BMCH2015-0074v
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING PERMIT
Application Number:
BMCH2O15-0074
Property Address:
56795 JACK NICKLAUS
APN:
762070010
Application Description:
BRISCOE RESIDENCE HVAC CHANGE
Property Zoning:
Application Valuation: .
$27,724.00
Applicant:
IE INC
31225 LA BAYA
WESTLAKE VILLAGE, CA 91362
MAR 17 2015
GR OF LA QUINTA
LICENSED CON TRACTOR'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 effe:t.
License Class: C20 License No.: 686310
Date: 311-7/LS- Contra011�,_=__ ��
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 ISec. 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.).
(_) 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
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 3/17/2015
Owner:
STUART BRISCOE'
Contractor:
HARRISON ENTERPRISES INC DBA G
31-170 RESERVE DRIVE STE A
THOUSAND PALMS, CA 92276
(760)343-7488
Llc. No.: 686310
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: _ Polity 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 3700 of the Labor Code, I shall forthwith
comply with those provisions. ,,,,www!����
Date: 31 17 is Apant:S�r�
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 enter upon the above-
mentioned property for inspection purposes.
In iJ
Dat . s Signature (Applicant or,,Agent):
CERTIFICATE OF COMPLIANCE
Alterations to Space Conditioning Systems (formerly CF -1R -ALT -HVAC).
Project Name:
STUART BRISCOE I Date Prepared:
CF1R-ALT-02-E
(Page 1 of 3 )
2015-03-16
A. General Information
CHR -ALT -02 is applicable to multiple space conditioning systems contained within a single dwelling unit. When multiple dwelling units must be
documented, use one CHR -ALT -02 document for each dwelling unit.
01
Project Name
STUART BRISCOE
02
Date Prepared
2015-03-16
03
Project Location
56795 JACK NICKLAUS BOULEVARD
04
Building Type
Single family
05
CA City
La Quinta
06
Dwelling Unit Name
STUART BRISCOE
07
Zip Code
92253
08
Dwelling Unit Conditioned
2800
s , ,
—•; �..
,,. r u
Floor Area (ft2)
SC System
SC System
CFA served
system a
refrigerant
Number of space conditioning
Installing
09
Climate Zone
15
10
(SC) systems in this dwelling
2
ducted
containing
system
more than 40
unit.
entirely new
B. Space Conditioning (SC) System Information
01
02
03;
05'
,} 06_
, 07 -
!08f
09
10
4
a-..
+a.,w
is the SC {�"
` Installing a
s , ,
—•; �..
,,. r u
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 (ft2)
system?
component?
components?
feet of ducts?
duct system?
SC system?
Alteration Type
System 1
Location 1
1400
Yes
Yes
Yes
No
No
No
Altered space
conditioning system
System 2
Location 2
1400
Yes
Yes
Yes
No
No
No
Altered space
conditioning system
C. Extension of Existing Duct System, Greater Than 40 Feet (Section 150.2(b)iDiib)
This section does not apply to this project.
Registration Number: 215-AO06959OA-000000000-0000
CA Building Energy Efficiency Standards - 2013 Residential Compliance
Registration Date/Time: 2015-03-16 09:31:09
Report Version: 2014-03-31
Schema Version: 0.5555DD
HERS Provider: CaICERTS
Report Generated: 2015-03-16 09:30:56
CERTIFICATE OF COMPLIANCE CF1R-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)1E 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
All new
Central split
All new
This field or
This field or
System 1
furnace
heating
AFUE
0.8
AC
cooling
SEER
19
Setback
section is not
section is not
components
components
applicable
applicable
Central gas
All new
Central split
All new
This field or
This field or
System 2
furnace
-heating
AFUE
0.8
AC
cooling
SEER
19
Setback
section is not
section is not
components
components
applicable
applicable
Reauired Documentation:
MR -MCH -01-E - Space Conditioning Systems Ducts and Fans
-Duct insulation requirement for newplenums: R6.
CF2R-MCH-20-H & MR -MCH -20-H — Duct Leakage testing required when heating or cooling components are installed inducted systems, or when more than 40 ft of duct length is replaced.
-Leakage rate compliance: s 15%, or 5 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 >_ 300:CFM/ton required when MCH -25 is required 1 ._ ' - . "0. l W
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-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)1Diia 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)iC)
This section does not apply to this project.
Registration Number: 215-AO06959OA-000000000-0000 Registration Date/Time: 2015-03-16 09:31:09 HERS Provider: CaICERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2014-03-31 Report Generated: 2015-03-16 09:30:56
Schema Version: 0.5555DD
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: ////
Jan
Jacoby, Ian
C�Iaco J
Company:
Signature Date:
Stratz Permit Service
2015-03-16 09:30:54
Address:
CEA/ HERS Certification Identification (if applicable):
5858 Dovetail Drive
City/State/Zip:
Phone:
Agoura Hills CA 91301
818-735-7876
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 Pait 6 of the Caldornia.Cocl 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 for approval with this bwldmg permit application.
5. 1 will ensure that a registered copy of this Certificate'of Compliance shall be made available with the building permit(s) issued for,the buildmg, 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:
Valdez, Dayana
Company :
Date Signed:
HARRISON ENTERPRISES INC dba GENERAL AIR CONDITIONING
2015-03-16 09:31:09
Address:
License:
31-170 RESERVE DRIVE STE A
686310
City/State/Zip: _
Phone:
THOUSAND PALMS CA 92276
(760)343-7488 - -
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: 215-A0069590A-000000000-0000 Registration Date/Time: 2015-03-16 09:31:09 HERS Provider: CaICERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2014-03-31 Report Generated: 2015-03-16 09:30:56
Schema Version: 0.555SDD
DESCRIPTION
INFORMATION
ACCOUNT
QTY AMOUNT
PAID PAID DATE.
