BMCH2016-0081(760)346-0677
Llc. No.: 374937
-------------------7--------------------------------------------
LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter I hereby affirm under penalty of perjury one of the following declarations:
9 (commencing with Section 7000) of Division.3 of the Business and Professions Code, I have and will maintain a certificate of consent to self -insure for workers'
and my License is in full force and effect. compensation, as provided for by Section 3700 of the Labor Code, for the performance
License Class -'C20 License No.: 374937 ) oftl�lie W,ork for which this permit is issued.
1. 4 1 have and will maintain workers' compensation insurance, as required by
Date: W Contractor: — Sect►loon 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:
OWNER -BUILDER DECLARATION Carrier: _ Policy Number:
1 hereby affirm under penalty of perjury that I am exempt from the Contractor's State I certify that in the performance of the work for which this permit is issued, I
License Law for the following reason (Sec. 7031.5, Business and Professions Code: Any shall not employ any person in any manner so as to become subject to the workers'
city or county that requires a permit to.construct, alter, improve, demolish, or repair compensation laws of California, and agree that, if I should become subject to the
any structure, prior to its issuance, also requires the applicant for the permit to file a workers' compensation provisions of Section 3700 of the Labor Code, I sh forthwith
signed statement that he or she is licensed pursuant to the provisions of the comply with t ose rovisions. y
Contractor's State License law (Chapter 9 (commencing with Section 7000) of Division a 1••� #
3 of the Business and Professions Code) or that he or she is exempt therefrom and the Dater e Applicant:.. .
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 WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL,
($500).: AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO
(� 1, as owner of the property, or my employees with wages as their4sole ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION TO THE COST OF
compensation, will do the work, and the structure is not intended or offered for sale. COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,
(Sec. 7044, Business and Professions Code: The Contractors' State License Law does not INTEREST, AND ATTORNEY'S FEES.
1 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 APPLICANT ACKNOWLEDGEMENT
are not intended or offered for sale. If; however, the building or improvement is sold IMPORTANT: Application is hereby made to the Building Official for a permit subject to
within one year of completion, the owner -builder will have the burden of proving that the conditions and restrictions set forth on this application.
he or she did not build or improve for the purpose of sale.). 1.. Each person upon whose behalf this application is made, each person at whose
(� I, as owner of the property, am exclusively contracting with licensed contractors request and for whose benefit work is performed under or pursuant to any permit -
to construct the project. (Sec. 7044, Business and Professions Code: The Contractors' issued as a result of this.application , the owner, and the applicant, each agrees to, and
State License Law does not apply to an owner of property who builds or improves shall defend, indemnify and hold harmless the City of La Quinta, its officers, agents, and
thereon, and who contracts for the projects with a contractor(s) licensed pursuant to employees for any act or omission related to the work being performed under or
the Contractors' State License Law.). following issuance of this permit.
(_) I.am exempt under Sec. B.&P.C. for this reason 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.
Date: Owner:
I certify that I have read this application and state that the above information is correct.
CONSTRUCTION LENDING AGENCY I agree to comply with all city and county ordinances and state laws relating to building
I hereby affirm under penalty of perjury that there is a construction lending agency for construction, and hereby authorize representatives of this city to enter upon the
the performance of the work for which this permit is issued (Sec. 3097, Civ. C.). above-mentioned roperty for inspection purposes.
Lender's -Name: Date: Signature.(Applicant or Agent):
Lender's Address:
Taff
T0 4.4
VOICE (760) 777-7125
78-495 CALLE TAMPICO
•Qumro
'
LA QUINTA,.CALIFORNIA 92253.
' FAX (760) 777-7011
COMMUNITY DEVELOPMENT DEPARTMENT
INSPECTIONS (760),777-7153
BUILDING PERMIT
Date: 4/5/2016
Application Number: BMCH2O16-0081
J
Owner:
Property Address: 78865 SUNBROOK LN
CAROL CARMEL .
APN: 604292005.
