'
'.t "AMOUNT;
PAID'
PAID DATEi
HVAC CHANGEOUT - SPLIT-SYSTEM
101-0000-42402
0
$72.52
$0.00
= PAID BY
METHOD i '•'
"RECEIPT#.,,,CHECK
#x �
CLTD BY
"Tw
,
Q
UNTDECRIP
"D
PAID DATE;
HVAC CHANGEOUT - SPLIT-SYSTEM PC
101-0000-42600
0
$36.26
$0.00
PAID::BY t . •_..
' �x ;METHOD i}_ " 'x'
':RECEIPT # #
CHECK # r . "
' . CLTD BY` `
Total Paid for CHANGEOUT: $108.78 • $0.00
_ f DESCRIPTION :`°` "f= +r
3 =` ACCOUNT ,;b.
:QTY
AMOUNT ,
PAID
>PAID DATE'
PERMIT ISSUANCE
101-0000-42404
0
$91.85
$0.00
.. PAID:BY `
,.
€` METHOD '`.' _J
�;
RECEIPT # .`
,
CHECK # ..r ::,
';CLTD BY.
Total Paid for PERMIT ISSUANCE: $91.85 $0.00
i
Description: CROSS / HVAC CHANGE OUT
Type: MECHANICAL Subtype: Status: UNDER REVIEW
Applied: 4/4/2016 SKH
Approved: .
Parcel No: 775142017 Site Address: 55306 SHOAL CREEK LA QUINTA,CA 92253
Subdivision: TR 20717-3 Block' Lot: 10
Issued:. '
Lot Sq Ft: 0 Building Sq Ft: 0 Zoning:
Finaled:
Valuation: $7,900.00 Occupancy Type: -Construction Type:
Expired:
No. Buildings: 0 No. Stories: 0 No. Unites: 0
Details: HVAC CHANGE OUT - 14SEER/78AFUE SPLIT SYSTEM [20 13 ENERGY] CARBON MONOXIDE ALARM(S) TO BE INSTALLED PRIOR TO
FINAL INSPECTION. 2013 CALIFORNIA BUILDING CODES.
V .
ADDITIONAL SITES
CONTACTSCONDITIONS
NAME TYPE �:
,;-
NAME.4-' ADDRESS'1
CITY
STATER
ZIP
-PHONE FAX " EMAIL
t F
APPLICANT
MAPLE LEAF PLUMBING HEATING
P 0 BOX 3653
PALM DESERT
CA
92261
.
RS1124@YAHOO.COM
AND AIR COND
f
CONTRACTOR
MAPLE LEAF PLUMBING HEATING
P 0 BOX 3653
PALM DESERT
CA
92261
RS1124@YAHOO.COM
-
AND AIR COND
OWNER
CONNIE CROSS
55114 SHOAL CREEK
LA QUINTA
CA
92253
. :. '4!,YV INSPECTION) "
- PARENT PROJECTS
Printad: Monday, April 04, 3016 10,50:41 AM - = -2 of 2 B?M
sysrE s
'';
CLTD';:
DESCRIPTION
`ACCOUNT -.
CITY
AMOUNT
PAID '�
PAID;DATE :
'RECEIPT#
CHECK#
METHOD
rPAID BY7..
y
y.
BY
BSAS SB1473 FEE'
101-0000-20306
0 •
$1.00
$0.00
Total Paid for BUILDING 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 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
• • ••
. :. '4!,YV INSPECTION) "
- PARENT PROJECTS
Printad: Monday, April 04, 3016 10,50:41 AM - = -2 of 2 B?M
sysrE s
°�. AG r. 4. 2016 12:40PM.MAPLE LEAF PLUMBING 760341 155 No. 8612—P. 211011
■
78-495 CALLE 7gMPICO VOICE (760) 777-7125
LA QUINTA, CALIFORNIA 92253 FAX (760) 777.7011
COMMUNITY DEVELOPMENT OEPAfiTMEIVT INSPECTIONS (760) 777-7153
BUILDING PERMIT
LICENSED CONTRACTOR'S OEcLARA noN
1 hereby affirm under penalty of perjury that 1 am licensed under provlslons of Chapter
9 (commencing with Section 70003 of Division 3 of the Business and professions coda,
and my license Is in full force and effect_
Llcenae [ass: C36_ c2o License No.: AI M93
Dat Contram
OWNER -BUILDER DECLARATION
I hereby affirm Unger penalty of perjury that 1 am exempt from the Contractor's State
License Law for the following reason ISec.70315, Buslness'and Professions Code_ Any
clty.or county that requlres a permit to Construct, alter, Improve, demolish, or repalt
any structure, prior to Its Issuance, also MQulresthe epphcentforthe permit toile a
signed statement that he or she Is Ilcensed pursuant to the provlslons of the _
Contractor's State License Law (Chapter 9 (commencing with Semon 70001 or otvsrlon`
3 of the Business and Professions Code).or that he or she Is exempttherefro"k end the]
basis for the alleged. exemption. Any violitlon of Section 70315 by arty applicant for
Permit subjeetsthe pplicant to a troll penalty of not rnoro than five hundred dollars
($500).:
1__) I, as owner of the property, or my employees with wages os their sole
compensation, will do the work, and the structure is not Intended or offered for sale,
(Ste- 70aa, Business and Professions Code: The Contractors' State Llcense Law does not
apply to an owner of propArty who builds or Improves thereon, and who does the work
himself or herself through his or her own employees, provided that the Improvements
are not Intended or offered for sale. If, however, the building or Improvement Is sold
within one year of cornpletlon, the owner•bullderwill have the burden of proving that
he or she did not build or improve for the purpose of sale.).
