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BMCH2015-001878-495 CALLE TAMPICO D �W LA QUINTA, CALIFORNIA 92253 Application Number: BMCH2O15-0018 Property Address: 78712 VIA CARMEL APN: 646430004 Application Description: (2) SPLIT SYSTEMS Property Zoning: (760)564-7530 Application Valuation: $9,500.00 Applicant: SIMMONS, ADAM 0 OUTSIDE CITY LIMITS LA QUINTA, CA 92253 COMMUNITY DEVELOPMENT DEPARTMENT BUILDING PERMIT VOICE (760) 777-7125 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Owner: JAMES KRUPINSKI 78712 VIA CARMEL LA QUINTA, CA 92253- Contractor: 2253 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. ense Class: License No.::LIC-0003427 t 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 of the Business and Professions Code) or that he or she is exempt therefrom and the )C, basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).: (1 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 he 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 Date: 1/15/2015 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 . 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 370 of the Labor,Code, I shall forthwith comply with those provisions. Date: fJ[l� Applicant: ��is 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 stateI ws relating to building construction, and hereby authorize representatives of this city tenter upon the abgyve• mentioned property for inspection purposes. 7 Date: Signature (Applicant or Agent Contractor: JAN 1 2 011J,4UU, SIMMONS, ADAM 0 OUTSIDE CITY LIMITS CITY OF LA QUINTA COMMUNITY DEVELOPMEMf DEPARTMENT LA QUINTA, CA 92253 (760)564-7530 Llc. No.: :LIC -0003427 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. ense Class: License No.::LIC-0003427 t 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 of the Business and Professions Code) or that he or she is exempt therefrom and the )C, basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).: (1 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 he 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 Date: 1/15/2015 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 . 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 370 of the Labor,Code, I shall forthwith comply with those provisions. Date: fJ[l� Applicant: ��is 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 stateI ws relating to building construction, and hereby authorize representatives of this city tenter upon the abgyve• mentioned property for inspection purposes. 7 Date: Signature (Applicant or Agent CERTIFICATE OF COMPLIANCE CF1R-ALT-02-E Alterations to Space Conditioning Systems (formerly CF-1R-ALT-1HVAC) (Page 1 of3 ) Project Name: Krumpenski Date Prepared: 2015-01-15" A. General Information MR -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 Krumpenski 02 Date Prepared 2015-01-15 03 Project Location 78712 Via Carmel 04 Building.Type Single family 05 CA City La Quinta 06 Dwelling Unit Name Krumpenski 07 Zip Code 92253 08 Dwelling Unit Conditioned Floor Area (ft2) 4000 Installing new SC Installing Installing Installing Number of space conditioning Identification or 09 Climate Zone 15 - 10 (SC) systems in this dwelling 2 entirely new entirely new Name unit. System (ft2); system? component? components? feet of ducts? duct system? SC system? .. $a+ �;'r'� �t',t�! �s r 4q. _' •i,,, ��`Y^`—' Y,� i,.: � b . .�" ,� % K_; �. x r Conditioning System Information B. Space (SC) ,L O1 02 03 .�04 �� �. ..� ,. �, 5 45, ..,� 06e:,y it U7'. 08 ' > ' 09 10 .meq :Isthe' SC filns'tallm axr SC System SC System CFA served system a T.. refrigerant Installing new SC Installing Installing Installing Identification or Location or Area.:l+ *51by 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 living ara 1600 " 'Yes Yes Yes No No No Altered space conditioning system System 2 'Bedrooms 1200 Yes Yes Yes No No No Altered space conditioning system C. Extension of Existing Duct System, Greater Than 40 Feet (Section 150.2(b)1Diib) This section does not apply to this project. Registration Number: 215-A0018455A-000000000-0000 CA Building Energy Efficiency Standards - 2013 Residential Compliance Registration Date/Time: Report Version: 2014-03-31 rncomn k/aminn• n rrlcnn 2015-01-15 09:18:25 HERS Provider: CalCERTS Report Generated: 2015-01-15 09:16:45 CERTIFICATE OF COMPLIANCE