BMCH2014-1098LICENSED 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 No.: 936600
Date: —�&q Contractor:
OWNER -BUILDER DECLARATI
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
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
Lender's
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 tk for which this permit is issued.
heW' 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 3700 of Labor Code shall forthwith
comply with those provisions.
Date: —Ol —144Applicant:
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 ve.
mentioned property for inspection purposes. n
72,90-14
Date: 2, 0—1 L Signature (Applicant or Agent):
sl� 4"Arru
VOICE (760) 777-7125
78-495 CALLE TAMPICO
D
FAX (760) 777-7011
FAX
LA QUINTA, CALIFORNIA 92253
COMMUNITY DEVELOPMENT DEPARTMENT
(760) 777-7153
BUILDING PERMIT
Date: 9/29/2014
Application Number:
BMCH2O14-1098.
Owner:
Property Address:
79110 DESERT STREAM DR
EARL PELLEGRINI
APN:
604373009
Property Zoning:
Application Valuation:
$600.00
Q
0
Applicant:
Contractor:
-9 dk6
BARNETT'S A/C
BARNETT'S A/C
w
P0BOX 741
P0BOX 741
W r;o
LA QUINTA, CA 92247
LA QUINTA, CA 92247
c Uz
(760)391-0350
Lic. No.: 936600
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 No.: 936600
Date: —�&q Contractor:
OWNER -BUILDER DECLARATI
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
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
Lender's
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 tk for which this permit is issued.
heW' 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 3700 of Labor Code shall forthwith
comply with those provisions.
Date: —Ol —144Applicant:
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 ve.
mentioned property for inspection purposes. n
72,90-14
Date: 2, 0—1 L Signature (Applicant or Agent):
CERTIFICATE OF COMPLIANCE
Alterations to Space Conditioning Systems (formerly CF -IR -ALT -HVAC)
Project Name:
langer I Date Pr,`ep��d:
CF111-ALT 02-E
(Page 1 of 4 ) I
2014-09-29 1
A. General Information NW
MR -ALT -02 is applicable to multiple space conditioning systems contained within a single dwelli urs hen multiple dwelling units must be
documented, use one CF111-ALT 02 document for each dwelling unit.
01
Project Name
langer 02
Date Prep a
2014-09-29
03
Project Location
79110 desert stream dr 04
Nr
Bu dype
Single family
OS
CA City
La Quinta 06
li Unit Name
langer
07
Zip Code
92253I3
belling Unit Conditioned
2000
CFA served
* ! �Ora
refrigerant
loor Area (ft2)
Installing
Installing
Installing
Number of space conditioning
Location or Area
09
Climate Zone
15 '10 ;
(SC) systems in this dwelling
1
entirely new
entirely new
'i'# f
unit.
Served
B. Space Conditioning (SC) System Information& 0
01
02
03
4
> 05
06
07
08
09
10
IsC
Installing a
SC System
SC System
CFA served
* ! �Ora
refrigerant
Installing new SC
Installing
Installing
Installing
Identification or
Location or Area
by this SC
cted
containing
system
more than 40
entirely new
entirely new
Name
Served
System(
tem?
component?
components?
feet of duds?
duct system?
SC system?
Alteration Type
System 1
Location 1
Yes
No
Yes
No
No
No
Altered space
conditioning system
C. Extension of Existing Duct S t reater Than 40 Feet (Section 150.2(b)iDiib)
This section does not apply to this project.
Registration Number: 214-A0103477A-000000000-0000 Registration Date/Time: HERS Provider: CaICERTS
CABuilding Energy Efficiency Standards - 2013 Residential Compliance Report Version; 2014-03-31 Report Generated: 2014-09-29 14:09:30
Schema Version: 0.551SDD
CERTIFICATE OF COMPLIANCE CFiR-ALT 02-E
Alterations to Space Conditioning Systems (formerly CF -1R -ALT -HVAC) (Page 2 of 4 )
Aft
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
I
�
Minimum
Required
New or
Identification
System
Heating
Efficiency
Efficiency
Cooling
Cooling
iency
Efficiency
Thermostat
Replaced
New Duct
or Name
Type
Components
Type
Value
System Type
Compone t
pe
Value
Type
Duct Length
R -Value
Central gas
No heating
This field or
This field or
Central split
Outdoor
This field or
This field or
System 1
furnace
component
section is not
section is not
AC
co d �g
SEER
13
Setback
section is not
section is not
altered
applicable
applicable
u�.:
applicable
applicable
ed Documentation:
CF2R-MCH-01-E -Space Conditioning Systems Ducts and Fans
2
CFR-
-Duct Insulation requirement for new plenums: R6.
