BMCH2016-0219n
78-495 CALLE TAMPICO
LA QUINTA,.CALIFORNIA 92253
Tit!t 4 -4 QuiRto
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING PERMIT
Application Number:
BMCH2O16-0219
Property Address:
79180 LAURIE CT
APN:
604343007
Application Description:
BENNER RESIDENCE / HVAC CHAN
Property Zoning:
Application Valuation:
$9,550.00
Applicant:
IE INC
31225 LA BAYA
WESTLAKE VILLAGE, CA 91362
GEOUTJUN 17- 2J
CITY OF LA OURNTA
CO.'JIP.L' i<ITY DEVELOPMENT DEPP,PTMEI,'T
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, C36 License No.: 977333
CDate:- ' nil lu 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.). .
(_) 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. Q.
Lender's Name:
Lender's
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 6/17/2016
Owner:
MICHAEL BENNER
79180 LAURIE CT
LA QUINTA, CA 92253
Contractor:
A#1 SERVICES HEATING & AIR CONDITIONING
78206 VARNER ROAD #D-189
PALM DESERT, CA 92211
(760)342-3610
Llc. No.: 977333
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 polity 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 3700 of the Labor Code, I shall forthwith
comply with those provisions.
Date: (011-711L. 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 enter upon the
above-mentioned property for inspection purposes.
Date: Signature (Applicant or Agent): 12� Y�
FINANCIAL INFORMATION
DESCRIPTION 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
CITY
AMOUNT
PAID
PAID DATE
HVAC CHANGEOUT - SPLIT -SYSTEM
101-0000-42402
0
$72.52
$0.00
PAID BY -
METHOD
RECEIPT #
CHECK #
CLTD BY
DESCRIPTION
ACCOUNT
CITY
AMOUNT
PAID
PAID DATE
HVAC CHANGEOUT - SPLIT -SYSTEM PC
101-0000-42600
0
$36.26
$0.00
PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY
Total Paid for CHANGEOUT: $108.78 $0.00
DESCRIPTION
ACCOUNT
CITY.
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:00
Description: BENNER RESIDENCE / HVAC CHANGE OUT
CONDITIONS
Type: MECHANICAL Subtype: Status: APPROVED
Applied: 6/17/2016 MFA
Parcel No: 604343007 Site Address: 79180 LAURIE CT LA QUINTA,CA 92253
Approved: 6/17/2016 MFA
Subdivision: TR 25363-1 Block: Lot: 26
Issued:
Lot Sq Ft: 0 Building Sq Ft: 0 Zoning:
Finaled:
Valuation: $9,550.00 Occupancy Type: Construction Type:
ADDRESSI
Expired:
No. Buildings: 0 No. Stories: 0 No. Unites: 0
ZIP
PHONE
Details: HVAC CHANGE OUT - 16 SEER/80AFUE SPLIT SYSTEM [2008 ENERGY] CARBON MONOXIDE ALARM(S)
TO BE INSTALLED PRIOR TO
FINAL INSPECTION. PER 2013 CALIFORNIA BUILDING CODES.
IE INC
CHRONOLOGY
CONDITIONS
CONTACTS
NAME TYPE
NAME
ADDRESSI
CITY
STATE
ZIP
PHONE
FAX
EMAIL
APPLICANT
IE INC
31225 LA BAYA
WESTLAKE
VILLAGE
CA
91362
(760)485-2750
CONTRACTOR
A#1 SERVICES HEATING & AIR
CONDITIONING
78206 VARNER ROAD
#D-189
PALM DESERT CA
92211
(760)485-2750
OWNER
MICHAEL BENNER
79180 LAURIE CT
LA QUINTA CA
92253
(760)485-2750
Printed:'Friday, June 17, 2016 3:12:17 PM 1 of 2 0SYSTEMs
INSPECTIONS
Printed: Friday, June 17, 2016 3:12.:17 PM 2 of 2 a SYSTEMS
_j'
CLTD
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
RECEIPT #
CHECK #
METHOD
PAID BY
t—
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
$72.52
$0.00
SPLIT -SYSTEM
HVAC CHANGEOUT -
101-0000-42600
0
$36.26
$0.00
SPLIT -SYSTEM PC
Total Paid for CHANGEOUT: $108.78 $0.00
PERMIT ISSUANCE
101-0000-42404
0
$91.85
$0.00
Total Paid for PERMIT ISSUANCE: $91.85 $0.00
TOTALS:00
INSPECTIONS
Printed: Friday, June 17, 2016 3:12.:17 PM 2 of 2 a SYSTEMS
City ofLa Qulrtta
. arMety Darvon
P.O Box fSO4,•78-495CageT=pko
Ld Qdnt4 CA 92253 --(760) 777-7012
Building Pem* Application and Tracking Sheet
Permit
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CERTIFICATE OF COMPLIANCE
Alterations to Space Conditioning Systems (formerly CF -IR -ALT HVAC)
Project Name:
JANINE BENNER I Date Prepared:
CF1R-ALT-02-E
(Page 1 of 3 )
2016-06-17
A. General Information
MR -ALT -02 is applicable to multiple space conditioning systems contained within a single dwelling unit. When multiple dwelling units must be documented,
use one MR -ALT -02 document for each dwelling unit.