7 8865.SUNBROOK {
Application Description: CARMEL / HVAC CHANGE
OUT
LA QUINTA, CA 92253
Property Zoning:
Application Valuation: $9,000.00
;
Applicant:
Contractor:
PALM DESERT AIR CONDITIONING CO INC DBA
PALM DESERT AIR CONDITIONING'CO INC DBA
42-081 BEACON HILL
42-081 BEACON HILL
PALM DESERT, CA 92211
PALM DESERT, CA 92211
(760)346-0677
Llc. No.: 374937
-------------------7--------------------------------------------
LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter I hereby affirm under penalty of perjury one of the following declarations:
9 (commencing with Section 7000) of Division.3 of the Business and Professions Code, I have and will maintain a certificate of consent to self -insure for workers'
and my License is in full force and effect. compensation, as provided for by Section 3700 of the Labor Code, for the performance
License Class -'C20 License No.: 374937 ) oftl�lie W,ork for which this permit is issued.
1. 4 1 have and will maintain workers' compensation insurance, as required by
Date: W Contractor: — Sect►loon 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:
OWNER -BUILDER DECLARATION Carrier: _ Policy Number:
1 hereby affirm under penalty of perjury that I am exempt from the Contractor's State I certify that in the performance of the work for which this permit is issued, I
License Law for the following reason (Sec. 7031.5, Business and Professions Code: Any shall not employ any person in any manner so as to become subject to the workers'
city or county that requires a permit to.construct, alter, improve, demolish, or repair compensation laws of California, and agree that, if I should become subject to the
any structure, prior to its issuance, also requires the applicant for the permit to file a workers' compensation provisions of Section 3700 of the Labor Code, I sh forthwith
signed statement that he or she is licensed pursuant to the provisions of the comply with t ose rovisions. y
Contractor's State License law (Chapter 9 (commencing with Section 7000) of Division a 1••� #
3 of the Business and Professions Code) or that he or she is exempt therefrom and the Dater e Applicant:.. .
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 WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL,
($500).: AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO
(� 1, as owner of the property, or my employees with wages as their4sole ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION TO THE COST OF
compensation, will do the work, and the structure is not intended or offered for sale. COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,
(Sec. 7044, Business and Professions Code: The Contractors' State License Law does not INTEREST, AND ATTORNEY'S FEES.
1 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 APPLICANT ACKNOWLEDGEMENT
are not intended or offered for sale. If; however, the building or improvement is sold IMPORTANT: Application is hereby made to the Building Official for a permit subject to
within one year of completion, the owner -builder will have the burden of proving that the conditions and restrictions set forth on this application.
he or she did not build or improve for the purpose of sale.). 1.. Each person upon whose behalf this application is made, each person at whose
(� I, as owner of the property, am exclusively contracting with licensed contractors request and for whose benefit work is performed under or pursuant to any permit -
to construct the project. (Sec. 7044, Business and Professions Code: The Contractors' issued as a result of this.application , the owner, and the applicant, each agrees to, and
State License Law does not apply to an owner of property who builds or improves shall defend, indemnify and hold harmless the City of La Quinta, its officers, agents, and
thereon, and who contracts for the projects with a contractor(s) licensed pursuant to employees for any act or omission related to the work being performed under or
the Contractors' State License Law.). following issuance of this permit.
(_) I.am exempt under Sec. B.&P.C. for this reason 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.
Date: Owner:
I certify that I have read this application and state that the above information is correct.
CONSTRUCTION LENDING AGENCY I agree to comply with all city and county ordinances and state laws relating to building
I hereby affirm under penalty of perjury that there is a construction lending agency for construction, and hereby authorize representatives of this city to enter upon the
the performance of the work for which this permit is issued (Sec. 3097, Civ. C.). above-mentioned roperty for inspection purposes.
Lender's -Name: Date: Signature.(Applicant or Agent):
Lender's Address:
E
MONSOON I!
