BMCH2015-019278-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA.92253
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COMMUNITY DEVELOPMENT DEPARTMENT
.BUILDING PERMIT
Application Number:
BMCH2O15-0192
Property Address:
78721 SIENA CT
APN:
609530001
Application Description:
CENTENO RESIDENCE HVAC CHANGE OUT
Property Zoning:
Application Valuation:
$5,500.00
Applicant:
LA QUINTA AIR CONDITIONING & H
53-875 AVENIDA NAVARRO
LA QUINTA, CA 92253.
. LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of,Chapter
9 (commencing with Section 70001 of Division 3 of the Business and Professions Code,
and my License is in full force and effect. '
License Class: C20 License No.: 90202
Date: Contracto .
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 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 i
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:
i
Lender's Address:
Owner:
JILL CENTEN(
78721 SIENA
LA QUINTA, (
Contractor:
LA QUINTA A
53-875 AVEN
LA QUINTA, CA 92253
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 6/8/2015
(760)837-9344
Llc. No.: 902029
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 polity 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: l� 'Applicant:
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUI,
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, ar_d
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 ofl
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 pr perty for inspection purposes.
Date: Signature (Applicant or•Agent):
f
FINANCIAL INFORMATION
mx} h DESCRIPTION
ACCOUNT QTY
y'g AMOUNTS PAID PAIDDATEr
s
BSAS 561473 FEE
101-0000-20306 0
$1.00 $1.00 6/8/15
x " PAID'BY
' <?xs' METHOD ` RECEIPT # E� CHECK # � r BY r.
aa'`�CLTD
LA QUINTA AIR CONDITIONING & H
CASH R6843 MFA
Total Paid'forBUILDING STANDARDS ADMINISTRATION BSA $1.00 $1.00
mDESCRIPTION ° * %
tt;`
: ACCOUNT a
:QTY
g fi
_ AMOUNT
r : >s".
PAID
_ „. ,k
�+
iz
r f .PAIDDATE_
HVAC CHANGEOUT - SPLIT -SYSTEM
101-0000-42402
0
$72.52
$72.52
6/8/15
fi PAID. BY z "r
METHOD ',"'
,.#
4x
,RECEIPT
LA QUINTA AIR CONDITIONING & H
CASH
R6843
MFA
' -
4 ACCOUNT
, AMOUNT
r
PAID;,>�
PAID DATE:
F �-DESCRIPTION
. ro
,QT1("
r
HVAC CHANGEOUT - SPLIT -SYSTEM PC
101-0000-42600
0
$36.26
$36.26
6/8/15
;1.
RECEIPT #�„”
CHECK #s
LA QUINTA AIR CONDITIONING & H
CASH
R6843
MFA
Total Paid forCHANGEOUT: $108.78 $108.78
•
DESCRIPTION
.xx ACCOUNT«
;!AMOUNT F
s `� PARD s'
PAID DATE:.
y
K
NQTYa
_
s. .._ z. :..
PERMIT ISSUANCE
101-0000-42404
0
$91.85
$91.85 _
6/8/15
PAID
� METHOD
;RECEIPT #
',° #
CLTD BY
,BY
,CHECK
LA QUINTA AIR CONDITIONING & H
CASH
R6843
MFA
Total Paid forPERMIT ISSUANCE: $91.85 $91.85
TOTALS:
f
Description: CENTENO RESIDENCE HVAC CHANGE OUT
Type: MECHANICAL Subtype: Status: ISSUED
Applied: 6/8/2015 MFA
Approved: 6/8/2015 MFA
Parcel No: 609530001 Site Address: 78721 SIENA CT LA QUINTA,CA 92253 -
Subdivision: TR 28457-3 Block: Lot: 1
Issued: 6/8/2015 MFA
Lot Sq Ft: 0 Building Sq Ft: 0 Zoning:
Finaled:
Valuation: $5,500.00 Occupancy Type: Construction Type:
Expired: 12/5/2015 MFA
No. Buildings: 0 No. Stories: 0 No. Unites: 0
Details: HVAC CHANGE OUT - 16.2 SEER/80AFUE SPLIT SYSTEM [2008 ENERGY] CARBON MONOXIDE ALARM(S) TO BE INSTALLED PRIOR TO
FINAL INSPECTION. 2013 CALIFORNIA BUILDING CODES.
