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BMCH2017-0136LICENSED 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.: 99082266 Datise7 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.). (1 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 WORKER'S COMPENSATION DECLARATION Lhereby 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 _ 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: EVEREST NATIONAL INSURANCE COMPANY Policy Number: 7600014807161 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 os provisions. i 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 I agree to comply with all city and county ordinances and construction, and hereby authorize representatives of this above-men9ont pr erty for inspection purposes. / Datelori�Signature (Applicant or Agent)/� C , VOICE (760) 777-7125 78-495 CALLE TAMPICO D FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 DESIGN & DEVELOPMENT DEPARTMENT INSPECTIONS (760)777-7153 BUILDING PERMIT Date: 4/17/2017 Application Number: BMCH2O17-0136 Owner: �— z Property Address: 51885 VIA BENDITA VIRGIL WILLILAMS L.0 APN: 777430069 51885 VIA BENDITA Application Description: WILLIAMS / CHANE OUT (1)16EER/80HSPF DUCTLESS SPLIT LA QUINTA, CA 92253 a Property Zoning: r` ¢ w O Application Valuation: $5,200.00 o z F— J N Applicant: Contractor: a ,..I p SUPERIOR HEATING & AIR CONDITIONING INC 73510 30TH AVENUE SUPERIOR HEATING &1R� 73510 30TH AVENUE NDIT&IING I1ME i THOUSAND PALMS, CA 92276 THOUSAND PALMS, CA 9227 Q U 2 Z (760)343-0203 L3 Llc. No.: 990826 co ---------------------------------------------------------------------------------------------- C3 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.: 99082266 Datise7 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.). (1 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 WORKER'S COMPENSATION DECLARATION Lhereby 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 _ 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: EVEREST NATIONAL INSURANCE COMPANY Policy Number: 7600014807161 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 os provisions. i 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 I agree to comply with all city and county ordinances and construction, and hereby authorize representatives of this above-men9ont pr erty for inspection purposes. / Datelori�Signature (Applicant or Agent)/� Application Number: BMCH2O17-0136 Property Address: 51885 VIA BENDITA APN: 777430069 Application Description: WILLIAMS / CHANE OUT (1)16EER/80HSPF DUCTLESS SPLIT Property Zoning: Application. Valuation: $5,200.00 Applicant: SUPERIOR HEATING & AIR CONDITIONING INC 73510 30TH AVENUE THOUSAND PALMS, CA 92276 Date: . 4/17/2017 Owner: WIRGIL WILLILAMS 51885 VIA BENDITA LA QUINTA, CA 92253 Contractor: SUPERIOR HEATING & AIR CONDITIONING INC 73510 30TH AVENUE THOUSAND PALMS, CA 92276 (760)343-0203 Llc. No.: 990826 ---------------------------------------------------------------------------------------------- Detail: HVAC CHANGE OUT - 16EER/80HSPF'DUCTLESS SPLIT SYSTEM. CARBON MONOXIDE ALARM(S) TO BE INSTALLED PRIOR TO FINAL INSPECTION. 2016 CALIFORNIA BUILDING CODES. \ 1 INFORMATIONFINANCIAL DESCRIPTION ACCOUNT CITY AMOUNT BSAS SB1473 FEE 101-0000-20306 0 $1.00 Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $1.00 DESCRIPTION ACCOUNT CITY AMOUNT HVAC CHANGEOUT - SPLIT -SYSTEM 101-0000-42402 0 $76.00 DESCRIPTION ACCOUNT CITY 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 CITY AMOUNT TECHNOLOGY ENHANCEMENT FEE 502-0000-43611 0 $5.00 Total Paid for TECHNOLOGY ENHANCEMENT FEE: $5.00 TOTALS: $216.27 I J I Bin 1f1 Permit u Project —��� Qty,of La.Quinto Building, U Safety Division 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-701,2 - Building Permit Application and Tracking,Sheet � t= Owner's Name: AP. Number: 1 =Address: Legal Description: 1 �ECity, ST, Zip: , ira Con ct r. 0 D�2 Tele ho n �--' P � - Address: r_ -Project Description: x)! L; J rCity, ST, Zip/.', r h 'Tele one: P G� 5 :State Lic: # : Q City Lie. #t Arch.,`Engr., Designer:, Address: City., ST, Zip: Telephone: - - Occupancy: aneY Con tructi n Type: P Slate Lic. Repair DemoAdd'n AlterProJeetPe circle one New .N -Name of Contact Person- S Ft.: #Stories: #Units: iTelephone # of Contact Person: � d -=Estimated Value of Project: Z7 # Submittal Req'd APPLICANT: DO NOT WRITE BELOW THIS LINE r Rcc'd TRACKING PERMIT FEES Plan Sets Plan Check submitted Item Amount Structural Cafes. Reviewed, ready for corrections Plan Check Deposit Truss Calcs. Called Contact Person Plan Check Balance. Title 24 Calcs. Plans picked up Construction ' Floodplain lain p p Plans resubmitted Mechanical Grading plan 2°" Review, ready for corrections/issue Electrical 'Subcontactor List Called Contact Person Plumbing + Grant Dced Plans picked up S.M.I. II.O.A. Approvaj Plans resubmitted Grading IN ROUSE:- ''d 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, I Total Permit Fecs 1 1 J 1 A. General Information CF11R-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 S.Williams 02 Date Prepared 2017-04-13 03 Project Location 51-885 Via Bendita La Quinta 04 Building Type Single family 05 CA City La Quinta ter... - 06 Dwelling Unit Name House Identification or Location or Area by this SC ducted containing 07 Zip Code 92253w.