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BMCH2015-0100LICENSED 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. Licen�sse,Class: C220 }� License No.: 78055344 Date:" �^ �^✓ �� Contracto6. ,/� 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 toga 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 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 ofAhe Labor Code, for the performance of the work for which this permit is issued. My workers` compensation insurance carrier and policy number are: n r Iii Policy Number: ertify 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: Applicant: � ei2�!C�—•� WARN ING:"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 forinspectionpurposes. 2.J `l Date: Signature (Applicant or Agent): ' 78-495 CALLE TAMPICO 4.4 Q VOICE (760) 777-7125 LA QUINTA, CALIFORNIA 92253 FAX (760) 777-7011COMMUNITY DEVELOPMENT DEPARTMENT INSPECTIONS (760) 777-7153 BUILDING PERMIT Date: 3/25/2015 Application Number: BMCH2O15-0100 Owner: Property Address: 78380 VIA PAVION BOBBY GATLIN APN: 604590045- P O BOX 5455 Application Description: DEL ORO/GATLIN/REPLACE (2) 13SEER/78AFUE SPLIT SYSTEMS LA QUINTA, CA 92253, Property Zoning: w Application Valuation: $10,000.00 tri Q O ti 20 Applicant: Contractor: pew ADAM SIMMONS ADAM SIMMONS PO BOX 314 P0BOX 314 LA QUINTA, CA 92247 LA QUINTA, CA 922 a (760)564-7525 Llc. No.: 780534 Q 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. Licen�sse,Class: C220 }� License No.: 78055344 Date:" �^ �^✓ �� Contracto6. ,/� 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 toga 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 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 ofAhe Labor Code, for the performance of the work for which this permit is issued. My workers` compensation insurance carrier and policy number are: n r Iii Policy Number: ertify 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: Applicant: � ei2�!C�—•� WARN ING:"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 forinspectionpurposes. 2.J `l Date: Signature (Applicant or Agent): ' I CERTIFICATE OF COMPLIANCE CF1R-ALT-02-E Alterations to Space Conditioning Systems (formerly CF -1R -ALT HVAC) Project Name: 78380 via pavion I Date Prepared: (Page 1 of 3") 2015-03-23 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 CF111-ALT 02 document for each dwelling unit. 01 Project Name. 78380 via pavion 02 Date Prepared 2015-03-23 03 Project Location 78380 via Pavion 04 Building Type Single family 05 CA City La Quinta 06 Dwelling Unit Name 78380 via pavion SC System SC System 08 Dwelling Unit Conditioned 3000 07 Zip Code 92253 nstalling Floor Area (ft2) Identification or Location or Area by this SC ducted ontaining� Number of space conditioning a than 40 09 Climate Zone 15 10 (SC) systems In this dwelling 2 system? component? components? feet of ducts? unit. SC system? B. Space Conditioning (SC) System information .. i 01 02 03 04f �05 7U 06 07 N fl- 08 09 10 Allis the .SC Installing a jv SC System SC System CFA served system a refrigerant Installing -new SC Instal,ling installing nstalling Identification or Location or Area by this SC ducted ontaining� systema a than 40 ent rely new entirely new Name Served System (ft2) system? component? components? feet of ducts? duct system? SC system? Alteration Type System 1 Living area 1600 Yes Yes Yes No No No Altered space conditioning system System 2 Bedrooms 1400 Yes Yes Yes No No No Altered space' conditioning system C. Extension of Existing Duct System, Greater Than 40 Feet (Section 150.2(b)1Diib) This section does not apply to this project. Registration Number: 215-A0075818A-000000000-0000 Registration Date/Time: 2015-03-23 13:42:11 HERS Provider: CaICERTS CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2014-03-31 Report