BMCH2015-0310f
I hereby affirm under penalty of perjury one of the following declarations:
9 (commencing with Section 7000) of Division 3 of the Business and Professions Code,
_ I have and will maintain a certificate of consent to self -insure for workers'
` 78-495 CALLL TAMPICO
compensation, as provided for by Section 3700 of the Labor Code, for the performance
Ct Q
4. U
VOICE (760) 777-7125
LA QUINTA, CALIFORNIA 92253
I have and will maintain workers' compensation insurance, as required by
FAX (760) 777-7011
Section 3700 of the Labor Code, for the performance of the work for which this permit
COMMUNITY DEVELOPMENT DEPARTMENT
INSPECTIONS (760) 777-7153
Carrier:_ Policy Number:
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State
BUILDING PERMIT
License Law for the following reason (Sec. 7031.5, Business and Professions Code: Any
shall not employ any person in any manner so as to become subject to the workers
city or county that requires a permit to construct, alter, improve, demolish, or repair
compensation laws of California, and agree that, if I sh9Qd become subject to the
Date: 8/11/2015
Application Number:
BMCH2O15-0310
comply with those ovisions.
.�
Date: Applicant:
Owner:
Property Address:
78085 AVENIDA LA FONDA
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL,
FORTUNE PROP
APN:
770122003
ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION TO THE COST OF
Property Zoning:
himself or herself through his or her own employees, provided that the improvements
APPLICANT ACKNOWLEDGEMENT
Application Valuation:
$8,000.00
within one year of completion, the owner -builder will have the burden of proving that
the conditions and restrictions set forth on this application.
Applicant:
ARNOLDS A / C SERVICE
76987 OKLAHOMA AVE
PALM DESERT, CA 92211
Contractor:
ARNOLDS A / C SERVICE
76987 OKLAHOMA AVE
PALM DESERT, CA 92211
(760)772-3731
Llc. No.: 860682
LICENSED CONTRACTOR'S DECLARATION I WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter
I hereby affirm under penalty of perjury one of the following declarations:
9 (commencing with Section 7000) of Division 3 of the Business and Professions Code,
_ I have and will maintain a certificate of consent to self -insure for workers'
and my License is in full force and effect.
compensation, as provided for by Section 3700 of the Labor Code, for the performance
License Clas : C2 License No.: 860682
of the work for which this permit is issued.
Q <
I have and will maintain workers' compensation insurance, as required by
Date: v , Contractor:
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:
OWNER -BUILDER DECLARATION
Carrier:_ Policy Number:
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State
I certify that in the performance of the work for which this permit is issu d, I
License Law for the following reason (Sec. 7031.5, Business and Professions Code: Any
shall not employ any person in any manner so as to become subject to the workers
city or county that requires a permit to construct, alter, improve, demolish, or repair
compensation laws of California, and agree that, if I sh9Qd become subject to the
any structure, prior to its issuance, also requires the applicant for the permit to file a
orkers' compensation provisions of Section 370 the abor C'90e, I shall forthwith
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 Divisio
of the Business and Professions Code) or that he or she is exempt therefrom and th
comply with those ovisions.
.�
Date: Applicant:
basis for the alleged exemption. Any violation of Section 7031.5 by any applicant f r a
permit subjects the applicant to a civil penalty of not more than five hundred do rs
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL,
($500).:
AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO
(1 1, as owner of the property, or my employees with wages as their sole
ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION TO THE COST OF
compensation, will do the work, and the structure is not intended or offered for sale.
COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,
(Sec. 7044, Business and Professions Code: The Contractors' State License Law does not
INTEREST, AND ATTORNEY'S FEES.
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
APPLICANT ACKNOWLEDGEMENT
are not intended or offered for sale. If, however, the building or improvement is sold
IMPORTANT: Application is hereby made to the Building Official for a permit subject to
within one year of completion, the owner -builder will have the burden of proving that
the conditions and restrictions set forth on this application.
he or she did not build or improve for the purpose of sale.).