1-) I, as owner of the property, am exclusively contracting with Ilceased Convectors
to construct the project. (Sec. 7044, euslness,and Profusions Code: The Contr9ctor5'
State License law does not apply to an owner of property who builds or improves
thereon, and who contacts for the projects with a contractor(s) licensed pursuant to
the Contractors' State License Law.).
(_) I am exempt under Sec S.$P.0 for this mason
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, Clv, C.).
Lender's Name:
Lenders Addrasr:
WORKER'S COMPENSATION OECLtRATION
I heretry affirm under penalty of perjury one of the following declarations:
_ I have and will maintaln a certificate of consent to see-Insune for workers'
compensatlon, as provided for by section 3700 of the Labor Code;. for the performance
of 11twork.for which this permit is lsrued.
I have and -111 maintain workers' compensation Insurance, as required by
Rion 3700 of the Labor Code, forthe performance of the work for which this permit
Is Issued. My workers' compensation insurance carrier and policy number are:
Carrier. Pollcy Number:
I cartify chat In the performance of the work for which this permit 1s issued, I
shall not Cmploy any person in any manner so as to become subject to the workers'
compensation la -L of California, and agree that, If I should become subject to the
workers' compensation provisions of Seedon 3700 of thI l or Cod I shall'forthwith
comply with those provisions. // 7
Date' APPA t.
WARNING: FAILURE TO SECURE wORICFRS PENSATION COVERAGE IS UNIAWPUL,
AND SHALL SUBJECT AN EMPLOYER 70 CRIMINAL PENALTIES AND CIVIL FINE$ UP TO
ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION TO THE COST OF
COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOIt CODE,
INTEREST, AND ATTORNEYS FEES.
APPLICANT ACI(NOwLFDOEMENT '
IMPORTANT: Application Is hereby made to the Building Official for a permit subject to
the conditions and restrlrtlon& set forth on this appllcatlon,
1. Each person upon whose behalf thls application Is made, each person et Whose
request and for whose benefit work Is performed under or pursuant to any permit
Issued as a result of this applicntich , the owner, and the applicant, each agrees to, and
shall defend; Indemnify end hold harmless the Clty of La Qulnta, Its officers, aeents, and
employtres for any act or omisslon related to the work being performed under or
10110WIM9 Issuance of this tvermlt
2. Any permit Issued as a'result of thio a.pp.ilcadon becomes null and void If work is
not commenced whhln lea days from date of Issuance OF such prrmlt, or cessation of
work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the ebove Information Is correct.
I agree to comply with all city and county ordinances and state laws relating to building
construction, and herebysuthodre representatives of this City to en up e
above-mentioned proopp�erly for Inspection purposes.