Generated: 2015-03-23 13:42:05 CERTIFICATE OF COMPLIANCE CF111-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)lE and F) 01 02 03 04 05 06 07 08 09 30 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 System 1 Central gas All new heating AFUE 0.78 Centrals lit p All new cooling SEER 13 Setback Less than or equal to 40. R-8 furnace components AC components feet System 2 Central as g All new heating AFUE 0.78 Central split All new cooling SEER 13 Setback Less than or equal to 40 R-8 furnace components AC components feet Requ*red Documentation: CF2R-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:heat ing.or cooling components are Installed In ductedd systems,,or when more than 40 ft of leaks. duct length is replaced. -Leakage rate compliance: 515%, or 510%leakageto;outside or seal alfaccessiible , installed or altered (app ble in CZ[3 815`) CF2R-MCH 25-H & CF3R MCH -25 H Refrigerant Charge Verrfication rre�quired whe refrigerant containing components arse CF2RCF3R-MCH-23 & CF3R-MCH-23 Air Flow 2 300 CFM/ton required when MCH -25 is required_„ pore ni ce".. W Exceptions: are exempt -Duct'systems registered with HERS provider as previously sealed from MCH -20 Duct Leakage Testing requirements. * s %. do not requifiEverificationlof Air Flow MCH -23 or Refrigerant Charge MECH 25. Heating -only systems and Air Handler/Furnace changes ts. insulated with asbestos are exempt from MCH -10 Duct Leakage Testing requirements. Existing dud systems constructed, or sealed E. Entirely New or Complete Replacement Duct System, with or without Equipment Changeout (Sections 150.2(b)lDiia 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)lC) This section does not apply to this project. Registration Number: 215-A0075818A-000000000-0000 Registration Date/Time 2015-03-23 13:42:11 HERS Provider: CalCERTS CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2014-03-31 Report Generated: 2015-03-23 13:42:05 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. i certify that this Certificate of Compliance documentation is accurate and complete. Documentation Author Name: Documentation Author Signature: Simmons, Donna Company: Signature Dater ADAM SIMMONS 2015-03-23 13:42:11 Address: CEA/ HERS Certification Identification (if applicable): 54440 AVENIDA CARRANZA . City/State/Zip: Phone: LA QUINTA CA 92253. (760) 564-7525 Responsible Person's Declaration statement I certify the following under penalty of perjury, under the, liws of the State of California: 1. The information provided on this Certificate of Compliance lsarue and correct. 2. 1 am eligible under Division 3 of:the Busiriess and Professions Code to acce,pvresponsibility 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 Title 24, Part 1 and Partthe California Code of Reg l0ons� requirements of .of The building design features or system design features identified onhthis Certificate:of Compliance are consistent with=the mformatjon,provided onfother, p Ucatile compliance documents, worksheets, 4. .. as c calculations, plans and specifications submitted to the enforcement agency for�,approvallwith this building perm, app�licatfon. � i-4 I 5. 1 will ensure that a registered copy of this, Ceitificate f Compliance shall be>made,available i;ff ttie building petmit(s),.issued for the,building, and,made available,to the enforcement agency for all applicable - inspections. I understand that a registered copy of this•Cettlfl�cate of Comp(l�anc els„requ red to be jncluded with,x the -w the�biillder provides to the building owner at occupancy. W ,*station Responsible Designer Name: T r Responsible Designer Signaiure: `' e Simmons, Donna Company: Date Signed: ADAM SIMMONS 2015-03-23 13:42:11 Address: License: 54440 AVENIDA CARRANZA 780534 City/State/Zip:Phone: LA QUINTA CA 92253 (760) 564-7525 Digitally signed by Ca10ERTS. 