BMCH2017-0058c
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
t
4
DESIGN & DEVELOPMENT DEPARTMENT
BUILDING PERMIT
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 3/16/2017
Application Number: BMCH2O17-0058 Owner:
Property Address: 48557 VISTA PALOMINO LARRY DICKENSON
APN: 602200008 7509 SE 76TH AVE
Application Description:. DICKENSON / (2)HVAC CHANGEOUTS-(1)&(2)16SEER/80AFUE SPLIT MERCER ISLAND, WA 92253
Property Zoning:
Application Valuation: $19,000.00 ,
Applicant: Q Contractor:
SAN'S AIR CONDITIONING & HEATING ® SAN'S AIR CONDITIONING & HEATING
51 -530 JACKSON STREET MAR 1 s 201 51 -530 JACKSON STREET
COACHELLA, CA 92236-2737 COACHELLA, CA 92236-2737
CITY OF LA QUINTA (760)398-4287
DESIGN AND DEVELOPMENT DEPARTMENT uc. No:: 522775
-------r------------------------------------------------------
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
Dane:`A k.-'\ ' 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 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 isnot 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 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:
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 thewo for which this permit is issued. '
have and will maintain workers' compensation insurance, as required by
Secti6n-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 should become subject to the
workers' compensation provisions of Section 3700 f the Labor Code, 1 shall forthwith
comply with those provisions.
Date: � �� \ ApA plicant0
li—
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;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,gity tawnter upon the above-
mentioned property fot inspection purposes. / 1„ 11 11
Date: 3/16/2017
Application Number: BMCH2O17-0058 Owner:
Property Address 48557 VISTA PALOMINO LARRY DICKENSON
APN: 602200008 7509 SE 76TH AVE
Application Description: DICKENSON / (2)HVAC CHANGEOUTS-(1)&(2)16SEER/80AFUE SPLIT- MERCER ISLAND, WA 92253
Property Zoning: l
Application Valuation: $19,000.00
•• •
:DESCRIPTION ACCOUNT
QTY AMOUNT
BSAS SB1473 FEE 101-0000-20306
0 $1.00
Total Paid for BUILDING STAN DARDS.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
101-0000-42600
0
$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
50270000-43611.
0
$5.00
$5.00
Bin tt
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%. BuildinD 82- Safety. Division .
Permit #t ; .
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Quinta, CA 92253- (760) 777-701,2 .,
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Building Perrriit Application and Tracking Sheet
Project-Address:� r, .
M', 3b Owner's Name: ` -�
A. P_ Number:
Address:
Legal Description: "
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ontract
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Telephone:
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StateLic.#: �a� '� �1J
City
Arch., Engr., Designer:
Address:
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City, ST, Zip:
Telephone:
P 0 ne:
cti n T e• , Occupancy:
Construction y
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State L ic. #
ProjecttYPe (circlele one • ..New Add n AIter Repair Demo'
'Name of Contact Pgon.MfS LbC
Sq. Ft.:
#` Stories: r
# Units:
¢Telephone # of Contact Person: � �; ��ol
fEstimated Value'o�Proj.eca : ADD()
'APPLICANT: DO NOT WRITE BELOW -THIS LINE
!!
Submittal
Req'd
Rcc'd
r TRACKING
PERMIT FEES'
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.
;
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs. 1
'Called Contact Person}
Plan Check Balance
Title 24 Calcs.
Plans picked up
Construction
Flood plain plan
1 t
4
Plans resubmitted
Mechanical
Grading plan
27" Review, ready for corrections/issue
Electrical
SubcontactorList
Called Contact Person '
Plumbing
Grant Aced
Plaris picked up ' '
S.M.I.
H.O.A. Approval
Plans resubmitted'
Grading
IN HOUSE-
Review, ready for corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person ..
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
`Scliool Fees,
_
"'
Total Permit Fees
STATE OF CALIFORNIA
ALTERATIONS - HVAC
CEC-CFIR-ALT-04-E Revised 01/16 CALIFORNIA ENERGY COMMISSION
CERTIFICATE OF COMPLIANCE. CFIR-ALT-04-E
Alterations - HVAC CZ 2, and 8-15 (Page 1 of 1)
Site ddress:
Enforcement Agency:
Date Prepared:
Permit#:
t-��j
Equipment Type
Equipment Efficiency
New Ducting or Lineset:
Required R -value
Conditioned 2
Floor Area (ft)
Thermostat
❑ Packaged
❑ Evaporator Coil
FOAFUE
COP
❑ R-6 (CZ 1-10, 12&13) Ducts
Served by system
❑ Setback
System
❑ Condensing Unit
❑ R-8' (CZ 11, 14-16) Ducts
ft
(If not already
OrSplit System
❑ Compressor
SEER
HSPF
❑ z R-2.8 Lineset°
present,•must
❑ Mini Split
❑ Linesetbe
installed)
❑ Furnace
11TXV
` EER
D I /
r1 1-0
HERS VERIFICATION SUMMARY Installer determines work to be completed and matches to one of the options below. At permit application this
form is allowed 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.
1. HVAC Changeout/Repair Required Compliance Documents to be left on site for Final:
All Equipment, CFIR-ALT-02-E
Condenser Unit, Evaporator Coil, CF2R-MCH-01-E, MCH -20-H, MCH -(23 or 24)2-H, MCH -25 -HZ
Compressor, TXV, Lineset, CF3R-MCH-20-H, MCH -(23 or 24)-H2, MCH -25-H2
Air Handler/Furnace' (Can include new ducting)
Installer Requirement: Duct leakage (:-S_15%, or <_10% to outside, or seal all accessible leaks), Air Flow z 300 CFM/ton, Refrigerant Charge.
Exempted from duct leakage testing if:
❑ 1. 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 .......
112. New HVAC System
Required Compliance Documents to be left on site for Final:
All new equipment and All New Ducts'
CF1R-ALT-02-E
including Mini Split
CF2R-MCH-01-E, MCH -20-H, MCH -22-H, MCH -(23 or 24)-H2, MCH -25-H2
CF3R-MCH-20-H, MCH -22-H, MCH -(23 or 24)-H2, MCH -25-H2
Mini Splits require CFIR-ALT-02-E, CF2R-MCH-01-E, and (CF2R-CF3R) MCH -25=H
Installer Requirement: Duct leakage:S 5%, Fan Efficacy (0.58W/CFM), Air Flow >_ 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 CF1R-ALT-02-E
replaced: Condenser Unit, Evaporator Coil, CF2R-MCH-03-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:S 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' CFIR-ALT-02-E, CF2R-MCH-20-H, CF3R-MCH-20-H
Installer Required to: Duct leakage L15% or, <_10% 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 &13, 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
3 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 (1" thick insulation) for linesets 1" 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 information 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.
5. 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 for approval with this building permit appl tion.•
Respon 'bl a '' rte I Si er Si nature: -
ktzl�C9
Date Signed
Compare^s:I 20�. _ , �o ,
City/ to i
Phone
For assistance or questions regarding the Energy Standards, contact the Energy Hotline at: 1-800-772-3300
STATE OF CALIFORNIA
ALTERATIONS - HVAC
Y
CEC-CF1 R -ALT -04-E Revised 01116 CALIFORNIA ENERGY COMMISSION
CERTIFICATE OF COMPLIANCE CF1R-ALT-04-E
Alterations - HVAC CZ 2, and 8-15 (Page 1 of 1)
Site Address:
Enforcement Agency:
Date Prepared:
Permit#:
Equipment Type
Equipment Efficiency.
New Ducting or Lineset:
Required R -value
Conditioned 2
Floor Area (ft)
Thermostat
❑ Packaged
❑ Evaporator Coil
tDAFUE
COP
❑ R-6 (CZ 1-10, 12&13) Ducts
Served by system
❑ Setback
System
Split System
❑ Condensing Unit
❑ Compressor
SEER
HSPF
,
❑ R (CZ 14-16) Ducts
2
ft
(If not already
must
R ❑ > R-2.8 Lineset°
present,
❑ Mini Split
❑ Lineset
, EER
be installed)
❑ Furnace
❑ TXV
r0 N
HERS VERIFICATION SUMMARY Installer determines work to be completed and matches to one of the options below. At permit application this
form is allowed 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.
1. HVAC 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 -25-1-12
Compressor, TXV, Lineset, CF3R-MCH-20-H, MCH -(23 or 24)-H2, MCH -25-H2
Air Handler/Furnace2 (Can include new ducting)
Installer Requirement: Dud leakage L15%, or <_10% to outside, or seal all accessible leaks), Air Flow Z 300 CFM/ton, Refrigerant Charge.
Exempted from duct leakage testing if:
❑ 1. Dud system registered with HERS provider as previously sealed, or ❑ 2. There is less than 40 linear feet of dud in unconditioned space, or
❑ 3. Existing dud systems are constructed, insulated or sealed with asbestos (list manufacture date of building 1
112. New HVAC System Required Compliance Documents to be left on site for Final:
All new equipment and All New DudS3 CFIR-ALT-02-E
including Mini Split CF2R-MCH-01-E, MCH -20-H, MCH -22-1-1, MCH -(23 or 24)-H2, MCH -25-H2
CF3R-MCH-20-H, MCH -22-H, MCH -(23 or 24)-H2, MCH -25-1-12
Mini Splits require CFIR-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 2 350 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, Furnace2 . CF3R-MCH-20-H, MCH -(23 or 24)-H, MCH -25-1-1
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 Duds' CFIR-ALT-02-E, CF2R-MCH-20-H, CF3R-MCH-20-H
Installer Required to; Duct leakage (< 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 &13, 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
3 All New Ducts is when at least 75%of the ductsystem 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 (1" 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 information 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 consistent with the information
provided on other applicable compliance documents, worksheets, calculations, plans and specifications submitted to the enforcement
agency for approval with this building permit pp4elV n.
_Responsib`e si ej Name
Company `�„
I D ig r nature.
ate Si�ged- `a
V
LiC £e, I ff—
l'q
``v
Address � c•�- �
City/ te/Zip:
Phone: 2•%�_
�b
For assistance or questions regarding the Energy Standards, contact the Energy Hotline at: 1-800-772-3300