BMCH2017-018578-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: BMCH2O17-0185
T 4 4auucrw
DESIGN & DEVELOPMENT DEPARTMENT
BUILDING PERMIT -
Property Address:
48457 VISTA PALOMINO
APN:
602200003
Application Description:
LIN DSEY /,,CONDENSER CHANGE OUT - 14 SEER SPLIT SYSTEM
Property Zoning:
Application Valuation:
$3,000.00
Applicant:
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JOHN BORDEN HEATING
AND AIR CONDITIONING
P 0 BOX 459
p 2 �-
N � W
YUCAIPA, CA 92399
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Contractor:
C 1
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.: 719570
(Contractor: /
OWNER-BUILDERCECT ARAT N '
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 owri 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 Na
Lender's Address:
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
` '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 tRon
rk for which this permit is issued.
I have and will maintain workers' compensation insurance, as required by
Sec700 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: INSURANCE COMPANY OF THE WEST Policy Number: WSD5031288
_ 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 those7ovisions..-
Date:( �J I J [ Aoolieant-
WARNING: FAILURE TO SECURE WORKERS' CYI%PENSATION RAGE IS UNLAWFUL,
AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALT 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 ab ve-
mentioned property for inspection purposes.
6-�&.JKSign�a�ure(-ApplicanttorAgent):
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Date: 5/15/2017
Owner:
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JOHN & PHYLLIS LINDSEY
48457 VISTA PALOMINO
°C
LA QUINTA, CA 92253
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p 2 �-
N � W
»< �
Contractor:
.fl W
JOHN BORDEN HEATING AND Al LNDITrkNING w
P 0 BOX 459
YUCAIPA, CA 92399
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(951)797-5669
CO
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Llc. No.: 719570
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` '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 tRon
rk for which this permit is issued.
I have and will maintain workers' compensation insurance, as required by
Sec700 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: INSURANCE COMPANY OF THE WEST Policy Number: WSD5031288
_ 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 those7ovisions..-
Date:( �J I J [ Aoolieant-
WARNING: FAILURE TO SECURE WORKERS' CYI%PENSATION RAGE IS UNLAWFUL,
AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALT 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 ab ve-
mentioned property for inspection purposes.
6-�&.JKSign�a�ure(-ApplicanttorAgent):
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FINANCIAL•• •
DESCRIPTION ACCOUNT QTY AMOUNT
BSAS SB1473 FEE 101-0000-20306 0
Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $1.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
HVAC CHANGEOUT - CONDENSER ONLY
101-0000-42402
0
$38.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
HVAC CHANGEOUT - CONDENSER ONLY PC
101-0000-426000
$25.33
Total Paid for CHANGEOUT: $63.33
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
F
Bin. #
City of La Quinta
Btdkgng 8r Safety Division
Permit #
P.O. Box 1504,-78-495 Calle Tamplco
ia.Quinta, CA 92253 - (760) 777-7012
Building Permit Application' and Tracking Sheet
Project Address:
1 15 (�
ql Owner's Name:14%Y\
i
A P. Number.
Address. o ,!� Q
8 a 1 �
Legal Description:
City, ST. Zip: IA
Contracto,
VP Telephone: 0-9
Address: 0 a--
14
Project Description:
City, ST, Zip:
00
902, T� e lace Go n l
i
Telephone
q TO L G✓�E
iState
Lic # :
GSty Lie. #: 7 7,5'
Arch., EW., Designer.,
..
i
Address:
City, ST, zip:
< Construction Type• V� (� 0 nq:
Telephone:
State Lic. #:
Project type (circle one): New Add'n Alter epair Demo
Name of Contact Person:
t)
- sq. Ft.:3551;
Stories:
#'Units:
Telephone # of Contact Person: —9
UO
i
Estimsbed Value of Proj �L?
j
APPLICANT:
DO NOT WRITE BELOW THIS UNE
t!
Submittal
Req'd
Recd
TRACMG
PERM[r FEES
Plea Sets
Plan Check submitted-
Item
Amount
Structural Calm
Reviewed, ready for corrections
Plan Check Deposit, .
11vss Calcs.
Caged Contact Person
Plan Check Balance-
;
Tide 24 Calcs.
Plans picked up
Construction
Flood plain plan
-
Plans resubmitted.'.
Mechanical
Giading plan
2" Review, readyfor corrections/issue
Electrical
Sabeontsetor List
Called Contact Person
Plumbing
Great Deed
Plana picked up
ML
HOA Approval
Plans resubmitted
Grading
IN Ht)lISi3:-
Revtew, ready for corrections/issue
Developer Impact Fee
Planning Approval.
Called Contact Person
A.LP.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees
CERTIFICATE OF COMPLIANCE CF1R-ALT 02-E
Alterations to Space Conditioning Systems (formerly CF -1R -ALT -HVAC) (Page 1 of 3)
Project Name: JOHN & PHYLLIS LIINDSEY.Date Prepared: 2017-05-08
A. General Information '
CFI117ALT-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
JOHN & PHYLLIS LIINDSEY
02
Date Prepared
2017-05-08'
03
Project Location
48457 VISTA PALOMINO
04
Building Type
Single family
05
CA City
LA QUINTA
06
Dwelling Unit Name
HOUSE
07
Zip Code
92253
'r.
08
Dwelling Unit Conditioned
3556
more than'40
entirely new
entirely new
Floor Area (ft2)
Served
-T
System (ft2)
system?
component?
components?
Number of Space
duct system?
09
Climate Zone
15
HOUSE
Conditioning (SC) Systems in
1
Yes .
Yes' "
No
No
this Dwelling Unit:
w,
B. Space Conditioning (SC) System Information
Ol
02
03
04
- _U 05 4=
07 .
08 '
09
10
SC System
SC System
CFA served
Is the SC
+-r�A(3"
system a
Installing a
alttx'� .,p rwi
refrigerant
'p With It'ttactril�
Installing new SC
Installing
Installing
Installing
Identification or
Location or Area
by this SC
y ducted
containing '
system
more than'40
entirely new
entirely new
Name
Served
-T
System (ft2)
system?
component?
components?
feet of ducts?
duct system?
SC system?
Alteration Type
SYSTEM
HOUSE
3556
Yes
Yes .
Yes' "
No
No
No
Altered space
conditioning system
Registration Number: 417-A020092799A-000-000-0000000-0000 Registration Date/Time: 2017-05-08 13:48:12 HERS Provider: CHEERS
CA Building Energy.Efficiency Standards - 2016 Residential Compliance Report Version: 2016.1.005 Report Generated: 2017-05-08 13:48:13
Schema Version: rev 10/16
CERTIFICATE OF COMPLIANCE CFiR-ALT 02-E
Alterations to Space Conditioning Systems (formerly CF -1R -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
Duct Length
R -Value
This field or
No heating
This field or
This field or
Central split
All new'
This field or
This field or
-,SYSTEM
section is not
component,
section is not
section is not
AC
cooling
SEER
14
Setback
section is not,
section is not
applicable
altered
applicable'
applicable
components
applicable
applicable
Required Documentation:
CF2R-MCH-01-E -Space Conditioning Systems ��'�-;
- Duct insulation requirement for the new portions of supply -air and return -air ducts or plenums:FR6 (CZ1 10.12 and 13) and R8 (CZ 11 and 14-16)
+
CF211 and COR -MCH -20-H - Duct Leakage Test 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: <= 15% or <= 10% leakage to outside, or seal all accessible leaks. U
CF2R and CF3R-MCH-25-H Refrigerant Charge verification required when refrigerant containing components are installed or altered (applicable in CZ 2; 8-15).
CF2R and CF3R-MCH-23 Airflow Rate >= 300 CFM penton required when MCH -25 is required.
Exceotions:
- Duct systems registered with HERS provider'as previously sealed are exempt from MCH -20 Duct Leakage Testing requirements.
Heating -only systems and Air Handler Furnace changes do not require verification of Air Flow MCH -23, or'Refrigerant Charge MCH -25.
, ,5
-Existing duct systems constructed, insulated or sealed with asbestos are exempt from MCH -20 Duct Leakage Testing requirements.
Vr� �' wf :• dkr••-� ��� if-'I�,
E. Entirely New or Complete Replacement Duct System, with or without Equipmentt Changieout (Sections 1501(b)1Diia 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:
M Registration Number: 417 A020092799A 000-000 0000000 0000 Registration Date/Time: 2017-05-08 13:48:12•. HERS Provider: CHEERS
CA Building Energy Efficiency Standards - 2016 Residential Compliance Report Version: 2016.1.005 Report Generated: 2017-05-08' 13:48:13,
Schema Version: rev 10/16 `
CERTIFICATE OF COMPLIANCE CF1R-ALT 02-E
w
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:
Connie'Goe.
Company:
Signature Date:
Russells Heating & Air Conditioning
2017-05-08
Address:
CEA/ HERS Certification Identification (if applicable):
33145 Yucaipa Boulevard
City/State/Zip:Phone:
Yucaipa CA 92399 -
Nt'
9. 09797-5669
Responsible Person's Declaration statement
I certify the following under penalty of perjuryunder 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., esponsibilitV fkor 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 1 and Part 6 of the California Code of Regulations. - <'
4. The building design features or system design features identified on this Certificate of Compliance are consistent with the information provided on other applicable compliance documents, worksheets,
calculations, plans and specifications submitted to the enforcement agency forapp�roval with this building permit
application.
Os
5. 1 will ensure that a`registered copy of this Certificate of Compliance shall be made available with the building:permit(s)�issued for the building, and made available to the enforcement agency for all applicable `
inspections. I understand that"a registered copy of this Certificate of Compliance is{required to be included wiih the documentation the builder provides to the building owner at occupancy. ,
Responsible Designer Name:
Connie Goe Vhrr5tchp-d Servx-('CtaixOvlo
Responsible; Designer Signature:
i-4-
Company:
Date Signed:
Russells Heating ,& Air Conditioning
2017-05-08
Address:
License:
33145 Yucaipa:Boulevard
719570
City/State/Zip:
Phone:
Yucaipa CA 92399
909-797-5669
Digitally signed by CHEERS'"'. This digital signature is provided in order to secure the content of this registered
document, and in no way implies Registration Provider responsibility for the accuracy of the information.
Registration Number: 417-A020092799A-000-000-0000000-0000 Registration Date/Time: 2017-05=08 13:48:12 HERS provider: CHEERS
CA Building Energy Efficiency Standards- 2016 Residential Compliance Report Version: 2016.1.005 Report Generated: 2017 -OS -08 13;48:13 _
Schema Version: rev 10/16 "'