BMCH2017-00511
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: BMCH2O17-0051
. c&ty,, 4 4 Qu&roa
DESIGN & DEVELOPMENT DEPARTMENT
BUILDING PERMIT
Property Address: 54145 AVENIDA VALLEJO
APN: 774212018
Application Description: SHICK / CHANGE OUT (1)SPLIT HVAC SYSTEM
Property Zoning:
Application Valuation: $7,000.00 /AO
Applicant:
P
1 ANTHONY PLUMBING HEATING & AIR CONDITI
72216 NORTH SHORE ST #101 MAR 13 2017
THOUSAND PALMS, CA 92276
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 3/13/2017
Owner:
ORPA SCHICK
54145 AVENIDA VALLEJO
LA QUINTA, CA 92253
Contractor:
J ANTHONY PLUMBING HEATING & AIR CONDITI
72216 NORTH SHORE ST.#101
THOUSAND PALMS, CA 92276
CITY OF LA QUINTA (760)328-8096
DESIGN AND DEVELOPMENT DEPARTMENT Llc. No.: 777794
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, C36 License No.: 7777
Date:, 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.). H .
(_) 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 Name:
Lender's Address:
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 wor rr 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 polity number are:
Carrier: MIDWEST EMPLOYERS CASUALTY COMPANY Policy Number:
BNUWC0135300
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 ould.become subject to the
workers' compensation provisions of section 3700 f the Labor Code, I shall forthwith
comply/ywi those provisions.
Date: ✓ Applicant:
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 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 thAcitynterupon the .
above-ment ned operty for inspection purposes.Date Signature (Applicant or Agent)
I
Date: 3/13/2017
Application Number: BMCH2O17-0051
Owner:
Property Address: 54145 AVENIDA VALLEJO
ORPA SCHICK
APN: 774212018
54145 AVENIDA VALLEJO
Application Description: SHICK /CHANGE OUT (1)SPLIT HVAC SYSTEM
LA QUINTA, CA 92253
Property Zoning:
Application Valuation: $7,000.00
Applicant:
Contractor:
J ANTHONY PLUMBING HEATING & AIR CONDITI
J ANTHONY PLUMBING HEATING & AIR CONDITI
72216 NORTH SHORE ST #101
72216 NORTH SHORE ST #101
THOUSAND PALMS, CA 92276
THOUSAND PALMS, CA 92276
(760)328-8096
---------------------------------------------------------------------------------------------
Llc. No.: 777794
Detail: HVAC CHANGE OUT - 14SEER/81AFUE SPLIT SYSTEM. CARBON MONOXIDE ALARM(S) TO BE INSTALLED PRIOR TO FINAL INSPECTION. 2016'
CALIFORNIA BUILDING CODES.
I
r
O• •
DESCRIPTION ACCOUNT QTY AMOUNT I
BSAS SB1473 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
$76.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
HVAC CHANGEOUT - SPLIT -SYSTEM PC
101-0000-42600
0
$38.00
Total Paid for CHANGEOUT: $114.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PERMIT ISSUANCE
101-0000-42404
0
$96.27
Total Paid for PERMIT ISSUANCE: $96.27
DESCRIPTION
ACCOUNT
QTY
AMOUNT
TECHNOLOGY ENHANCEMENT FEE
502-0000-43611
0
$5.00
Total Paid for TECHNOLOGY ENHANCEMENT FEE: $5.00
1. .
l
CERTIFICATE OF COMPLIANCE
Alterations to Space Conditioning Systems (formerly CF -1R -ALT -HVAC)
Project Name:
SCHICK I Date Prepared:
CF1R-ALT 02-E
(Page 1 of 3)
2017-03-13
A. General Information
CFIR-ALT-02 is applicable to multiple space conditioning systems contained within a single dwelling unit. When multiple dwelling units must be documented, use one
CF1R-ALT-02 document for each dwelling unit.
02
Project Name
SCHICK
02
Date Prepared
2017-03-13
03
Project Location
54145 AVENIDA VALLEJO
04
Building Type
Single family
05
CA City
La Quinta
06
Dwelling Unit Name
SCHICK
Dwelling Unit Conditioned
07
Zip Code
92253 I,
OS
Floor Area (ft)2000
SC System
SC System
CFA served-
system a
refrigerant
Installing new SC
Installing
i
Installing
Number of Space
Identification or
09
Climate Zone
15_
10
Conditioning (SC) Systems in
1
entirely new
entirely new
Name
this Dwelling Unit:
System (ft)
B. Space Conditioning (SC) System Informatn
� L
4wac�a.,.
Ol
02
03
04
.'
OS
r">2=$ ?§re3
06
°�#t 'lk a�"
07
,.(: ,
08
'#
09
10
FIs the SCS
I stalli g a
°1
SC System
SC System
CFA served-
system a
refrigerant
Installing new 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 (ft)
system?
component?
components?
feet of ducts?
duct system?
SC system?
Alteration Type
System 1
Location 1
2000
Yes
Yes
Yes
No
No
No
Altered space
conditioning system
C. Extension of Existing Dud System, Greater Than 40 Feet (Section 150.2(b)1Diib)
This section does not apply to this project.
