BMCH2016-0109LICENSED 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
License No.: 794315
`Date_ �—lI `� 1 4 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, atter, 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 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 Add
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: _
ify that in the performance of the work for which this permit is issued, I
sha 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 those provisions. A
iI -`
Date: /F
`e f 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 this city to nter upon the
above-mentioned prop/arty for inspection purposes.
Date. 1 '%V Signature (Applicant or Agent).
78-495 CALLE TAMPICO '
U
VOICE (760) 777-7125
LA QUINTA, CALIFORNIA 92253
FAX (760) 777-7011
COMMUNITY DEVELOPMENT DEPARTMENT
INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 4/15/2016
Application Number: BMCH2O16-0109
Owner:
O
Property Address: 51770 AVENIDA CORTEZ
MONIKA MOH LER
U
APN: 773153001
P 0 BOX 1825
Application Description: MOHLER / CHANGE OUT FURNACE AND COIL
LA QUINTA, CA 92253
C7
Property Zoning:M.
w
Application Valuation: $2,500.00
m O ;,J
O -n y� i ►�
D
Applicant:
Contractor:
1Z
DOVE AIR INC
DOVE AIR INCv
68-749 RISUENO ROAD
68-749 RISUENO ROAD
a v'
CATHEDRAL CITY, CA 92234
CATHEDRAL CITY, CA 92
(760)327-1890
Llc. No.: 794315
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
License No.: 794315
`Date_ �—lI `� 1 4 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, atter, 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 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 Add
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: _
ify that in the performance of the work for which this permit is issued, I
sha 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 those provisions. A
iI -`
Date: /F
`e f 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 this city to nter upon the
above-mentioned prop/arty for inspection purposes.
Date. 1 '%V Signature (Applicant or Agent).
DESCRIPTION
FINANCIAL INFORMATION
ACCOUNT' CITY. . AMOUNT PAID
PAID DATE
BSAS SB1473 FEE
101-0000-20306
0 $1.00 $0.00
PAID BY
METHOD
RECEIPT # CHECK #
CLTD BY
Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $1.00 $0.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE'
HVAC CHANGEOUT - FURNACE ONLY
101-0000-42402
0
$36.26
$0.00
PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY
DESCRIPTION _
ACCOUNT
QTY
AMOUNT
PAID.
PAID DATE
HVAC CHANGEOUT - FURNACE ONLY PC
101-0000-42600
0
$24.17
$0.00
PAID BY
METHOD 1
RECEIPT #
-CHECK #
CLTD BY
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
HVAC CHANGEOUT -REPAIR/ALTERATION
101-0000-42402
0
$12.09
$0.00
PAID BY'
METHOD
RECEIPT #
CHECK #
CLTD BY
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
HVAC CHANGEOUT - REPAIR/ALTERATION
PC
101-0000-42600
0
$4.83
$0.00
PAID BY
METHOD -
RECEIPT #
CHECK #
CLTD BY
Total Paid for CHANGEOUT: $77.35 $0.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
PERMIT ISSUANCE
101-0000-42404
0
$91.85
$0.00
PAID BY
METHOD
RECEIPT # .
CHECK #
CLTD BY
Total Paid for PERMIT ISSUANCE: $91.85 $0.00
TOTALS:••
Description: MOHLER / CHANGE OUT FURNACE AND COIL
CUNDITIONS
'°....NAME"INK """"
Type: MECHANICAL Subtype:
Status: UNDER REVIEW
Applied: 4/15/2016 SKH
Approved:
Parcel No: 773153001 Site Address: 51770 AVENIDA CORTEZ LA QUINTA,CA 92253
Subdivision: SANTA CARMELITA VALE LA QUINTA Block: 30
Lot: 24
Issued:
UNIT 2
CONTACTS
CITY STATEF92234
Lot Sq Ft: 0 Building Sq Ft: 0
Zoning:
Finaled:
Valuation: $2,500.00 Occupancy Type:
Construction Type:
Expired:
No. Buildings: 0 No. Stories: 0
No. Unites: 0
Details: HVAC CHANGE OUT - (1) FURNACE AND (1) COIL. [2013 ENERGY) CARBON MONOXIDE ALARM(S) TO BE INSTALLED PRIOR TO FINAL
INSPECTION. 2013 CALIFORNIA BUILDING CODES.
