BMCH2017-0143&' '
78-495 CALLE TAMPICO Ci 0 D
LA QUINTA, CALIFORNIA 92253 DESIGN & DEVELOPMENT DEPARTMENT
BUILDING PERMIT
Application Number: BMCH2O17-0143
Property Address: 48504 STILLWATER DR
APN:" 623480018
Application Description: MASEK / HVAC CHANGE OUT - (2)14SEER/81AFUE SPLIT SYSTEMS
Property Zoning:
Application Valuation:. $19,000.00 ,
Applicant:
PRO-FORMANCE HEATING & AIR CONDITIONING
P 0 BOX 2041
INDIO, CA 92202
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.: 924629
i Date: bh&,=T�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.).
(� 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 Add
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 4/19/2017
Owner:
MASEK
48504 STILLWATER
LA QUINTA, CA 92253
Contractor:
PRO-FORMANCE HEATING & AIR CONDITIONING
P 0 BOX 2041
INDIO., CA 92202
(760)812-0872
Llc. No.: 924629
WORKER'SCOMPENSATION DECLARATION
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
Df t e rk for which this permit is issued.
x149 1, 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: NORGUARD INSURANCE COMPANY Polity Number: HUWC749046
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: Applic t:
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: W) Signature (Applicant or Agent):
t
Dater 4/19/2017
Application Number: BMCH2017.0143
Owner:
Property Address: 48504 STILLWATER.DR
MASEK
APN: 623480018
48504 STILLWATER
Application Description: MASEK / HVAC CHANGE OUT - (2)14SEER/81AFUE SPLIT SYSTEMS
LA QUINTA, CA 92253
Property Zoning:.
Application Valuation: $19,000.00
Applicant:
Contractor:
PRO-FORMANCE HEATING &AIR CONDITIONING -
PRO-FORMANCE HEATING & AIR CONDITIONING'
P 0 BOX 2041
P 0 BOX 2041
INDIO, CA 92202
INDIO, CA 92202
(760)812-0872
---------------------------------------------------------------------------------------------
LIc. No.: 924629
Detail: HVAC CHANGE OUT - (2)14SEER/81AFUE SPLIT SYSTEMS. CARBON MONOXIDE ALARM(S) TO BE INSTALLED PRIOR TO FINAL INSPECTION. 2016 -
CALIFORNIA BUILDING CODES.
t
DESCRIPTION
INFORMATION, 1i
FINANCIA(i
ACCOUNT QTY ,
AMOUNT
BSAS SB1473 FEE
101-0000-20306 0
$1.00
i
Total Paid for BUILDING STANDARDS ADMINISTRATION BSA:
$1.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
HVAC CHANGEOUT - SPLIT -SYSTEM
101-0000-42402
0
$152.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
HVAC CHANGEOUT - SPLIT -SYSTEM PC
101-0000-42600'
0
$76.00
Total Paid for CHANGEOUT:
$228.00
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
330.27.
0
r
i
0
Bin # pity of La. Quiets
Building 81- Safety Division
Permit u 78-495 Calle Tampico
La •Quinta, CA 92253 -(760) 777-701,2
Building Permit Application and Tracking Sheet
Project Address: S� Owner's Name: C, 6,�.
A. P. Number:
Address:
Legal Description:
City, ST; Zip: l_l4 1 ,ALA C'Ls4,
r. 0--
�t
'—J lSJ � Telephone: -Contract —
V
Address: J&
Project Description: 14 If
City- ST, Zip: ��l U.. C LA
Telephone: U
—
State Lic. # : q 2
City Lic.
Arch.,`Engr., Designer:
u
Address:
City, ST, Zip:
Telephone:
ancY:
n Type: Occupancy:
Constructiontructi P
State Lic. #'
Project ect type (circle one)! • Ne w Add'n Alter Repair -air Demo.
Name of Contact Person:
1A £ S
Sq. Ft.:
# Stories:
# Units:
Telephone # of Contact Person: o _ L _ lqO L
Estimated Value of Project: (�Q
APPLICANT: DO NOT WRITE BELOW THIS LINE
N
Submittal
Req'd
Rcc'd
TRACKING
PERMIT FEES
P1an.Sets
Plan Check submitted
Item )
Amount
Structural Cafes.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance.
Title 24 Calcs.
4
Plans picked up
Construction '
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2" Revicw, 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 HOUSE:-
Jrd Review, ready for corrections/issue
Developer Impact Fee
f
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
Alterations to Space Conditioning Systems (formerly CF -1R -ALT -HVAC) (Page 1 of 3)
Project Name: Mas ek Date Prepared: 2017-04-19
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
Masek
02
Date Prepared
2017-04-19
03
Project Location
48504 Stillwater
04
Building Type
Single family
05
CA City
La Quinta
06
Dwelling Unit Name
Masek
Dwelling Unit Conditioned
`" Is the S6;
07
Zip Code
92253
08
Floor Area (ft2)
3600
SC System
SC System
CFA served
system a
Number of Space
Installing new SC
09
Climate Zone
15 ' _ ;'
10
Conditioning (SC) Systems in
2
by this SC
ducted
containing
system
this Dwelling Unit:
entirely new
7 F .l �-°"....,:-. I. ,l,» -:-s I r`" --..L -11 r"" If: /"-.-- A E
B. Space Conditioning (SC) System Information
L� C
01
02
03
0 4
05
0.6
07 „
08 ...
09
10
.