1. Each person upon whose behalf this application is made, each person at whose
(1 1, as owner of the property, am exclusively contracting with licensed contractors
request and for whose benefit work is performed under or pursuant to any permit
to construct the project. (Sec. 7044, Business and Professions Code: The Contractors'
issued as a result of this application , the owner, and the applicant, each agrees to, and
State License Law does not apply to an owner of property who builds or improves
shall defend, indemnify and hold harmless the City of La Quinta, its officers, agents, and
thereon, and who contracts for the projects with a contractor(s) licensed pursuant to
employees for any act or omission related to the work being performed under or
the Contractors' State License Law.).
following issuance of this permit.
(� I am exempt under Sec. B.&P.C. for this reason
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.
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 N
Lender's Add
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 relatingAo building
construction, and hereby authorize representatives acieer o above-
mentionedop22 for inspection purposes:
Date: Signature (Applicant or Ag
- DESCRIPTION
FINANCIAL •!•
ACCOUNT QTY.' AMOUNT
PAID
PAID DATE
BSAS SB1473 FEE
101-0000-20306 0 $1.00
$0.00
PAID BY
METHOD RECEIPT #
CHECK #
CLTD BY
Total Paid forBUILDING STANDARDS ADMINISTRATION BSA $1.00 $0.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
HVAC CHANGEOUT - PACKAGED UNIT _
101-0000-42402
0
$36.26
$0.00
PAID BY .
METHOD-
RECEIPT #
CHECK #
CLTD BY
DESCRIPTION
ACCOUNT
QTY -
AMOUNT
PAID
PAID DATE
HVAC CHANGEOUT - PACKAGED UNIT PC
101-0000-42600
0
$24.17
$0.00
PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY
Total Paid for CHANGEOUT: $60.43 $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: FORTUN RESIDENCE REPLACDE ROOF TOP PACKAGE UNIT
Type: MECHANICAL Subtype: Status: UNDER REVIEW
Applied: 8/11/2015 PJU
Approved:
Parcel No: 770122003 Site Address: 78085 AVENIDA LA FONDA LA QUINTA,CA 92253
Subdivision: DESERT CLUB TR UNIT 4 Block: Lot: 7
Issued:
Lot Scl Ft: 0 Building Sq Ft: 0 Zoning:
Finaled:
Valuation: $8,000.00 Occupancy Type: Construction Type:
Expired:
No. Buildings: 0 No. Stories: 0 No. Unites: 0
Details: REPLACE EXISTING PACKAGED UNIT SAME FOR SAME EXISTING PARAPIT WALL TO HIDE UNIT 14 SEER 80% AFUE 2013 CALIFORNIA
MECHANICAL CODES. 2008 ENERGY) CARBON MONOXIDE ALARM(S) TO BE INSTALLED PRIOR TO FINAL INSPECTION..
DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE RECEIPT # CHECK # METHOD PAID BY CLTD
BY
BSAS SB1473 FEE 101-0000-20306 0 $1.00 $0.00
Total Paid forBUILDING STANDARDS ADMINISTRATION $1.00 $0.00
BSA:
Printed: Tuesday, August 11, 2015 1:45:14 PM 1 of 2
SYSTEMS
CHRONOLOGY
CONDITIONS
NAME TYPE
NAME
ADDRESSI
CONTACTS
CITY
STATE
ZIP
PHONE FAX EMAIL
APPLICANT
ARNOLDS A / C SERVICE
76987 OKLAHOMA AVE
PALM DESERT
CA
92211.
.(760)391-3892
CONTRACTOR
ARNOLDS A / C SERVICE
76987 OKLAHOMA AVE
PALM DESERT
CA
92211
(760)391-3892
OWNER
FORTUNE PROP
5800 125TH LN NE
KIRKLAND
WA
92253
(760)391-3892
DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE RECEIPT # CHECK # METHOD PAID BY CLTD
BY
BSAS SB1473 FEE 101-0000-20306 0 $1.00 $0.00
Total Paid forBUILDING STANDARDS ADMINISTRATION $1.00 $0.00
BSA:
Printed: Tuesday, August 11, 2015 1:45:14 PM 1 of 2
SYSTEMS
INSPECTIONS
SEQID INSPECTION TYPE INSPECTOR SCHEDULED COMPLETED
DATE DATE
RESULT REMARKS NOTES
MECHANICAL FINAL" BLD
LTD.
