BMCH2015-0076�..aw
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253 7
COMMUNITY DEVELOPMENT DEPARTMENT
Application Number: BMCH2O15-0076
Property Address:
81612 ULRICH DR
APN:
764450033
Application Description:
MATTHEWS RESIDEN
Property Zoning:
Application Valuation:
$14,100.00
Applicant:
IE INC.
32115 LA BAYA
WESTLAKE VILLAGE, CA 91362
BUILDING PERMIT
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 LicenseNo.: 86310
`a�3 ll iS Co Tactor: _ ��
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 ) 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 ) 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 N
Lender's
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 3/17/2015
Owner:
STEPHEN MATTHEWS
81612 ULRICH DR
LA QUINTA, CA 92253
Contractor:
HARRISON ENTERPRISES INC DBA G
31-170 RESERVE DRIVE STE A
THOUSAND PALMS, CA 92276
(760)343-7488
Llc. No.: 686310
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.
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
co Date:pl
with those provisions.
�� I S Applican" "t: �—
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 ($100,000). IN ADDITION TO THE COST OF
COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,
INTEREST, AND ATTORNEY'S FEES.
APPLICANT ACKNOWLEDGEMENT
IMPORTANT: Application is hereby made to the Building Official for a permit subject to
the conditions and restrictions set forth on this application.
1. Each person upon whose behalf this application is made, each person at whose
request and for whose benefit work is performed under or pursuant to any permit
issued as a result of this application , the owner, and the applicant; each agrees.to, and
shall defend, indemnify and hold harmless the City of La Quinta, its officers, agents, and
employees for any act or omission related to the work being performed under or
following issuance'of this permit.
2. Any permit issued as a result of this application becomes null and void if work is
not commenced within 180 days from date of issuance of such permit, or cessation of
work for 180 days will subject permit to cancellation.
I certify that l have read this application and state that the above information is correct.
I agree to comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives of this city to enter upon the above-
mentioned property for inspection purposes.
Date: 1! I$ Signature (Applicant or Agent):Z �`�
CERTIFICATE OF COMPLIANCE CF1R-ALT-02-E
Alterations to Space Conditioning Systems (formerly CF -IR -ALT -HVAC) (Page 1 of 3 )
Project Name: STEPHEN MATTHEWS Date Prepared: 2015-03-16
A. General Information
CHR -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.
' A-
01
Project Name
STEPHEN MATTHEWS
02
Date Prepared
2015-03,16
03
Project Location
81612 ULRICH DRIVE
.04
Building Type
Single family -
05
CA City
La Quinta
06
Dwelling'Unit Name
STEPHEN MATTHEWS.
07
Zip Code
92253
08
Dwelling Unit Conditioned
1872
os.!"p"1"iG..ean
..
4".y .?,w }�1
-
Floor Area (ft2)
SC System
SC System
CFA served
systema
„.
refrigerant
Number of space conditioning
Installing
09
Climate Zone
15 ' _
10
(SC) systems in this dwelling
1
ducted
containing .
system
more than 40
unit.
entirely new
B. Space Conditioning (SC) Systerri4'formation'
02
"
03;
*c
F 5 �
U7
09.
1001
roi
.
•'
;1y .. V" L,.,e `
y, r
,w:.:: - .. - .. .- Wr
-.,Is the SC-
-:wy:.lq+
Installing a
os.!"p"1"iG..ean
..
4".y .?,w }�1
. ar
I • �+i y.^ 'hT _ ..
SC System
SC System
CFA served
systema
„.
refrigerant
Installing new SC
Installing
Installing
Installing
Identification or
Location or Area
67 'Rh ih s 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
Location 1•
1872
7.
"`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-A0069557A-000000000-0000 Registration Date/Time: 2015-03-16 09:16:04 HERS Provider: CalCERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2014-03-31 Report Generated: 2015-03-16 09:14:45
Schema Version: 0.555SDD
f � a
D. Altered Space Conditioning System (Sections 150.2(b)1E and F)
r
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
,
This field or
This field or
System 1
furnace
heating
AFUE
0.8
AC
cooling
SEER
14.5
Setback'
section 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.