`" Is the S6;
I`Q'sialliga
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
Altered space
System 1
Location 1 living
1800
Yes
Yes
Yes
No
No
No
conditioning system
System 2
Location 2
bedroom
1700
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: 217-A020128170A-000-000-0000000-0000
Registration Date/Time: 2017-04-19 14:43:20
HERS Provider: CalCERTS
CA Building Energy Efficiency Standards - 2016 Residential Compliance Report Version: 2016.1.005 Report Generated: 2017-04-19 14:43:38
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)
l
•01
02
03.
'04
05
06
07
-0.8
' 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
p
Less than or
'
System 1
furnace
heating
AFUE
81
AC
cooling
SEER
14
Setback
equal to 40
R78
components
components
feet
System.2
Central gas
All newAll
heating
'AFUE
81
-Central split
new
cooling
SEER
14
p
Setback
Less than or
equal to 40
R-8
furnace r
components
°
AC
components
—�
feet
Reauired Documentation: s
,
CF2R-MCH-01-E - Space Conditioning Systems
t lR6
-
- Duct insulation requirement for the new portions of su -air.and return-air:ducts orplenums: CZ 1-30, 12 and 13) and R8 (CZ 11 and 14-16
CF2R and CF3R-MCH-20-H - Duct Leakage Test required when heating or cooling components`are installed inducted systems, or when more than 40 ft of.duct length is replaced
-Leakage rate compliance: <= 15% or r_ 10% leakageyto outside or seal all accessible leaks. -
CF2R and CF3R-MCH-25-H Refrigerant Charge verification required when refrigeran ontaining_ components are installed or�altered (appli•cablerin CZ 2,8-15).
CF2R and CBR -MCH -23 Airflow Rate >= 300 CFM penton required when.MCH 25 is requir"ed
Exceptions:
n:c,
Duct systems registered with HERS provider as previously seal'.. are exempt from MCH,.20Duct, Leakage Testing requirements.,. z
Flow Refrigerant �`.
t
- Heating -only systems and Air Handler Furnace changes do not regwrevrverification . Air MCHr23, or Charge MCH 25
49" t
-Existing duct systems constructed, insulated orsealed with asbestos are?,,exempt from IV1CH 20 Du t Leakage Testing re.Guirements
E. Entirely New or Complete Replacement Duct System, with or without Equipment Changeout (Sections 150.2(b)lDiia and 150.2(b)lE, 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: 217-A020128170A-000-000-0000000-0000' . Registration Date/Time:• 2017-04-19 14:43:20
CA Building Energy Efficiency Standards - 2016 Residential Compliance Report Version: 2016.1.005
r
HERS Provider: CalCERTS
Report Generated: 2017-04-19 14:43:38
CERTIFICATE OF COMPLIANCE + CF1R-ALT-02-E
Alterations to Space Conditioning Systems (formerly CF -IR -ALT -HVAC) (Page 3 of 3j
Documentation Author's Declaration Statement
1.1 certify that this Certificate of Compliance documentation is accurate and complete.
Documentation Author Name:
Documentation Author Signature:
Reyes, Hugo
Company:
Signature Date:
PRO-FORMANCE HEATING & AIR CONDITIONING'
2017-04-19 14:43:20
Address:
CEA/ HERS Certification Identification (if applicable):
P 0 BOX 2041 -
City/State/Zip:
Phone:
INDIO CA 92202
760-812-0872`
Responsible Person's Declaration statement ti
I certify the following under penalty of perjury, under the laws of the State of California:
1. The information provided on this CertificateofCompliance is true and correct. C
2.-' 1 am eligible under Division 3'of.the Business and Professi s 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, matenals; components, and manufactured devices for the building. design o.r system design identified on this Certificate of Compliance conform to the -
6 of the California Cr , . '
requirements of Title 24, Part 1 and Part ode of Reg lat on
Compliance
bi
4. The building design features or system design features identified on this Certificate of are consistent withahe informatiomprovided on other:applicacompliance documents, worksheets;
` With building
calculations, plans and specifications s6b6tted.t a enforcement agency four approval this permit applications
,t
5. I will ensure that a registered copy of this Certificate of -Compliance shall be:made,available with the building per."mit(s) issued for<the building, and•made availableaoafie enforcement agency for all applicable
�.� ..<
inspections. I understand that a registered copy of this;Ceertificate of Complyiance Ls: required to be:;included wit the�documentation;th6 uilder prow des to the building owner at occupancy.
_
Responsible Designer Name: i '
Hugon -
Responsible Designer Signature: VW I�1. ,
; P.0�
Reyes,
�1 aF
Company `' _
Date Signed: `
PRO-FORMANCE HEATING& AIR CONDITIONING Y':
2017-04-19 14:43:20 w.
Address:
Licenser
P 0 BOX 2041 - _
924629 "
City/State/Zip:
Phone: r
INDIO CA 92202
760-812-0872
Digitally signed b CaICERTS. This digital signature is provided in order to secure the content of this registered document, and in no way implies Registration Provider r
9 Y 9. Y 9 9 P 9 Y P 9 ,
responsibility for the accuracy of the information.
Registration Number: 217-A020128170A-000-000-0000000-0000 Registration Date/Time: 2017-04-1914:43:20 HERS Provider: CaICERTS
CA Building Energy Efficiency Standards - 2016 Residential Compliance Report Version: 2016.1.005 Report Generated: 2017-04-19 14:43:38