CF111-ALT-02-E . Alterations to Space Conditioning Systems (formerly CF -IR -ALT -HVAC) (Page 2 of'3 ) D. Altered Space Conditioning System (Sections 150.2(b)lE acid 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 Dud or Name Type Components Type Value. System Type. Components Type Value Type Duct Length R -Value Central gas All new heating AFUE 0.78 Central split All new cooling SEER 16 Setback J Less than or equal to 40 R-8 System 1 furnace components AC components feet System 2 Central gas All new heating AFUE.:: 0.78 Central split All new cooling SEER 16 Setback Less than or equal to 40 R-8 furnace components AC components feet �!7: Required Documentation:, a CF2R-MCH-01-E - Space Conditioning Systems Ducts and Fans y -Duct insulation requirement for new plenums: R6..;.: heating or cooling components are installed inducted systems, or when more than 40 ft of duct length is replaced. CF2R-MCH-20-H & CF3R-MCH-20-H — Duct Leakage testing required when o-Yyue:yY• ':tic aslHrt"iS'MYdw"<.. ..- b+ � - ,�.:'� "� � . .. ,_. <_ 15%, or. 10%teaka�ge to outside, or, seal all accessible leaks. <� -Leakage rate compliance: CF2R-MCH-25-H & CF3R-MCH-25-H Refrigerant Charge Verification^required when refrigerant containing components are installed itered (applicable m CZ 2,.8-.15). CF2RCF3R-MCH-23 & CF3R-MCH-23 Air Flow >_ 300 CFM/ton required when MCH -25 is required', v°r�' ';;•� . rr s s s S a Exceptions: Duct systems registered with HERS provider as previously sealed are exempt„frrom MCH -20 Duct Leakage Testing requirements. r.. _• t .. -Heating-only systems and Air Handler/Furnace changes do not require verification of Air Flow MCH -23, or Refrigerant Charge MECH-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 without Equipment Changeout (Sections 150.2(b)lDiia 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-A0018455A-000000000-0000 CA Building Energy Efficiency Standards - 2013 Residential Compliance Registration Date/Time: 2015-01-15 09:18:25 Report Version: 2014-03-31 Crhoma Vaminn• n SS1 CMM) HERS Provider: CalCERTS Report Generated: 2015-01-15 09:16:45 . r' CERTIFICATE OF COMPLIANCE CF111-ALT-02-E Alterations to Space Conditioning Systems (formerly CF -IR -ALT HVAC) (Page 3 ofI ) Documentation Author's Declaration Statement 1.1 certify that this Certificate of Compliance documentation is accurate and complete. Documentation Author Name: Documentation Author Signature: Bachus, Tom Company: Signature Date: 2015-01-15 09:16:47 MLC Building Performance CEA/ HERS Certification Identification (if applicable): Address: 77825 Delaware Place City/State/Zip: Phone: 760-836-0066 Palm Desert CA 92211 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. Division 3 ofthe Business and Professions Code to accept responsibility for the building design or system design identified on this Certificate of Compliance (responsible designer). 2. 1 am eligible under x .,r: x�t a «erx es. .� ..arzr 3. That the energy features and performarnnpecifications, matena0ls,�cor4p'onents 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 PMof of the California Code of Regulations. 4. The building design features or systedesign features ident�ifi�e�d ons Certificate of Compliance are c sist�ent with th�nformaUon provided o her applicable compliance documents, worksheets, calculations, plans and specifications submitted to the enforcement agency for approval with this building permit application '...: •F -z - s+ rrx nc sha. st Vis+- i .z_• .:z 5. 1 will ensure that a registered copy of this Certificate of Compliance shall be made available with the building permit) 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: _ '' ' r: ... Responsible Designer Signature: Simmons, Donna Company: Date Signed: ADAM SIMMONS 2015-01-15 09:18:25 Address: License: 54440 AVENIDA CARRANZA 780534 City/State/Zip: Phone: LA QUINTA CA 92253 (760) 564-7525 Digitally signed by CaICERTS. 