�..::. �,� . �: � : '' CITY . _` <; �AMO.UNT' ' ,.. PAIDzx 4 R PAID
DESCRIP,--TION z . i; „ACCOUNT,..` e
BSAS SB1473 FEE 101-0000-20306 0 "$1.00 $0.00
Irxg PAID BY :y,"�x'x x% "zMETFIOD:* ««
p� 4u
ECEIP.T
ypd _x
Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $1.00 $0.00.
ti
M2 DESCRIPTION`»
ACCOUNT
FQTY
AMOUNT *��'
PAID ',�PAID
DATE
N q$Ex
r
E"`&`
HVAC CHANGEOUT.- SPLIT -SYSTEM
101-0000-42402
0
$72.S2 "
i $0.00,
Y. Ts,.3S w-
4zPAID BY >
S.K '.. "2 .... <? �:
METHOD
$ k .Y.. ,�, ,. X.
`°RECEIP.T #
t'.-.X,,.� 3f -- <
� CHECK # ' '
.:,.
B CLTD By,,LOU
�.r,w i
�:�t
�
} � �
_, •
� DESCRIPTION �4_4,
'k t � �4 �$q� � Y
ACCOUNT$ I
;,QT,Y
�_r'�
AMOUNT
�
PAID
PAID DATE`,
k.
s .,�... � y.
.. t+
.. ,
HVAC CHANGEOUT - SPLIT -SYSTEM PC,
101-0000-42600
0
$36.26
$0.00
PAID`BY` ` ;;
s METHOD sa.F
RECEIPT+# °
4CHEGK # M'
CLTD BY'
'4 �„c
,,,tea
a.s..�.,_e�-+
1...s ..
Total Paid for CHANGEOUT: $108.78. .$0.00,
s, - DESCRIP;TION
-�
QTYH
F AMOUNT`t
”
PAID
PAIUDATEY
_
aACCOWNT
#�_._
_ s��
Faj�°
r� .r
PERMIT ISSUANCE
101-0000-42404
0
$91.85,
$0.00
BY 1 ij
��s`MET:H.-.O.D
�
#
BY'`411
Total Paid for PERMIT ISSUANCE: $91.85 $0.00
TOTALS:00
Description: CARMEL / HVAC CHANGE OUT:
-
Type: MECHANICAL Subtype:
Status: APPROVED
Applied: 4/5/2016 SKH
Approved: 4/5/2016 SKH
Parcel No: 604292005 Site Address: 78865 SUNBROOK LN LA QUINTA,CA 92253
Subdivision: TR 23995-1 Block:
Lot: 26
Issued:
Lot Scl Ft: 0 Building Scl Ft: 0
Zoning:
Finaled:
Valuation: $9,000.00 Occupancy Type:'
Construction Type:
Expired:
No. Buildings: 0 _No. Stories: 0
No. Unites:'O
Details_: HVAC CHANGE OUT-16SEER/80 SPLIT SYSTEM [2013 ENERGY] CARBON MONOXIDE ALARM(S) TO BE INSTALLED PRIOR TO FINAL
INSPECTION. 2013 CALIFORNIA'BUILDING CODES..
'"FINANCIAL IN ro A MAT! •
Printed:. Tuesday, April 05, 2016 3:58:51 PM 1 of 2 sysTrnns
't_'DESCRIPTION
.ACCOUNT.
I
T #
CHEC
*
CLTD'
QTY
MOUNT4�'
P
�,,RECEIP
BY�4'
�0
BSAS SB1.473 FEE
101-0000-20306
6
s1.00 -
$0.66
Total Paid for BUILDING STANDARDS ADMINISTRATION
$1.00 $0.00
4 BSA:.
HVAC eHANGEOUT-
101-0000-42402
0'
$72.52
$0.00
SPLIT-SYSTEM
=
HVAC CHANGEOUT-
101-0000-42600
0
$36.26
$0.00
SPLIT-SYSTEM PC
Total Paid for CHANGEOUT: $108.78 $0.00
PERMIT ISSUANCE
101-0000-424 . 0.4
0.
