BMCH2015-016378-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253 COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING PERMIT
Application Number: BMCH2O15-0163 Owner.
Property Address: 52440 AVENIDA VALLEJO ROMA LALA
APN: 773263010 20401 VIA GALILEO
Application Description: LALA RESIDENCE / HVAC CHANGE OUT NORTHRIDGE, CA 92
Property Zoning:
Application Valuation: $3,000.00
Applicant:
COMPLETE MECHANICAL SERVICE
77564 COUNTRY CLUB DR STE 368
PALM DESERT, CA 92211
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 Pr fessions Code,
and my License is in full force and effect.
License Class: C36, D35, C20, C10, B Licensq�o.: 896899
'
Date: t- �� ' I Contractor:
OWNER -BUILDER DEC RATION
I hereby affirm under penalty of perjury that I am tempt from the CAntractor's State
License Law for the following reason (Sec. 7031.5, siness and Profe ions Code: Any
city or county that requires a permit to construct, alt r, 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 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 Address:
Contractor:
AMERIPAN INC DBA
77564 COUNTRY CL(
PALM DESERT, CA 9-,
(760)972-8068
Llc. No.: 896899
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
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.
e,jh.—.1 have and will maintain wofkers' 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 subjecto the workers'
compensation laws of California, and agree that 'f I should become bjec to the
workers' compensation provisions of Section 37/0 of the Labor Co , I shall forthwith
comply with those provisions.
Date: S s.19,i — 'Applicant: !� M
WARNING: FAILURE TO SECURE WORKERS' CO PENSATION COV RAGE IS UNLAWFUL,
AND SHALL SUBJECT AN EMPLOYER TO CRIMI AL PENALTIES AN CIVIL FINES UP. TO
ONE HUNDRED THOUSAND DOLLARS ($100,0 IN ADDITION T THE COST OF
COMPENSATION, DAMAGES AS PROVIDED FO 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 I s relati4the
'Iding
construction, and hereby authorize representatives of this city t nter upbove-
mentioned property for inspection purposes.
Date:' 1 ° J Signature (Applicant or Agent):
71
FINANCIAL •1 -
DESCRIPTION' r 9 • ° "' ACCOUNTS a -
QTY.
AMOUNT : PAID
PAID DATE
BSAS S61473 FEE 101-0000-20306 •
0
$1.00 $0.00
PAID BY. METHOD
RECEIPT # FS CHECK # •
CLTD BY
Total Paid for BUILDING'STANDARDS ADMINISTRATION' BSAr $1.00 $0.00
DESCRIPTION: n L`
M "ACCOUNT .'
QTY
_ AMOUNT F'
`.PAID ",'"
PAID DATE
HVAC CHANGEOUT - CONDENSER ONLY
101-0000-42402
0
'$36.26
$0.00
• BY,
. METHOD
�.
, .#PAID
� CHECK # + '
CLTD BY,
DESCRIPTION ='
�' ACCOUNT
QTY/
„ r AMOUNT,
-.,'PAID
PAID DATE
HVAC CHANGEOUT - CONDENSER ONLY PC
101-000042600
0
$24.17
$0:00
PAID BY, '
YMETHOD
RECEIPT# -,k
CHECK# 1
CLTD BY.
DESCRIPTIONS
ACCOUNT'
QTY
`'AMOUNT ` _ .w
#_ PAID, '." ''
PAID DATE
HVAC CHANGEOUT - REPAIR/ALTERATION
101-0000-42402
0-
$12.09'
$0.00,
PAID BY
METHOD "
" .RECEIP.T#
:CHECK#..s
CLTD BY.,
4 ` DESCRIPTION , ° < a
ACCOUNT'AMOUNT
QTY
PAID r
PAID DATE
HVAC CHANGEOUT'- REPAIR/ALTERATION
• PC
101-0000-42600
a
0
'$4:83
$0.00
PAID BY ',tl
METHOD . • .'
RECEIPT.#' .` , ,•
b CHECK # -
CLTD BY
Total Paid forCHANGEOUT: a $77:35 $0.00 -
DESCRIPTION ``'
" « ACCOUNT, R ..
QTY
AMOUNT :`
PAID,
PAID DATE
PERMIT'ISSUANCE
101-0000-42404
0
$91.85
$0.00
;. PAID BY.'