� entirely new Dwelling Unit Conditioned 800 Served System (ft2) system? ,08 Z Floor Area (ft ) feet of ducts? duct system? SC system? I Alteration Type Unit #1 Living Space 800 Yes rYes `''ii V " Number of Space No 09 Climate Zone 15 -M Conditioning (SC) Systems in 1 this Dwelling Unit: B. Space Conditioning (SC) System Information ., 01 02 03 04 05' 06 ' 07 08 09 10 SC System SC System CFA served Is the SC. , ,.. L. 1, systema , Jnstalling;a f k.:....l°'_; 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 (ft2) system? component? components? feet of ducts? duct system? SC system? I Alteration Type Unit #1 Living Space 800 Yes rYes 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: 417-A020089693A-000-000-0000000-0000 Registration Date/Time: 2017-04-13 12:18:55 HERS Provider: CHEERS CA Building Energy Efficiency Standards - 2016 Residential Compliance Report Version: 2016.1.005 Reoort Generated: 2017-04-13 12:1A:56 N CERTIFICATE OF COMPLIANCE CF1R-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 0S 06 07 08 09 10 it 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 Ductless split All new Ductless split All new This field or This field or Unit #1 heating HSPF 80 HP cooling EER 16 Setback section is not section is not HP components components applicable applicable Required Documentation: a Ott CF2R-MCH-01-E - Space Conditioning Systems".r~�, - 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 (C2 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 <= 30% leakage to outside, or seal all accessible leaks. t :: �'' ` CF2R and CF3R-MCH-25-H Refrigerant Charge verification required when refrigerant containing components are;lnstalled or altered (applicable in C2 2, 8-15). z CF2R and CBR -MCH -23 Airflow Rate >= 300 CFM per ton required when MCH -25 is required. Exceptions: Duct systems registered with HERS provider as previously sealed are exempt from MCH -20 Duct Lea kage.Testing requirements. Heating -only systems and Air Handler Furnace changes do not require verification of Air Flow MCH -23, or Refrigerant Charge MCH -25. -Existing duct systems constructed, insulated or sealed with asbestos are exempt from MCH -20 Duct Leakage Testing requirements. E. Entirely New or Complete Replacement Duct System, with or'withoutEqquipment Chan eout (Sections 150.2 b 1Diia and 150.2 b lE, F) '? ir,�. �. (•`�!�,.',,�ls!•.,<` This sectibh 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: 417-A020089693A-000-000-0000000-0000 Registration Date/Time: 2017-04-13 12:18:55 CA Building EnerRv Efficiency Standards - 2016 Residential Compliance Report Version: 2016.1.005 HERS Provider: CHEERS Report Generated: 2017-04-13 12:18:56 9 CERTIFICATE OF COMPLIANCE i CF111-ALT-024 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: Shawn Malette Sh"YL Ma ette., Company: Signature Date: Superior Heating & Air Conditioning, Inc. 2017-04-13 Address: CEA/ HERS Certification Identification (if applicable): 73510 30th Avenue City/State/Zip: ° .Phone: Thousand Palms CA 92276 626.7589-8609 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 Part 6 of the California Code of Regulations. 4. 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, calculations, plans and specifications submitted to the enforcement agency forapproval:with this building permit application. 1. 5. 1 will ensure that a registered copy of this Certificate of Compliance shall be made available with thY6uilding permit(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 documentation the builder provides to the building owner at occupancy. Responsible Designer Name:_� Responsible.,Designer Signature: .�',r�f�l�t_�: Shawn Malette Shaw�tiM'i�Zette� Company: Date Signed: Superior Heating & Air Conditioning, Inc. 2017-04-13 Address: - License: 73510 30th Avenue 990826 City/State/Zip: Phone: Thousand Palms CA 92276 626-589-8609 Registration Number: 417-A020089693A-000-000-0000000-0000 Digitally signed by CHEERSIm. 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 Date/Time: 2017-04-13 12:18:55 HERS Provider: CHEERS CA Buildine Energy Eificiencv Standards - 2016 Residential Compliance Report Version: 2016.1.005 Report Generated: 2017-04-13 12:18:56