BMCH2017-024878-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
4 a>rw
:DESIGN & DEVELOPMENT DEPARTMENT
BUILDING PERMIT .
Application Number: BMCH2O17-0248
Property Address`. 47810 VIA LIVORNO
APN: 643140057
Application Description: EKSTROM / HVAC CHANGEOUT 165EER/81 AFUE SPLIT SYSTEM
Property Zoning:
Application Valuation: $8,965.00
Applicant:
CERTIFIED COMFORT SYSTEMS INC DBA HYDES
42-949 MADIO STREET
INDIO,CA92201 JUN 2 ® 2017
CITY OF LA QUINTA
DESIGN AND 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 70001 of Division 3 of the Business and Professions Code, and
my License is in full force and effect.
License Class- C20. C36 License No.: 906115
Date:' Contractor:
4 -
VOICE (760) 777-7125
FAX (760).777-701 1
INSPECTIONS (760) 777-7153
Date:' 6/19/2017
Owner:
BRIAN EKSTROM
47810 VIA LIVORNO
LA QUINTA, CA `32253
Contractor:
CERTIFIED COMFORT SYSTEMS INC DBA HYDES
42-949. MADIOSTREET
INDIO,CA9220L ,
(760)360=2202
Llc. No.: 90611E
, 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 the work for which this permit is issued.
\ JA& -I have 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:
OWNER -BUILDER DECLARATION
Carrier: EVEREST NATIONAL INSURANCE COMPANY Policy Number: 7600015264
1 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
I certify that in the performance of -the work for which this permit is issued, I
city or county that requires a permit to construct, alter, improve, demolish, or repair any
shall not employ any person in any manner so as to become subject to the workers'
structure, prior to its issuance, also requires the applicant for the permit to file a signed
compensation laws of California, and agree that, if I should become subject to the
statement that he or she is licensed pursuant to the provisions of the Contractor's State
workers' compensation provisions of Section 3700 of the r ode, I shall forthwith
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business
comply with t ose'provisions.
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
Date: to 61 1- Applicant:`
t,
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
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL,
compensation, will do the work, and the structure is not intended or offered for sale.
AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO
(Sec. 7044, Business and Professions Code: The Contractors' State License Law does not
ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION TO THE COST OF
apply to an owner of property who builds or improves thereon, and who does the work
COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,
himself or herself through his or her own employees, provided that the improvements
INTEREST, AND ATTORNEY'S FEES.
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
-APPLICANT ACKNOWLEDGEMENT
or she did not build or improve for the purpose of sale.). ;
IMPORTANT: Application is hereby made to the Building Official for a permit subject to
(� I, as owner of the property, am exclusively contracting with licensed contractors to
the conditions and restrictions set forth on &is application.
construct the project. (Sec. 7044, Business and Professions Code: The Contractors' State
. 1. Each person upon whose behalf this appication is made, each person at whose
License Law does not apply to an owner of property who builds or improves thereon,
request and for whose benefit work is performed under or pursuant to any permit issued
and who contracts for the projects with a contractors) licensed pursuant to the
as a result of this application , the owner, and the applicant, each agrees to, and shall
Contractors' State License Law.)..
defend, indemnify and hold harmless the City of La Quinta, its officers, agents, and
(� I am exempt under Sec. • . B.&P.C. for this reason
employees for any act or omission related torthe 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
Date: Owner:
commenced within 180 days from date of issuance of such permit, or cessation of work
for 180'days will subject permit to cancellati m. '
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
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 orcinances and state laws relating to building
construction, and hereby authorize represertatives of this city to.enter upon the above-
meritioned p operty for inspection purposes
Date: Signature (Applicanc or Agent):'
o •
Date: 6/19/2017
Application Number: BMCH2O17-0248
Owner .
Property Address: 47810 VIA LIVORNO
BRIAN EKSTRONI
APN: 643140057
47810 VIA LIVORNO
Application Description: EKSTROM / HVAC CHANGEOUT 16SEER/81 AFUE SPLIT SYSTEM
LA QUINTA, CA 42253
Property Zoning:
Application Valuation: $8,965.00
Applicant:
Contractor:
CERTIFIED COMFORT SYSTEMS INC DBA HYDES
CERTIFIED COH=ORT SYSTEMS INC DBA HYDES
42-949 MADIO STREET,
42-949 MADIO STREET
INDIO, CA 92201
INDIO, CA 9220_
(760)360-2202
Llc. No.: 906115
Detail: HVAC CHANGE OUT - 16SEER/81AFUE SPLIT SYSTEM..CARBON MONOXIDE ALARM(S) TO BE INSTALLED PRIOR TO FINAL INSPECTION. 2016
CALIFORNIA BUILDING CODES.
1
FINANCIAL FORMAT. •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 ISSJANCE:. $96.27
DESCRIPTION
ACCOUNT
QTY
AMOUNT
TECHNOLOGY ENHANCEMENT FEE
502-0000-43611
0
$5:00
Bin #
Permit It
Project Address g i
A. P. Number:
Legal Description:
Contractor: ev tl/
Address: -
City, ST, Zip: rte'/ IG
CG
. Telephone: 5 6C, _ -ZZ &Z
State Lic. # : (4 06- 1'[ � I City Lic. #•
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone:
State Lic. #:
City of La Quinia
- Building o Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Trackir_g Sheet
1,Ny EAddress:
me:
0 : 4 vVvI 9n
CA
5
ZZdI
Name of Contact Person:
Telephone # of Contact person:
# Submittal
Plan Sets
Structural Calcs.
Truss Calcs.
Energy Calcs.
Flood plain pian
Grading, plan
Subcontactor List
Grant Deed
]ELO.A. Approval
IN HOUSE: -
Planning Approval
Pub. Wks. APpr
School Fees
� nfift.�
Project Description:
S
Total Permir Fees
Construction Type:
Ct:cupancy:
Project type (circle one):
New Add'a Alter Repair' Demo
Sq. Ft:
# Stories:
# Units:
Estimated Value of Project:
APPLICANT:
DO NOT WRITE BELOW THIS UNE
Recd
TRACKING .
.
PERMIT FEES '
Plan Check submitted
Item
Amount
Reviewed, ready for corrections
Plan Check Deposit
Called Contact Person
Plan Check Balance
Plans picked up
Construction
Plans resubmitted
Mechanical
god Review, ready for correciions/issue
Electrical
Called Contact Person
Plumbing
Plans picked up
S.M L
Plans resubmitted
Grading
3'4 Review, ready for corrections/issue
Developer Impact Fee
Called Contact Person
A LP.P.
Date of permit issue
•
Total Permir Fees
CERTIFICATE OF COMPLIANCE CF1R-ALT-02-E
Alterations to Space Conditioning Systems (formerly CF -1R -ALT -HVAC) (Page 1 of 3)
Project Name: 47810 Via Livorno Date Prepared: 2017-06-16
A. General Information
CF1R-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
47810 Via Livorno
02
Date Prepared
2017-06-16
03
Project Location
47810 Via Livorno
04'
Building Type
Single family
05
CA City
La Quinta
06
Dwelling Unit Name
47810 Via, Livorno
07
Zip Code
92253
08
Dwelling Unit Conditioned
2605
system a
refrigerant
Installing new SC
Installing
Floor Area (ft)
Installing
Identification or
Location or Area
by this SC
Number of Space
containing
09
Climate Zone
15
10
Conditioning (SC) Systems in
1
Served
System (ftZ)
system?
component?
this Dwelling Unit:
feet of ducts?
1r is rr -- — *r x r --�% --Ta rr —+ as
B. Space Conditioning (SC) System Information
Ol
02
03 N4
04
05
06
07
08
09
10
"'Is the SCr-`
I stalli &a
r� M
V t
C
M
SC System
SC System
CFA served
system a
refrigerant
Installing new SC
Installing
Installing
Installing
Identification or
Location or Area
by this SC
ducted
containing
system
more than 40
entirely new
entirely new
Name
Served
System (ftZ)
system?
component?
components?
feet of ducts?
duct system?
SC system?
Alteration Type
System 1
Location 1
1600
Yes
Yes
Yes
No
No
No
Altered space
conditioning system
C. Extension of Existing Duct System,.Greater Than 40 Feet (Section 150.2(b)1Diib)
This section does not apply to this project.
Registration Number: 217-A020204785A-000-000-0000000-0000
CA Building Energy Efficiency Standards - 2016 Residential Compliance
Registration Date/Time:
Report Version: 2016.1.005
Schema Version: rev 10/16
2017-06-16 15:28:51 HERS Provider: CalCERTS
Report Generated: 2017-06-16 -15:29:30
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)lE and F)
01
02
03
04
05
06
07
08
09
10
it
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
Central split
All new
Central split
All new -
This field or
This field or
System 1
HP
heating
AFUE
81
AC
cooling
SEER
16
Setback
section is not
section is not
components
components
applicable
applicable
Reauired Documentation:
CF2R-MCH-01-E - Space Conditioning Systems
- Duct insulation requirement for the new portions of supply -air and return -air ducts or plenums: R6 (CZ 1-10, 12 and 13) and R8 (CZ 11 and 14-16)
CF2R and CF3R-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.
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 per ton required when MCH -25 is required.
Exceptions:
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 �MCHj23 or Refiigerant Charge NICH-25?
Existing duct systems insulated
constructed, or sealed with asbestos�are exemptffrom MCH=20 Duc'Mt�Leakage Test[ ng•requirements.
V%_ I4 a 3+r V%, RA ik vY 64 E -t .— tr U 1.i VA,
E. Entirely New or Complete Replacement Duct -System, with or without,Equipment Changeout (Sections,150.2(b)lDiia:.and 150.2(b)1E, 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: 217-A020204785A-000-000-0000000-0000 Registration Date/Time: 2017-06-16 15:28:51 - HERS Provider: CalCERTS
CA Building Energy Efficiency Standards - 2016 Residential Compliance Report Version: 2016.1.005 Report Generated: 2017-06-16 15:29:30
Schema Version: rev 10/16
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:
Documentation Author Signature: zz
Hyde, Mark
Company:
Signature Date:
CERTIFIED COMFORT SYSTEMS INC
2017-06-16 15:28:51
Address:
CEA/ HERS Certification Identification (if applicable):
42949 Madio
City/State/Zip:
Phone:
Indio CA 92201
760-360-2202
Responsible Person'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 Business and Professions Code to accept responsibility for 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 ofR eg laions` I t }
4. The building design features or system design features identified on this Certificate of Compliance are cons istentwitF-,the inform ation_provided on other appjl[icay#ble compliance documents, worksheets,
calculations, plans and specifications submitted to the enforcement agency for approval:with this building permit application.
0 � J 1
5. 1 will ensure that a registered copy of this Certificate of,Compliance shall be-made:available with the building permit(s).issued forthe,building,and made available;to the enforcement agency for all applicable
inspections. I understand that a registered copy of this Certificate of Compliance is,requiired to be included with the documentation�the�builder provides to the building owner at occupancy.
Responsible Designer Name: `" l' ., I " . w
Responsible Designer Signature: V f'_#0 K '#
Hyde, Mark
Company:
Date Signed:
CERTIFIED COMFORT SYSTEMS INC
2017-06-16 15:28:51
Address:
License:
42949 Madio
906115
City/State/Zip:
Phone:
Indio CA 922U1
760 360-3201
Easy to Verify O� O
at CaICERTS.com
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 f
the accuracy of the inform
Registration Number: 217-A020204785A-000-000-0000000-0000
Registration Date/Time: 2017-06-16 15:28:51
HERS Provider: CaICERTS
CA Building Energy Efficiency Standards - 2016 Residential Compliance. Report Version: 2016.1.005 Report Generated: 2017-06-16 15:29:30
Schema Version: rev 10/16