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-A0075818A-000000000-0000 Registration Date/Time: 2015-03-23 13:42:11 HERS Provider: CaICERTS CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2014-03-31 Report Generated: 2015-03-23 13:42:05 QTY; DESCRIPTION; ' ce 7 *. t� ACCOUNTS¢ gra ,'• r 6 1 'pm i BSAS SB1473 FEE . 'AMOU3 � �PAID�'�� � =PAIp$DATE; } `tPAID BYr ' METHOD � 0 $1.00 $0.00 �CHECK Total Paid for BUILDING'STANDARDS ADMINISTRATION'S a CLTD BY * ACCQLINT�> QTY g 1 AMOUNT,l r � < PAID DATE HVAC CHANGEOUT - SPLIT -SYSTEM 101-0000-42402 sa $i.00 $o.00' $0.00 1 1 0 DESCRIPTION; ' ce 7 *. t� ACCOUNTS¢ gra 1 BSAS SB1473 FEE 101-0000-20306 } `tPAID BYr ' METHOD t Total Paid for BUILDING'STANDARDS ADMINISTRATION'S "''DESCRIPTION'"° } <& * ACCQLINT�> QTY g 1 AMOUNT,l r PAID PAID DATE HVAC CHANGEOUT - SPLIT -SYSTEM 101-0000-42402 0 $145.04 $0.00 »� METHOD , i1;,4;RECEIPT=# CHECK#, CLTD BYE �` : � DESCRIP,TION y _ ACCOUNT S � ;''=IQTY� µ AMOUNT ;,>3 PAID k #PAIDgDATE HVAC CHANGEOUT - SPLIT -SYSTEM PC 101-0000-42600 0 . $72.52 $0.00 a g ., PAIO BY z '� z+ . y METHOD 3� 'CLTD BY,,, r Total Paid forCHANGEOUT: $217.56 $0.00 + �'•$° k DESCRIPTION ."r' y r'<ACCOUNT x QTY>AINIOUNT ' M`�PAID « PAID`DATE'° PERMIT ISSUANCE 101-0000-42404 0 $91.85 $0.00 " `�`}PAIL?$Y x r �.- 9>'=«METFIOD f �: RECEIPT# �t,, f "* CHECK`#}CLTOBY Total Paid forPERMIT ISSUANCE: $91.85 $0.00 TOTALS: i4��� 1 � t 1 + Y A Description: DEL ORO/GATLIN/REPLACE (2) 13SEER/78AFUE SPLIT SYSTEMS Type: MECHANICAL Subtype: Status: UNDER REVIEW Applied: 3/25/2015 SKH Approved: Parcel No: 604590045 Site Address: 78380 VIA PAVION.LA QUINTA,CA 92253 Subdivision: TR 30521-2 Block: Lot: 54 Issued: Lot Scl Ft: 0 Building Sq Ft: 0 Zoning: Finaled: Valuation: $10,000.00 Occupancy Type: Construction Type: Expired: No.. Buildings: 0 No. Stories: 0 No. Unites:0 .P...HONE u .Yh - ;.y.z..:w qg,� .`ASSY ,� <E`:..-r.3A 2 ;L'ZM1gx >d4: .,'"a d^.n.. Y5 .a..�P �"f Details: HVAC CHANGE OUT -REPLACE (2)13SEER/78AFUE SPLIT SYSTEMS [2013 ENERGY] CARBON MONOXIDE ALARM(S) TO BE INSTALLED I PRIOR TO FINAL INSPECTION. 2013 CALIFORNIA BUILDING CODES. -.CbNDITIONS � a Printed: Wednesday, March 25, 2015 3:45:59 PM 1 of 2 CRWIYSTEA4S �:.i!t. K.4 a,C: �. ...r.� _r: '.Y.' ,..a ..:e. .. F -. r. .. :.. �. .. ::1 .,.r. .a .. ��...:. S'X<:»-' . S�..e , e„ :. r. .:.-i!.t. .. i J.�.; �`. ,. .v .�`d.:. 3t:. r.':;6, � . +I '-';. •Rs @':.'. -.,v "1Y.. .,.>.':'. MEYPE,;TME'. aCITY�r NA . t £xesADDRESSl ?•-> T-;. 1 - \:� p �'':...+ <e.3g - ..y-�.. .« 4+: `'!'9'`F ,,.: j °"'nyi'i'.i '.» k+ay_...+ ..n e »�;.e^..f h ••':. ZIP ,#y EIMAII .. FAX, ,. �P'� ...,:� 'N e` ry"f �..�SIi M a .:s....:b L d'< .Y'-•'. w Yv7'? "�. .s .:'w". $ , ;<<.STATE" n�p'`F; 'sY'' r`el:.,v .P...HONE u .Yh - ;.y.z..:w qg,� .`ASSY ,� <E`:..-r.3A 2 ;L'ZM1gx >d4: .,'"a d^.n.. Y5 .a..�P �"f APPLICANT ADAM SIMMONS P O BOX 314 LA QUINTA CA 92247 CONTRACTOR ADAM SIMMONS P O BOX 314 LA QUINTA CA 92247 OWNER BOBBY GATLIN . P O BOX 5455 LA QUINTA CA 92253 Printed: Wednesday, March 25, 2015 3:45:59 PM 1 of 2 CRWIYSTEA4S v 6 7_1 7.1777-77-1 77- 7 S 7, 'M ill IUI aw W h- 2� Z W "; REVIEW,�T PtRg: AMOUNT 'N " AD6 :.,RETURNED "74 ,x'% ` N E."', NY CTD, DESCRIPTION ACCOUNT, QTY PAI DATE RECEIPT,# CHECK# METHOD. -PAID BY W, . HVAC CHANGEOUT- 101-0000-42402 0 $145.04 $0.00 SPLIT-SYSTEM HVAC CHANGEOUT- • 101-0000-42600 0 $72.52 $0.00 SPLIT -SYSTEM PC Total Paid forCHANGEOUT: $217.56 $0.00 PERMIT ISSUANCE 101-0000-42404 0 $91.25 $0.00. Total Paid forPERMIT ISSUANCE: $91.85 $0.00 N 7_1 7.1777-77-1 77- 7 S 7, 'M ill IUI aw W h- 2� Z W "; REVIEW,�T PtRg: i :REV EWER; IEEW_�,VSENT-DATE�l 'N " AD6 :.,RETURNED "74 ,x'% ` N E."', NY A W, ii' g, W-7 7, J. X kit A." 70 Printed: WedneAay, March 25, 2015 3:45:59 PIVI 2 of 2 CReWlysTEMS