,.._ CONTACTS
FINANCIAL INFORMATION
Printed: Monday; June 08, 2015 9:14:26 AM 1 of 2
SYSTEtitS
DESCRTON
•ACOUNT,
—•-
r.
";.:PAID
---•-•,- ----
,DATE,
---
RECEIPT#
-.-�-�--
CHECK
-- --
,METHOD'
,
.,--- m
CLTD
4
BY
BSAS.SB1473 FEE
101-0000-20306
0
$1.00
$1.00
6/8/15
R6843
CASH
LA QUINTA AIR
MFA
CONDITIONING & H
Total Paid forBUILDING STANDARDS ADMINISTRATION $1.00 $1.00
BSA:
HVAC CHANGEOUT -
101-0000-42402
0
$72.52
$72.52
6/8/15
R6843
CASH
LA QUINTA AIR
MFA
SPLIT -SYSTEM
CONDITIONING & H
HVAC CHANGEOUT -
101-0000-426000
$36.26
$36.26°
6/8/15..__R6843
--
CASH._ _
LA QUINTA AIR
_.
MFA..
---.-SPLIT-SYSTEM PC--
-----_— _..---__.-_
- _
-_ _ _ _.
_ �_ _ - _-- _
T.
--
-- ---
-�
CONDITIONING &N
Total Paid forCHANGEOUT: $108.78 $108.78
PERMIT ISSUANCE
101-0000-42404
0
$91.85
$91.85
6/8/15
R6843
CASH
LA QUINTA AIR
MFA
CONDITIONING & H
Total Paid for PERMIT ISSUANCE: $91.85 $91.85
TOTALS:
PARENT PROJECTS
I
Printed: Monday, lune 08, 2015 0:14:2G ANI 2 of 2
1YST1M3
STATE OF CALIFORNIA
ALTERATIONS% HVAC
CEC-CFIR-ALT-04-E Revised 06/14
CALIFORNIA ENERGY COMMISSION
CERTIFICATE OF COMPLIANCE
CF1R-ALT-04-E
Alterations - HVAC CZ 2, and 8-15 (formerly CF -IR -ALT -HVAC)
(Page 1 of 1)
Site Address. _ Enforcement Agency:
/t3 Go� C l �A N/
Date Prepared:
Permit#:
Equipment Type
Equipment Efficiency New Ducting, Plenums, Lineset:
Conditioned
Thermostat
Required R -value
Floor Area (sq ft)
❑ Packaged System
Evaporator Coil
F'i1 AFUE
COP 11R-6 (CZ 1, 8-13) Ducting
Served by system
-Setback
® Split System
londensing Unit
GJ
❑ R-8' (CZ 11, 14, 15) Ducting!!
sgft
(If not already
❑ Mini Split
11 Compressor
lle SEER
HSPF ❑ R-6 (all CZ's) Plenums
present must
-Furnace
0 Lineset
EER
❑ R-5 or R7.5) Lineset°
be installed)
HERS VERIFICATION SUMMARY Installer determines work to be completed and matches to one of the options below. At permit application this
form is allpy
jed to be filled out by hand. For final inspection all forms are to be registered (no hand filled forms allowed) and a copy left on site.
VAC Changeout/Repair
Required Compliance Documents to be left on site for Final:
All Equipment,
CFIR-ALT-02-E
Condenser Unit, Evaporator Coil,
CF2R: MECH-01, MECH-20-HERS, MECH-(23 or 24)2 -HERS, MECH-25-HERS2
Compressor, TXV, Lineset,
CF3R: MECH-20-HERS, MECH-(23 or 24)-HERS2, MECH-25-HERS2
Air Handler/Furnace2 (Can include new ducting)
Installer Requirement: Duct leakage (:<_15%, or < 10% to outside, or seal all accessible leaks), Air Flow z 300 CFM/ton, Refrigerant Charge.
