BMCH2016-040878-495 CALLE TAMPICO D �NNI�Cl/
LA QUINTA, CALIFORNIA 92253 DESIGN & DEVELOPMENT DEPARTMENT
BUILDING PERMIT
Application Number: BMCH2O16-0408
Property Address: 50565 SPYGLASS HILL DR
APN: 770320081
Application Description: DOCKEN / CHANGE OUT (2)HVAC SYSTEMS
Property Zoning:
Application Valuation: $13,120.00
Applicant:
AIR EXPERTS AIR CONDITIONING & HEATING
84-160 MEADOWS LANE
COACHELLA, CA 92236
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: C201 License No.: 1008665
Date" I' ��'O 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 ) 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 Na
Lender's Add
VOICE (760) 777-7125
FAX (760) 777-7011
INSPFlO -
z Date: 6
Owner: 0 n Z
RITA DOCKEN
O
� � . D
5535 E EVERGREEN APT 76 C>
VANCOUVER, WA 92253 E3 -^ O
co
M fl CM
;z p
09
Contractor. m0
AIR EXPERTS AIR CONDITION & FK
84-160 MEADOWS LANE
COACHELLA, CA 92236
(760)397-3438
Llc. No.: 1008665
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.
LJ�dJbave 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 Policy Number: LUWC739940
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. `-
ll// % r✓/
Date: / r Applicant:
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE 15 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
above-mentioned property for inspection purposes.
Date:f+ Signature (Applicant or Agent)
G
Date: 11/9/2016
Application Number: BMCH2O16-0408
Owner:
Property Address: . ' 50565 SPYGLASS HILL DR
RITA"DOCKEN
APN: 770320081
5535 E EVERGREEN APT 7605
Application Description:' " DOCKEN / CHANGE OUT (2)HVAC SYSTEMS
VANCOUVER, WA 92253
Property Zoning:
Application Valuation: $13,120.00
Applicant:
Contractor:
AIR EXPERTS AIR CONDITIONING & HEATING ;":
AIR'EXPERTS AIR CONDITIONING &,HEATING
84-160 MEADOWS LANE
84-160 MEADOWS LANE
COACHELLA,'CA 92236
COACHELLA, CA 92236
(760)397-3438
Llc. No.: 1008665
Detail: HVAC CHANGE OUT- (2)165SEER/78AFUE SPLIT SYSTEMS [2013 ENERGY] CARBON MONOXIDE ALARMS) TO BE INSTALLED PRIOR TO FINAL
INSPECTION. 2013 CALIFORNIA BUILDING CODES. ,
FINANCIAL.INFORMATIOW
DESCRIPTION ACCOUNT
QTY AMOUNT
BSAS 581473 FEE 101-0000-20306
0 $1.00
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
CERTIFICATE OF COMPLIANCE CF1R-ALT 02-E
Alterations to Space Conditioning Systems (formerly CF -IR -ALT -HVAC) (Page 1 of 3 )
Project Name: Docken Rita I Date Prepared: 2016-11-08
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 MR -ALT -02 document for each dwelling unit.
01
Project Name
Docken Rita
02
Date Prepared
2016-11-08
03
Project Location
50565 spyglass hill
04
Building Type
Single family
05
CA City
La Quinta
06
Dwelling Unit Name
Docken Rita
07
Zip Code
92253
08
Dwelling Unit Conditioned
2360
..�.;: � �.
� -�;�
� �. �•
.�,,
Floor Area (ft2)
SC System
SC System
CFA served
system a. 3
refriger nt
Number of space conditioning
Installing
09
Climate Zone
15
10
(SC) systems in this dwelling
2
ducted.
containing
system s
more than 40
unit.
entirely new
B. Space Conditioning (SC) System Information.' -
01
02
03
04-
i'l
S ',h
09
10
• ..�
FIs the SC
_ � ams ,:--.�..;�
Installing a
..�.;: � �.
� -�;�
� �. �•
.�,,
SC System
SC System
CFA served
system a. 3
refriger nt
nstalhng ew SC
Installing
-Ina alling
Installing
Identification or
Location or Area
by this SC
ducted.
containing
system s
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
BEDROOM
1180
Yes
Yes
Yes
No
No
No
Altered space
conditioning system
System 2
LIVING ROOM
1180
Yes
Yes
Yes
No
No
No
Altered spaceconditioning
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-A0417190A-000000000-0000
Registration Date/Time: 2016-11-08 21:44:19
HERS Provider: CaICERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013 Rev 1.008 Report Generated: 2016-11-08 21:44:41
Crhoma Vnrcin— n ccrcnn
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)1E 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
All new
All new
This field or
This field or
System 1
Central gas
heating
AFUE
78
Centrals lit
p
cooling
SEER
16
Setback
section is not
section is not
furnace
components
AC
components
applicable
applicable
2
Central
All new
heating
AFUE
78
Centrals lit
p
All new
cooling
SEER
16
Setback
This field or
section is not
This field or
section is not
System
components
AC
components
applicable
applicable
Reouired 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 510% leakage.to outside, or seal all accessible leaks.
yea was 1
, A,
& .sem" . K- e a
CZ7% 8-15)..