BSAS SB1473 FEE
101-0000-20306
0 $2.00
$0.00
PAID BY
METHOD :
RECEIPT #
CHECK # CLTD BY
Total Paid for BUILDING STANDARDS ADMINISTRATION BSA $2.00 $0.00
DESCRIPTION
ACCOUNT -
QTY
AMOUNT
PAID
;PAID DATE.
HVAC CHANGEOUT - SPLIT -SYSTEM
101-0000-42402
0
$145.04
$0.00
PAID BY
METHOD;
RECEIPT # _
CHECK #
CLTD BY
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE''
HVAC CHANGEOUT - SPLIT -SYSTEM PC
101-0000-42600
0
$72.52
$0.00
PAID BY
METHOD
RECEIPT #=
CHECK #
CLTD BY
Total Paid forCHANGEOUT: $217.56 $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 forPERMIT ISSUANCE: $91.85 $0.00
TOTALS:00
Description: BRISCOE RESIDENCE HVAC CHANGE OUT
Type: MECHANICAL Subtype: Status: UNDER REVIEW Applied: 3/17/2015 MFA
Parcel No: 762070010 Site Address: 56795 JACK NICKLAUS LA QUINTA,CA 92253 Approved:
Subdivision: TR 28340-1 Block: Lot: 9 Issued:
Lot Sq Ft: 0 Building $q Ft: 0 Zoning: Finaled:
Valuation: $27,724.00 Occupancy Type: Construction Type: Expired:
No. Buildings: 0 No. Stories: 0 No. Unites: 0
Details: HVAC CHANGE OUT- REPLACE 13TON AND 14 TON19 SEER/80AFUE SPLIT SYSTEM [2008 ENERGY] CARBON MONOXIDE ALARM(S)
TO BE INSTALLED PRIOR TO FINAL INSPECTION. 2013 CALIFORNIA BUILDING CODES.
CHRONOLOGY
CONDITIONS
CONTACTS
NAME TYPE
NAME
ADDRESS1
CITY
STATE
ZIP
PHONE
FAX
EMAIL
APPLICANT
IE INC
31225 LA BAYA:
WESTLAKE
CA
91362
VILLAGE
CONTRACTOR
HARRISON ENTERPRISES INC DBA G
31-170 RESERVE DRIVE
THOUSAND
CA
92276
STE A
PALMS
OWNER
STUART BRISCOE
Printed: Tuesday, March 17, 2015 3:08:40 PM 1 of 2
Jsysrenns
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
RECEIPT #
CHECK #
METHOD
PAID BY
CLTD
BY
BSAS SB1473 FEE
101-0000-20306
0
$2.00
$0.00
Total Paid forBUILDING STANDARDS ADMINISTRATION $2,00 $0.00
BSA:
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 for PERMIT ISSUANCE: $91.85 $0.00
TOTALS:0i
INSPECTIONS
SEQID INSPECTION TYPE INSPECTOR SCHEDULED I COMPLETED
DATE DATE
I RESULT REMARKS NOTES
MECHANICAL FINAL" BLD
Printed: Tuesday, March 17, 2015 3:08:40 PM 2 of 2 C
SYSTEh1S
A Bin #City of La Q urn to .
Building 8t; Safety Division
Permit # P.O. Box 1504, 78 495 Calle Tampico .
La Quinta, CA 92253 - (760) 777-7012
Building Permit, Application and Tracking Sheet
Project Address:��7q� J GG�L 'yic1r�o�e7L5 Owner's Name: �e�sC 0 e -
A. P. Number:
Address:. (o79s J-Ae k t4iJ,. S 3ivei
Legal Description:
City, ST, Zip: LQ CA 9 Z Z S y
Contractor: 1 i^ i
Address: 3 117 C)
Telephone: )
Project Description:
City, ST, Zip: C.A ')ZZ
1 CC_i 3
Telephone: 7(tsO-3 3- ��i
:><<•;:•:<:
LA G�G r-1 V /1 GYi1 S
State Lic. # : (0$(o3 (O
CityLic. k:
Arch., Engr., Designer:
Address:
City., ST, Zip:
Telephone:
:<<>: >:>.:•>:><>:-><:>:> >-<:<<:;-:
......................................................
Construction Type: Occupancy:
State L c
Project type (circle one): New Add'n Alter Repair Demo
Name of Contact Person:
Sq. Ft.:
#Stories:
# Units:
Telephone #,of Contact Person:
/
Estimated Value of Project: Z "7 -72-4. t
# Submittal Req'd
APPLICANT: DO NOT WRITE BELOW THIS LINE
Recd TRACKING PERMIT FEES
Plan Sets
PIan Check submitted
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
i Plan Check Deposit
Truss Cala.
Called Contact Person
Plan Check Balance.
Title 24 Calcs.
Plans picked up
Construction
Floodplain plan
Plans resubmitted
Mechanical
Grading plan
2°" Review, ready for corrections/issue
Electrical
Subeontactor List
Called Contact Person
Plumbing
Grant Decd
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
'`d Rcyicrv, ready for eorrectionstiissue
Developer Impact Fee
Planning Approval
Called Contact.Person
A.I.P.P..
Pub. Wks. Appr
Date of permit issue
School Fccs
Total Permit Fees