CONTRACTOR
DOVE AIR INC
CHRONOLOGY
CUNDITIONS
'°....NAME"INK """"
"'" ..... ""NAME.':.
ADDRESSl
CONTACTS
CITY STATEF92234
PHONE•
FAX
EMAIL
APPLICANT
DOVE AIR INC
68-749 RISUENO ROAD
CATHEDRAL CA
CITY
DOVEAIRINC@VERIZO
N.NET
CONTRACTOR
DOVE AIR INC
68-749 RISUENO ROAD
CATHEDRAL CA
CITY
DOVEAIRINC@VERIZO
N.NET
OWNER
MONIKA MOHLER
P 0 BOX 1825
LA QUINTA CA
92253
FINANCIAL INFORMATION
Printed: Friday, April 15, 2016 1:30:06 PM 1 of 2
SYSTEMS
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
FURNACE�ONLY
HVAC GHANGEOUT -
101-0000-42600
0
$24.17
$0.00
FURNACE ONLY PC
HVAC CHANGEOUT -
101-0000-42402
0
$12.09
$0.00
REPAIR/ALTERATION
HVAC CHANGEOUT -
101-0000-42600
0
$4.83
$0.00
REPAIR/ALTERATION PC
Total Paid for CHANGEOUT: $77.35 $0.00
PERMIT ISSUANCE
101-0000-42404
0 •
$91.85
$0.00
Total Paid for PERMIT ISSUANCE: $91.85 $0.00
TOTALS:
INSPECTIONS
BOND INFnRMATION "
ATTACHMENTS
Printed: Friday, April 15, 2016 1:3006 PM 2 of 2.
SYS7Eti1S
CERTIFICATE OF COMPLIANCE CF1R-ALT 02-E
Alterations to Space Conditioning Systems (formerly CF -IR -ALT -HVAC) (Page 1 of 3) .
Project Name: Monika Mohler Date Prepared: 2016-04-15
A. General Information
CF1R-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
Monika Mohler
02
Date Prepared
2016-04-15
03
Project Location
51770 Avenida Cortez
04
Building Type
Single family
05
CA City
La Quinta
06
Dwelling Unit Name
Monika Mohler
07
Zip Code
92253
08
Dwelling Unit Conditioned
1650
Installing new SC
rt Installing
Installing
t4 Installing
Floor Area (ft2)
Identification or
Location or Area
by this SC
ducted
con
containing
Number of space conditioning
more than 40
09
Climate Zone
15
30
(SC) systems in this dwelling
1
system?
component?
components?
feet of ducts?
unit.
SC system?
B. Space Conditioning (SC) System Information
01
02
03 ..`"
=fit 041"
D5'=
r.+i
--06
08 }
t
09
10
z
-'J
A the SC
' ''...,m„ •.'ar - •w
InstallingtJ a
:.e++�, a..,..`..r..r. ..,
.� - i,.;..+
.ea �_
+r -.+y,
SC System
SC System
CFA served
'system a. -
refrigerant
Installing new SC
rt Installing
Installing
t4 Installing
Identification or
Location or Area
by this SC
ducted
con
containing
system
more than 40
entirely new
entirely new
NameI
Served
System (ft2)
system?
component?
components?
feet of ducts?
duct system?
SC system?
Alteration Type
System 1
Entire Home (
. 3-BDRS)
1650
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: 216-A0141117A-000000000-0000
CA Building Energy Efficiency Standards - 2013 Residential Compliance
Registration Date/Time: 2016-04-15 11:26:10
Report Version: 2013 Rev 1.007,
Schema Version: 0.555SDD
HERS Provider: CaICERTS
Report Generated: 2016-04-1S 11:26:36
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 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
System 1
Central gas
All new
heating
AFUE
0.78
Centrals lit
p
Indoor coil
SEER
13
Setback
This field or .
section is not
This field or
section is not
furnace
components
AC
'
applicable
applicable
Required Documentation:
CF2R-MCH-01-E - Space Conditioning Systems Ducts and Fans
-Duct insulation requirement for new plenums: R6.
