BMCH2015-028978-495 CALLE TAMPICO
LA,QUINTA, CALIFORNIA 92253
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING PERMIT
Application Number: BMCH2O15-0289
Property Address: 80689 VIA GLORIETA
APN: 777430042
Application Description: CENTRAL SPLIT A/C INIT 13 SEER
Property Zoning:
Application Valuation: $1,200.00
Applicant:
ANTHEM MECHANICAL
53-800 POLK STREET t
COACHELLA, CA 92236
JUL. 2 3 2015
CITY OF LA QUINTA
COMMUNITY DEVELOPMENT DEPARTMENT
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: A B C2 License No.: 1001659
Date: % Contractor:
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 Divi si0
of the Business and Professions Code) or that he or she is exempt therefrom and th
basis for the alleged exemption. Any violation of Section 7031.5 by any applicant or 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: 7/23/2015
Owner:
CHARLES KAHN
80689 VIA G LORI ETA
LA QUINTA, CA 92253
Contractor:
ANTHEM MECHAMICAL
53-800 POLK STREET
COACHELLA, CA 92_236
(760)469-2525
Llc. No.: 1001659`
WORKER'S COMPENSAT20N 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 3700of 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 of the Labor Code, for the perfornance 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 ;,s to become subject to the workers'
compensation laws of California, and agree thac, if I should become subject to the
workers' compensation provisions of Section 3'00 of the abor Code, I shall forthwith
comply with those rovisions.
Qte: % 23 f 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 ($100,00x). 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 owne-, and the applicant, each agrees to, and
shall defend, indemnify and hold harmless the :ity 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 st: to that the above information is correct.
I agree to comply with all city and county ordirances and state laws relating to building
construction, and hereby authorize representa:ives of this city.t0 enter po th bove- .
mentioned property for inspection purposes.
Date:Z Signature (Applicant or Agent):
i
FINANCIAL •• 1•
" <.;s^,DESCRIPTION`S000UNT•" ' tyr;;:: QTYf „; AMOUNT+L'- .PAID , "PAID DATE?.
BSAS SB1473 FEE 101-0000-20306
0 $1.00 $0.00
{ ],.PA ID BY r METHOD, •
-'RECEIPTW" )_ '' .." CHECK # CLTD BY ,
Total Paid for BUILDING STANDARDS ADMINISTRATION BSA $1.00 $0.00
�� s fiDESCRIPTION N: �` ?� '
ikACCOUNT r� eye
QTY
•,AMOUNTe
PAID %; ,
"PAID DATE -
HVAC CHANGEOUT - SPLIT -SYSTEM.
101-0000-42402
0
$72.52
40.00
METHODksL
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rya DESCRIPTION ;,-ACCOUNT,,,1y
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QTY:,
" y, AMOUNT..,, `
L:fv, `PAID � }�k;
PAID DATE:
HVAC CHANGEOUT - SPLIT -SYSTEM PC
101-0000-42600
0
$36.26
$0.00
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Total Paid forCHANGEOUT: $108.78 $0.00 • .
DESCRIPTION `'
; A00OUNT ; .
,`
QTY.'
r
,AMOUNT'
r { t
,PAID )-
PAID DATE
PERMIT ISSUANCE
101-0000-42404
0
$91.85
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Total Paid for PERMIT ISSUANCE: $91.85 $0.00
TOTALS:00
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Description: CENTRAL SPLIT A/C INIT 13 SEER
Type: MECHANICAL Subtype: Status: UNDER REVIEW,
Applied: 7/23/2015 PJU
Approved:
Parcel No: 777430042 Site Address:.80689 VIA GLORIETA LA QUINTACA 92253
^
^�
U�
Description: CENTRAL SPLIT A/C INIT 13 SEER
Type: MECHANICAL Subtype: Status: UNDER REVIEW,
Applied: 7/23/2015 PJU
Approved:
Parcel No: 777430042 Site Address:.80689 VIA GLORIETA LA QUINTACA 92253
Subdivision: TR 31123-1 Block: Lot: 42
Issued:
Valuation: $1,200.00 Occupancy Type: Construction Type:
Expired:
No; Buildings: 0 No. Stories: 0 No. Unites: 0
Details: A/C CHANGE OUT SPLIT SYSTEM36 TON SEER PER 2013 CBC CARBON MONOXIDE ALARM(S) TO BE INSTALLED PRIOR TO FINAL -
INSPECTION. 2013 CALIFORNIA BUILDING CODES.
.^
.. ^ 'Total Paid for BUILDING STANDARDS ADMINISTRATION.
-$1.00 $0.00�.
.'
�
. . � . .
