BMCH2015-018578-495 CALLE TAMPICO. D
LA QUINTA, CALIFORNIA 92253 COMMUNITY DEVELOPMENT DI
BUILDING PERMIT
Application Number: BMCH2O15-0185
Property Address: 55568 SOUTHERN HILLS
APN: 775190024
Application Description: BAAK / CHANGEOUT (2) 16SEER/80AFUE SPLIT SYSTEMS
Property Zoning:
Application Valuation: $16,000.00
Applicant:
PRIORITY ONE AIR CONDITIONING
P0BOX 1681
PALM DESERT, CA 92261
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.: 752180
Date: 9 '� Contractor: \' A.'
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 contractors) 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 Nam
Lender's Address:
Owner:
THOMAS BAAK
55568 SOUTHERN
LA QUINTA, CA 92
Contractor:
PRIORITY ONE AIR
P0BOX 1681
PALM DESERT, CA
(760)773-0811
Llc. No.: 752180
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 5/28/2015
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
ofwork 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: J v Applicant: v 7
WARNING: FAILURE TO SECURE WORKERS' COMPEA ION COVERAGE IS UNLAWFUL,
AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PE LTIES 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 actor 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: Signature (Applicant or Agent):
ti
H I 1-4. �Q
F
25--0
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z r3
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Q>
O
COITONING
i
o
92251
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
ofwork 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: J v Applicant: v 7
WARNING: FAILURE TO SECURE WORKERS' COMPEA ION COVERAGE IS UNLAWFUL,
AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PE LTIES 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 actor 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: Signature (Applicant or Agent):
FINANCIAL ••
•
.,{ 'ACCOUNT e nt;ti�
CITY
AMOUNT` ;- ° 'PAID`" 'PAID,'DATE
_,.D,ESCRIPTION' � .^max
, .,
BSAS SB1473 FEC,- 101-0000-20306.
0 .
$1.00'$ 0.00
4r, `PAID BY ` hs, j?METHOD
;RECEIPT # CHECK #'b ` CLTD BY
k?' ',,j
Total Paid forBUILDING STANDARDS ADMINISTRATION BSA •. .$1.00'. ' '`. $0.00
tDESCRIPTION
{. ' s ACCOUNT
AMOUNT
PAID, ' •
PAID DATE
-�CtTY
�.
HVAC CHANGEOUT - SPLIT -SYSTEM
101-0000-42402
0 " '
r $145.04
- $0.00
x Y`PAID BYE '
=w� F tMETHOD .3
_
RECEIPT # �ti� '',,
" CHECK #
; ,
VP
At „ DESCRIPTION~.
FA000UNT z
QTY
7 AMOUNT
sPAID r
';M
PAID DATE'
e,
y
„
HVAC CHANGEOUT - SPLIT -SYSTEM PC "
101-0000-42600
0
','$72..52,
•$0.00
P PAIDBYcF� w� �,�`;
s 'METHOD
fi CHECK #Wj;CLTUBY'
�t ,;RECEIPT#`
Total Paid forCHANGEOUT: $217.56 $0.00
-`t r DESCRIPTION �„ r�`*
:i� •1ACCOUNT b
QTYY
- } 'AMOUNT,*,
`"F ':PAID �' *'�
PAID DATE
,x�:'
.m
PERMIT ISSUANCE- y
_ 101-0000-42404
0
$91.85
$0.00
,•� �a' 4 F�r�� , `%y.
PAID;BY
'... METHOD
rRECEIPT# `.'. �X
-CHECK # + red
i
i
€ .CLTD'BYs.
't Total Paid for PERMIT ISSUANCE: , $91:85 $0.00
• • T.41 $0.00
Description: BAAK / CHANGEOUT (2) 16SEER/80AFUE SPLIT SYSTEMS '
Type: MECHANICAL Subtype: Status: UNDER REVIEW
Applied: 5/28/2015 SKH
Approved:
Parcel No: 775190024 'Site Address: 55568 SOUTHERN HILLS LA QUINTA;CA 92253 ,
Subdivision: 28149 _ Block, Lot: 77.
Issued:
Lot Sq Ft: 0Building Sq Ft: 0 Zoning:.
Finaled:
Valuation: $16,000.00 v Occupancy Type: Construction Type y
Expired: i
No: Buildings: 0 ..No. Stories: 0 No. Unites: 0
x r PHONE ,
Details: HVAC- HANGE OUT - (2)16SEER/80AFUE SPLIT SYSTEMS [2013 ENERGY] CARBON MONOXIDE ALARM(S) TO BE INSTALLED PRIOR TO
FINAL INSPECTION. 2013 CALIFORNIA BUILDING CODES. +
-
s
r
_
F-
•
NAMEfTYPE F NAME i
-..
y
ADDITIONAL SITES,
X t
ADDRESSI k � y CITY f,
Y STATE ZIP �.
x r PHONE ,
'EMAIL F
_ FAX -R
APPLICANT PRIORITY ONE AIR CONDITIONING
P O BOX 1681
PALM DESERT
CA'
92261
CONTRACTOR PRIORITY ONE AIR CONDITIONING
P O BOX 1681.
