BMCH2015-021478-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Twit °F rwQ�rw
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING PERMIT
Application Number: BMCH2O15-0214 �1Z
Property Address:t S�-3460 AVENIDAA4A9ERO
APN: d ( 774032023
Application Description: SLEZACK RESIDENCE HVAC CHANGE
Property Zoning:
Application Valuation: $6,385.00 .
Applicant:
IE INC:
32115 LA BAYA
WESTLAKE VILLAGE, CA 91362
JUN 18 2015
CITY OF LA QUINTA
!COMMUNITY DEVELOPMENtDEPARTMENT
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.: 968141
Date: rContractor
OWNER -BUILDER DECLARATIO
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. C.).
Lender's Name:
Lender's Address:
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 6/18/2015
Owner:
SLEZAK MADERO TRUST
Contractor:
HARRISON ENTERPRISES INC DBA D
31170 RESERVE DRIVE
THOUSAND PALMS, CA 92276
(760)343-5562
Llc. No.: 968141
WORKER'S COMPENSATION DECLARATION
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
Df the work f Fwhich this permit is issued.
ave 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 the Labor Code, I shall forthwith
complywith hose provisions.
Date: App i nca tl
t
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION CO AGE IS UNLAW L,
AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP O
ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION TO THE COST OF
COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,
INTEREST, AND ATTORNEY'S FEES.
APPLICANT ACKNOWLEDGEMENT
IMPORTANT: Application is hereby made to the Building Official for a permit subject to
the conditions and restrictions set forth on this application.
1. Each person upon whose behalf this application is made, each person at whose
request and for whose benefit work is performed under or pursuant to any permit
issued as a result of this application , the owner, and the applicant, each agrees to, and
shall defend, indemnify and hold harmless the City of la Quinta, its officers, agents, and
employees for any act or omission related to the work being performed under or
following issuance of this permit.
2. Any permit issued as a result of this application becomes null and void if work is
not commenced within 180 days from date of issuance of such permit, or cessation of
work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is correct.
I agree to comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives of this city to enter upon the above- .
mentioned property for inspection purposes.
Date: [ �Signatuee (Applicant or Ag
Citijr of La Quinta
sr Safety DivUm
P.O. Box 1504,'78495 Calve Tampka
LaQrrl..24 CA 92253 - (760) 777-7012
o2t'4-1 Building Permit Applicadon and Tracidng Sheet
pmt #
13 M C I '2p t �
ProjedAddtess: 53160 AVENIDA MADERO
owawsNnma. JACKLINE SLEZACK
A. P. Number.
Addn=:
ramal Dew ipdon:
Contractor. ESS ER SERVICES
city, sT, zip:
Tdeowne:
Address: P.O. BOX 1636
PmjeaD=iption: CHANGE OUT A/C 3 1/2
Citr.$'.ZiP: CATHEDRAL CITY, CA . 92235
Telephone: 760-324-0550
FURNACE 70,000 BTU, (1) RETURN .&
REPLACE EXISTING (8) REGISTERS
State Lim N: 489046. City Lia C.
Arch., EW..
Addre=
C'*. ST. Zip.
Tckph m: Caristruction Type: Occtipaucy:
State Lic. 8: project type (*de one): New AcWn Alter Repair Dem
Name of Conw Person: MICHAEL ESSER Sq. Ft.: d Stoner. q Unita
Telephone it of Contact Petsmr: Estimn6od• Value of Projoct 6385.00
APPLICANT: DO NOT WRITE BMOW THIS LINE
N Sabmitttl Req'd Reed TRACXIG PERK[T"FEES
P[aa Seb
Plan Chock submitted Item Amount
Structural Cales.
Revkn,4 ready for cornetiont Plan Ckedc Deposit.
Trust Cates.
Called Cbntaet Person Plan Ctuek Balance
Twe 24 calci.
Plans pkw up Construction
Flood Plain plan
Plans resubmitted Meebartal
Gradin Plan
T! Review, rndy for eerreetionsJasue Electrical
Sabeonaetor list
Called Contact Person Plambiag
Grant Deed
Plans piled up SAU
H.O.A. Approval
Plant ruabmitted Grading
IN HOUSE:-
''' Review; ready for eorrecdons/issue Developer Impact Fee
Planning AAPr m al
Called Contact Person
Pub. Wks ApprDate
Of permit issue,
School Fes
Total Permit Fees
CERTIFICATE OF COMPLIANCE CF111-ALT-02-E
Alterations to Space Conditioning Systems (formerly CF -IR -ALT -HVAC) (Page 1 of 3 )
Project Name: JACKLINE SLEZACK Date Prepared: 2015-06-16
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 CFIR-ALT 02 document for each dwelling unit.