Phnted:Thv,aday, July ZlZOl53:Z6xQPK8 . �16fZ � _ � ' _
. ^ - . � . . _-__---- --TEMS--
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ADDITIONAL SITES
.^
.. ^ 'Total Paid for BUILDING STANDARDS ADMINISTRATION.
-$1.00 $0.00�.
.'
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. . � . .
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ADDITIONAL SITES
CHRONOLOGY
CONDITIONS
CONTACTS
APPLICANT
ANTHEM MECHANICAL
53-800 POLK STREET
COACHELLA
CA
92236
(760)771-24 70
CONTRACTOR
ANTHEM MECHANICAL
53-800 POLK STREET
COACHELLA
CA
92236
(760)771-2470
OWNER
CHARLES KAHN
80689 VIA GLORIETA
LA QUINTA
CA
!�2V13
(Mq)771-
.^
.. ^ 'Total Paid for BUILDING STANDARDS ADMINISTRATION.
-$1.00 $0.00�.
.'
�
. . � . .
Phnted:Thv,aday, July ZlZOl53:Z6xQPK8 . �16fZ � _ � ' _
. ^ - . � . . _-__---- --TEMS--
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A
CITY
A COUNT
PAID DATE
ECK#4
'METHOD,
PAID BY
REVIEWS
.DUE DATE
^ �
BY
BOND INFORMATION
`.
Printed: Thursday, ]ulyz]1'20153:26w3PW
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.HVACCHANGEOUT-
101-0000-42600
Fo
$36.26
F
$0. 00
i
SPLIT-SYSTE IV
Total Paid forCHANGEOUT: $108.78 $0.00
_F0
PERMIT ISSUANCE-
101-0000-42404 1
$92.B.5
$0.00
TotalPaid for PERMIT ISSUANCE $91.85 $0.00
TOTALS: $201.63 $0.00
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PARENT PROJECTS
.
�
REVIEWS
.DUE DATE
^ �
BOND INFORMATION
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Bin #
City of La Quinta
Building 8t 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: d 6a UicL
Owner's Name: C k-1- I.e
A. P. Number:
Address: 9 C) 68 c' ue-t- G-- 6c -'le
c -s-
Legal Description:
City, ST, Zip: (� Qv't n,�q CA 9 ZZ ,5-3
Contractor.
. C
C 4
T U-
elehn
Telephone: -
P 6 2 1
Address: o I k S'
Project Description: /j
ft C �. p:
j
City, ST, Zip: CA 9 223
3 4, IVIEEk
Telephone: G— 2 7 2
6
State Lic. # : (00
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone:
one:
"«
.......................
n
Co tru ti n
s c o Type: ecu
P Occupancy:
P Y:
State Lic. #•
Project type (circle r le ne • New Add'n Alter Repair.air Demo
0
Name of Contact Person: ke So�Gw�Cs(�
Sq. Ft.:
# Stories:
# Units:
Telephone # of Contact Person: 76c) - Z% 2 - Y 2 (
Estimated Value of Project: I zc)o
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Rec'd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.
Rev'icNved, ready for corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance
Title 24 Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2p' Review, ready for corrections/issue
Electrical
Subcontactor List
Called Contact Person'
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
7rd Review, ready for corrections/issue
Developer Impact Fee
Planning Approval
Called ContactTerson
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees
+ R
,
,
CERTIFICATE OF COMPLIANCE
Alterations to Space Conditioning Systems (formerly CF -IR -ALT HVAC) .
Project Name:
Kahn I . Date Prepared:
CF1R-ALT-02-E
(Page 1 of 3 )
2015-07-23
A. General Information
CRR -ALT -02 is applicable to multiple space conditioning systems contained within a single dwelling unit. When multiple dwelling units must be
documented, use one CF1R-ALT 02 document for each dwelling unit.
01
Project Name
Kahn
02
Date Prepared
2015-07-23
03
Project Location
80689 Via Glorieta
04
Building Type
Single family
05
CA City
La Quinta
06
Dwelling Unit Name
Kahn
07
Zip Code
92253
OS
Dwelling Unit Conditioned
1200
:;i+r: +x�Py+i.;�.. +.Yw
#i°.. .vi+ •,,. "",
s; 9y,..
, , :; ;
Floor Area (ft2)
SC System
SC System
CFA served
system at*�
refngerant
Number of space conditioning
09
Climate Zone-
15
10
(SC) systems in this dwelling
1
sw
ducted
containing
system
more than 40
unit.
.:
entirely new
ef
B. Space Conditioning (SC) System Information ��'
2.
. ss t<
Ol
02
03
04x05
06
07
08
09
10
*,
Is the SC"
InnstSlln:sg a'ct'-
stain
:;i+r: +x�Py+i.;�.. +.Yw
#i°.. .vi+ •,,. "",
s; 9y,..
