BMCH2016-014178-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
BMCH2O16-0141
Property Address:
47535 VIA MONTIGO
APN:
643120027
Application Description:
KURT MOMORTENSON / H'
Property Zoning:
Application Valuation:
$6,548.00
Applicant:
ARNOLDS A'/ C SERVICE
76987 OKLAHOMA AVE
PALM DESERT, CA 92211
o uuitw
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING PERMIT
OU
11AY 03 2035
CITYOFLAQUINTA -
.CO_ �U DgELOPMENTDEPARTMENT
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 icense No.: 860682
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 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)::
(� 1, 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.).
(_) 1, 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 contractors) 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
Lender's Address:
Owner:
KURT'MORrENSON
92253
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 5/3/2016
Contractor:.
ARNOLDS A / C SERVICE
76987 OKLAHOMA AVE
PALM DESERT; CA 92211
(760)772-3.731
Llc. No.: 86.7682
WORKER'S COMFENSATION DECLARATION
I hereby affirm under penalty of perjury, one of the following declarations:
I have and will maintain a ce,-tificate 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 I have and will maintain wor-ers' compensation insurance, as required by
Section 3700 of the Labor Code, for the 1performance of the work for which this permit
is issued. My workers' compensation insurance carrier and policy number are:
Carrier: Polity Number:
I certify that in the performance of the work for which this permit is issued, I
shall not employ any person in any mariner 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
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL
AND SHALL SUBJECT AN EMPLOYER TO =RIMINAL 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 thi! application becomes null and void if work is
not commenced within 180 days from este of issuance of such permit, or cessation of
work for 180 days will subject permit tocancellation.
I certify that I have read this applicationand 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 ofthis ci ent r up
o
above mentio d pr perty for inspecticn purposes.
Date: c� Signature (Ap �licant or Age ):
FINANCIAL INFORMATION
v'' Y DESCRIPTIONS ACCOUNT ;QTY AMOUNT PAID £` '` PAID DATE{
,'
BSAS SB1473 FEE 101-0000-20306 0 $1.00
$1.00 5/3/16
�� : '" BYE METHODS >"�RECEIPT #
nK# s T
CL D�BY��
,PAID
_._ . K� �� rx• F;. ". ��. .��
t,.a
:'�<CHEC
ARNOLDS A / C SERVICE DEBIT R15226
RSE
Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: - $1.00 $1.00
DESCRIPTION'
'` ACCOUNT 4`AMOUNT
, PAID y 01-:!
PAIODATE
Y !7. -.- ^`
y ,R
'. f r.- :',S .....e- .v -r �+ `..x+
'< F >.5
➢. L� :_ n _ E9
r3 r wk Ti
HVAC CHANGEOUT - SPLIT -SYSTEM
101-0000-42402
0
$72.52
$72.52
5/3/16
BY
°r'MsETHOD
i RECEIPT#
a:` CHECK#
CLT,D BY
•_ «� ..
y : 3 - r
�. w
w
y:. .
ARNOLDS A / C SERVICE
DEBIT
R15226 .
RSE
ffiQTY
AMOUNT�''�
*� PAID;3
v*`�DESCRIPTION� `f`",ACCOUNT
sr.
$s W,
PAID DATE:
HVAC CHANGEOUT -SPLIT-SYSTEM PC
101-0000-42600
0
$36.26
$36.26
5/3/16
_,xPAIDk$Y °u�
Frur
`RECEIPT#��
�"{
CLTDBY;
FAMETHOO
aCHECK#
ARNOLDS A / C SERVICE
DEBIT
R15226
RSE
.Total Paid for CHANGEOUT:. $108.78 $108.78
DESCRPTION``
s 4:
PAID
ATE'"
:A00OT°r�
PERMIT ISSUANCE
101-0000-42404
0
$91.85
$91.85
5/3/16
PAID BY ":� Y
METHOD
g ` wRECEIP:T. #� h
'V,XHECK W,
�C T. D BY -
, R
ARNOLDS A / C SERVICE
DEBIT
R15226
RSE
Total Paid for PERMIT ISSUANCE: $91.85 $91.85
TOTALS:
r
z.
ut
6yOFat11,
Description: KURT MOMORTENSON / HVAC CHANGE OUT
ARNOLDS A / C SERVICE
Type: MECHANICAL Subtype:
Status: APPROVED
Applied: 5/3/2016 RSE
Approved: 5/3/2016 RSE
Parcel No: 643120027 Site Address: 47535 VIA MONTIGO LA QUINTA,CA 92253
Subdivision: TR 26152 Block:
Lot: 255
Issued:
Lot Sq Ft: 0 Building Sq Ft: 0
Zoning:
Finaled:
Valuation: $6,548.00 Occupancy Type:
Construction Type:
Expired:
No..Buildings: 0 No. Stories: 0
No. Unites: 0 -
Details: HVAC CHANGE OUT - 16.5SEER/80AFUE SPLIT SYSTEM [2013 ENERGY] CARBON MONOXIDE ALARM(S) TO,BE INSTALLED PRIOR TO
FINAL INSPECTION. 2013 CALIFORNIA BUILDING CODES.
APPLICANT
ARNOLDS A / C SERVICE
76987 OKLAHOMA AVE PALM DESERT CA
92211
CONTRACTOR
ARNOLDS A / C SERVICE
76087 OKLAWOMA AVE PALM DESERT r -.A
97.7.].].
OWNER
KURT MORTENSON
92253
Printed: Tuesday, May 03, 2016 10:39:07 AM 1 of 2
SYSTEMS
INSPECTIONS
.......... ..............
. ..... .......... . ........... ...... .. . . . . .
........................ 11-11 ............ .. ..........
7
L�3
'r:'ACCdUW,
-V7
E
af� DESCRIPTION.
0
%RECEIPT4'
ETHOD'4.1,
BYE
.HVACCHANGEOUT-
10.1-0000-42402
0
$72.52
$72.52
5/3/16
R15226
DEBIT
ARNOLDS A C
RSE
SPLIT -SYSTEM
SERVICE
HVACCHANGEOUT-
ARNOLDS A C
101-0000-42600
.0
$36.26
$3616
5/3/16
R15226
DEBIT
RSE
SPLIT -SYSTEM PC
SERVICE
Total Paid for C.HANGEOUT: $108.78 $108.78
ARNOLDS A C
PERM'
IT ISSUANCE
101-0000-42404
0
$91.85
$91.85
5/3/16
R15226
DEBIT
RSE
SERVICE
Total Paid for PERMIT ISSUANCE: $91.85 $91.85
INSPECTIONS
.......... ..............
. ..... .......... . ........... ...... .. . . . . .
........................ 11-11 ............ .. ..........
7
4
B;h #
Permit #
Project Address::V4Owner's
City of iii QuInta
q Building a Safety Division
78-495 Calle Tampico
' La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Name:
A. P. Number:
Address:
Legal Description:
City; ST, Zip: ` O' doGS
Contractor: hO S
E5720 t Ci
h
Telephone:
one: 9
..........................................
Address: 7g
.
Project Description:
City, ST, Zip V,'
'LC'
TPele h one:
State Lic. 9: ,
City .Lie. #.:
Arch., Engr., Designer:
Address:
City., ST, Zip:
ele h
Telephone:
one:
...............................................
Cantructi n
s o Type: ane
Occu
P -Occupancy:
. # •.
c,
Lic,.
StateLi
0roJ
ecti tYPa (circle cle one)• New Ad j'n Alter Repair Dem
Name of Contact Person:
Sq. Ft.:
# Stories:
#Units:
Telephone # of Contact Person:
/^
Estimated Value of Project:
APPLICANT: DO NOT WRITE'BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Cht--k Deposit
Truss Calcs.
Called Contact Person
Plan Chez-k.Balance
Title 24 Cales.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2"' Review, ready for corrections/issue
Electric
Subcontactor List
Called Contact Person
Plumbin:
Grant Dced
Plans 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
School Fees,
t
.
Total Permit Fees
STATE OF CALIFORNIA
ALTERATIONS - HVAC
CERTIFICATE OF COMPLIANCE CF1R-ALT-04-E
Alterations - HVAC CZ 2, and 8-15 (formerly CF -IR -ALT -HVAC) (Page 1 of 1)
Site Address:*
��
Enforcement Agency:
Date Prepared:
Permit#:
Equipment Type
Equipment Efficiency
New Ducting, Plenums, Lineset:
Conditioned
Thermosta
Required R -value
Floor Area (sq ft)
❑ P oefaged System
OlEppeltator Coil
p'yUE
COP
O R-6 (CZ2, 8 Ducting
Served by system
Setback
Split System
ondensing Unit
❑ R-8' (CZ 11, 14, 15)Ducting
sgft
(lfnotalready
❑ Mini lit
❑Compressor
SEER
HSPF
's
❑ R-6 (a// CZ) Plenums
present must
rnace
❑ Lineset
EER
❑ R-5 or R7.5) Lineset'
be installed)
❑ TXV
HERS VERIFICATION SUMMARY Installer determines work to be completed and matches to one of the options below. At permit application this
form ilaRoV9ed to be filled out by hand. Tor final inspection all forms are to be registered (no hand filled forms allowed) and a copy left on site.
AEr-1. HVAC Changeout/Repair
Required Compliance Documents to be left on site for Final:
All Equipment,
CF1R-ALT-02-E
Condenser Unit, Evaporator Coil,
CF2R: MECH-01, MECH-20-HERS, MECH-(23 or24)'-HERS, MKH-25-HERSZ
Compressor, TXV, Lineset,
CF3R: MECH-20-HERS, MECH-(23 or 24) -HERS,', MECH-25-HERS'
Air Handler/Furnace2 (Can include new ducting)
Installer Requirement: Dud leakage L15%, or < 10% to outside, or seal all accessible leaks), Air Flow >_ 300 CFMIton, 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 cud in unconditioned space, or
❑ 3. Existing dud systems are constructed, insulated or sealed with asbestos (list manufacture date of building 1
❑ 2. 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: MECH-01, MECH-20-HERS, MECH-22-HERS, MECH-(23 cr 24) -HERS', MECH-25-HERS2
CF3R: MECH-20-HERS, MECH-22-HERS, MECH-(23 or 24) -HERE', MECH-25-HERSZ
Mini Splits require CF111-ALT-02-E, CF2R-MECH-01, and (CF2R-CF3R) MECH-25-HERS
Installer Requirement: Duct leakage < 6%, Fan Efficacy (.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: MECH-01, MECH-20-HERS, MECH-(23 or 24) -HERS, MEC:+25-HERS
Compressor, TXV, Lineset, Furnace'
CF3R: MECH-20-HERS, MECH-(23 or 24) -HERS, MECH-25-HERS
Installer Requirement: Duct leakage < 6%, 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' CF1R-ALT-02-E, CF2R: MECH-20-HERS, CF3R: MECH-20-HERS
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 R-8 required when more than 40 ft installed and R-6 when less than 40 ft installed. This includes in walls, between floors etc.
' Heating only systems and Air Handler/Furnace changes do not require Air Flow MECH-(23 or 24), or Refrigerant Charge verification MECH-25
' All New Duds is when at least 75 percent of the duct system is new duct material, and up to 25 percent 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-5 (1" thick insulation) for linesets 1" and less. R-7.5 (1.5" thick insulation) for linesets over 1 inch. Most mfg will require Suction line Diameter
with insulation as the following 1.5-2T-2%", 2.5 -3T -2W, 3.5 to 4T-2%", 5T -4Y."
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 Complence 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 fir the building design or
system design identified on this Certificate of Compliance conform to the requirements of Title 24, Part 1 and Dart 6 of the CCR.
5. The building design features or system design features identified on this Certificate of Compliance are consistE nt with the information
provided on other applicable compliance documents, worksheets, calculations, plans and specifications submi_ted to the enforcement
agency for approval with this building permit application.
Responsible Designer Name:
Responsible Designer Signature:
Date Signed:
License:
Company:
Address:
City/State/Zip:
Phone:
For assistance or questions regarding the Energy Standards, contact the Energy Hotline at:1-800-772-3300