61`211 -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 5 10% leakage to outside, or seal all accessible leaks.
"when
CF2R-MCH-25-H & CF3R-MCH-25-H Refrigerant Charge Verification required refrigerant containing components are iristalled or altered (applicable in CZ 2, 8-15).
, is require
CF2RCF3R-MCH-23 & CF3R-MCH-23 Air Flow >_ 300 CFM/ton required when MCH -25 d
Exceptions:if
=Duct systems registered with HERS provider as previously sealed are -exempt from MCH 20 Duct Leakages est,ng-regwrements,
Heating -only systems and Air Handler/Furnaceychanges do not require verification of Air Flow MCH -23; or Refrigerant Charge MECH-25 r
-Existing duct systems constructed, insulated ors1.ealed withh,asbestos are exempt from MCH 20 Duct Leakage Testing requirements. ';}�77A
F. Entirely New or Complete Replacement Space Conditioning System (Section 150.2(6)1C)
r . This section does not apply to this project.
-
Registration Number: 215-A0069557A-000000000-0000 Registration Date/Time: 2015-03-16 09:16:04 HERS Provider: CalCERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2014-03-31 Report Generated: 2015-03-16 09:14:45
Schema Version: 0.555SDD
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: /l �'
�acoby
Jacoby, Ian
cJail
Company:
Signature Date:
Stratz Permit Service _ _ _
2015-03-16 09:14:42
Address:
CEA/ HERS Certification Identification (if applicable):
5858 Dovetail Drive
City/State/Zip:
Phone:
Agoura Hills CA 91301
818-735-7876
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 responsibility4for,tthe building design orisystem.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 land Part 6 of the California{ode of Re 'lations. j
4. The building design features or system design features identified on this Certificate of Compliance a,re consistent with the information provided on other applicable compliance documents, worksheets,
calculations, plans and specifications sulimitted.to the enforcement agency for approval with this building permit application g '
..gr..�.' i• - - a: dig
t -b i ,
5. 1 will ensure that a registered copy of this Certificate of Compliance shall be made available with the building permil(s) issued 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 with the�documentationthe 'builder provides to the building owner at occupancy.
Responsible Designer Name:
Responsible Designer Signature:
�lLyl�fGRi`�
Valdez, Dayana':
-
Company:
Date Signed:
HARRISON ENTERPRISES INC dba GENERAL AIR CONDITIONING
2015-03-16 09:16:04
Address:
License: F
31-170 RESERVE DRIVE STE A
686310
City/State/Zip: _
Phone:
THOUSAND PALMS CA 92276
(760) 343-7488
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: 215-A0069557A-000000000-0000 Registration Date/Time: 2015-03-16 09:16:04 HERS Provider: CaICERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2014-03-31 Report Generated: 2015-03-16 09:14:45
Schema Version: 0.555SDD
y. DESCRIPTION t
FINANCIAL • 1•
;ACCOUNT ` ' ,;`" ;QTY ' AMOUNT``. �`` F 'PAID -PAID DATE
BSAS SB1473 FEE
101-0000-20306 0 .$1.00 $0.00.
PAID BY
�,�'''4RECEIPT# `�� CHECK#
L
CLTDBY.
Total Paid forBUILDING STANDARDS ADMINISTRATION BSA $1.00 $0.00
" DESCRIPTION„` Z
ACCOUNT `
CZTY_,
w[i 'AMOUNT a
PAID?,`_ k „„
PAIDDATE
HVAC CHANGEOUT - SPLIT -SYSTEM
101-0000-42402
0
$72.52
$0.00
-PAIDBY„I -_
s �. METHOD
RECEIPT#
CHECK#
, CLTDBY�
,Y DESCRIPTION''-
QTY,
_ ;AMOUNT''- •
`N PAID
PAID DATE
HVAC CHANGEOUT - SPLIT -SYSTEM PC
101-0000-42600
0
$36.26
$0.00
PAID BY,,RECEIPT
#
E r M CHECK #
,CLTD.BY`
Total Paid forCHANGEOUT: $108.78 $0.00
” "DESCRIPTION s
. k '
,.AMOUNT
ry' PAID .