METHOD"
r' RECEIPT #
;;= ' CHECK #'
#CLTD BY.
Total Paid f&PERMIT ISSUANCE: $91.85 $0.00
Description: LALA RESIDENCE / HVAC CHANGE OUT
Type: MECHANICAL Subtype: Status: ON HOLD S
Applied: 5/8/2015 MFA
Approved:
Parcel No: 773263.010 Site Address. 52440 AVENIDAVALLEJO LA QUINTA,CA 92253
Subdivision: SANTA CARMELITA VALE LA QUINTA Block: 83 Lot: 13
Issued:
UNIT 10 1 '
Lot Sq Ft: 0 Building Sq Ft: 0 Zoning: _
Finaled: '
Valuation: $3,000.00 Occupancy Type: Construction Type:
Expired:
No. Buildings: 0 No. Stories:0 No. Unites:.O
Details: HVAC CHANGE OUT - 13 SEER/10EER CONDENSOR AND AIR HANDLER [2013 ENERGY) CARBON MONOXIDE ALARM(S).TO BE
INSTALLED PRIOR TO FINAL INSPECTION. 2013 CALIFORNIA BUILDING CODES: -
- BEADDITIONAL SITES, ,..,, ,,... ...... ............ ..... , „ . .
{NAME•TYPE
'. ADDRESSl
CITY
STATE;f
ZIP °rPHONE;'
T'4
'T
H":NAME ,-z,
�.
f-
APPLICANT
COMPLETE MECHANICAL SERVICE
77564 COUNTRY CLUB'
PALM DESERT
A CA
92211
DR STE 368
CONTRACTOR
AMERIPAN INC DBA COMPLETE
77564 COUNTRY CLUB
PALM DESERT
CA
92211
MECH .
DR #368 B
OWNER
ROMA LALA
20401 VIA GALILEO
NORTHRIDGE
: CA
92253
•INFORMATION
Printed: Tuesday, May 19, 2015 8:20:39 AM
1 of 2
srsTeMs
DESCRIPTION
ACCOUNT
CITY
AMOUNT
PAID•
PAID DATE
RECEIPT#
CHECK "#
METHOD
PAID BY
CLTD.
BY
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
CONDENSER ONLY
HVAC CHANGEOUT -
101-0000-42600
0
$24.17
CONDENSER ONLY PC
.$0.00
HVAC CHANGEOUT -.
101-0000-42402
0
$12.09.
$0.00
`
REPAIR/ALTERATION
HVAC CHANGEOUT -
101-0000-42600
0
$4.83 `
$0.00 •
t
REPAIR/ALTERATION PC
Total Paid forCHANGEOUT: $77.35 $0.00
PERMIT ISSUANCE
101-0000-42404
0
$91.85
,. $0.00
Total Paid for PERMIT ISSUANCE: $91.85 $0.00
TOTALS:••
PARENT PROJECTS
Printed: Tuesday, May 19, 2015 8:20:39 AM 2 of 2 i
SYSTEMS
a- M01;�2 n 14% 01 G 3
Bin .#
Stories:
City Of 1.a QuInta
Building a Safety Division
P.O. Box 1504,78-495 Calle Tampico
La.Quinta, CA 92253 -:(760) 777-7012
Building Permit' Application and Tracking Sheet
Permit #
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
S.2 q to Ai* oa t 6 A t tizitr0
Owner's Name:. Lam.
EN.umber
TRACKING
Adder:
n:
Plan Sets
City, ST, Zip:
Contractor WML{ ft*c N I CAL- Swam
Telephone: , ;,., .
Address:
5`Q A M3 8
Project Description:
City, ST, Zip:
,
'ONj--iJli �r.11- Z
Telephone:'2
SO��
lcmityyluc.
State Lie. # :
Q
#
Arch, Engr., Designer
Called Contact Person
Address:
Plan Check Balance
City., ST, Zip:
Telephone:
State Lic. #:
Construction Type:. Occupancy:
Project type (circle one): New Add'n /l&+ ) Repair Demo
Name of Contact Person: �� j„ Sq. Ft.:#
Stories:
# Unitg:
Telephone # of Contact Person: —3 fl —05 -?0 Estimated Value of Project 0 ob
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACKING
PERMIT FEES
Plan Sets
Pian Check submitted
Item Amount
Structural Calm
Reviewed, ready for corrections
Plan Check Deposit. .
