BMCH2016-0419LICENSED 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.: 974908
.Dahl (e Contract�\ �s�2
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
Lender's Add
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 th work for which this permit is issued.
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: TRAVELERS PROPERTY CASUALTY COMPANY OF AMERICA Policy
Number: UB8325BO96
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.
D_at�1 1 1t_ Applicant:.�� f7_ n
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.
Da N 11 L_ Signature (Applicant or Agent)
� �
VOICE (760) 777-7125
78-495,CALLE TAMPICO
D.
FAX (760) 777-7011DESIGN
LA QUINTA, CALIFORNIA 92253
& DEVELOPMENT DEPARTMENT
INSPE FAN 60) 777-7153
BUILDING PERMIT
C�
Da e: it / 0.6
Application Number: BMCH2O16-0419
Owner:
co
¢
Property Address: 77125 CALLE TEMECULA
DWAYNE 1URETICH
APN: 774261007
77125 CALLE TEMECULA
(30 Cy
Application Description: JURETICH / HVAC CHANGEOUT
(1) SPLIT SYSTEM
LA QUINTA, CA 92253
Property Zoning:
Application Valuation: $9,309.00
c (J
•
z
Applicant:
Contractor:
o
KEN STARR INC DBA HOME COMFORT USA
KEN STARR INC DBA HOME COMFORT USA
3154 EAST LA PALMA AVENUE
3154 EAST LA PALMA AVENUE
SUITE B
SUITE B
ANAHEIM, CA 92806
ANAHEIM, CA 92806
(714)632-8789
LIc. No.: 974908
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.: 974908
.Dahl (e Contract�\ �s�2
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
Lender's Add
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 th work for which this permit is issued.
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: TRAVELERS PROPERTY CASUALTY COMPANY OF AMERICA Policy
Number: UB8325BO96
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.
D_at�1 1 1t_ Applicant:.�� f7_ n
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.
Da N 11 L_ Signature (Applicant or Agent)
r
Date: 11/18/2016
Application Number: BMCH2O1b�A419
Owner.
Property Address:. 77125 CALLS TEMECULA,
DWAYNE JURETICH
APN: 774261007
77125 CALLE TEMECULA
Application Description:. JURETICH / HVAC CHANGEOUT (1) SPLIT SYSTEM
LA QUINTA, CA 92253
Property Zoning: -
Application Valuation: $91309.00
Applicant:
Contractor:
KEN STARR'INC DBA HOME COMFORT USA -
KEN STARR INC DBA HOME COMFORT USA
3154 EAST LA PALMA AVENUE
3154 EAST LA PALMA AVENUE
SUITE B
SUITE B
' ANAHEIM, CA 92806
ANAHEIM, CA 92806 .
(714)632-8789
Llc. No.: 974908
Detail: HVAC CHANGE OUT (1)14SEER/80AFUE SPLIT SYSTEM [2013 ENERGY] CARBON
MONOXIDE ALARM(S) TO BE INSTALLED PRIOR TO FINAL
INSPECTION. 2013 CALIFORNIA BUILDING CODES.
FiNANCIAL;INFORMAT.ION',,'�.:-",;.
DESCRIPTION ACCOUNT CITY AMOUNT
BSAS SB1473 FEE 101-0000-20306 0 $1.00
Total Paid for BUILDING STANDARDS ADMINISTRATION BSA:' $1.00
DESCRIPTION
ACCOUNT
CITY
AMOUNT ,
HVAC CHANGEOUT - SPLIT -SYSTEM
101-0000-42402
0
$76.00
DESCRIPTION
ACCOUNT
CITY
AMOUNT
HVAC CHANGEOUT - SPLIT -SYSTEM PC
101-0000-42600
0 .
$38.00
Total Paid for CHANGEOUT: $114.00
DESCRIPTION
ACCOUNT
CITY
AMOUNT .
PERMIT ISSUANCE
101-0000-42404
0
$96.27
Bin.#
Cit}/ Of T.d Quiiltd
Building 8L Safety Division
P.O. Box 1504,79-495 Calle Tampico
la.Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet.
Permit #
Project Address: 77125 Calle Temecula
Owner's Name:. Dwayne Juretich
A. P. Number. '.
Address: 77125 Calle Temecula
Legal Description:
Contractor: Home Comfort USA
City, ST, Zip. La Quirita, CA 92253
Telephone: 760-636-9059
Address: 3154 E La Palma Ave Suite B
Project Description: Replace 4 ton complete HVAC system .
City, ST, Zip: Anaheim, CA 92806
Telephone: 714-632-8789
State Lic. # : 974908
City Lie'. 9.
Arch., Engr., Designer.
Address:
City., ST, Zip: "
�;.
Telephone: Y.::`� Construction Type:. Occupancy.
State i.ic. #:' �.
^ „ j y �1� _ ,r Project type (circle one): New Add'n Alter Repair Demo
Name ofCoataetPerson: Steven Schnierer Sq. Ft.: # Stories: # Units:
Telephone # of Contact Person: 818-735 7876 Estimated Value of Project: $9,309.00
APPLICANT: DO NOT WRITE BELOW THIS UNE
#
Submittal
Req'd
Recd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item Amount
Structural Calks.
Reviewed, ready for corrections
Plan Check Deposit. .
Truss Calcs.
Called Contact Person
Plan Check Balance
Title 24 Calm
Plans picked up
Construction
Rood plain plan
Plans resubmitted..
Mechanical
Grading plan
Zi° Review, ready for correctionsAssue
Electrical
Subeontactor List
Called ContactPerson
Plumbing
Grant Deed
Plans picked up
SALL
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 F f CF1R-ALT:02-E
Alterations to Space Conditioning Systems (formerly CF -IR -ALT -HVAC) (Page 1 of 3 )
Project Name: = 1 ` DWAYNE 1URETICH Date Prepared:-. - 2016-11-17
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 CFIR-ALT-02 document for each dwelling unit. • .
01 r`
Project Name'
DWAYNE 1URETICH
02
Date Prepared
2016-11-17
03'
Project Location
77125 CALLE TEMECULA
04
Building Type
Single family
05
CA City
LA QUINTA
06
Dwelling Unit Name
WHOLE HOUSE
07
tDwelling
Zip Code
92253
0»
Unit Conditioned :
Floor Area (ft2) .
-
1138
Installing
Installing .
Installing
.Identification or
Location or Area
1 b this SC .
ducteaInry
�' `
�)sysi
Number of space conditioning
'
09
Climate Zone
15' ,
1 10
(SC) systems in this dwelling
1
+
component?
components?
'feet of ducts?,.
duct system?
unit.
Alteration Type
B. Space Conditioning (SC) System Information
01 • •
02
03
04
X..n 05 ,, �
i � 06�k
07
08 .
09
= 10
Is the SC,#
(Installing:a:.
SC System
SC System,
CFA served
system a
refrigerant '
Installing new SC
Installing
Installing .
Installing
.Identification or
Location or Area
1 b this SC .
ducteaInry
atcontairiih-g'
�)sysi
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'
t
WHOLE HOUSE
1138•
Yes
w Yes
Yes
No
No
No
Altered space
conditioning system
C. Extension of Existing Duct System; Greater Than 40 Feet (Section150.2(b)iDiib) ,
• This section does not apply to this project. '
Registration Number: 416-A0008736A-000000000-0000 Registration Date/Time: 2016-11-17 13:01:29
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013 Rev 1.008
HERS Provider: CHEERS
Report Generated: 2016-11-17 13:01:37
CERTIFICATE -OF COMPLIANCE , - CF1117ALT-02-E
Alterations to Space Conditioning Systems (formerly CF -IR -ALT HVAC) t (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 '
F 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 view
Central split
All new
This field or
"section
This field or
SYSTEM 1
furnace
heating
. AFUE
0.80
AC
cooling
SEER
14.00
Setback
is not
section is not
components
components
-
applicable
applicable
Required Documentation:
CF2R-MCH-01-E - Space Conditioning Systems Ducts and Fans :
-Duct insulation requirement for new plenums: R6..34.
entsare;nstalled4in
n
CF2R-MCH-20-H & CF3R-MCH-20-H – Duct Leakage testing required when heating or cooling compo ducted systems, or when more than 40 ft of duct length is replaced.
-Leakage rate compliance: 515%, or <- 10% leakage to outside, or seal all accessible leaks. x
CF2R-MCH-25-H & CF311-MCH-25-H Refrigerant Charge Verification required when refrigerant containing components:are installed or altered (applicable in CZ 2, 8-15).
CF2RCF3R-MCH-23 & CF3R-MC4-23 Air Flow z 300 CFM/ton required when MCH -25 is required. ' "•
Exceptions:
-Duct systems registered with HERS provider as previously sealed are exempt from MCH -20 Dud Lea kage,Testing requirements.
'
-'Heating-only systems and Air Handler/Furnace changes do not require verification of Air Flow MCH -23, orRefrigerant Charge MECH-25.
-Existing duct systems constructed, insulated or sealed with asbestos are exempt from MCH -20 Duct Leakage Testing requirements.
*11 i R-11111 1 1:177 ii Imo'"• i '.' i {III(,
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 se tion does nnoira ply to this pro ect.
1
F. Entirely New or Complete Replacement Space Conditioning System (Section 150.2(b)1C)
This section does not apply to this project.
- 1
Registration Number: 416-A0008736A-000000000-0000 Registration Date/Time: 2016-11-17 13:01:29 HERS Provider: CHEERS
SCA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013 Rev 1.008 Report Generated: 2016-11-17 13:01:37
of
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:
Leslie Urak
LeaielUra ,
Company:
Signature Date:
Home Comfort USA
2016-11-17
Address:
CEA/ HERS Certification Identification (if applicable):
3154 East La Palma Avenue, Suite B
City/State/Zip:Y
_Phone:
Anaheim CA 92806' r
714632-8789
Responsible Persons 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).
III FYI"
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 of Regulations.`r
4. 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 petro al0,,kh this buildinIt g permit application.
�agewcy#four;
5. 1 will ensure that a registered copy of this Certificate of Compliance'shhalll be,madeiavailable, with the bwlding.pN it(s) imed for the building, and made available to the enforcement agency for all applicable
inspections. I understand that a registered copy of this Certificate of Compliance is,required to be included witlithe documentation the builder provides to the building owner at occupancy.
Responsible Designer Name:
�l°``L'e%U
Respo, Bible Designer Signature:
ctTv
Pi r
Leslie Urak
Company:
Date Signed:
Home Comfort USA
2016-11-17
Address:
License:
3154'East La Palma Avenue, Suite B
974908
City/State/Zip:
Phone:
Anaheim CA 92806
714-632-8789
Digitally signed by CHEERS TM. This digital signature is provided in order
to secure the content of this registered document, and in no way implies
Registration Provider responsibility for the accuracy of the information.
Registration Number: 416-A0008736A-000000000-0000 Registration Date/Time: 2016-11-17 13:01:29 HERS Provider: CHEERS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013 Rev 1.008 Report Generated: 2016-11-17 13:01:37