CF2R-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: 515%, or <_ 10% leakage to outside, or seal all accessible leaks.
CF2R-MCH-25-H & CF3R-MCH-25-H Refrigerant Charge Verification required when refrigerant containing components are installed or altered (applicable in .CZ 2,8-15).
CF2RCF3R-MCH-23 & CF3R-MCH-23 Air Flow 2 300 CFM/ton required when MCH -25 is required.
Exceptions:
-Duct systems registered with HERS provider as previously sealed are exempt from MCH:20 Duct Leakage Testing requirements.
Heating -only systems and Air Handler/Furnace changes do not require verification of Air Flow MCH 23; or Refrigerant Charge MECH-2
Its
MCH 20 Duct Leakage Testing requirements.
-Existing duct systems constructed, insulated or sealed with asbestos are exempt,from
3
E. Entirely New or Complete Replacement Duct.System, withorwithout,Equipment Changeout (Sections -150.2(b) Mia -and .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 not apply to this project.
Registration Number: 216-A0141117A-000000000-0000 Registration Date/Time: 2016-04-15 11:26:10 HERS Provider: CaICERTS .
CA Building Energy. Efficiency Standards - 2013 Residential Compliance Report Version: 2013 Rev 1.007 Report Generated: 2016=04-15 11:26:36
Schema Version: 0.5555DD
CERTIFICATE OF COMPLIANCE CF1R-ALT-02-E
Alterations to Space Conditioning Systems (formerly CF -1R -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: �� ^
CI�X/fi
Laster, Gary
Company:
Signature Date:
DOVE AIR INC
2016-04-15 11:26:10
Address:
CEA/ HERS Certification Identification (if applicable):
68-749 RISUENO ROAD
City/State/Zip:
Phone:
CATHEDRAL CITY CA 92234
760-327-1890
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 Certi ica a of Compliance are'co_nsistent with the information provided on� o!ther applicable mpliance documents, worksheets,
calculations, plans and specifications submitted to the enforcementagency for approval with this building permit application. '`i ft E
w
5. I will ensure that a registered copy of this Certificate of -Compliance 211 be made. available with the building 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 C,e`rtificate of Compliance, is. required to be included with the, documentation the;builder provides to the building owner at occupancy.
Responsible Designer Name:YV a 1 1 =�•• } --
Responsible Designer Signature:
��
Laster, Gary
v
Company:
Date Signed:
DOVE AIR INC
2016-04-15 11:26:10
Address:
License:
68-749 RISUENO ROAD
794315
City/State/Zip: T
Phone:
CATHEDRAL CITY CA 92234
760-327-1890
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.
♦r
Registration Number: 216-A0141117A-000000000-0000 Registration Date/Time: 2016-04-15 11:26:10 HERS Provider: CalCERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013 Rev 1.00.7 Report Generated: 2016-04-15 11:26:36
Schema Version: 0.555SDD
Permit #
Project Address:
o
City of La Quin to
Building 8L Safety Division
78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
eZ 1 11 K G ' h/Pr'
A. P. Number:
Address: S -410 ° Q 6f / C -L -
Legal Description:
City, ST, Zip: ,'n fo, (off -
Contractor: 6
.r T
ele one•
Telephone:
Address: ��-7 l 9 (�� f
? n
Project Description: . Q� 'f �:::...:::C at' -
City, ST, Zip:
City,
Telephone:
one: 6 4 3L l�' b
7
co
State Lie. # : l
City Lie. #... 0 (<1DJ 51'1
Arch., Engr., Designer:
Address:
City., ST, Zip:
Telephone:
one:
Construction ane
Type: Occupancy:
P Y:
Lie. #
ProJeStato ct type (circle one): New Add'n Alter Repair Demo
Name of Contact Person: r
Z)
Sq. Ft.:
# Stories:
# Units:
Telephone # of Contact Person:Estimated
Value of Project: �25-0 0 0
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
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
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:-
'"! Review, ready for corrections/iissuc
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees,
Total Permit Fees