BMCH2017-0344LICENSED 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.: 522775
T �
ate: � � �Contr tca or' �i�
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 forthe 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 ) 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 Na
Lender's Address:
WORKER'S COMPENSATION DECLARATION
I herebx affirm under penalty of perjury one of the following declarations:
I have and will maintain a certificate of consent to self -insure for workers'
compensati n, , ovided for by Section 3700 of the Labor Code, for the performance
of the wo f ch this permit is issued.
S
i I e 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: STATE COMPENSATION INSURANCE FUND Policy Number: 9074503
-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 shouldbecome subject to the
workers' compensation provisions of Section 3700 of the?6b o I shall forthwith
comply with those pro isions.
�''L P
Date! v / �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 ($100000). 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 `his 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, a id 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 apolication 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 an i state that the above information is correct.
I agree to comply with all city and county o dinances and state laws relating to building
construction, and hereby authorize representatives of this city to t upon the above-
mentioned property for inspection purposes.
D to: Si iature (Applicait or Agent):
��
Twit 4 44"
VOICE (760) 777-7125
78-495 CALLE TAMPICO
FAX (760) 777-7011DESIGN
LA QUINTA, CALIFORNIA 92253
& DEVELOPMENT DEPARTMENT
INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 8/7/2017
Application Number: BMCH2O17-0344
Owner:
Property Address: 52165 VIA CASTILE
MACHARGO
APN: 777440004
52165 VIA CASTILE
Application Description: MACHARGO /CHANGE
OUT (1)16SEER/13EER SPLIT SYSTEM
LA QUINTA, CA 92253
Property Zoning:
Application Valuation: $11,000.00
Applicant:
Contractor:
0HEATING1
SAN'S AIR CONDITIONING & HEATINGSAN'S
AIR CONDITIONING
51 -530 JACKSON STREET
51 -530 JACKSON STREETCOACHELLA,
CA 92236-2737
COACHELLA, CA 92236-273rn
(760)398-428'
Llc. No.: 5227:5
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.: 522775
T �
ate: � � �Contr tca or' �i�
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 forthe 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 ) 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 Na
Lender's Address:
WORKER'S COMPENSATION DECLARATION
I herebx affirm under penalty of perjury one of the following declarations:
I have and will maintain a certificate of consent to self -insure for workers'
compensati n, , ovided for by Section 3700 of the Labor Code, for the performance
of the wo f ch this permit is issued.
S
i I e 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: STATE COMPENSATION INSURANCE FUND Policy Number: 9074503
-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 shouldbecome subject to the
workers' compensation provisions of Section 3700 of the?6b o I shall forthwith
comply with those pro isions.
�''L P
Date! v / �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 ($100000). 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 `his 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, a id 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 apolication 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 an i state that the above information is correct.
I agree to comply with all city and county o dinances and state laws relating to building
construction, and hereby authorize representatives of this city to t upon the above-
mentioned property for inspection purposes.
D to: Si iature (Applicait or Agent):
��
Applicant:
SAN'S AIR CONDITIONING & HEATING
51-530 JACKSON STREET
COACHELLA, CA 92236-2737
d
Date: 8/7/2017
Owner:
MACHARGO
52165 VIA CASTILE
LA QUINTA, CA 92253
Contractor:
SAN'S AIR CONDITIONING & HEATING
51-530 JACKSON STREET
COACHELLA, CA 92236-2737
(760)398-428:
Llc. No.: 522775
------------------------------------------7---------------------------------7---------------
Detail: CHANGE OUT (1)16SEER/13EER SPLIT SYSTEM. CARBON MONOXIDE ALARM(S) TO BE INSTALLED PRIOR TO FINAL INSPECTION. 2016 CALIFORNIA
BUILDING CODES.