01
Project Name
JACKLINE SLEZACK
02
Date Prepared
2015-06-16
03
Project Location
53160 AVENIDA MADERO
04
Building Type
Single family
05
CA City
La Quinta
06
Dwelling Unit Name
JACKLINE SLEZACK
SC System
SC System *
' CFA served
Dwelling Unit Conditioned
refrige�r nt
07
Zip Code
92253 s
08
Floor Area (ft2)
1300
Location or Area
by this SC
?'Number
containing
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?
B. Space Conditioning (SC) System Information
01
02r
,'U3',e+.
04
}
X05 1r.
1I "6
07
�8:
09
10
ti
�Is the SC '
a b ::a=cu "
Installing a
u to 1"
SC System
SC System *
' CFA served
' system aI
refrige�r nt
installing ew SC
�In,,stAih g f
tln talli g
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
1300
Yes
Yes
Yes
Yes
No
No
Altered space
conditioning system
C. Extension of Existing Duct System, Greater Than 40 Feet (Section 150.2(b)1Dilb)
This section does not apply to this project.
Registration Number: 215-A0161303A-000000000-0000 Registration Date/Time: 2015-06-16 16:45:42 HERS Provider: CalCERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2014-03-31 Report Generated: 2015-06-16 16:21:31
Schema Version: 0.555SDD
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
Dud Length
R -Value
System 1
Central gas
All new
heating
AFUE
0.8
Central split
All new
cooling
SEER
13
Setback
Greater than
R-8
furnace
AC
40 feet
components
components
Required Documentation: t,
CF2R-MCH-01-E - Space Conditioning Systems Ducts and Fans':•
-Duct insulation requirement for new plenums: R6. " `a
CF2R-MCH-20-H & MR -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 510% leakage to outside,` o' 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 Flo'w2 300 CFM/ton required when MCW2.5.is required.
Exceptions:
oft Now
-Duct systems registered with HERS provider as previously sealed are: exempt from MCH -20 -,Duct Loom eakage Testing requirements
Heating -only systems and Air Handler/Furnace changes do: not require verification of Air F MCH -23 or Refrige ant Charge MECH-25,':
S
I
Existing duct systems constructed, insulated or sealed with:asbestos,are exempt from MGH -20 Duct Leakage Testingrequirements.
-nr
R
E. Entirely New or Complete Replacement Duct System, with or without Equ pment Changes ut (Sectiotl5 15Q.2(b D!i nd 0.2(b)U, 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-A0161303A-000000000-0000 Registration Date/Time: 2015-06-16 16:45:42 HERS Provider: CalCERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2014-03-31 Report Generated: 2015-06-16 16:21:31
Schema Version: 0.555SDD
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:
Jacoby, Ian
L;an dacobJr
Company:
Signature Date:
Stratz Permit Service
2015-06-16 16:21:19
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 land Part 6 of the California Code ofRegUlations.
jr
4. The building design features or system design features identified on this Certificate of Compliance are co nsistent,withithe information.p vided on other appliwlile compliance documents, worksheets,
calculations, plans and specifications submitted to the enforcement agency for approval with this butlding permit application.
5. 1 will ensure that a registered copy of this Certifica 00%, f.Compliance shallbe: rr atle available vvitb%WO b�uildi�g pe�mit(s),issued forathe'tiuildi g, and made aval.lablMo th enforcement agency for all applicable
inspections. I understand that a registered copy of this Certificate of Compl ance�; requvged to be mduded witwh thudocum�nt anon the.builder provides tphe build ng owner at occupancy.
Responsible Designer Name: � '� � i :�
ir ' .
Responsible Designerg Signature: �' rA
WGad
Esser, Michael
lv
Company:
Date Signed:
ESSER SERVICES INC
2015-06-16 16:45:42
Address:
License:
P 0 BOX 1636
489046
City/State/Zip:
Phone:
CATHEDRAL CITY CA 92235
(760) 324-0550
Digitally signed by CaICERTS. This digital signature is provided in order to secure the content of this registered document and in noway implies Registration Provider responsibility for the accuracy of the information.
Registration Number: 215-A0161303A-000000000-0000 Registration Date/Time: 2015-06-16 16:45:42 HERS Provider: CaICERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2014-03-31 Report Generated: 2015-06-16 16:21:31
Schema Version: 0.555SDD
,yn
`E PAID PAID DATE.
Y,yA000UNT,
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BSAS SB1473 FEE 101-0000-20306
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Total Paid forBUILDING STANDARDS ADMINISTRATION BSA$1.00 $0.00
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DESCRIPTIONu s QTY'AMOUNT°
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4&VAMOUNT�
°PAID
o-PAIDDATE:
} z a..-'�_
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Ett
HVAC CHANGEOUT -'SPLIT-SYSTEM
101-0000-42402
0
$72.52
$0.00
'.`°
PAID413i,BY
'{ 4 5.: qz�<Y"w. ,.r�#''.
