BMCH2016-0155rt'
78-495 CALLE TAMPICO
4
LA QUINTA, CALIFORNIA 92253 COMMUNITY DEVELOPMENT DEPARTMENT
I I
BUILDING PERMIT
Application Number: BMCH2O16-0155 Owner:
Property Address: 77318 CALLE TEMECULA JOHN KLIMKIEWICZ
AP14: 774234012 P 0 60X.264.
Application Description: KLIMKIEWICZ / HVAC CANGE OUT LA QUINTA, CA 92253
Property Zoning:
Application Valuation: $6,500.00
Applicant:
ADAM SIMMONS
P 0 BOX 314
LA QUINTA, CA 92247
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.: 780534
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 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 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 Address:
Contractor:
ADAM SIMMONS
PO BOX 314
LA QUINTA, CA 92247
(760)564-7525.
Llc. No.: 780534
(760)
��j
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 I a or 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, 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: 1Applicant
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 ASPROVIDED 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 Quintal 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 thiscity to a ter upon the
above-mentioned property for inspection purposes.
Date: Signature (Applicant or Agent
'DESCRIPTIONa 'ACCOUNT AMOUNT ;"R
y.PAIDr PAIO;DATE
r tiQTY r
5F
BSAS SB1473 FEE 101-0000-20306 0 $1.00
$0.00
' z RECEIPT #` ,
PAID'BY METHOD'
CHECK # CLTD BY-.:.'
r u t ,
Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $1.00 $6.00
ACCOUNT •1 y ; f
;QTY
t?. AMOUNTS
vW 'PAID
'PAID DATE'
w
HVAC CHANGEOUT - PACKAGED UNIT
101-0000-42402
0
$36.26
$0.00
t: PAID BY ,+= ` i"
" *: METHOD <
#
CHECK ,#"
�� CLTD BY
,RECEIP,7
t €
;ACCOUNTS V_'
QTY
( �� AMOUNT
+='PATO
TAIU DATE
,DESCRIPTION
ri x +
HVAC CHANGEOUT - PACKAGED UNIT PC
101-0000-42600
0
$24.17
$0.00
y i aPAID BY
%METHOD'
RECEIPT # ':,
" :.` CHECK # r
CLTD By
V7,
4
i,
Total Paid for CHANGEOUT: $60.43 $0.00
«:DESCRIPTION' _ .::
ACCOUNT
QTY.
'G
PAID
PAID. DATE,
f
.:
.AMOUNT:
m
PERMIT ISSUANCE
101-0000-42404
0
$91.85
$0.00
z°. PAID BYr..
METHOD,, :
RECEIPT #':
CHECK #
CLTD.BY. `
Total Paid for PERMIT ISSUANCE: $91.85 $0.00
TOTALS:00
Description: KLIMKIEWICZ / HVAC CANGE OUT
Type:. MECHANICAL Subtype:
Status: APPROVED
Applied: 5/17/2016 SKH
Approved: 5/17/2016 SKH "
Parcel No: 774234012 Site Address: 77318 CALLE TEMECULA LA QUINTA,CA 92253
Subdivision: SANTA CARMELITA VALE LA QUINTA Block: 263
Lot: 13
Issued:
UNIT 24
Lot Sq Ft.: 0 Building,Sq Ft: 0 '
Zoning:
Finaled:
Valuation: $6,500.00 Occupancy Type:
Construction Type:
Expired:
No. Buildings: 0 No. Stories: 0
No. Unites: 0
Details: HVAC CHANGE OUT- 14.5SEER/78AFUE PACKAGE SYSTEM [2013 ENERGY] CARBON MONOXIDE ALARM(S) TO BE INSTALLED PRIOR
TO FINAL INSPECTION. 2013 CALIFORNIA BUILDING CODES.
Printed:. Tuesday, May 17, 2016 11:33:30 AM 1 of 2
ChqW1ySTrmS
r DESCRIPTION
ACCOUNT
CITY.
AMOUNT
PAID
PAID,DATE
RECEIPT #
CHECK #,,
METHOD
PAID BY
CLTD '
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
$36.26
$0.00
PACKAGED UNIT
HVAC CHANGEOUT -
101-0000-42600
0
$24.17
$0.00
PACKAGED UNIT PC
Total Paid for CHANGEOUT: $60.43 $0.00 `
PERMIT ISSUANCE
101-0000-42404
0
$91.85
$0.00
Total Paid for PERMIT ISSUANCE: $91.85 $0.00
TOTALS:• 0 -
PARENT PROJECTS .
BOND- INFORMATION.
ATTACHMENTS
Printed: Tuesday, May 17, 2016 11:33:30 AM 2 of 2 C
SYSTEAAS
CERTIFICATE OF COMPLIANCE
Alterations to Space Conditioning Systems (formerly CF -1R -ALT -HVAC)
Project Name:
77318 Calle Temecula I Date Prepared:
CF1R-ALT-02-E
(Page 1 of 3 )
2016-05-02
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 MR -ALT -02 document for each dwelling unit.
01
Project Name
77318 Calle Temecula
02
Date Prepared
2016-05-02
03
Project Location
77318 Calle Temecula
04
Building Type
Single family
05
CA City
La Quinta
06
Dwelling Unit Name
77318 Calle Temecula
07
Zip Code
92253
08
Dwelling Unit Conditioned
1400
,+
Floor Area (ft2)
SC System
SC System
CFA served
system a '
re rf igerantr
Number of space conditioning
InstalIir g
09
Climate Zone
15 'h=
10
(SC) systems in this dwelling
1
ducted
b
containing
system
more than 40
unit.