Application Number:
BMCH2017-0344
Property Address:
52165 VIA CASTILE
APN:
777440004
Application Description:
MACHARGO / CHANGE OUT (1)16SEER/13EER SPLIT SYSTEM
Property Zoning:
Application. Valuation:
$11,000.00
Applicant:
SAN'S AIR CONDITIONING & HEATING
51-530 JACKSON STREET
COACHELLA, CA 92236-2737
d
Date: 8/7/2017
Owner:
MACHARGO
52165 VIA CASTILE
LA QUINTA, CA 92253
Contractor:
SAN'S AIR CONDITIONING & HEATING
51-530 JACKSON STREET
COACHELLA, CA 92236-2737
(760)398-428:
Llc. No.: 522775
------------------------------------------7---------------------------------7---------------
Detail: CHANGE OUT (1)16SEER/13EER SPLIT SYSTEM. CARBON MONOXIDE ALARM(S) TO BE INSTALLED PRIOR TO FINAL INSPECTION. 2016 CALIFORNIA
BUILDING CODES.
FINANCIAL INFORMATION
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
$76.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
HVAC CHANGEOUT - SPLIT -SYSTEM PC
101-0000-42600
0
$38.00
Total Paid for CHANGEOUT: $114.00
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
$S.00
Total Paid for TECHNOLOGY ENHANCEMENT FEE: $5.00
STATE OF CALIFORNIA
ALTERATION'S - HVAC
CEC-CFIR-ALT-04-E Revised 01/16 CALIFOPNIA ENERGY COMMISSION `r4W-
CERTIFICATE OF COMPLIANCE CFIR-ALT-04-E
Alterations - HVAC CZ 2, and 8-15 (Page 1 of 1)
r
Site Address: r-
Enforcement Agency:
Date Prepared:
Permitil:
(
Equipment Type
Equipment Efficienty
New Ducting or Lineset:
Required R -value
Co-iditioned
Flcor Area (ft2)
Thermostat
❑ Packaged
❑ Eva�eretor Coil
gFUE
COP
❑ R-6 (CZ 1-10, 12&13) Ducts
Served by system
❑ Setback
System�-
0ndensing Unit❑
7--Z-�
R-8' (CZ 11, 14-16) Ducts
ftZ
(if not already
® pl5 it System
❑ Compressor
SEER
HSPF
❑ Z R-2.8 Lineset°
present, must
❑ Mini lit
❑ Lineset
be installed)
rnace
❑ TXV
EER
HERS VERIFICATION SUMMARY Installer determines work to be completed and matches to one of the options below. At permit application this
form is all ed to be filled out by hand. For final inspection all forms are to be registered (no hand filled forms allowed) and a copy left on site.
VAC Changeout/Repair Required Compliance Documents to be left on site for Final:
All Equipment, CF111-ALT-02-E
Condenser Unit, Evaporator Coil, CF2R-MCH-01-E, MCH -20-H, MCH -(23 or 24)2-H, MCH -25-H2
Compressor, TXV, Lineset, CF3R-MCH-20-H, MCH -(23 or 24)-H2, MCH -25 -HZ
Air Handler/Furnace2 (Can include new ducting)
Installer Requirement: Duct leakage (!5_15%, or <_10% to outside, or seal all accessible leaks), Air Flow 2 300 CFM/ton, Refrigerant Charge.
Exempted from duct leakage testing if:
111. Duct system registered with HERS provider as previously sealed, or ❑ 2. There is less than 40 linear feet of duct in unconditioned space, or
❑ 3. Existing duct systems are constructed, insulated or sealed with asbestos (list manufacture date of building
❑ 2. New HVAC System Required Compliance Documents to be left on site for Final:
All new equipment and All New Ducts' CFIR-ALT-02-E
including Mini Split CF2R-MCH-01-E, MCH -20-H, MCH -22-H, MCH -(23 or 24)-H2, MCF -25-H2
CF3R-MCH-20-H, MCH -22-H, MCH -(23 or 24)-H2, MCH -25-H2
Mini Splits require CF1R-ALT-02-E, CF2R-MCH-01-E, and (CF2R-CF3R) MCH -25-H
Installer Requirement: Duct leakage < 5%, Fan Efficacy (0.58W/CFM), Air Flow z 350 CFM/ton (or alternative), Refrigerant Charge
❑ 3. All New Ducts with Replacement Required Compliance Documents to be left on site for Final:
All New Ducts' and one or more of the following CFIR-ALT-02-E
replaced: Condenser Unit, Evaporator Coil, CF2R-MCH-01-E, MCH -20-H, MCH -(23 or 24)-H, MCH -25-H
Compressor, TXV, Lineset, Furnace CF3R-MCH-20-H, MCH -(23 or 24)-H, MCH -25-H
Installer Requirement: Duct leakage < 5%, Air Flow z 350 CFM/ton (or alternative), Refrigerant Charge
Exempted from duct leakage testing if: ❑ 1. Existing duct systems are constructed, insulated or sealed with asbestos
❑ 4. New Ducting over 40 feet Required Compliance Documents to be left on site for Final:
New ducting but less than All New Ducts' I CFIR-ALT-02-E, CF2R-MCH-20-H, CF311-MCH-20-H
Installer Required to: Dud leakage (5 15% or, 510% to outside or, or seal all accessible leaks)
❑ EXCEPTION: Existing duct systems constructed, insulated or sealed with asbestos.
'All new ducting requires R-8 insulation when more than 40 ft installed in CZs 11 & 14-16 and R-6 in CZs 1-10, 12 &3, and R-6 insulation when less
than 40 ft installed. This includes in walls, between floors etc.
2 Heating only systems and Air Handler/Furnace changes do not require Air Flow MCH -(23 or 24), or Refrigerant Charge verification MCH -25
' All New Ducts is when at least 75%of the duct system is new duct material, and up to 25%may consist of reused parts from the dwelling unit's
existing duct system (e.g., registers, grilles, boots, air handler, coil, plenums, duct material)
° R-2.8 W' thick insulation) for linesets I" and less.
Contractor (Documentation Author's /Responsible Designer'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 California Business and Professions Code to accept responsibility for the in=ormation on this document.
3. That the energy features and performance specifications for the design identified on this Certificate of Compliance conform to the
requirements of Title 24, Parts 1 and 6 of the California Code of Regulations (CCR).
4. 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 CCR.
S. The building design features or system design features identified on this Certificate of Compliance are consistertt with the information
provided on other applicable compliance documents, worksheets, calculations, plans and specifications submitted to the enforcement
,zioncy for approval with this building permit application.
Re ib a e:
Responsible Designer Signature:
Da Sig d:
e:
Comp r
Addrgas'� City/State/Zig;,Phone:
�•—
�r�
For assistance or questions regarding the Energy Standards, contact the Energy Hotline at: 1-800-772-3300
97
E
C
Bin#
I
City of La Quinta
Building & Safety Division
78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
B ilding Permit Application and Tracking S.' eet
Permit#
�A(
Project Address: Z _
�i�s�
O1-1 ' Name: damn /
��
A:PTlumber —
A��ss: S �Zl j�i��
Legal Description:
City §T, Zip:
Contractor: r
Te ephone:���
Add�ess:
�
Project'Description:
..
Telepho /'/�
Sty afe Lic. #: Q�
City Lic #:
AArrell, Engr.,, Designer:
Address:
City, ST, Zip:
Telephone:
Construction Type:
OccupaLcy:
State Lic. #:
Proj. Type
New
. Add'n
Alter
Repair
Demo
Name of Contact:
SgFt:
#Stories
# Units:
Telephone of Contact:
E-stirr%ue of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Rec'd
TRACKING
PERMIT FEES
Plan Sets
Plan Check Submitted
Item
Amount
Structural Cales
Reviewed, ready for corrections
Plan Check Deposit:
Truss Cales
Called Contact Person
Plan Check Balance:
Title 24 Calcs
Plans Picked Up
Construction:
Flood Plain Plan
Plans Resubmitted
Mechanxal:
Grading Plan
2nd Rev, Ready for corrections /
Electriczl:
Subcontractor List
Called Contact Person
Plumbing:
Grant Deed
Plans Picked Up
S.M.I.
HOA Approval
Plans Resubmitted
Grading
IN-HOUSE
3rd Rev, Ready for corrections /
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Apps
Date of permit issue
School Fees
Total Pe. -mit Fees