Truss Cales.
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 correctionsfissue
Electrical
Subeontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
SALL
H.O.A. Approval
Plans resubmitted
Grading
AV HOUSE:-
'^' Review; ready for corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr '
Date of permit Issue
School Fees
Total Permit Fees
CONT'AoRs. CT -STAT BOARD,TR
$.
Contractor's License Detail for License # 896899
)ISCLAIMER: A license status check provides information taken from the CSLB license database. Before relying on
his information, you should be aware of the following limitations.
CSLB complaint disclosure is restricted by law (B&P 7124.6)„If this entity is subject to public complaint disclosure, a link for complaint disclosure will appear
below. Click on the link or button to ,obtain complaint and/or legal action information.
Per B&P 7071.17 , only construction related civil judgments reported to the CSLB are disclosed.
Arbitrations are not listed unless the contractor fails to comply with the.terms of the arbitration.
Due to workload, there may be relevant information that has not yet been entered onto the Board's license database.
....:Data current as of 5/1.9/204.5 8:19:04 AN
Business Information
r AMERIPAN INC
DBA COMPLETE MECHANICAL SERVICE
77564 COUNTRY CLUB DR #368 B
PALM DESERT, CA 92211
Business Phone Number.(760) 972-8068
Entity Corporation
Issue Date. 05/21/2007
Reissue Date 05/17/2010
Expire Date 05/31/2016
License Status
his license is current and active.
All information below should be reviewed.
.'Classifications
C36 - PLUMBING
D.35 - POOL AND SPA MAINTENANCE
C20 -WARM -AIR HEATING,- VENTILATING AND AIR-CONDITIONING
C10 - ELECTRICAL
B GENERAL BUILDING CONTRACTOR
This license filed a Contractor's Bond with AMERICAN CONTRACTORS INDEMNITY COMPANY.
Bond Number: 100275325
Bond Amount: $12,500
Effective Date: 05/07/2015
Contractor's Bond History
Bond of Qualifying individual
Noting stock/equity of the corporation. A bond of qualifying individual is not required.
Effective Date: 07/11/2013 t
BQi's Bond History .
Workers' Compensation
This license has workers compensation insurance with the WESCO INSURANCE COMPANY
Policy Number:WWC3088209 .
Effective Date: 05/15/2014
Expire Date: 05/15/2016
Workers' Compensation History
Miscellaneous Information
05/17/2010 -LICENSE REISSUED TO ANOTHER ENTITY
Other
STATE OF CALIFORN IA
ALTERATIONS - HVAC
lr* f
CEC-Cr1'R-ALT-04-E Revised 03/15 CALIFORNIA ENERGY COMMISSION "4W'
CERTIFICATE OF COMPLIANCE CF1R-ALT-04-E
Alterations - HVAC CZ 2, and 8-15 (formerly CF -IR -ALT -HVAC) (Page 1 of 1)
Site Address:
Enforcement Agency:
Date Prepared:
Permitil:
Equipment Type
Equipment Efficiency
New Ducting, Plenums, Lineset:
Conditioned
Thermostat
Required R -value
Floor Area (sq ft)
❑ Packaged
vaporator Coil
AFUE
COP
❑ R-6 (CZ 1, 8-13) Ducting
Served by system
❑ Setback
System
Cil�Split System
'Condensing Unit
❑ Compressor
L3 SEER
HSPF
❑ R-8' (CZ 11, 14, 15) Ducting
li00 sgft
(If not already
❑ R-6 (a/1 CZ's) Plenums
present, must
❑ Mini Split
❑ Lineset
/'' EER
❑ R-5 or R7.5) Lineset'
be installed)
❑ Furnace
❑ TXV
HERS VERIFICATION SUMMARY Installer determines work to be completed and matches to one of the options below. At permit application this
form is allowed to be filled out by hand. For final inspection all forms are to be registered (no hand filled forms allowed) and a copy left on site.