PALM DESERT
ACA •
, 92261
``
OWNER THOMAS BAAK.'
55568 SOUTHERN HILLS
LA QUINTA
CA
92253
Printed: Thursday,, May 28, 2015 4:20:21 PM 1 of 2 0 SYSTEMS ,
•
E IdN'Typt", -4
N�o dT_
OSCHEDULED
N�SPECT INSPECTOR
I COMPLETED ;''RESULTS
7�tPAID:
k_-
W_
. 77
"CHECK
All
"PAID 13Y,--�*��
CLTD,
DESCRIPTI ON
REVIEWS
RETURNED STATUS�
AMOUNT
. - j �, LfP - �1_j_
PAID DATE
RECEIPT
REVIEWER'
-METHOD,
DUE DATE�
By';
131.1)
'NOTES,-,
A
PATE
HVAC CHAIiGEOUT-
101-0000-42462
0
$145.04
$0.00.
SPLIT-SYSTEM
HVAC CHANGEOUT -
101-0000-42600
0
$72.52
$0.00 2
SPLIT -SYSTEM PC
Total Paid forCHANGEOUT: _t_$217.56 $0.00,
-—
PERMIT ISSUANCE
101-0000-42404
0
$91.8-5
$0.00-
Total Paid forPERMIT ISSUANCE: -$91.85 $0.00
TOTALS: $310.41 $0.00
•
E IdN'Typt", -4
N�o dT_
OSCHEDULED
N�SPECT INSPECTOR
I COMPLETED ;''RESULTS
RESULT)r�" REMARKS'
NOTES�,--J-
DATE
r
REVIEWS
RETURNED STATUS�
.
REMARKS
. - j �, LfP - �1_j_
REVIEW TYPE
REVIEWER'
'S
DUE DATE�
MECHANICAL FINAL"
131.1)
'NOTES,-,
PARENT PROJECTS
r
REVIEWS
RETURNED STATUS�
.
REMARKS
. - j �, LfP - �1_j_
REVIEW TYPE
REVIEWER'
'S
DUE DATE�
v
'NOTES,-,
PATE
BOND INFORMATION
Din #
'City of La Qu* to
Building 81: Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 -(760)777-7012.
Building Permit Application and Tracking Sheet
Permit #
Project Address:
U
,
Owner's Name:
A. P. Number:
Address: sa4 1 S
Legal Description:
City, ST, Zip:
Contractor:Te
L'
le hone:
P
Address: ��'
l , (? I
Project Description:
City, ST, Zip:
L .
Tel ePhone .
N
State Lic.
Arch., Engr., Designers
City Lic. #t.....,.
Address:
City., ST, Zip:
Telephone:
e one:
P
X.
Construction n T
o e: Occupancy:
Type: P Y:
State Lic. #
e (circle one): New. Re Pair. Demo
AlterProJect h
Name of Contact Person:
Sq. Ft.:
# Stories:
#Units:
Telephone # of Contact Person:
<
Estimated Value of Project: io O(JL/
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Reed
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 Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
' Grading plan
V 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 ROUSE:-
'^' Review, ready for corrections/issue
Developer Impact Fee'
Planning -Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr. .
Date of permit issue
Schoch Fees.
Total Permit Fees
II
CERTIFICATE OF COMPLIANCE CF1R-ALT-02-E
Alterations to Space Conditioning Systems (formerly CF -IR -ALT -HVAC) (Page 1 of 3 )
Project Name: Tom Baak Date Prepared: 2015-05-27
A. General Information
CF111-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
Tom Baak 02 ,
Date Prepared 2015-05-27
03
Project Location
55568 Southern Hills 04
Building Type Single family
05
CA City
La Quinta 06
Dwelling Unit Name Tom Baak '
07
Zip Code
92253, . 08
Dwelling Unit Conditioned 3200
Floor Area (ft2)
y
ls the SC
+a�aa
of space conditioning
.09
Climate Zone
15 10stems
rNumber
in this dwelling 2
'
SC System
SC System j
CFA served
a -
B. Space Conditioning (SC) System Information,wo,
Aim
01
02
V,03,
A 04
^0QlF06
11
yy
`## USV
09
10
.071 N
y
ls the SC
+a�aa
m�In> :.:wsttalling mak
'
a
'
SC System
SC System j
CFA served
"�S,ystem,a
re rf igerant °
klnstalling,n 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,
System 1
whole home
2000
Yes
Yes
Yes
No
No
No
Altered space
conditioning system
System 2
whole
1200
Yes
Yes
Yes
No
No
No
Altered space
conditioning system
'C. Extension of Existing Duct System, Greater Than 40 Feet (Section150.2(b)1Diib)
This section does not apply to this project.