CF2R-MCH-25-H & CF3R-MCH-25-H Refrigerant Charge Verification required when,refngeraanttccontaining components are installed altered (applicable in
CF2RCF3R-MCH-23 & CF3R-MCH-23 Air Flow 2 300 CFM/ton regwreed.when MCH=25 is regtu ed '' )
-n
Exceptions:
Duct systems registered with HERS provider as reviousl sealed""are�exem t fro�m�MCH 20 Ductleaka 1(a Testis
Y g P p Y P g �g.g
vas<?
re„vire tints0.
. q ln:-a'
-Heating-only systems and Air Handler/Furnace changes do not require:verification of Air Flow MCH 23, or Refrigerant Charge MECH-25 .
Kj'Apc1f`!{�'°"t fiA4'iq; rd°anc .6µ,A �''"`�R , 'Y
armee exempt from,MCH 20 Duclleakage requirements. F.
-Existing duct systems constructed, insulated or. sealed with asbestos besting
E. Entirely New or Complete Replacement Duct System, with or without Equipment Changeout (Sections 150.2(b)1Diia 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)lC)
This section does not apply to this project.
Registration Number: 216-A0417190A-000000000-0000 Registration Date/Time: 2016-11-08 21:44:19 HERS Provider: CalCERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013 Rev 1.008 Report Generated: 2016-11-08. 21:44:41
Schpma Vprsinn: n.555Snr)
CF1R-ALT 02-E
CERTIFICATE OF COMPLIANCE
Alterations to Space Conditioning Systems (formerly CF -IR -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:
Lira, Luis M
Company:
Signature Date:
2016-11-08 21:4419
Air Experts Air Conditioning
CEA/ HERS Certification Identification (if applicable):
Address:
PO Box 94
City/State/Zip:
Phone:
760-777-1724
La Quinta CA 92247
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 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).
am
system design identified on this Certificate of Compliance conform to the
3. That the energy features and performance specifications, materials;'components, and manufactured devices for the building design orr"thnproMed
of Title 24, Part 1 and Part6.of the California Code of gulations Ct R.
requirements sae
building design features or system design features identified onthis Certificate of Compliance areacoonnsisstent witih,the informon ther�applicable compliance documents, worksheets,
4.' The v..� * u�l::.
calculations, plans and specifications submitted t6the enforcement -agency for•,approval wtth this building permit application.
� r� ff for
. . all applicable
5. I ensure that a registered copy of YhisCertrfica' tie of Compliance shall be made.,availablewitn the builtlmg:permit(5);issued for,the building, and.;made available to theaenforcement agency
will 5•s �.
inspections. I understand that a registered copy of this Certificate of Compliance is,required to bg:included with the docum�enta�tion the bu lder p ov es to the bu ld ng owner at occupancy.
Responsible Designer Name: Y -A--,2 Responsible Designer Signature: V
Lira, Luis M
Company:
Date Signed:
Air Experts Air Conditioning
2016-11-08 21:44:19
Address:
License:
1008665
PO Box 94
City/State/Zip:
Phone:
760-777-1724
-La Quinta CA 92247
,, Digitally signed by CaICERTS. 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-A0417190A-000000000-0000
Registration Date/Time: 2016-11-08 21:44:19
HERS Provider: CaICERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013 Rev 1.008 Report Generated: 2016-11-08 21:44:41
Schema Version: n..ssssnn
.
Bin I! ,
-_ - .0ty of La -Qu ita
Building & Safety Division
Permit # 78-495 Calle Tampico
. LiQuinta, CA 92253 - (760) 777-701,2
Building Permit Application and Tracking Sheet
Project Address: KGs y' l\ owner's Name: t.
,
A. P. Number:
.Address` SO - SG' S� ILSS
Legal .Description:
City, ST, Zip:
hone:
Telephone:
Co t a ct r: ' -U
0 v& 1
Address:
Project Description:
City, ST, Zip:
IiCOd{�
Telephone: O 33
State Lie. # : 1
City Lie. #:
_
Gan
Arch.,-Engr., Designer:,
Address: ,
City, ST, Zip:
Telephone -__
......................................:.::.
Co •.
n trucf ` Occupancy:
s ton Type:e: O P Y•
YP L
State S t Lie. #
n Demo
type n w dd Repair Project (circle one): . Ne A R atr
tYP
J � ) P
Name of Contact Person: ; z
Sq. Ft.: ` 6 •
# Stories: t
# units -
Telephone # of Contact Person: +.
Estimated Value of Project: C�• .
•
-APPLICANT: DO. NOT WRITE BELOW THIS LINE,
#
Submittal
Req'd
Rec'd..
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calm
Reviewed, ready for corrections-
Plan Check Deposit
Truss Calcs.. -
Called Contact Person
Plan Check Balance
Title 24 Cafes.
?
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.
11.O.A. Approval
Plans resdbmitted
Grading:
IN IiOUSE:-
Review, ready for corrcctionshssuc
Developer Impact Fee
PlannineApproval
Called Contact Person
A.I.P.P.
'Pub. Wks. Appr
Date or permit- issue
School Fees,
Total Permit Fees