1. HVAC Changeout/Repair
Required Compliance Documents to be left on site for Final:
All Equipment,
CF1R-ALT-02-E
Condenser Unit, Evaporator Coil,
CF2R: MECH-01, MECH-20-HERS, MECH-(23 or 24)' -HERS, MECH-25-HERS'
Compressor, TXV, Lineset,
CF3R: MECH-20-HERS, MECH-(23 or 24) -HERS', MECH-25-HERS'
Air Handler/Furnace' (Can include new ducting)
Installer Requirement: Duct leakage (:S_15%, or < 10% to outside, or seal all accessible leaks), Air Flow >_ 300 CFM/ton, Refrigerant Charge.
Exempted from duct leakage testing if:
❑ 1. Duct system registered with HERS provider as previously sealed, or ❑ 2. There is less than 40 linear feet of duct in unconditioned space, or
113. Existing duct systems are constructed, insulated or sealed with asbestos (list manufacture date of building
❑ 2. New HVAC System
Required Compliance Documents to be left on site for Final:
All new equipment and All New Ducts3
CF1R-ALT-02-E
including Mini Split
CF2R: MECH-01, MECH-20-HERS, MECH-22-HERS, MECH-(23 or 24) -HERS', MECH-25-HERS'
CF3R: MECH-20-HERS, MECH-22-HERS, MECH-(23 or 24)-HERS2, MECH-25-HERS'
Mini Splits require CF1R-ALT-02-E, CF2R-MECH-01, and (CF2R-CF3R) MECH-25-HERS
Installer Requirement: Duct leakage < 6%, Fan Efficacy (.58W/CFM), Air Flow z 350 CFM/ton (or alternative), Refrigerant Charge
113. All New Duds with Replacement
Required Compliance Documents to be left on site for Final:
All New Ducts3 and one or more of the following
CF113-ALT-02-E
replaced: Condenser Unit, Evaporator Coil,
CF2R: MECH-01, MECH-20-HERS, MECH-(23 or 24) -HERS, MECH-25-HERS
Compressor, TXV, Lineset, Furnace'
CF3R: MECH-20-HERS, MECH-(23 or 24) -HERS, MECH-25-HERS
Installer Requirement: Duct leakage < 6%, Air Flow > 350 CFM/ton (or alternative), Refrigerant Charge
Exempted from duct leakage testing if: ❑ 1. Existing duct systems are constructed, insulated or sealed with asbestos
❑ 4. New Ducting over 40 feet
Required Compliance Documents to be left on site for Final:
New ducting but less than All New Ducts,
CF1R-ALT-02-E, CF2R: MECH-20-HERS, CF3R: MECH-20-HERS
Installer Required to: Duct leakage (!L15% or, < 10% to outside or, or seal all accessible leaks)
❑ EXCEPTION: Existing duct systems constructed, insulated or sealed with asbestos.
' All new ducting R-8 required when more than 40 ft installed and R-6 when less than 40 ft installed. This includes in walls, between floors etc.
2 Heating only systems and Air Handler/Furnace changes do not require Air Flow MECH-(23 or 24), or Refrigerant Charge verification MECH-25
3 All New Ducts is when at least 75 percent of the duct system is new duct material, and up to 25 percent may consist of reused parts from the
dwelling unit's existing duct system (e.g., registers, grilles, boots, air handler, coil, plenums, duct material)
R-5 (1" thick insulation) for linesets 1" and less. R-7.5 (1.5" thick insulation) for linesets over 1 inch. Most mfg will require Suction line Diameter
with insulation as the following 1.5-2T-2%", 2.5-3T-2%", 3.5 to 4T-2%", ST -4%'
Contractor (Documentation Author's /Responsible Designer'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 California Business and Professions Code to accept responsibility for the information on this document.
3. That the energy features and performance specifications for the design identified on this Certificate of Compliance conform to the
requirements of Title 24, Parts 1 and 6 of the California Code of Regulations (CCR).
4. 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 CCR.
5. The building design features or system design features identified on this Certificate of Compliance are consistent with the information
provided on other applicable compliance documents, worksheets,ulations, plans and specifications submitted to the enforcement
agency for approval with this building permit ap ation
'
Res Ie Designerme:
Responsib Des n re:
Date Sign
License:
C-- D C
Compan
Address: 1-?. S6 (r City/State/Zip:
Phone:
For assistance or questions regarding the Energy Standards, contact the Energy Hotline at: 1-800-772-3300
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