Registration Number: 215-A0140540A-000000000-0000 Registration Date/Time: 2015-0527 14:33:30 HERS Provider: CalCERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance . Report Version: 2014-03-31 Report Generated: 2015-05-27 14:33:36
Schema Version: 0.555SDD '
f
• t 3
1
01
02
03
CERTIFICATE OF COMPLIANCE t CF1R-ALT-02-E
Alterations to Space ConditioningSystems (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
30
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
This field or
This field or
System 1
furnace
heating
AFUE
80
AC
cooling
SEER
16
Setback
section is not
section is not
components
components
applicable
:applicable
Central gas
All new
JI
Central split
All new
This field or
This feld or
System 2
furnace
heating
c,,AFUE
80
AC
cooling
SEER.
16
Setback
section is not
section is not
components
components I
applicable
applicable
Required Documentation:
CF2R-MCH-01-E-Space Conditioning Systems; Ducts and Fans
.' .¢1r✓'s+,y�an..p-
-Duct insulation requirement for new plenums R6
-
CF2R-MCH•20•H & MR•MCH-20-H —Duct Leakage testing required whenheating or.cooling components are installedin ducted systems, or when more than 40 ft of duct length is replaced.
-Leakage rate compliance: s 15%, or s 10%leakage to-::putside or seaf.all accessible leaks ' YA116t '"° .
.
CF2R-MCH-25-H & CF3R-MCH-25•H Refrigerant Charge VegRca�t�onetquired when refrigerantcontainingcomponents•are installed or altered (applicable in Qr2, 8 -Is ).
MRMR-MCH-23 & CF3R-MCH-23 Air Flow 2 300 CFM/ton regwred when MIA25 is required
I UJ
Exceptions:' , -
HERS
fps' e'
-Duct systems registered with provider as previously sealed areexempt from MCH -20 Duct Leakage Testing requirements
%.^ , a y, , f... , ,�
9s'j
-Heating systems and Air Handler/Furnace changes do not regwm- rification oflAli FIgw�MCH 23, or Refngera nt Charge OV I ��„uuww��
'
duct
-Existing duct systems constructed, insulated or sealed with asbestos are exempt from MCH' Duct Leakage Testing requirements
E. Entirely New'or Complete Replacement Duct System, with or without Equipment Changeout (Sections 150.2(6)1Diia and 150,2(b)1E, 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: 215-A0140540A-000000000-0000 Registration Date/Time: 2015-055-27 14:33:30 HERS Provider: CaICERTS
. CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2014-03-31 Report Generated:. 2015-05-27 14:33:30
Schema Version: 0.5555DD
4•
CERTIFICATE OF COMPLIANCE CFIR-ALT-02-E
Alterations to Space Conditioning Systems (formerly CF -IR -ALT -HVAC) (Page 3 of 3 )
t
Documentation Author's Declaration Statement
1.1 certify that this Certificate of Compliance documentation is accurate and complete.
Documentation Author Name: -
Documentation Author Signature:
Meghnagi, Roy�d
4v
Company:
Signature Date: -
PRIORITY ONE AIR CONDITIONING AND HEATING CO
2015-05-27 14:33:30 ,
Address:
CEA/ HERS Certification Identification(ifapplicable):
P 0 BOX 1681
City/State/Zip: -.
Phone: -
PALM DESERT CA 92261
(760)773-0811 -
Responsible Person's Declaration statement
I certify the following under penalty of perjury, under theela`ws of the State of California:
;
. y
1. The Information provided on this Certificate' Compliance is true and correct.
2. 1 am eligible under Division 3 of,the Business and Professions Code to,a�cept responsibility for the bulid ing 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 Pari' of the California Code of Regulations. '°
4. The building design'features orsystem design features identified on this Cemficate:of Compliance are.consistent-with the information.provida on other applic bl�mpliance documents, worksheets,
F ' f 2 A ; 4' 4 snacY .tA
r..w4.0
calculations, plans and specifications submitted to the enforcement agency for approvagl with this bwlding permb ti apphcati,-'. t f .
r 4 e. Y �}at, f t a g
0' !# ,
S. I will ensure that a registered copy this Ce shalLke madearilable wR6the building permit(s),issued fonthe�buil Ing, and made availebleitgthe enforcement agency for all applicable
of t:"of,mpliance
inspections. I understand that a registered copy of thirCertHicate of Comphance,'u;regw(ed to be,induded wish the�documentation�[he�,bulider provides to,the building owner at occupancy.
is copy ~
Responsible Designer Name: .l c +
Responsible Des g er Signature:
Meghnagi, Roy"
Company: -
Date Signed: r, '
PRIORITY ONE AIR CONDITIONING AND HEATING CO
2015-05-27 14:33:30 '
Address:
License: -
P 0 BOX 1681
752180
State/Zip:
Phone:
M DESERT CA 92261
F
(760) 773-0811
Digitally signed by CsICERTS. 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.
t
Registration Number: 215-A0140540A-000000000-0000 Registration Date/Time: 2015-05-27 14:33:30 _ HERS Provider: CaICERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2014-03-31 Report Generated: 2015-05-27 14:33:30
Schema Version: 0.5555DD