D Slenature (Applicant or Ag ):
J
Date: 4/4/2016
Application Number:
Property Address:
BMCH2O16-0077
55306 SHOAL CREEK•
Owner:
CONNIE CROSS'
=
�.,`�
j
CD
APN:
775142017
55114 SHOAL CREEK
Application Description:
CROSS / HVAC CHANGE OUT
LA QUINTA, CA 92253
Property Zoning:
Application Valuation:
$7,900.00
Ty
cz
Applicant:
Contractor:
z
to,
MAPLE LEAF PLUMBING HEATING AND AIR COND
MAPLE LEAF PLUMBING
r,'
ND PAIR C ND
P O BOX 3653
P0BOX 3653
�
PALM DESERT, CA 92261
PALM DESERT, CA 92261
(760)346-.675H
Ur_ No,: 491393
LICENSED CONTRACTOR'S OEcLARA noN
1 hereby affirm under penalty of perjury that 1 am licensed under provlslons of Chapter
9 (commencing with Section 70003 of Division 3 of the Business and professions coda,
and my license Is in full force and effect_
Llcenae [ass: C36_ c2o License No.: AI M93
Dat Contram
OWNER -BUILDER DECLARATION
I hereby affirm Unger penalty of perjury that 1 am exempt from the Contractor's State
License Law for the following reason ISec.70315, Buslness'and Professions Code_ Any
clty.or county that requlres a permit to Construct, alter, Improve, demolish, or repalt
any structure, prior to Its Issuance, also MQulresthe epphcentforthe permit toile a
signed statement that he or she Is Ilcensed pursuant to the provlslons of the _
Contractor's State License Law (Chapter 9 (commencing with Semon 70001 or otvsrlon`
3 of the Business and Professions Code).or that he or she Is exempttherefro"k end the]
basis for the alleged. exemption. Any violitlon of Section 70315 by arty applicant for
Permit subjeetsthe pplicant to a troll penalty of not rnoro than five hundred dollars
($500).:
1__) I, as owner of the property, or my employees with wages os their sole
compensation, will do the work, and the structure is not Intended or offered for sale,
(Ste- 70aa, Business and Professions Code: The Contractors' State Llcense Law does not
apply to an owner of propArty who builds or Improves thereon, and who does the work
himself or herself through his or her own employees, provided that the Improvements
are not Intended or offered for sale. If, however, the building or Improvement Is sold
within one year of cornpletlon, the owner•bullderwill have the burden of proving that
he or she did not build or improve for the purpose of sale.).
1-) I, as owner of the property, am exclusively contracting with Ilceased Convectors
to construct the project. (Sec. 7044, euslness,and Profusions Code: The Contr9ctor5'
State License law does not apply to an owner of property who builds or improves
thereon, and who contacts for the projects with a contractor(s) licensed pursuant to
the Contractors' State License Law.).
(_) I am exempt under Sec S.$P.0 for this mason
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, Clv, C.).
Lender's Name:
Lenders Addrasr:
WORKER'S COMPENSATION OECLtRATION
I heretry affirm under penalty of perjury one of the following declarations:
_ I have and will maintaln a certificate of consent to see-Insune for workers'
compensatlon, as provided for by section 3700 of the Labor Code;. for the performance
of 11twork.for which this permit is lsrued.
I have and -111 maintain workers' compensation Insurance, as required by
Rion 3700 of the Labor Code, forthe performance of the work for which this permit
Is Issued. My workers' compensation insurance carrier and policy number are:
Carrier. Pollcy Number:
I cartify chat In the performance of the work for which this permit 1s issued, I
shall not Cmploy any person in any manner so as to become subject to the workers'
compensation la -L of California, and agree that, If I should become subject to the
workers' compensation provisions of Seedon 3700 of thI l or Cod I shall'forthwith
comply with those provisions. // 7
Date' APPA t.
WARNING: FAILURE TO SECURE wORICFRS PENSATION COVERAGE IS UNIAWPUL,
AND SHALL SUBJECT AN EMPLOYER 70 CRIMINAL PENALTIES AND CIVIL FINE$ UP TO
ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION TO THE COST OF
COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOIt CODE,
INTEREST, AND ATTORNEYS FEES.
APPLICANT ACI(NOwLFDOEMENT '
IMPORTANT: Application Is hereby made to the Building Official for a permit subject to
the conditions and restrlrtlon& set forth on this appllcatlon,
1. Each person upon whose behalf thls application Is made, each person et Whose
request and for whose benefit work Is performed under or pursuant to any permit
Issued as a result of this applicntich , the owner, and the applicant, each agrees to, and
shall defend; Indemnify end hold harmless the Clty of La Qulnta, Its officers, aeents, and
employtres for any act or omisslon related to the work being performed under or
10110WIM9 Issuance of this tvermlt
2. Any permit Issued as a'result of thio a.pp.ilcadon becomes null and void If work is
not commenced whhln lea days from date of Issuance OF such prrmlt, or cessation of
work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the ebove Information Is correct.