CF2R-MCH-20-H & CF3R-MCH-20-H — Duct Leakage testing required when heating or cooling compo nts a installed In ducted systems, or when more than 40 ft of duct length is replaced.
-Leakage rate compliance: 515%, ors 30% leakage to outside; or, seal all accessible leaks. '
CF2R-MCH-25-H & CF3R-MCH-25-H Refrigerant Charge Verification required when refrigerantitaining components are installed or altered (applicable
CF2RCF3R-MCH-23 & CF3R-MCH-23 Air Flow, 3 300 CFM/ton requlred when MCH -25 is.required�
in CZ 2, 8-15).
Exceptions:
-Duct systems registered with HERS provider as previously sealed are exempt fro -20 Duct Leakage Testing requirements.
-Heating-only systems and Air Handler/Furnace changes do not require verificatio`j2ffW MCH -23, or Refrigerant Charge MECH-25.
-Existing duct systems constructed, Insulated or sealed with asbestos are e=pt fro�CH-20 Duct Leakage Testing requirements.
E. Entirely New or Complete Replacement DuSLR. t_ eR'!f—ith or without Equipment Changeout (Sections 150.2(b)1Diia and 150.2(b)lE, F)
0NO
O
Registration Number: 214-A0103477A-000000000-0000
This section does not apply to this project.
Registration Date/Time:
HERS Provider: CalCERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version; 2014-03-31 Report Generated: 2014-09-29 14:09:30
Schema Version: 0.551SDD
CERTIFICATE OF COMPLIANCE CF1R-ALT 02-E
Alterations to Space Conditioning Systems (formerly CF -IR -ALT -HVAC) (Page 3 of 4 )
F. Entirely New or Complete Replacement Space Conditioning System (Section 150.2(b)1C) A' j
This section does not apply to this project.
•�V
s
4
SO
0
V�
Registration Number: 214-A0103477A-000000000-0000 Registration Date/Time: HERS Provider: CaICERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version; 2014-03-31 Report Generated: 2014-09-29 14:09:30
Schema Version: 0.551SDD
CERTIFICATE OF COMPLIANCE CFiR-ALT 02-E
Alterations to Space Conditioning Systems (formerly CF -IR -ALT HVAC) (Page 4 of 4 )
Aft.
Documentation Author's Declaration Statement
1. 1 certify that this Certificate of Compliance documentation is accurate and complete.
Documentation Author Name:
Documentation Author Si n3i21 e.
Barnett, Scott
Company:
Signature Dater
BARNETT'S A/C
Address:
CEA/ HERS Ion Identification (if applicable):
51390 AVENIDA NAVARRO
City/State/Zip:
-391-0350
LA QUINTA CA 92253
(- KO'
.Responsible Person's Declaration statement _
I certify the following under penalty of perjury, under the laws of the State of Californla:
1. The information provided on this Certificate of Compliance is true and correct. -
2. I am eligible under Division 3 of the Business and professions Code to accept res on Ibility for the building, design or system design Identified on this Certificate of Compliance (responsible designer).
3. That the energy features and performance specifications, materials, compogn_,'Ran�i anufactured 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 Rel.;Iat4.
The building design features or system design features identified on t i�sete of Compliance are consistent with the information provided on other applicable compliance documents, worksheets,
calculations, plans and specifications submitted to the enforceent agen r approval with this building permit application.
S. I will ensure that a registered copy of this Certificate of Complia—Mck hall be made available with the building permit(s) issued for the building, and matle available to the enforcement agency for all applicable
inspections. I understand that a registered copy of this CWifi to o . mpliance is required to be included with the documentation the builder provides to the building owner at occupancy.