, , :; ;
SC System
SC System
CFA served
system at*�
refngerant
*InstaIIin&ne% S,CIralling
Installing
Installing
Identification or
Location or Area
by this SC
sw
ducted
containing
system
more than 40
entirely ne�:w
.:
entirely new
Name
Served
System (ft2)
system?
component?
components?
feet of ducts?
duct system?
SC system?
Alteration Type
System 1
Location 1
1200
Yes
Yes
Yes
No
No
No
Altered space
conditioning system
C. Extension of Existing Duct System, Greater Than 40 Feet (Section150.2(b)1Diib)
This section does not apply to this project.
Registration Number: 215-A0203146A-000000000-0000 Registration Date/Time: 2015-07-23 09:31:13 HERS Provider: CaICERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2014-03-31 Report Generated: 2015-07-23 09:31:07
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)IE and F)
01
02
03
04
05
06
07
08
09
10
11
12
HLIaTing
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
Central split
All new
Central split
All new
This field or
This field or
System 1
HP
heating
AFUE
0.78
AC
cooling
SEER
13
Setback
section is not
section is not
components
components
applicable
applicable
Required Documentation:
CF2R-MCH-01-E - Space Conditioning Systems Ducts and Faris-
-Duct insulation requirement for new plenums: R6:
CF2R-MCH-20-H & CF311-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 out3ide; or -seal all accessible leaks.
CF2R-MCH-25-H & CF3R-MCH-2S-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 w?2 300 CFM/ton required when MCH -25 is'required.
Exceptions: �# y
..t `YrAl r afro'" .; .•;� ,.
-Duct systems registered with HERS provider as previously sealed are exempt ffom`MCH-20,Duct LeakagexTesting regwrements
-Heating-only systems and Air Handler/Furnace changes do not req i r verifica ign of Air FI MCW23;.0r Refrigerant'Cha�rge,MECH 25 ,-.
•'
gA
-Existing duct systems constructed, insulated or seAl cl.witi : s eogre exempwfrpm MCU-z29i %u akage Testi-Hg requ cements.
E. Entirely New or Complete Replacement Duct System, withor %koclutIcidipment Changeout (Sections 150 2(b)i1Diia�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)1C)
This section does not apply to this project.
Registration Number: 215-A0203146A-000000000-0000 Registration Date/Time: 2015-07-23 09:31:13
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2014-03-31
c�homn W-;.,..• n ccccnn -
HERS Provider: CaICERTS
Report Generated: 2015-07-23 09:31:07
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. 1 certify that this Certificate of Compliance documentation is accurate and complete.
Documentation Author Name:
Pvcumwntat on'b.rrthor Signature:
Solomon, Michael
Company:
Signature Date:
ANTHEM MECHANICAL
2015-07-23 09:31:13
Address:
CEA/ HERS Certification Identification (if applicable):
53-800 POLK STREET
City/State/Zip:
Phone:
COACHELLA CA 92236
(760) 469-2525
Responsible Person's Declaration statement; .
I certify the following under penalty of perjury, under thelawsof the State of California:
1. The information provided on this Certificate of Compliance is,true.and correct.
2. I am eligible under Division 3 of the Businessand Professions Code to accept.r6sponsibility for the building design or system design identified on this Certificate of Compliance (responsible designer).
3. That the energy features andperformance 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 &of the California Code of R gula ons.. � t17 '
a"►,a
4. The building design features or system design features identified or .- Certifica�tee of Compliance are,c'&nsWenntjw :the iMormatton.provided on ptherapplicatjle`compliance documents, worksheets,'
calculations, plans and specifications submitted toahe enforcemen � agency for approvalfwith this building permit application:
e�of adevailable w th
5. 1 will ensure that a registered copy of this Ceitifica Co plianceh a')1*bei the':buildmgp# �mrt( );issued forsthe�bu�ilding and ade avaiabl�e 3ptfieienforcement agency for all applicable
inspections.
I understand that a registered copy of this Certri irate of Compliance, _!eqy, red to be_,included.with the documentation thetbiiilder ppropides to the building owner at occupancy.
Responsible Designer Name:` ;a✓
Responsible Des goer Sgnature.v Psa^F
Solomon, Michael�ld?!/
Company:
Date Signed:
ANTHEM MECHANICAL
2015-07-23 09:31:13 f
Address:
License:
53-800 POLK STREET
1001659
City/State/Zip:
Phone:
COACHELLA CA 92236
(760) 469-2525
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-A0203146A-000000000-0000 Registration Date/Time: 2015-07-23 09:31:13 HERS Provider: CalCERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2014-03-31 Report Generated: 2015-07-23 09:31:07