Exempted from duct leakage testing if:
❑ 1. Dud system registered with HERS provider as previously sealed, or ❑ 2•. There is less than 40 linear feet of duct in unconditioned space, or
❑ 3. Existing dud systems are constructed, insulated or sealed with asbestos (list manufacture date of building ....... I
❑ 2. New HVAC System Required Compliance Documents to be left on site for Final:
All new equipment and All New Ducts' CF1R-ALT-02-E
including Mini Split CF2R: MECH-01, MECH-20=HERS, MECH-22-HERS, MECH-(23 or 24)-HERSZ, MECH-25-HERSZ
CF3R: MECH-20-HERS, MECH-22-HERS, MECH-(23 or 24) -HERS', MECH-25-HERSZ
Mini Splits require CF1R-ALT-02-E, CF2R-MECH-01, and- (CF2R-CF3R) MECH-25-HERS
Installer Requirement: Duct leakage < 6%, Fan Efficacy (.58W/CFM), Air Flow z 350 CFM/ton (or alternative), Refrigerant Charge
❑ 3. All New Duds with Replacement Required Compliance Documents to be left on site for Final:
All New Ducts' and one or more of the following CFI11-ALT-02-E
replaced: Condenser Unit, Evaporator Coil, CF2R: MECH-01, MECH-20-HERS, MECH-(23 or 24) -HERS, MECH-25-HERS
Compressor, TXV, Lineset, Furnace CF3R: MECH-20-HERS, MECH-(23 or 24) -HERS, MECH-25-HERS
Installer Requirement: Duct leakage < 6%, Air Flow >_ 350 CFM/ton (or alternative), Refrigerant Charge
Exempted from duct leakage testing if: ❑ 1. Existing duct systems are constructed, insulated or sealed with asbestos
❑ 4. New Ducting over 40 feet Required Compliance Documents to be left on site for Final:
New ducting but less than All New Ducts'. CF1R-ALT-02-E, CF2R: MECH-20-HERS, CF3R: MECH-20-HERS
Installer Required to: Duct leakage (L15% or, < 10% to outside or, or seal all accessible leaks)
❑ EXCEPTION: Existing duct systems constructed, insulated or sealed with asbestos.
' All new ducting R-8 required when more than 40 ft installed and R-6 when less than 40 ft installed. This includes in walls, between floors etc.
.2 Heating only systems and Air Handler/Furnace changes do not require Air Flow MECH-(23 or 24), or Refrigerant Charge verification MECH-25
' All New Ducts is when at least 75 percent of the duct system is new duct material, and up to 25 percent may consist of reused parts from the
dwelling unit's existing duct system (e.g., registers, grilles, boots, air handler, coil, plenums, duct material)
R-5 W' thick insulation) for linesets 1" and less. R-7.5 (1.5" thick insulation) for linesets over 1 inch. Most mfg will require Suction.line Diameter
with insulation as the following 1.5-2T-25/8", 2.5-3T-2%", 3.5 to 4T-2%", 5T-4%"
Contractor (Documentation Author's /Responsible Designer'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. i am eligible under Division 3 of the California Business and Professions Code to accept responsibility for the information on this document.
3. That the energy features and performance specifications for the design identified on this Certificate of Compliance conform to the
requirements of Title 24, Parts 1 and 6 of the California Code of Regulations (CCR).
4. 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 CCR.
5. The building design features or system design features identified on this Certificate of Compliance are consistent with the information
provided on other applicable compliance documents, worksheets, calculations, plans and specifications submitted to the enforcement
agency for approval with this building permit a
Responsible Designer Name:
Responsible tore:
-
Date Signe
License:
6 /I
Company:
Address: s
City/State/Zip:
Phone:
For assistance or questions regarding the Energy Staontad the Energy Hotline at: 1-800 772-3300
r
Bin #
City of La Quinta
Building & Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012.
Building Permit Application and Tracking Sheet
Permit #
Project Address:
Owner's Name: , / LG 4f��ur��lG
A. P. Number:
Address:
Legal Description:
Contractor:LrT d G Gam'
City, ST, Zip./_4� jr raj.
Tele hon . �l
Address:
Project Description:
City, ST, Zip:
e
Telephone -A -/,,t9 -17,5-5F0
S ,
State Lic. # :
City Lic. #.: �9��
Arch., Engr., Designer:
Address:
City., ST, Zip:
Telephone: e one:
P
Con structi n Type: e• Y-
Occupancy -
Y ccu P anc
State Lic . •
State #.
Pro ' ect type (circlew one • New Add'n Alter e
J Repair air Demo
Name of Contact Person:
Sq. Ft.:
# Stories:
#Units:
Telephone # of Contact Person:
Estimated Value of Project: U !'
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
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 Calcs.
Called Contact Person
Plan Check Balance
Title 24 Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
Z"d•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
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees