BMCH2017-026278-495 CALLE TAMPICO D
LA QUINTA, CALIFORNIA 92253. DESIGN & DEVELOPMENT DEPARTMENT
BUILDING PERMIT
Application Number: BMCH2O17-0262
Property Address: 80555 WEISKOPF
APN:. 762100005
Application Description: FOULKES / CHANGE OUT (2) SPLIT SYSTEMS
Property Zoning:
Application Valuation: $20,311.00
Applicant:
EFFICIENT AIR CONDITIONING INC
P O BOX 1043
THOUSAND PALMS, CA 92.276
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: B C20 License No.: 881926
Date: L6 Contractor.'
OWNER -BUILDER DIEL
I hereby affirm under penalty of perjury that I a t 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
Lender's Address:
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 6/26/2017
Owner:
FOULKES CALIF RESIDENCE TRUS
1412 HIAWATHA
BEAVER DAM, WI 92253
Contractor:
EFFICIENT AIR CONDITIONING INC
P 0 BOX 1043
THOUSAND PALMS, CA 92276
(760)343-5335
Llc. No.: 881926
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 rk for which this permit is issued.
ve and will maintain workers' compensation insurance, as required by
S 700 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: BENCHMARK INSURANCE COMPANY Polity Number: CSTS010065
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: v _Applicant: 4i
WARNING: FAILURE TO SECURE WORKERS' COM PEN COVERAGE IS UNLAWFUL,
AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL P NALTIES 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 upo the
above-mentioned property for inspection purposes.
Date: Signature (Applicant or Agent
Date:.. 6/26/2017
Application Number: BMCH2017-0262
Owner:
Property Address: 80555 WEISKOPF
FOULKES CALIF RESIDENCE TRUS
APN: 762100005
1412 HIAWATHA
Application Description: FOULKES / CHANGE OUT (2) SPLIT SYSTEMS
BEAVER DAM, WI 92253
Property Zoning:
Application Valuation: $20,311.00
Applicant:
Contractor:
EFFICIENT AIR CONDITIONING INC
EFFICIENT AIR CONDITIONING INC
P 0 BOX 1043
P 0 BOX 1043
THOUSAND PALMS, CA 92276
THOUSAND PALMS, CA 92276
(760)343-5335
----------------------
Llc. No.: 881926
-----------------------------------------------------.------------------
Detail: HVAC CHANGE OUT - (2)14SEER/80AFUE SPLIT SYSTEMS. CARBON MONOXIDE ALARM(S) TO BE INSTALLED PRIOR TO FINAL INSPECTION. 2016
CALIFORNIA BUILDING CODES.
DESCRIPTION
ACCOUNT QTY. AMOUNT
BSAS SB1473 FEE
101-0000-20306 0 $1.00
Total Paid for BUILDING STANDARDS ADMINISTRATION BSA:. $1.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
HVAC CHANGEOUT - SPLIT -SYSTEM
101-0000-42402
0
$152.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT.
HVAC CHANGEOUT - SPLIT -SYSTEM PC
101-0.000-42600
10
$76.00
Total Paid for CHANGEOUT: $228.00
DESCRIPTION
ACCOUNT
QTY .
AMOUNT
PERMIT ISSUANCE
101-0000-42404
0
$96.27
Total Paid for PERMIT ISSUANCE: $96.27
DESCRIPTION
ACCOUNT
QTY
AMOUNT
TECHNOLOGY ENHANCEMENT FEE
502-0000-43611
0
$5.00
Total Paid for TECHNOLOGY ENHANCEMENT FEE: $5.00
B►° #
City of b Quina
Bullding 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: T17f
Vle-
Owner'sNeme:. j
A. P. Number.
Address:
Legal Description:
Contractor. �. a !l /
;�,.�
City, ST, Zip: % eu
Telephone: v ;;.
Address: P (�
0 q
Project Description: �� C
City, ST, Zip: 17,
'�ZZ %6
Telephone:��(y
<.. `.t
State Lic. # :
City Lic. #,
Arch., Engr., Designer
Address:
City., ST, Zip:
V�'w..
.
Telephone:
P
State Lic. #: �
Name of Contact Person:
.
�',
.�;�
Construction Type:. Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
Sq. Ft.: # Stories: # Units.
Telephone # of Contact Person:
Estimated Value of Project: d
APPLICANT: DO NOT WRITE BELOW THIS UNE
#
Submittal
Req'd
Recd
TRACKING
PERMIT FEES
Plan Sete
Plan Check submitted
Item Amount
Structural Calm
Reviewed, ready for corrections
Plan Check Deposit • .
Truss Cates.
Called Contact Person
Pian Check Balance
Title 24 Coles.
Pians picked up
Construction
Mood plain plan
Plans resubmitted..
Mechanical
Grading plan
2•! Review, ready for correetionsfissue
Electrical
Subeontaetor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
'^' Review; ready for correctionsAssue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees
13
Simplified Prescriptive Certificate of Compliance: 2008 Residential HVACAlterations CF -
IR -ALT -HVA -C. -Climate Zones 10 to 15
Site Address:
Enforcement A en
S c1'�
Dat
Permit 11:
We.
6, �
�
ui ment Type'
List Minimum Efficiency 2
Duct insulation requirement
Conditioned Floor
Area
Therm
❑ Packaged Unit
�-F�a
�AFUE ❑COP
Over 40 ft of duce added or
❑Setback
1gladoor Coil
ER / ❑ HSPF
replaced in unconditioned space
Served b Y system
(If ot,b�y -
ES Condensing Unit
❑ EER ❑ Resistance
❑ R 6 (CZ 10-13)
sf
present must be
❑ Other
❑ R 8 (CZ 14-15)
installed)
L. Equipment Type: Choose the equipment being installed if more than one system, use another CF -1 R -ALT -HVAC for each system.
2. Mht mum Equipment Efyidendes: 13 SEED 78•- AFU& 7.7HSPFjor typical residential systems.
HERS VERIFICATION SUMMARY Listed below are four HVAC alteration Options. The installer decides what work is being done and
picks one of the appropriate Options. Each Option lists the HERS measures that must be conducted. A copy of the forms shall be left on site for final
inspection and a copy given to the.homeowner. At food, the.inspector-verifies that-the--work-listed on -this -form was in fact-thework completedby-the -
installer. The inspector also verifies that each appropriate CF -6R and registered CF -4R forms (no hand filled CF-4Rs allowed) are filled out and
siBeginning October 1, 2010, a registered copy of the CF -1R and CF -611 shall also be on site for final Inspection.
1: HVAC Changeout
Required Forms:
• All HVAC Equipment replaced
CF -6R forms: MECH-04, MECH-2I-HERS and (for split systems) MECH- 25 -HERS
CF4R forms: MECH- 21 and for split stems MECH-25
• Condenser Coil and/or
• Indoor Coil and/or
CF -6R forms: MECH-2I-HERS and (for split systems) MECH- 25 -HERS
• Fumliace
CF -4R forts: MECH- 21 and (for split systems) MECH-25
For Split Systems: Duct leakage < 15 percent; RC, CCA >_ 300 CFM/ton(Minimum Air Flow Requirement), TMAH
For Packaged Units: Duct leakage < 15 percent
Exempted from duct leakage testing if
❑ 1. Duct system was documented to have been previously sealed and confirmed through HERS verification, or
❑ 2. Duct systems with less than 40 linear feet in unconditioned space, or
❑ 3. Existing duct systemis are constructed, insulated or sealed with asbestos
❑ 2. New HVAC System
Required Forms:
• Cut in or Changeout with new
ducts: (all new ducting and all
CF -6R forms: MECH-04, MECH-20-HERS,and (for split systems) MECH-22-HERS, and MECH-25 -HERS
new ui ment)CF-4R
forms: MECH 20-, and (for split systems)MECH•22, and MECH 25
For Split Systems: Duct leakage < 6 percent; RC, CCA> 350 CFA&ton, FWD, TMAH, STMS, and either HSPP or PSPP.
For Packaged Units: Duct leakage < 6 percent
❑ 3. New Ducts with Replacement
Required Forms:
• Includes replacing or installing all new ducting
CF -6R forms: MECH-04, MECH-20-HERS,and (for split systems) MECH-25-HERS
and/or outdoor condensing unit and/or indoor
CF -4R forms: MECH-20 and (for split systems) MECH-25
coil and/or furnace. Not all equipment changed.
For Split Systems: Duct leakage < 6 percent, RC, CCA >_ 300 CFM/ton, TMAH
For Packaged Units: Duct leakage < 6 percent
❑ 4. New Ducting over 40 feet
Required Forms:
• Includes adding or replacing more than 40
linear feet of duct in unconditioned space.
CF -6R forms: MECH-04, MECH-2I-HERS CF -411 forms: MECH-21
For split system or packaged units: Duct leakage < 15 percent
❑ EXCEPTION: Existing duct systems constructed,insulated or sealed with asbestos.
.Contractor (Documentation Author's /Responsible Designer's Declaration Statement)
• I certify drat this Certificate ofCompliance documentation is accurate and complete.
• 1 am eligible under Division 3 of the Califomia Business and Professions Code to accept responsibility for the design identified on this Certificate of Compliance.
'I
certify itis[ the energyteatura—andperf—rm— since specif cations for the design identified on this Certificate of Compliance conform to the requirements of Tide 24,
Parts 1 and 6 of the California Code of Regulations.
• The design features identified on this Certificate of Compliance are consistent with the infomsatio in ed� er applicable compliance forms, worksheets,
calculations, plans and specifications submitted to the enforcement agency for approval witim
Name:
Signature
Company: jry
t Z6 I
Address. License:
City/State/Zip. �% C ZZ
r^ Phone: G_ 3
Simplified Prescri tWe Certificate of Compliance: 2008 Residential HVAC Alterations CF -IR -ALT -HVAC
Climate Zones 10 to 15
Site Address:
Enforcement Agency:
Date:
Permit A
� 4za
6 Z6 / �-
Conditioned Floor
E ui ment Type' List Minimum Efficiency
Duct insulation requirement
Area
Thermostat
❑ Packaged Unit
%rFumace 4W AFUE_.�b
❑ COP
Over 40 ft of ducts added or
❑Setback
T5 Indoor Coil 41SEER1q-
❑ HSPF
replaced in unconditioned space
❑ R 6 10-13)
Served by system
/
(If not alreath
he
0 Condensing Unit ❑EER
❑ Resistants
(CZ
—� sf
present. must
❑ Other I
❑ R 8 (CZ 14-15)
I
installed)
1. Equipment Type: Choose the equipment being installed: if more than one sYstetn, use another CF -I R -ALT -HVAC for each spstem.
2. Minimum Equipment Efficiencies: 13 SEER, 78%AFUE, 7.7HSPF for typical residential sYstems.
HERS VERIFICATION SUMMARY Listed below are four HVAC alteration Options. The installer decides what work is being done and
picks one of the appropriate Options. Each Option lists the HERS measures that must be conducted. A copy of the forms shall be left on site for final
inspection and a copy given to the homeowner. At final, the inspector verifies that the work listed on this form was in fact the work completed by the
installer. The inspector also verifies that each appropriate CF -6R and registered CF -4R forms (no hand filled CF-4Rs allowed) are filled out and
signed. Beginning October 1, 2010, a registered copy of the CF -IR and CF -611 shall also be on site for final inspection.
1. HVAC Changeout
Required Forms:
• All HVAC Equipment replaced
CF-611forms: MECH-04, MECH-2I-HERS and (for split systems) MECH- 25 -HERS
CF-411forms: MECH- 21 and (fors lits stems) MECH-25
• Condenser Coil and/or
CF -6R forms: MECH-2I-HERS and (for split systems) MECH- 25 -HERS
• Indoor Coil and/or
CF -4R forms: MECH- 21 and (for split systems) MECH-25
• Furnace
For Split Systems: Duct leakage < 15 percent; RC, CCA >_ 300 CFM/ton(Minimum Air Flow Requirement), TMAH
For Packaged Units: Duct leakage < 15 percent
Exempted from duct leakage testing if:
❑ I. Duct system was documented to have been previously sealed and confirmed through HERS verification, or
❑ 2. Duct systems with less than 40 linear feet in unconditioned space, or
❑ 3. Existing ducts stems are constructed, insulated or sealed with asbestos
❑ 2. New HVAC System Required Forms:
• Cut in or Changeout with new CF -6R forms: MECH-04, MECH-20-HERS,and (for split systems) MECH-22-HERS, and MECH-25-HERS
ducts: (all new ducting and all
CF -411 forms: MECH 20-, and (for split systems)MECH-22, and MECH 25
new equipment)
For Split Systems: Duct leakage < 6 percent; RC, CCA > 350 CFM/ton, FWD, TMAH, STMS, and either HSPP or PSPP.
For Packaged Units: Duct leakage < 6 percent
❑ 3. New Ducts with Replacement
Required Forms:
• Includes replacing or installing all new ducting
CF -6R forms: MECH-04, MECH-20-HERS,and (for split systems) MECH-25-HERS
and/or outdoor condensing unit and/or indoor
CF -4R forms: MECH-20 and (for split systems) MECH-25
coil and/or furnace. Not all equipment changed.
For Split Systems: Duct leakage < 6 percent, RC, CCA > 300 CFM/ton, TMAH
For Packaged Units: Duct leakage < 6 percent
❑ 4. New Ducting over 40 feet
Required Forms:
• Includes adding or replacing more than 40
CF -611 forms: MECH-04, MECH-2I-HERS CF -411 forms: MECH-21
linear feet of duct in unconditioned space.
For split system or packaged units: Duct leakage < 15 percent
❑ EXCEPTION: Existing ducts stems constructed, insulated or sealed with asbestos.
Contractor (Documentation Author's /Responsible Designer's Declaration Statement)
• I certify that this Certificate of Compliance documentation is accurate and complete.
• 1 am eligible under Division 3 of the California Business and Professions Code to accept responsibility for the design identified on this Certificate of Compliance.
• 1 certify that the energy features and performance specifications for the design identified on this Certificate of Compliance conform to the requirements of Title 24,
Parts I and 6 of the California Code of Regulations.
• The design features identified on this Certificate of Compliance are consistent with the information documents applicable compliance forms, worksheets,
calculations, plans ands specifications submitted to the enforcement agency forapproval with the emit c '
Name: v�
Signature:
Com an r �O
P Y V D
x .Y `- 4o r
Adress: License:
City/State/Zip: �% e-) ZZ Phone: �-
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