C
DESCRIPTION
ACCOUNT'
QTY
AMOUNT
PAID
PAID DATE
RECEIPT #
CHECK #
METHOD
PAID BY
BY
BY
HVAC CHANGEOUT -
101-0000-42402
0
$36.26
$0.00
PACKAGED UNIT
HVAC CHANGEOUT -
101-0000-42600
0
$24.17
$0.00
PACKAGED UNIT PC
Total Paid forCHANGEOUT: $60.43 $0.00
PERMIT ISSUANCE
101-0000-42404
0
$91.85
$0.00
Total Paid for PERMIT ISSUANCE: $91.85 $0.00
TOTALS:00
INSPECTIONS
SEQID INSPECTION TYPE INSPECTOR SCHEDULED COMPLETED
DATE DATE
RESULT REMARKS NOTES
MECHANICAL FINAL" BLD
1. PARENT PROJECTS
Printed:. Tuesday, August 11, 2015 1:45:14 PM 2 of 2
sysrrMs
Bin #
Cit} of La Quinta
Building 8I• Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet.
Permit #
Project Address: —
Owner's Name:
A. P. Number:
Address:
Legal Description:
City, ST, Zip: L - z
Contractor: r�
f
Telephone:
Address: O
Project Description:
City, ST, Zip:�yv�
Telephone •
.
Dna
G
State Lic. # : Q$� city Lie. #;
(J - l M6,k,
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone:
`:
Can truct
s ton Type: Occupancy:
State Ltc. #
Sta•
Project type (circle r le ne • New Add'n Alter Repair Demo
Name of Contact Person: rC'e (�
Sq. Ft.:
# Stories:
# Units:
Telephone # of Contact Person: —
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
/i
Submittal
Req'd
Recd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance
Title 24 Cates.
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.
H.O.A. Approval
Plans resubmitted
Grading
IN ROUSE:-
'"' 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 Fees
4 2-�-11 C/o r
STATE OF CALIFORNIA
ALTERATIONS v- HVAC
Mil
CEC-CFIR-ALT-04-E Revised 06/14 CALIFORNIA ENERGY COMMISSION
CERTIFICATE OF COMPLIANCE CF111-ALT-04-E
Alterations - HVAC CZ 2, and 8-15 (formerly CF -IR -ALT -HVAC) (Page 1 of 1)
Site Address:r-- — � V� �
Enforcement Agency:
Date Prepared:
Permitil:
EquipmentType1�
EquipmentEfficiencyNew
Ducting, Plenums, Lineset:
Conditioned
Thermostat
Required R -value
Floor Area (sq ft)
Packaged System
❑ Evaporator Coll
AFUE
COP
❑ R-6 (CZ 2, 8-13) Ducting
Served by system
❑ Setback
❑ Split System
❑ Condensing Unit
❑ R-8' (CZ 11, 14, 15) Ducting
sqft
(If not already
❑ Mini Split
❑ Compressor
SEER
HSPFpresent,
❑ R-6 (all CZ's) Plenums
must
❑ Furnace
❑ Lineset
EER
❑ R-5 or R7.5) Lineset°
be installed)
❑ TXV
HERS VERIFICATION SUMMARY Installer determines work to be completed and matches to one of the options below. At permit application this
for is allowed to be filled out by hand. For final inspection all forms are to be registered (no hand filled forms allowed) and a copy left on site.
JX 1. HVAC Changeout/Repair
Required Compliance Documents to be left on site for Final:
All Equipment,
CF1R-ALT-02-E
Condenser Unit, Evaporator Coil,
CF2R: MECH-01, MECH-20-HERS, MECH-(23 or 24)Z -HERS, MECH-25-HERS2
Compressor, TXV, Lineset,
CF3R: MECH-20-HERS, MECH-(23 or 24)-HERS2, MECH-25-HERS2
Air Handler/FurnaceZ (Can include new ducting)
Installer Requirement: Duct leakage (< 15%, or < 10% to outside, or seal all accessible leaks), Air Flow 2 300 CFM/ton, Refrigerant Charge.