PAID DATE
PERMIT ISSUANCE
101-0000-42404
0
$91.85
$0.00
°r PAID BY
h METHOD
"+RECEIPT # s, j
CHECK #
,.CLTD BY:
Total Paid forPERMIT ISSUANCE: $91.85 $0.00
TOTALS:••
11
C
11
Description: MATTHEWS RESIDENCE/HVAC CHANGE OUT
Type: MECHANICAL Subtype: Status: UNDER REVIEW
Applied: 3/17/2015 MFA
Approved:
Parcel No: 764450033 Site Address: 81612 ULRICH DR LA QUINTA,CA 92253
Subdivision: TR 30023-4 Block: Lot: 94
Issued:
Lot Sq Ft: 0 Building Sq Ft: 0 Zoning:
Finaled:
Valuation: $14,100.00 Occupancy Type: Construction Type:
Expired:
No. Buildings: 0 No. Stories: 0 No. Unites: 0
Details: HVAC CHANGE OUT - 14.SSEER/80AFU E SPLIT SYSTEM [2008 ENERGY] CARBON MONOXIDE ALARMS) TO BE INSTALLED PRIOR TO
FINAL INSPECTION. 2013 CALIFORNIA BUILDING CODES.
ADDITIONAL SITES
,.... .., CONDITIONS
..
FINANCIAL INFORMATION
Printed: Tuesday, March 17, 2015 3:40:02 PM 1 of 2 Cri
sysTcMs
DESCRIPTION
ACCOUNT
QTY
'r"AMOUNT
PAID
PAID DATE
' RECEIPT #
CHECK #
METHOD
PAID BY
CLTD
E
.
BY
BSAS SB1473 FEE
101-0000-20306
0-
$1.00
$0.00
Total Paid forBUILDING STANDARDS ADMINISTRATION
$1.00 $0.00
BSA:
HVAC CHANGEOUT - .
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 forCHANGEOUT: $108.78 $0.00
PERMIT ISSUANCE
101-0000-42404
0
$91.85
$0.00
Total Paid forPERM1T ISSUANCE: $91.85 $0.00
TOTALS:i 00
PARENT PRQJECTS
Printed: Tuesday, March 17, 2015 3:40:02 PM 2 of 2
SYSTFti1S
Bin # City of La Q Grin to .
Building & safety Division
Permit # P.O. Box 1504, 78-495 Calle Tampico .
La Quinta, CA 92253 - (760) 777-7012.
Building Permit Application and Tracking Sheet
Project Address: 21(017— �� r e� Owner's Name:
A. P. Number:
Address: S((v j Z U I I c1. 17a i ve
Legal Description:
City, ST, Zip: (•.•Qv;C A gZ2S3
nn �c�p
Contractor:telephone:
l� h cr ' 1 Al,f
C01r��l��bY\ Ir
- Z� - G cl
9 �} o
Address: 3 j l�0 1� eS c�cvG r
Project Description:
City, ST, Zip: 1�.ovse_
�LNY" A g2Z-1
£ •
\ice L tC L C ' _ q0 Ogg
Telephone: a 3-3
r
rY,
StatcLic.#:
8(03) Q
City Lia #:
Arch.; Engr., Designer:
i
Address:
City., ST, Zip:
Telephone:
s
aneY
Occupancy:
nTYPe: •
Construction
State Lic. #:
Project type (circle one): New Add'n Alter Repair Demo
Name of Contact Person:
Sq. Ft.:
#Stories:
# Units:
Telephone # of Contact Person:
Estimated Value of Project: ly, / 00 . co
# Submittal Rcq'd
APPLICANT: DO NOT WRITE BELOW THIS LINE
Rcc'd TRACKING PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Cates.
Reviewed, ready for corrections
Plan Cheek Deposit
Truss Cala.
Called Contact Person
Plan Check Balance •
Title 24 Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
tad Review, ready for corrections/issue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Decd
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
'rd Review, ready for correctionstissue
Developer Impact Fee
Planning Approval
Called Contact.Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue.
School Fees
Total Permit Fees