01
Project Name
JANINE BENNER
02
Date Prepared
2016-06-17
03
Project Location
79180 LAURIE COURT
04
Building Type
Single family
05
CA City
La Quinta
06
Dwelling Unit Name
JANINE BENNER
07
Zip Code
92253
08
Dwelling Unit Conditioned
1618
Installing new SC
i�lnstalling
llInstalling
Installing
Floor Area (ft2)
Identification or
Location or Area
by this SC
ducted
co taining
Number of space conditioning
more than 40
09
Climate Zone
15
10
(SC) systems in this dwelling
1
system?
component?
components?
feet of ducts?
unit.
SC system?
T
B. Space Conditioning (SC) System lnformation� A "
Ir::*
n F7
e=,'
01
02
03 '�
04
05
x^-06
07
0$
1.
09
10
N
Y% the SC'""
Installing a
SC System
SC System
CFA served
-,system +4
refrigerant t
Installing new SC
i�lnstalling
llInstalling
Installing
Identification or
Location or Area
by this SC
ducted
co taining
system
more than 40
ent ely a
entirely new
Name .
Served •
System (ft2)
system?
component?
components?
feet of ducts?
duct system?
SC system?
Alteration Type
System 1
Location'l
1618
Yes
Yes
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: 216-A0224263A-000000000-0000
Registration Date/Time: 2016-06-17 08:41:59
HERS Provider: CalCERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013 Rev 1.007 Report Generated: 2016-06-17 08:42:24
Schema Version: 0.555SDD
CERTIFICATE OF COMPLIANCE CF111-ALT-02-E
Alterations to Space Conditioning Systems (formerly CF -111 -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
80
AC
cooling
SEER
16
Setback
section is not
section is not
components
components
applicable
applicable
Required Documentation:
CF211-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: 5 15%, or 510% leakage to outside, or seal all accessible leaks.
CF2R-MCH-25-H & CF311-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 1300 CFM/ton required when MCH -25 is required.
Exceptions:
-Duct systems registered with HERS provider is previously sealed are exempt from MCH -20 Duct Leakage Testing requirements.. wrrau�
""
-Heating-only systems and Air Handler/Furnace changes do not require verification of Air Flow.MCH 23 or'Refrigerant Charge IVIECH=25
Existing duct systems constructed, insulated or sealed with asbestos are exempt;from MCH 20 DuKeakage Testing regwremer's`.
' '4 +tea � -,: � �.. +-A.-.+,r.. a-. v.+i w+ ,+w..•' �i �.. ..F +w z-....,. �,:
E. Entirely New or Complete Replacement DuctrSystem, with or without.;Equipment Changeout (Sections 150.2(b)1Diia,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-A0224263A-000000000-0000 Registration Date/Time: 2016-06-17 08:41:59 HERS Provider: CaICERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013 Rev 1.007 Report Generated: 2016-06-17 08:42:24
Schema Version: O.SSSSDD
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
�acobJc
Company:
Signature Date:
i PERMIT E RATERS
2016-06-17 08:41:59
Address:
CEA/ HERS Certification Identification (if applicable):
31225 La Baya Drive #213
City/State/Zip:
Phone:
West Lake Village CA 91.362 !
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 Professlon's 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 ofRegulat ons
I f 75' `.
0
4. The building design features or system design features, identified on this Certificate of Compliance are consistent with the information provided on other,applicab1lernmpliance documents, worksheets,
calculations, plans and specifications submitted toothe enforcement}agency for with,this building permit application.'
-approval
��+, x r k i :9 ..�
S. I will ensure that a registered copy of this Certificate of Compliance shall.be made.available withahe bulldfng per'mtt(s) Issued forat e;building, and made available tot, e,ehforcement agency for all applicable
inspections. I understand that a registered copy of this Certificate of Compliance.is:required to be -included with the.documentation.tthe bullder provides. to the building owner at occupancy.
Responsible Designer Name:
Responsible Designer Signature: /
An
Jacoby, Ian
�acob'
Company:
Date Signed:
A 1 SERVICES
2016-06-17 08:41:59
Address:
License:
74866 Lennon PI
977333
City/State/Zip:
Phone:
Palm Desert CA 92260
760-565-2269 1
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.
Registration Number: 216-A0224263A-000000000-0000 Registration Date/Time: 2016-06-17 08:41:59 HERS Provider: CaICERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013 Rev 1.007 Report Generated: 2016-06-17 08:42:24
Schema Version: 0.555SDD