I agree to comply with all city and county ordinances and state laws relating to building
construction, and herebysuthodre representatives of this City to en up e
above-mentioned proopp�erly for Inspection purposes.
D Slenature (Applicant or Ag ):
J
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
4amow:
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING PERMIT
Application Number:
BMCH2O16-0077
Property Address:
55306 SHOAL CREEK'
APN:
775142017
Application Description:
CROSS / HVAC CHANGE OUT
Property Zoning:
Application Valuation:
$7,900.00
Applicant:
MAPLE LEAF PLUMBING HEATING AND AIR COND
P 0 BOX 3653
PALM DESERT, CA 92261
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 lass: C36. C20 License No.: 481393
Dat Contract <
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
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 ) 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•
Owner:
CONNIE CROSS
55114 SHOAL CREEK
LA QUINTA, CA 92253
Contractor:
MAPLE LEAF.PLUMBING
P 0 BOX 3653
PALM DESERT, CA 92261
(760)346-6758
LIC. No.: 481393
Date: 4/4/2016
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 a work for which this permit is issued.
1 have and will maintain workers' compensation insurance, as required by
S lion 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.
Date: Applit:
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL.
ANDSHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES URTO
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, an -9
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 corree.
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.
D . Signature (Applicant or Aged):
FINANCIAL INFORMATION
AMOUNT p
_.
` PAID PAID DATEtr
__ _ ....m
BSAS SB1473 FEE, 101-0000-20306 0 $1.00
$0.00
�PAID:BY'}METHOD �b'}a i �sr s +t' RECEIPT # `
` ,CHECK # CLTD BY
l
Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $1.00 $0.00
;,,
v b F DESCRIPTION s rt
£; ...
ACCOUNT �.
YQTY
_ AMOUNT �
ItTo YPAID ;.:
sPA1D DATE'.
HVAC CHANGEOUT - SPLIT-SYSTEM
101-0000-42402
0
$72.52
$0.00
PAID 6Y T
A METHOD ,
' RECEIPT # ��
CHECK #
CLTD BY tt
a-DESCRIPTION
-
'' ACCOUNT
QTY
�-AMOUNT,
PAID s� a".`
�PAID�:DATE
HVAC CHANGEOUT - SPLIT-SYSTEM PC
101-0000-42600
0
$36.26
$0.00
PAID;BY� l`*,� '
METHOD
*.& ..*F
RECEIPT #4 "
�x. ;
Description: CROSS / HVAC CHANGE OUT
Type: MECHANICAL Subtype: Status: UNDER REVIEW
Applied: 4/4/2016 SKH
Approved:
Parcel No: 775142017 Site Address: 55306 SHOAL CREEK LA QUINTA,CA 92253
Subdivision: TR 20717-3 Block: Lot: 10
Issued:
Lot Sq Ft: 0 Building Sq Ft: 0 Zoning:
Finaled:
Valuation: $7,900.00 Occupancy Type: Construction Type:
Expired:
No. Buildings: 0 No. Stories: 0 No. Unites: 0
STATET
Details: HVAC CHANGE OUT - 14SEER/78AFUE SPLIT SYSTEM [2013 ENERGY] CARBON MONOXIDE ALARM(S) TO BE INSTALLED PRIOR TO
FINAL INSPECTION. 2013 CALIFORNIA BUILDING CODES. .
FINANCIAL INFORMATION
Printed; Monday, April 04, 2016 1050;41 AM 1 of L
0TWlYSTEMS
CONTACTS
............................ _......................................................................................_........_..
NAME=TYPE '
:, NAME..
; ` ADDRESS1
CITY
STATET
�. _ -
ZIPr:4 PHONE. FAX: EMAIL
APPLICANT -
MAPLE LEAF PLUMBING HEATING..
P 0 BOX 3653
PALM DESERT
CA
92261
RS1124@YAHO. O.COM
AND AIR COND
CONTRACTOR
MAPLE LEAF PLUMBING.HEATING
P 0 BOX 3653
PALM DESERT
CA
92261 RS1124@YAHOO.COM
AND AIR COND
OWNER
CONNIE CROSS
55114 SHOAL CREEK
LA QUINTA
CA �
92253
FINANCIAL INFORMATION
Printed; Monday, April 04, 2016 1050;41 AM 1 of L
0TWlYSTEMS
DESCRIPTION ..
-� °°-ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
''RECEIPT #
CHECK W .