METHOD;
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RECEIPTS#
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CL'TD BY
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< ^DESCRIPTION
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PAID
PAID_'DATE
z �K? x . c
CITY
AMOUNT
HVAC CHANGEOUT - SPLIT -SYSTEM PC
101-0000-42600
0
$36.26
$0.00
METHOD
RECEIPT #
CHECK #
CLTD BY
W b
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Total Paid forC<H�ANGEOUT:. $108.78 $0.00 .
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ACCOUNT
.:�.�3<
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DATE:
DESCRIPTION ; ��
A o-
QTYP
,.i�'!S��Y.k
AMOUNT r
PAID
PAID
PERMIT ISSUANCE
101-0000-42404
0
$91.85
$0.00
i�: �F �� �
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Total Paid forPERMIT ISSUANCE: $91.85 $0.00
e;$201.63,��
,
Description: SLEZACK RESIDENCE HVAC CHANGE OUT
Type: MECHANICAL
Subtype:
Status: UNDER REVIEW
Applied: 6/18/2015 EVA
Approved:
Parcel No: 774032023 Site Address: 53160 AVENIDA MADERO LA QUINTA,CA 92253
Subdivision: SANTA CARMELITA
VALE LA QUINTA Block: 179
Lot: 17
Issued:
UNIT 18
CONTACTS
CITY
._.STATE
ZIP
Lot Sq Ft: 0
Building Sq Ft: 0
Zoning:
Finaled:
Valuation: $6,385.00
Occupancy Type:
Construction Type:
Expired:
No. Buildings: 0
No. Stories: 0
No. Unites: 0
31170 RESERVE DRIVE
Details:
CA
92276
(
FINANCIAL INFORMATION
Printed: Thursday, June 18, 2015 9:12:02 AM 1 of 2 CRNI
IWEY SYSTEMS
DESCRIPTION
ACCOUNT'
QTY
AMOUNT
PAID
PAID DATE
RECEIPT #
CHECK # y
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:
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 forCHANGEOUT: $108.78 $0.00
PERMIT ISSUANCE
101-0000-42404
0
$91.85
$0.00
Total Paid for PERMIT ISSUANCE: $91.85 $0.00
r 00
INSPECTIONS
.SEQID INSPECTION TYPE INSPECTOR SCHEDULED COMPLETED
DATE DATE
RESULT REMARKS NOTES
MECHANICAL FINAL" BLD
Printed: Thursday, June 18, 2015 9:12:02 AM 2 of 2
UILY SYSTEMS
Bin. i9 �� of,.La Qullita
Btl kIbw a Safety Dwon
Pen-nit # P.O. Box 1504,18-495 Cage Taq*0
La..Qdnta, CA 92253 --(760) 777-7012
M c 12 11, Building Permit Application and Tracking Sheet
PmjcdAddrcss: 51$45 AVz.,�dC �cx2_ { Owner'sNeme:. JACKLINE SLEZACK '
A P. NumberAddt=-
-512'15 AYex�%cic3- INa —
uaal tli":
city, sr, zip: LA QUI NTA, CA 92253
Contractor. ESSER SERVICES
Telephone:
Address: P.O. BOX 1636
Projeanes«iption: CHANGE OUT A/C 3 1/2
CitOT-4: CATHEDRAL CITY, CA .
92235 FURNACE 70,000 BTU, (1) RETURN .&
Telephone: 760-324-0550REPLACE
State Lir- N: 489046. City
EXISTING (8) REGISTERS
Lie, 9,
Ard, EW-.
Address
City ST. Zip -
Telephone: Consttttcdon Type:. oc-6 cy:
State Lic, 9: Project type (*dc oak): New Add'n Alter Repair Dena
Name of Conw Person: MICHAEL E S S E R Sq. Ft.: g stories: a units:
Telephone f of Contact Person: EVjM iod.Valae of project 6385.00
APPLICANT: DO NOT WRITE BELOW THIS UNE
d
Sobmltbtl
Mom Sets
Req'd
Reed
TBAQONG PERBITT FEES
Pias Cheek submitted Item Amount
Structatal Cala
Revkwed, ready for cormcios s Play Chcek Deposit •
Ism Glu.
Colied Contact Person Pian Cheek Balance.
We 24 Cats.
Pians picked up Coostratdon
Stood plain pts
Plans rcmbmitt.ed Mechaakal
Grading plan
V Review, ready for correction asut Electrical
Sabeontaetor Lost
Called Contact Person Fl-bing
Grant Deed
runs picked cap S.hLL
iLO.A. Approval
Plans resubmitted Gradtng
IN HOUSE:-
''` Review, ready for correctiou0ssae Developer Impact Fee
planning Approval
Calted Contact Perm" A" P.
Pub. Win. Appr
Date of permit issue
School Fen
Total Permit Fees