*
entirely new
B. Space Conditioning (SC) System Informations
jo
01
02
U8
09
10
` ,.,
.els the SC
Installing a
SC System
SC System
CFA served
system a '
re rf igerantr
Installing new SC
InstalIir g
IInstalli g
Installing
Identification or
Location or Area
by this SC
ducted
b
containing
system
more than 40
L�
entirely new
*
entirely new
Name
Served
System (ft2)
system?
component?
components?
feet of ducts?
duct system?
SC system?
Alteration Type
System 1
whole house
1400
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: 216-A0162361A-000000000-0000
Registration Date/Time: 2016-05-02 08:16:30
HERS Provider: CalCERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013 Rev 1.007 Report Generated: 2016-05-02 08:16:32
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)lE and F) -
01
02
03
04
05
06
07
08
09
10
11
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
All new
Central
All new
Less than or
System 1
packaged HP
heating
AFUE
0.78
packaged AC
cooling
SEER
14.5
Setback
equal to 40
R-8
components
components
feet
Required 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::5 15%, or <— 10% leakage to outside, or seal all accessible leaks.
CF2R-MCH-25-H & CF3R-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-MCH-23 Air"Flow z 3MCFM/t6n required,when.MCH-25 is required.,_ ,.
Exceptions: R ,,.....
-Duct systems registered with HERS provider A previously sealed are exempt from MCH -20 Duct Leakage Testing requirements. CK
-Heating-only systems and Air Handler/Furnace changes do not require verification of Air Flow MCH" 23 For'Refngerant Charge'MEC 25
-Existing duct systems constructed, insulated or sealed with a3bestos�are exempt4rom MCH=20 DuctIedkage Test npr quirements.
;
"1 "w�se.n" ,a.rw�a.-*,.w -#-,r �' '•�`�':' 3� m'+. >.a ry„..K,�.;. ::E;a
E. Entirely New or Complete Replacement Duct System, with or without�Equipment Changeout (Sectionsg150 2(b).lDHa•and 150.2(b)lE, F)
1. ?A 4 P
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: 216-A0162361A-000000000-0000 Registration Date/Time: 2016-05-02 08:16:30 HERS Provider: CaICERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013 Rev 1.007 Report Generated: 2016-05-02 08:16:32
Schema Version: 0.555SDD
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:
Simmons, Donna
Company:
Signature Date:
ADAM SIMMONS
2016-05-02 08:16:30
Address:
CEA/ HERS Certification Identification (if applicable):
54440 AVENIDA CARRANZA
City/State/Zip:
Phone:
LA QUINTA CA 92253
760-564-7525
Responsible Person'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. 1 am eligible under Division 3 of the Business and Professions Code to.acceptresponsibility 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 on this Certificate of Compliance conform to the
requirements of Title 24, Part 1 and Part 6'of the California.Code of Re ulitions. s
qg
4. The building design features or system,design features identified on;fhis Certifcate of Compliance are,consistent wifhrthe information.provided on.other pplicable�cdmpliance documents, worksheets,
calculations, plans and specifications submitted jto the enfoorcement:agency four approval wifh this building per k it application.41
if�'
.. 5
S. I will ensure that a registered copy of.this Certificate of compliance shall be made available with the bwlding permit(s)ussued forthe bwld%ng, and,made availableto'theenforcement agency for all applicable
inspections. I understand that a registered copy of this Certificate of Compliance is required to be_included w,itth the dlocumeentaation the builder proves t he building owner at occupancy.
Responsible Designer Name: .a:
Responsible Designer Signature: •.
�G>yfiXf.BtLO'
Simmons, Donna
Company:
Date Signed:
ADAM SIMMONS
2016-05-02 08:16:30
Address:
License:
54440 AVENIDA CARRANZA
780534
City/State/Zip:
Phone:
LA QUINTA CA 92253
760-564-7525
Digitally signed by Ca10ERTS. 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: 216-A0162361A-000000000-0000 Registration Date/Time: 2016-05-02 08:16:30 HERS Provider: CaICERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013 Rev 1.007 Report Generated: 2016-05-02 08:16:32
Schema Version: 0.555SDD
Bin #
Cl ty of La Quin to
Building &r Safety Division
78=495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
5� Building Permit Application -and Tracking Sheet
Permit #
Project Address: �-� —x�
Owner's Name:
A. P. Number:
Address:
Legal Description: l
City, ST, Zip: L& FDD-gcg74, CaA 92.ei 5 3
Contractor:
5
,Wz :,, �5T
ele ho
P
Address: �C-!�) B�
Project Description: zv-e-
City, $T, Zip: 67-M. ' Q ZZ %
h
Telephone:
P -57,S:.
State Lic. # : ffb 3 City Lic. #;
Arch., Engn, Designer:
Address:
City,, ST, Zip:
Telephone: h
one:
Con tructi T
s on e• Occupancy:
Type: ane Y:
State Lic. #:
Project tYPa circle one • New A dd'nAlter Repair Demo
Name of Contact Person:c
5 14 l yuSW/45Sq.
Ft.:
#Stories:
#Units:
Telephone# of Contact Perso (92C> Ff"
Estimated Value of Project: G «�
APPLICANT: DO NOT WRITE.BELOW THIS LINE
tl
Submittal '
Req'd
Rcc'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 Cates.
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.
H.O.A. Approval
Plans resubmitted
Grading
IN IiOUSE:-
'"! Review, ready for correct ionsfissue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees,
Total Permit Fees