Exempted from duct leakage testing if:
❑ 1. Duct system registered with HERS provider as previously sealed, or,® 2. There is less than 40 linear feet of duct in unconditioned space, or
❑ 3. Existing duct systems are constructed, insulated or sealed with asbestos (list manufacture date of building .......
❑ 2. New HVAC System
Required Compliance Documents to be left on site for Final:
All new equipment and All New Ducts'
CF1R-ALT-02-E
including Mini Split
CF2R: MECH-01, MECH-20-HERS, MECH-22-HERS, MECH-(23 or 24)-HERSZ, MECH-25-HERS2
CF3R: MECH-20-HERS, MECH-22-HERS, MECH-(23 or 24) -HERS', MECH-25-HERS2
Mini Splits require CF1R-ALT-02-E, CF2R-MECH-01, and (CF2R-CF3R) MECH-25-HERS
Installer Requirement: Duct leakage < 6%, Fan Efficacy (.58W/CFM), Air Flow i 350 CFM/ton (or alternative), Refrigerant Charge
113. All New Ducts with Replacement Required Compliance Documents to be left on site for Final:
All New Ducts' and one or more of the following CF1R-ALT-02-E
replaced: Condenser Unit, Evaporator Coil, CF2R: MECH-01, MECH-20-HERS, MECH-(23 or 24) -HERS, MECH-25-HERS
Compressor, TXV, Lineset, Furnace CF3R: MECH-20-HERS, MECH-(23 or 24) -HERS, MECH-25-HERS
Installer Requirement: Duct leakage < 6%, Air Flow a 350 CFM/ton (or alternative), Refrigerant Charge
Exempted from duct leakage testing if: ❑ 1. Existing duct systems are constructed, insulated or sealed with asbestos
❑ 4. New Ducting over 40 feet Required Compliance Documents to be left on site for Final:
New ducting but less than All New Ducts' CF1R-ALT-02-E, CF2R: MECH-20-HERS, CF3R: MECH-20-HERS
Installer Required to: Duct leakage (:<_15% or, < 10% to outside or, or seal all accessible leaks)
❑ EXCEPTION: Existing duct systems constructed, insulated or sealed with asbestos.
' All new ducting R-8 required when more than 40 ft installed and R-6 when less than 40 ft installed. This includes in walls, between floors etc.
Z Heating only systems and Air Handler/Furnace changes do not require Air Flow MECH-(23 or 24), or Refrigerant Charge verification MECH-25
' All New Ducts is when at least 75 percent of the duct system is new duct material, and up to 25 percent may consist of reused parts frotrr the
dwelling unit's existing duct system (e.g., registers, grilles, boots, air handler, coil, plenums, duct material)
° R-5 (1" thick insulation) for linesets 1" and less. R-7.5 (1.5" thick insulation) for linesets over 1 inch. Most mfg will require Suction line Diameter
with insulation as the following 1.5-2T-2%", 2.5-3T-2'/<", 3.5 to 4T-2%", 5T-4%"
Contractor (Documentation Author's /Responsible Designer'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 California Business and Professions Code to accept responsibility for the information on this document.
3. That the energy features and performance specifications for the design identified on this Certificate of Compliance conform to the
requirements of Title 24, Parts 1 and 6 of the California Code of Regulations (CCR).
4. 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 CCR.
5. 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, va4ksheets, calculations, plans and specifications submitted to the enforcement
agency for approval with this building permit apptWirtioJil/ If
R onsible De' am
�a,v
Responsib Desi Sign u
Date Sign d:
L'
Co any:
—
Ad ress:
ate/Zip:—
,
Phone:N
3�3�
For assistance or questions regarding the Energy Standards, contact the Energy Hotline at: 1-800-772-3300