$91.85
$0.00
Total Paid for PERMIT ISSUANCE: $91.95 $0.00-
TOTALS: $201.63 $0.00
INSPECTIONS
REVIEWS
-7 RK
'�T
0,
W4,
pi
Rivi i E EN�LPATE.-[,,.�.°DUEDATE_
I EW TYPE.
EV
DAT14
X"' 2
9OND INFORMATION
CERTIFICATE OF COMPLIANCE CFiR-ALT 024
Alterations to. Space Conditioning Systems (formerly CF -IR -ALT HVAC) (Page 1 of 3 )
Project Name: CARMEL, CAROL Date Prepared: 2016-04-04
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
CARMEL; CAROL
02
Date Prepared
2016-04-04
03
Project Location
78-865 SUNBROOK LN
04
Building Type
Single family
05
CA City
La Quinta
06
.Dwelling Unit Name
CARMEL, CAROL
07
Zip Code
92253
08
Dwelling Unit Conditioned -
1600
Floor Area (ft2)
SC System
SC System
CFA served
system a,
refrigerant
'rah
Number of space conditioning
"
Installing
more
09
Climate Zone
15
10
(SC) systems in this dwelling
1
ducted
containing
system
than 40
unit.
entirely new
�
B. Space Conditioning (SC) System'InformationAr
++_
01
02
4 03:•"
04�'
k
�05.
��0 "'
07
Q8
09
10
:;6"
is the SC
Installing a
SC System
SC System
CFA served
system a,
refrigerant
'rah
�r`` w
�instaIIiQNew;SC
"
Installing
more
' .
Installs g,
Installin g
Identification or
Location or Area
by this SC
ducted
containing
system
than 40
. enn ely new
entirely new
Name
Served
System (ft2)
system?
component?
components?
feet of ducts?
duct system?
SC system?
Alteration Type
Altered space
System 1
HOME
1600
Yes
Yes
Yes
No
No
No
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-A0124597A-000000000-0000 Registration Date/Time: 2016-04-04 14:08:11 HERS Provider: CalCERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013 Rev 1.007 Report Generated: 2016-04-04 14:08:16
CERTIFICATE OF COMPLIANCE s CFIR-ALT 02-E
Alterations to Space Conditioning Systems (formerly CF -111 -ALT -WAC) (Page 2 of 3 )
D. Altered Space Conditioning System (Sections 150.2(b)3E 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 gas
All new
-
Central split
All new
Less than or
System 1
furnace
heating
AFUE
80
AC
cooling
SEER
16
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. i-
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: <_ 15%, ors 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 300 CFM/ton required when MCH -25 is required.
Exceptions:
-Duct systems registered with HERS provider as previously sealed are exerimp f bin MCH -20 Duct Leakage Testing requirements
4
-Heating-only systems and Air Handler/Furnace changes do not -require verification of A'ir Flow MCH -23; or Refrigerant Charge MECH 2
� xG ti ". a'< 4C01
-Existing duct systems constructed, insulated or sealed with asbestos,are exempt from MCH 20 Duct Leakage Test ng regw�ements. (4
%
,
V Cr .JF J1 Ate- - U M %,t _ r1f, 34 -..� 14 'k1 J1 !l.
"'-'ryy�.1 .'� "�o-ya,.+• '•max �. '�+� :.t »r. � "�.r•' �� a.s �? +cr '
E. Entirely New or Complete Replacement Duct System, with.,or w,ithout;Equipment Changeout (Sections,f1-50.2(b)1Diia,and 150.2(b)1E, F)
This section does not apply to this project.
v
F. Entirely New or Complete Replacement Space Conditioning System (Section 150.2(b)IC)
This section does not apply to this project.