METHOD
'' PAID BY
C D
BYg:
BSAS SB1473 FEE
101-0000-20306
0
$1.00
$0.00
Total Paid for BUILDING 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 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
TOTALS:�i
PARENT
PROJECTS •. ..,. •.••
Printed: Monday, APrll U4, 1U1b 1U:SU:41 ANI L Of L
CIRWIYSTEMS
. r
CFSR-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.
Y
CERTIFICATE OF COMPLIANCE CFIR-ALT-02-E
Alterations to Space Conditioning Systems (formerly CF -IR -ALT -HVAC) ' (Page 1 of 3 )
Project Name: Connie Cross Date Prepared: 2016-0404
A. General Information w .
CFSR-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
Connie Cross
02
Date Prepared
2016-04-04
03
Project Location
55114 Schoal creek
04
Building Type
Single family
05
CA City
La Quinta
06
Dwelling Unit Name
Connie Cross
07
Zip Code
92253
08
Dwelling Unit Conditioned
1600
Installing newW *
Installing
' stalls g
Installing
Floor Area (ft2)
Identification or
Location or Area
by this SC
ducted
containing
Number of space conditioning
more than 40
09H,Z,ne
entirely new
15
�
10
(SC) systems in this dwelling
1
system?
„r..,„,,,
components?
feet of ducts?
unit.
SC system?
i
B. Space Conditioning (SC) System Informal on,r' .
01
02
.i4 04,1V
COSI
If -661M
11 07))
09
10
FIs the SC -4
Installing a
SC System
S[ System
,.�
'CFA served
'systema
r� g a t 4
Installing newW *
Installing
' stalls g
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
main unit
Main house
1600
Yes
Yes
Yes
No
No
No
Altered space
conditioning system
C. Extension of Existing Duct System, Greater Than 40 Feet (SectIon1S0.2(b)1Dlib)
This section does not apply to this project.
" 4
.Registration Number: 216-A0124030A-000000000.0000 Registration Date/nme: 2016.04-04 10:26:18 HERS Provider: CaICERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance . Report Version: 2013 Rev 1.007 Report Generated: 2016-04-04 10:26:25
Schema Version: 0.555SDD
CERTIFICATE OF COMPLIANCE CF1R-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)IE and F)
i\ It At it AA fl' WI. 40 A
al' .-s
,
r ,
CERTIFICATE OF COMPLIANCE CF1R-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)IE and F)
i\ It At it AA fl' WI. 40 A
al' .-s
'
01
02
03
04
05
06
07
08
09
10
11
12
Heating
Cooling
r
System
Heating
Altered
Heating
Minimum
Altered
Cooling
Minimum
Required
a New or
Identification
System
Heating
Efficiency
Efficiency
Cooling
Cooling
Efficiency
Efficienry
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
main unit
furnace
heating
AFUE
0.78
AC
cooling .
SEER
14
Setback
section is not
section is not
components
components
applicable
applicable
Required Documentation: _
CF211 MCH -01-E - Space Conditioning Systems Ducts and Fans
-Duct insulation requirement for newplenums: R6. ry
CF2R-MCH-20-H & CF3R-MCN-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: 5 15%, or 5 10% leakage to outside, or seal all accessible leaks.
'
CF2R-MCH-2S-H & CHR -MCH -15-H Refrigerant Charge Verification required when refrigerant containing components are installed or altered (applicable in CZ 2, 8-15).
'
CF2RCF3R-MCN-23 & CF3R-MCH-23 Airflow 2'300CFM/ton required when.MCH 25 is required.
-
Exceptions-"'
-Duct systems registered with HERS provider sp sly sealed am exemptZfro �M� Leakage Testing requirements.,
-Heating-only systems and Air Handler/Furnace changes do not require verification of Air Flow MCH -23 Refrigerant Charge MECH•25 "
-Existing duct systems constructed, insulated or sealed with asbestos are exempt from MCH=20 Duct'Le.kage Tesdng.requirements. AAA����►1�
A+ f ./e. 1 It
i\ It At it AA fl' WI. 40 A
al' .-s
it ¢F P6 6l
'...� yy Z� � ' '+�"'•k' ;.q.-+.,yw• 'arK-�:..n' w.+'. h+ `•w.>.;! fr! ...! hr.:..w' -..,R? w{
E. Entirely New or Complete Replacem ent DuCvsystem, with or without.Equipment Changeout (Sections 15O.2(b)1Diia,and.1S0.2(b)lE, F)
All" %A *-Wt Ik-k . ) s&+K ac 'I A ft R
This section does not apply to this project.