Registration Number: 217-A020079321A-000-000-0000000-0000 Registration Date/Time: 2017-03-13 10:21:17 HERS Provider: CaICERTS
CA Building Energy Efficiency Standards - 2016 Residential Compliance Report Version: 2016.1.005 RgR4rt Qtn@rdted; 2017-03-13 10:21,31
Schema Version: rev 10/16
CERTIFICATE OF COMPLIANCE CFIR-ALT 02-E
Alterations to Space Conditioning Systems (formerly CF -1R -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
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
Gas furnace
Central split
Outdoor
This field or
This field or
System 1
furnace
AHU
AFUE
81
AC
condensing
SEER
14
Setback
section is not
section is not
unit
applicable
applicable
Required Documentation:
CF2R-MCH-01-E - Space Conditioning Systems
- Duct insulation requirement for the new portions of supply -air and return -air ducts or plenums: R6 (CZ 1-10, 12 and 13) and R8 (CZ 11 and 14-16)
CF2R and CF3R-MCH-20-H - Duct Leakage Test 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% or <= 10% leakage to outside; or seal all accessible leaks.
CF2R and CF3R-MCH-25-H Refrigerant Charge verification: required when refrigerant containing components are installed or altered (applicable in CZ 2, 8-15).
CF2R and CF3R-MCH-23 Airflow Rate >=:300 CFM per town, required When -MCH -25 is required.
x t,M
Exceptions:
as previously
-Duct systems registered with HERS provider sealed are:exempt from MCH 0 Duct Leakage Testing requirements.
Heating Air Handler Furnace do Air Flow MCH '
- -only systems and changes not require verification of -23 or'Refrigerant Charge MCH 2S4
�4i rr. ne �u v
Existing duct systems constructed, insulated or sealed wtthaSbestorare. exemptfrom MGH°20 Duct leakage Testing requirements.
Y -a rF_::.r....,: .- 4. 3!` _... _. �' T .: .eta_.. _ 01 'NAR i k z._. I& T'K 19 R-&'41:.
.. »
E. Entirely New or Complete Replacement Duct System, with.or without Equipment Changeout (Sections 150 2(b)WiWand 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)1C)
This section does hot apply to this project.
Registration Number: 217-A020079321A-000-000-0000000-0000 Registration Date/Time: 2017-03-13 10:21:17 HERS Provider: CalCERTS
CA Building Energy Efficiency Standards - 2016 Residential Compliance Report Version: 2.016.1.005 RgR4rt Gell€rd001: 3Q17-43-13 10;x1,31
Schema Version: rev 10/16
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:
Robinson, Kevin
Company:
Signature Date:
J ANTHONY PLUMBING HEATING & AIR CONDITIONING
2017-03-13 10:21:17
Address:
CEA/ HERS Certification Identification (if applicable):
72216 NORTH SHORE ST #101
City/State/Zip:
Phone:
THOUSAND PALMS CA 92276 {
760-343-2121
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. lam eligible under Division 3 of the Business and Pro fessionsCode toaccept 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 Ca�Irfornia:Code o gulation E -
4. The building design features or system design features' identified ontohis Certifcateof Compliance ar pct e�ht�;the �normatton provided another applicaBietompliance documents, worksheets,
calculations, plans and specifications submitted to the a i rcementa ency for, provat'wit this building per ilt applicat Patna '
#f P S, wK
5. 1 will ensure that a registered copy of thls'fertificate of;�Compliance all' marte�available with the butidmglpermtt(s) issued fo he wilding and made available to file enforcement agency for all applicable
inspections. I understand that a registered copy of this{tctificate of Complanceissrequired to bendudedw,'th thedocumenttionhebilder provides tothe buW*'Idng owner at occupancy.
Responsible Designer Name: '°
Respons b Desig er Signature: „/
K
Robinson, Kevin
Company:
Date Signed:
J ANTHONY PLUMBING HEATING & AIR CONDITIONING
2017-03-13 10:21:17
Address:
License:
72216 NORTH SHORE ST #101
777794
City/State/Zip:
Phone:
THOUSAND PALMS CA 92276
760-343-2121
Digitally signed by Ca10ERTS. 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: 217-A020079321A-000-000-0000000-0000
Registration Date/Time
2017-03-13 10:21:17
HERS Provider: CaICERTS
CA Building Energy Efficiency Standards - 2016 Residential Compliance Report Version: 2016.1.005 Report Generated: 2017-03-13 10:21:31
Schema Version: rev 10/16
Bin 1r .
Permit #
iMCN17-
Project Address:
Qty of La Quin to
Building 81- Safety Division
78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-701,2
05 I Building Permit Application and Tracking Sheet
e- o Owner's Name: O /7-
A. P. Number:,
Address:
Legal Description:
City, ST, Zip:
Contractor:'
T elehn•
P o c.
Address: J ANTHONY sepwicES
Project Description: •
City, ST, Zip-
THOUSAKRALMS
TH SHORE ST STE 101
T0 << �.
Telephone:
State Lic.# 7
eiry Lic.:#>:`i:>:
Arch.,:Engr., Designer:
Address:
City, ST,'Zip.
Telephone.
h one:
Construction s on Type:Occupancy:
O P ane Y:
t a ,
Sto . Lic.. #
New Add'n
0ProJect
tYPe (circle ne • Alter Repair- Demo
Name ofContact Person:
Sq. Ft.:
# Stories:
#Units:
Telephone # of Contact Person: ��?�
Estimated Value of Project::
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Rcc'd
TRACIQNG
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Cafes.
Called Contact Person
Plan Check Balance. '
Title 24 Calcs.
Pians picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2" Review, ready for corrections/issue
Electrical .
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
Ii.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
''d 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,
I
Total Permit Fees -