Responsible Designer Name:
Responsible Designer Signature:
Barnett, Scott
Company :Date
Signed:
OARNETT'S A/C AV",
Address:
License:
51390 AVENIDA NAVARRO
936600
City/State/Zip:
Phone:
LA QUINTA CA 92253
(760) 391-0350
ACV
Registration Number: 214-A0103477A-000000000-0000
Registration Date/Time:
HERS Provider: CaICERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance. Report Version; 2014-03-31 Report Generated: 2014-09-29 14:09:30
Schema Version: 0.551SDD
DESCRIPTION
CITY AMOUNT PAID PAID DATE
FINANCIAL INFORMATION
ACCOUNT
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
CITY
AMOUNT
PAID
PAID DATE
HVAC CHANGEOUT - CONDENSER ONLY
101-0000-42402
0
$36.26
$0.00
PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY
DESCRIPTION
ACCOUNT
CITY
AMOUNT
PAID
PAID DATE
HVAC CHANGEOUT - CONDENSER ONLY PC
101-0000-42600
0
$24.17
$0.00
PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY
Total Paid forCHANGEOUT: $60.43 $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: REPLACE CONDENSOR
CONDITIONS
Type: MECHANICAL
Subtype: Status: SUBMITTED
Applied: 9/29/2014 SKH
Approved:
Parcel No: 604373009 Site Address: 79110 DESERT STREAM DR LA QUINTA,CA 92253
Subdivision: TR 27899
Block: Lot: 29
Issued:
Lot Sq Ft: 0
Building Sq Ft: 0 Zoning:
Finaled:
Valuation: $600.00
Occupancy Type: Construction Type:
Expired:
No. Buildings: 0
No. Stories: 0 No. Unites: 0
P O BOX 741 LA QUINTA
Details: HVAC CHANGE OUT - REPLACE (1)13SEER CONDENSOR [2008 ENERGY] CARBON MONOXIDE ALARM(S) TO BE INSTALLED PRIOR TO
FINAL INSPECTION. 2013 CALIFORNIA BUILDING CODES.
CHRONOLOGY
CONDITIONS
CONTACTS
NAME TYPE NAME
ADDRESSS CITY
STATE
ZIP PHONE
FAX EMAIL
APPLICANT BARNETT'S A/C
P O BOX 741 LA QUINTA
CA
92247
CONTRACTOR BARNETT'S A/C
P O BOX 741 LA QUINTA
CA
92247
OWNER EARL PELLEGRINI
78100 MAIN ST STE 205 LA QUINTA
CA
1 92253
Printed: Monday, September 29, 2014 3:29:01 PM 1 of 2 CR—w—
SYSTEMS
Printed: Monday, September 29, 2014 3:29:01 PM 2 of 2
SYSTEMS
INSPECTIONS
SEQID INSPECTION TYPE INSPECTOR SCHEDULED COMPLETED
DATE DATE
RESULT REMARKS NOTES
MECHANICAL FINAL"
CLTD
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
RECEIPT #
CHECK #
METHOD
PAID BY
BY
HVAC CHANGEOUT -
101-0000-42402
0
$36.26
$0.00
CONDENSER ONLY
HVAC CHANGEOUT -
101-0000-42600
0
$24.17
$0.00
CONDENSER ONLY PC
Total Paid forCHANGEOUT: $60.43 $0.00
PERMIT ISSUANCE
101-0000-42404
0
$91.85
$0.00
Total Paid forPERMIT ISSUANCE: $91.85 $0.00
TOTALS:0•
Printed: Monday, September 29, 2014 3:29:01 PM 2 of 2
SYSTEMS
INSPECTIONS
SEQID INSPECTION TYPE INSPECTOR SCHEDULED COMPLETED
DATE DATE
RESULT REMARKS NOTES
MECHANICAL FINAL"
Printed: Monday, September 29, 2014 3:29:01 PM 2 of 2
SYSTEMS
Bin #
Qty of La Quznta
Building & 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: 7q&O , • —
Owner's Name:/AW1r,4,-e-
A. P. Number:
Address:`7�"0 Oec
Legal Description:
City, ST, Zip:�f f"
Contractor: �6�
Telephone:
Address:.'
Project Description:
City, ST, Zip: L• e 9,>f-
oh
Tel one:
State Lic. # : �j 6�0 0
City Lie. #c.
Arch., Engr., Designer:
Address:
City., ST, Zip:
Telephone:
w `z
cu cy:
Construction Type: Occupancy:
Add'n A]te Repair Demo ProjetYPc (circle one):
New
'tate Lic. #.
,lame,, of Contact Person:
m
Sq. Ft.:�
# Stories: r
Units:
Ccicphone # of Contact Person:
Estimated Value of Project: Q
APPLICANT: DO NOT WHITE BELOW THIS LINE
# Submittal Req'd Recd TRACTMgG PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Cala.
Reviewed, ready for corrections
Plan Cluck Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance •
Title 24 Cala.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2"' Review, ready for corrcctions/issue .
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
R.O.A. Approval
Plans resubmitted
Grading
IN IIOUSE:-
'`d Review, ready for corrections(ssue
Developer Impact Fee
Planning Approval
Called Contact Person
A.LP.P.
Pub. Wks. Appr
Date of permit issue
School Fccs
Total Permit Fees