F. Entirely New or Complete Replacement Space Conditioning System (Section 150.20111C)
This section does not apply to this project.
1 y '
Registration Number: 216-A0124030A-000000000-0000 Registration Date/Time: 2016-04-04 10:26:18 HERS Provider: CaICERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013 Rev 1.007 Report Generated: 2016-04-04 10:26:25
Schema Version: 0.55SSDD
e �
. ? r
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 «
1.1 certify that this Certificate of Compliance documentation is accurate and complete.
Documentation Author Name:
Documentation Author Signature: .
Grosjean, Robert
CL770rNel/
OOO a
Company:
Signature Date:
MAPLE LEAF PLUMBING HEATING AND AIR CONDITIONING INC
2016-04-04 10:26:18
Address:
CEA/ HERS Certification Identification (if applicable):
P 0 BOX 3653
,
City/State/Zip:
r76(7346-6758
PALM DESERT CA 92261
Responsible Person's Declaration statement
I certify the following under penalty of perjury, under the laws of the State of California:
i
1. The information provided on this Certificate of Compliance,is true and correct. «
2. -1 am eligible under Division 3'of the Businessland Professions accepfrespcnsibllity for the building design or system design identified on this Certificate of Compliance (responsible designer).
4 �..
3. That the energy features and perforfnance specifications, materials, components, and manufactured ddevi�cest for the building design or system design identified on this Certificate of Compliance conform to the
requirements of Title 24, Part 1 and Part B of the �hfornia Code ofd egulations�- { `� Pt6� * Pr�n { 1
�� .�
4. The building design features or system design features' identified on this Certificate of Compliance ares consistent.with the information,provided an atheoapplica}ble ccompliance documents, worksheets,
a. f
a ' a• _ pr xWt
..a.�e ac - i i
calculations, plans and specifications submitted,to the enforcemerrt agency for'approval with this budding permit application.
S. I will ensure that a registered m of this'Certificate of,Com !lance slia8'be:made.avadable with the builds ermFt s issued fodthe;buildin , and made a Ila ble,tothe errforcemem en for all applicable
g PY P n@P. (.) agency pp
r g,8
Inspections. I understand that a registered copy of thisCertiricate of Compliancerequire•d to be.induded with the,documentation.the�,builder proyldes to�the Building owner at occupancy. -
Responsible Designer Name: _ 1-111 IF— ..
Responsible Designer Silinature: V 9�;9—_
Grosjean, Robert
O
Company:
Date Signed:
MAPLE LEAF PLUMBING HEATING AND AIR CONDITIONING INC
2016-04-04 10:26:18
Address:
License:,
P 0 BOX 3653
481393
City/State/Zip:
Phone:
PALM DESERT CA 92261
760-346-6758
Digitafly signed byCeICERTS. This digital signature is provided in order tosecure the content of this registered document and in noway implies Registration provider responsibility for the accuracy of the information. ,s
Registration Number: 216-AO12403OA-000000000-0000 Registration Date/T-ime: 2016-04-04 10:26:18 r HERS Provider. CaICERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013 Rev 1.007 Report Generated: 2016-04-04 10:26:25
Schema Version: 0.S5SSDD
Bin #
City of La Quinta
Building 8Z Safety Division
78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
lip'
Project Address: $S I V e e
Owner's Name:
A. P. Number: C� 0,vk, c 225•
Address:
Legal Description:
A
City, ST, Zip: t4 a Z
Contractor: G I L
Telephone:
Address: 7Y(S2WY
ProJectDescri tion: n
C L24
eSe ^
City, ST, Zip: (44
n
Telephone:
P ho e: 6 d
7 3
State Lic. # : 13�
City Lie.
Arch., Engr., Designer:
Address:
City., ST, Zip:
Telephone:
le one:
P
:>
-
Con tructi n TY Pe• Occupancy:
:
Lic. #•
0State
Project tXPa (circle one • New Add'n Alter Re Pair Demo
Name of Contact Person:
Sq. Ft.:#Stories:
# Units:
Telephone # of Contact Person:
P
dv
Estimated Value of Project: CJ00,
APPLICANT: DO NOT WRITE BELOW THIS LINE
N
Submittal
Req'd
Rec'd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Cales.
Called Contact Person
Plan Check Balance
Title'24 Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2"" Review, ready for corrections/issue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
Ii.O.A. Approval
Plans resubmitted
Grading
IN I10USE:-
3r! 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