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. Registration Number: 215-A0018455A-000000000-0000 Registration Date/Time: 2015-01-15 09:18:25 HERS Provider: CaICERTS CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2014-03-31 Report Generated: 2015-01-15 09:16:45 Crhama Varcinn• n c;rl'Mn PAID PAID DATE FINANCIAL •R ACCOUNT { • 'QTY AMOUNT, ` BSAS SB1473 FEE 101-0000-20306 0 $1.00 $0.00 -PAID BYy . n ` °_.. METHOD, '. RECEIPT # CHECK # - CLTD BY„ Total Paid forBUILDING STANDARDS ADMINISTRATION BSA $1.00 $0.00 =' DESCRIPTION"'}" �' 4_ f M+ ~" ACCOUNT • ` QTY QTY: ' AMOUNT; X , PAID: . ,� PAI D DATE- CHANGEOUT - SPLIT -SYSTEM 101-0000-42402 0 $145.04 $0.00 -a PAID BY "-METHOD ; -RECEIPT,# CHECK #' ,CLTD' BY _ r - ,DESCRIPTION 3 ACCOUNT , FQTYAMOUNT -~PAID 'PAID DATE HVAC CHANGEOUT - SPLIT -SYSTEM PC 101-0000-42600 0 $72.52• $0.00 PAID BY ' a " METHOD;, ., ' , ; ' RECEIPT # :: r "'` CHECK # = CLTD BY ^ Total Paid forCHANGEOUT: $217.56 $0.00 DESCRIPTION . - r t r ;.ACCOUNT' 1e ,� QTY, + - AMOUNT PAI -PAID DATE PERMIT ISSUANCE 101-0000-42404 0 $91.85 $0.00 PAID BY . �. , p' METHOD RECEIPT # CHECK # ,CLTD BY Total Paid for PERMIT ISSUANCE: $91.85 $0.00 TOTALS:• i0 J Description: (2) SPLIT SYSTEMS Type: MECHANICAL Subtype: Status: UNDER REVIEW Applied: 1/15/2015 PJU Approved: Parcel No: 646430004 Site Address: 78712 VIA CARMEL LA QUINTA,CA 92253 Subdivision: TR 28343 Block: Lot: 48 Issued: Lot Sq Ft: 0 Building Sq Ft: 0 Zoning: Finaled: Valuation: $9,500.00 -Occupancy Type: Construction Type: Expired: No. Buildings: 0 No. Stories: 0 No. Unites: 0 CA Details: HVAC CHANGE OUT (2) SYSTEMS (1) 4 TON & (1) 3 TON UNITS .78 16 SEER .2013 CALIFORNIA MECHANICAL CODE CARBON MONOXIDE ALARM(S) TO BE INSTALLED PRIOR TO FINAL INSPECTION. 2013 CALIFORNIA BUILDING CODES DESCRIPTION. ADDITIONAL SITES v _ DESCRIPTION ,. " "'ACCOUNT QTY AMOUNT PAID 'PAID DATE RECEIPT#' CHECK#- METHOD PAID BY' BY, YD . BSAS SB1473 FEE 101-0000-20306 0 $1.00 $0.00 Total Paid forBUILDING STANDARDS ADMINISTRATION $1.00 $0.00 BSA: Printed: Thursday, January 15, 2015 2:35:12 PM 1 of 2 CN?x srsreMs NAME.TYPE ; NAME ADDRESS3 . CONTACTS CITY' STATE ZIP PHONE FAX `- EMAIL APPLICANT SIMMONS, ADAM 0 OUTSIDE CITY LIMITS LA QUINTA CA 92253 (760)771-9414 CONTRACTOR SIMMONS, ADAM 0 OUTSIDE CITY LIMITS LA QUINTA CA 92253 (760)771-9414 OWNER JAMES KRUPINSKI 78712 VIA CARMEL LA QUINTA CA 92253 (760)771-9414 v _ DESCRIPTION ,. " "'ACCOUNT QTY AMOUNT PAID 'PAID DATE RECEIPT#' CHECK#- METHOD PAID BY' BY, YD . BSAS SB1473 FEE 101-0000-20306 0 $1.00 $0.00 Total Paid forBUILDING STANDARDS ADMINISTRATION $1.00 $0.00 BSA: Printed: Thursday, January 15, 2015 2:35:12 PM 1 of 2 CN?x srsreMs DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE '-RECEIPT # CHECK # METHOD PAID BY CLTD -By, HVAC CHANGEOUT - 101-0000-42402 0 $145.04 $0.00 SPLIT -SYSTEM HVAC CHANGEOUT - 101-0000-42600 0 $72.52 $0.00 SPLIT -SYSTEM PC Total Paid forCHANGEOUT: $217.56 $0.00 PERMIT ISSUANCE 101-0000-42404 0 $91.85 $0.00 Total Paid forPERMIT ISSUANCE: $91.85 $0.00 TOTALS:00 SEQID INSPECTION TYPE INSPECTORSCHEDULED COMPLETED RESULT.. "REMARKS -,.NOTES.,-., , DATE DATE ,j MECHANICAL FINAL" PARENT PROJECTS REVIEWS _.-_- -_ _ ._ _ �. e - - - - -. - REVIEW TYPE REVIEWER SENT DATE DUE DATE RETURNED STATUS REMARKS NOTES DATE . Printed: Thursday, January 15, 2015 2:35:12 PM 2 of 2 cff�SrsrEMS BOND INFORMATION ATTACHMENTS Printed: Thursday, January 15, 2015 2:35:12 PM 2 of 2 cff�SrsrEMS City of La Quinta. Building 8r 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: 7tM int 0- Owner's Name: Q M• ��u �� A. P. Number: Address: 79- 2 }tt Cae 24 Legal Description: City, ST, Zip: Contractor: �« s j2 Telephone % %' yi Y Address: -yyv I-qV111-, Gewl&+/fir Project Description: City, ST, Zip: ou Telephone: - 6 r State Lic. # : City Lic. #: Arch., Engr., Designer: 44 Address: City., ST, Zip: Telephone: i�tyU Construction Type: Occupancy: State Lic. #: Project ty< a circle one : New Add'n Alter Repair Demo Name of Contact Person: Sq. Ft.: # Stories: # Units: Telephone # of Contact Person: Estimated Value of Project: APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Req'd Rec'd TRACKING PERMIT FEES Plan Sets PIan Check submitted Item Amount Structural Calcs. Reviewed, ready for corrections Plan Check Deposit Truss Calcs. Called Contact Person I Plan Check Balance • Title 24 Calcs. Plans picked up Construction Flood plain plan Plans resubmitted 'Mechanical Grading plan 21" Review, ready for corrections/issue Electrical Subcontactor List Called Contact Person 'Plumbing Grant Dccd Plans picked up S.M.I. II.O.A, Approval Plans resubmitted Grading IN IiOUSE:- 'rd 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 Rees J.