Registration Number: 216-A0124597A-000000000-0000 Registration Date/Time: 2016-04-04 14:08:11
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013 Rev 1.007
i
HERS Provider: CalCERTS
Report Generated: 2016-04-04 14:08:16
CERTIFICATE OF COMPLIANCE CF1R-ALT 02-E
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:
McCoy, William
Company:
Signature Date:
Palm Desert Air Conditioning Co
2016-04-04 14:08:11
Address:
CEA/ HERS Certification Identification (if applicable):
42-081 Beacon Hill
City/State/Zip: _
Phone:
Palm Desert CA 92211
760-346-0677
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 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, 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 Part6.of the California,Code of RegulaYions. � d s W
.
4. The building design features or system design features identified on this Certificate of Compliance are.consistent:with the informaton other, applicable compliance documents, worksheets,
.t n �. X„< i
.kr+ i 4..:ppr P} i j l ngO
calculations, plans and specifications submitted tothe enforcement agency frEaprovalwihthis building perm }t applicatin
.-�
5. 1 will ensure that a registered copy ofthis-Certificate of -Compliance shall•be�made;available with=the building permit(s))ssued forQthe building, and made available tontlh enforcement agency for all applicable
inspections. l understand that a registered copy of this Certificate of Complanceis require�d to beincludedthe documentation#thebuilder provides tothe building owner at occupancy.
Responsible Designer Name: �, f� �-,�, ,
Designer Si nature:
Responsible x B g . V I�J� W� ,�����X;� a
McCoy, William
Company:
Date. Signed:
Palm Desert Air Conditioning Co
2016-04-04 14:08:11
Address:
License:
42-081 Beacon Hill
374937
City/State/Zip:
Phone:
Palm Desert CA 92211
760-346-0677
Digitally signed by Ca10ERTS. This digital signature is provided in order to secure the content of this registered document, and in noway implies Registration Provider responsibility for the accuracy of the information.
Registration Number: 216-A0124597A-000000000-0000 Registration Date/Time: 2016-04-04 14:08:11 HERS Provider: CaICERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013 Rev 1.007 Report Generated: 2016-04-04 14:08:16
stn.#
Cltj/ Of Ld Qutnta
Building a Safety Msl6n
P.O. Box 1504,78-495 Calle Tampico
La.Quinta, CA 92253 -:(760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
(�
ProjectAddirss: 78-865 SUNBROOK LN.
Owner's Name:. CARMEL, CAROL
A. P. Number.
Address: 78-865 SUNBROOK LN.
Legal Description:
City, ST, Zip: LA QUINTA CA. 92253
Contractor. PALM DESERT AIR CONDITIONING CO.
760-360-7540 '`'' `yai�:s<
Telephone: ,.
Address: 42-081 BEACON HILL
Project Description: AMERICAN STANDARD (16) SEER
City, ST, Zip: PALM DESERT, CA. 92211.
(13) EER COOLING AND HEATING CHANGE OUT
Telephone: 760-346-0677
City Lie. 9,
State Lic. # : 374937
Arch., Engr., Designer:
Address:
City., ST, Zip:
Telephoner
State Lie.#:!� �� ' ' »,
.<.:.<.::�u
Construction Type: RES IDENTIALOccupancy:
Project type (circle one): New Add'n Alte Repair Demo
Name of Contact Person: ' LIN McCOY
Sq, Ft.: 1566#Stories:
1 # Units: 1
Telephone # of Contact Person: 760-34670677
Estimated Valine of Project: $9,000.00,
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
' ReNd
TRACMG
PERMIT FEES
Plan Sets
Plan Check submitted
Item Amount
Structural Calls.
Reviewed, ready for corrections
Plan Check Deposit. .
Truss Cates.
Called Contact Person
Plan Check Balance
Title 24 Calci.
Plans picked up
Construction
Flood plain plan
Pians resubmitted,' .
Mechanical
Grading plan
2sd Review, ready for correctiionstissue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.L
H.O.A. Approval
Plans resubmitted
Grading
IN ROUSE:-
'^` Review; ready for correctionsAssae
Developer Impact Fee
Planning Approval.
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees