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BMCH2015-0407LICENSED 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: Q0, C36 License No.: 686310 Date: ZO I L5 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 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 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: (760)601-3500 Llc. No.: 686310 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. c 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: 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 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: 0 LO IS Applicant: R 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, ODE;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 above-mentioned property for inspection purposes. Date: l0 20 Signature (Applicant or Agent). �:�GL �� 76 78-495 CALLE TAMPICO • D VOICE (760) 777-7125 LA QUINTA, CALIFORNIA 92253 FAX (760) 777-7011 COMMUNITY DEVELOPMENT DEPARTMENT INSPECTIONS (760) 777.-7153 BUILDING PERMIT C� Date: 10/20/2015 Application Number: BMCH2O15-0407 z Owner: Zi Property Address: 79682 ARNOLD PALMER DUFFY BRIAN T & ANDREA M g APN: 775241023 . S 11087 ARRY' YO�,-BEACHmPL SWz Application Description: DUFFY / CHANGE OUT (1) COIL SEATTLE, WA 981(46 C f Property Zoning: c .2 Application Valuation: $1,019.00 U— o CD v Applicant: Contractor: g HARRISON ENTERPRISES INC DBA GENERAL AIR HARRISON E ETNE ETN RP -RISES INC DBA GENERAL AIR 31170 RESERVE DRIVE 31170 RESERV D THOUSAND PALMS, CA 92276 THOUSAND PALMS, CA 92276 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: Q0, C36 License No.: 686310 Date: ZO I L5 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 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 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: (760)601-3500 Llc. No.: 686310 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. c 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: 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 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: 0 LO IS Applicant: R 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, ODE;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 above-mentioned property for inspection purposes. Date: l0 20 Signature (Applicant or Agent). �:�GL �� w as ACCQ,UNT s,W ti k bESCRIPTION��'��:"%*'�;���',",, ty AN zr ID.DATE4 :PAID BSAS S81473 FEE 101-0000-20306, 0 $1.00 $0.00 . . ... ..... ','PAID ""METHOD::�'pAh�,'-�,�'3,...•�. 4 �N $ M -vXHECK#,m RECEIP.M#V�"`N`��--, ME M C LITD, JI Total.Paid for BUILDING STANDARDS ADMINISTRATION BSA: $1.00 $0.00 ... ........ ... . ..... :DESCRIPTIONTAIDMATE-,', HE AMOUNT,` PAID PAID" 1? 'k HVAC CHANGEOUT.- REPAIR/ALTERATION 101-0000-42402 0, $12.09 $0.00' "PAID Bw, 0 D; NE RECEIPITi CHEC 0-XL--TD%y- Mom w! �VRY d i M -T DESCRIPTION $'PAID fe U -4 - w -7- 'it nn - gl.44-i 0 -RO kbAft! Rl--COUNTU V ;DATE! PAID HVAC CHANGEOUT - REPAIR/ALTERATION 101-0000-42600 0 $4.83 $0.00. PC - M 2 �V` PAID, T W, 0 -�5 --`V Ev M ET H D� 1j, EC E I PT, #0,',Q;ADt, CHECK"W NOR, W CLTD T Total Paid for CHANGEOUT: $16.92 $0..00 -ACCOUNT-0 PERMIT ISSUANCE 101-0000-42404 0 $91.85 $0.00 i�ngp PAID By S1 g *,M is , M 1-,,i R44. TO V, A I R � g Or RECEIPT c No EPE,p iCHEC 7' BV, Total Paid for PERMIT ISSUANCE: $91.85 $0.00 ITA:CS. C 7 $0.00," Description: DUFFY / CHANGE OUT (1) COIL Type: MECHANICAL Subtype: Status: UNDER REVIEW Applied: 10/20/2015 SKH Approved: Parcel No: 775241023 Site Address: 79682 ARNOLD PALMER LA QUINTA,CA 92253 Subdivision: TR 21381-3 SEE ASSESSORS MB 769-41 Block: Lot: 4 Issued: 40 FOR CMS Lot Sq Ft: 0 Building Sq Ft: 0 Zoning: Finaled: Valuation: $1,019.00 Occupancy Type: Construction Type: Expired: No. Buildings: 0 No. Stories: 0 No. Unites: 0 CITY Details: HVAC CHANGE OUT - (1) EVAPORATIVE COIL [2013 ENERGY] CARBON MONOXIDE ALARM(S) TO BE INSTALLED PRIOR TO FINAL INSPECTION. 2013 CALIFORNIA BUILDING CODES. ADDITIONAL CHRONOLOGY CONDITIONS CONTACTS NAME TYPE NAME ADDRESSS CITY STATE ZIP PHONE FAX EMAIL APPLICANT HARRISON ENTERPRISES INC DBA GENERAL AIR 31170 RESERVE DRIVE THOUSAND PALMS CA 92276 CONTRACTOR HARRISON ENTERPRISES INC DBA GENERAL AIR 31170 RESERVE DRIVE THOUSAND PALMS CA 92276 OWNER DUFFY BRIAN T & ANDREA M 11087 ARROYO BEACH PL SW SEATTLE WA 98146 FINANCIAL INFORMATION Printed: Tuesday, October 20, 2015 2:31:45 PM 1 of 2 i SYS TEARS ATTACHMENTS Printed: Tuesday, October 20, 2015 2:31:45 PM 2 of 2 S YS7f AAS CLTD DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE RECEIPT # CHECK # 'METHOD PAID BY BY BSAS SB1473 FEE 101-0000-20306 0 $1.00 $0.00 Total Paid for BUILDING STANDARDS ADMINISTRATION $1.00 $0.00 BSA: HVAC CHANGEOUT - 101-0000-42402 0 $12.09 $0.00 REPAIR/ALTERATION HVAC CHANGEOUT - 101-0000-42600 0 $4.83 $0.00 REPAIR/ALTERATION PC Total Paid for CHANGEOUT: $16.92 $0.00 PERMIT ISSUANCE 101-0000-42404 0 $91.85 $0.00 Total Paid for PERMIT ISSUANCE: $91.85 $0.00 TOTALS:•• • 00 ATTACHMENTS Printed: Tuesday, October 20, 2015 2:31:45 PM 2 of 2 S YS7f AAS o i M i c ur i MLirurtrvw ALTERATIONS - HVAC CEC-CFIR-ALT-04-E Revised 0311 CALIFORNIA ENERGY COMMISSION CERTIFICATE OF COMPLIANCE CF1R-ALT-04-E Alterations - HVAC CZ 2, and 8-15 (formerly CF -IR -ALT -HVAC) (Page 1 of 1) Site Address: .79(a$Z Arnold cL1.*%.- 1br Enforcement Agency: C: Cbl LG F'?s UiV%t= Date Prepared: 001 ZC 15 Permit#: E ui ment T q P YPe Equipment Efficiency New Ducting, Plenums, Lineset: Conditioned Thermostat Required R -value Floor Area (sq ft) 13 Packaged �rEvaporator Coil AFUE COP 11R-6 (CZ2, 8-13) Ducting Served by system KSetback System ❑ Condensing Unit ❑ R-8' (CZ 11, 14, 15) Ducting ;�i4 sgft (Ifnot already ❑ Split System ❑ Compressor T SEER HSPF ❑ R-6 (all Ws) Plenums present must ❑ Mini Split ❑ Lineset EER ❑ R-5 or R7.5) Lineset' be Installed) ❑ Furnace ❑ TXV 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, CF1R-ALT-02-E Condenser Unit, Evaporator Coil, CF2R: MECH-01, MECH-20-HERS; MECH-(23 or 24)2 -HERS, MECH-25-HERS2 Compressor, TXV, Lineset, CF3R: MECH-20-HERS, MECH-(23 or 24) -HERS=, MECH-25-HERS2 Air Handler/Furnace' (Can include new ducting) Installer Requirement: Duct leakage L<15%, or < 309,.' to outside, or seal all accessible leaks), Air Flow z 300 CFM/ton, Refrigerant Charge. Exempted from duct leakage testing If: O 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 ❑ 2. New HVAC System Required Compliance Documents to be left on site for Final: All new equipment and All New Ducts' MR -ALT -02-E including Mini Split CF2R: MECH-01, MECH-20-HERS, MECH-22-HERS, MECH{23 or 24)-HERSZ, MECH-25-HERS2 CF3R: MECH-20-HERS, MECW22-HERS, MECH-(23 or 24) -HERS, MECH-25-HERS2 Mini Splits require CF1R-ALT-02-E, CF2R-MECH-01, and (CF2R-CF3R) MECH-25-HERS Installer Requirement: Duct leakage:5 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' andone 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, MECH-25-HERS Compressor, TXV, Lineset, Furnace2 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 ducts stems 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 (< 15% 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. 2 Heating only systems and Air Handler/Furnace changes do not require Air Flow MECH-123 or 24), or Refrigerant Charge verification MECH-25 ' All New Ducts 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) a 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'/s", 2.5-3T-2%", 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 ofthe 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 application. Responsible Designer Name: Responsible Designer Signature: Date Signed: Llcense: (�$(o31C7 Company: Gex,err�J Nc ay.Xi'ItoY�ti1 Address: 3\\-70 -Ple-se-vvc-b, City/State/Zip: J tiouscs. )-Im 92Z7b Phone: 7GC)-3�7r7'i�2s g For assistance or questions regarding the energy stanaaros, contact the rnergy nouine ac i-ovu-1 # .0ty, of La Quanta Building 8r Safety Division P.O. Box 1504,78-495 Calle Tampico 14.Quinta, CA 92253 -:(760) 777-7012 Building Permit Appllcation and Tracking Sheet Permit # Project Address: 79682 Arnold Palmer Drive Owner'sName:. Brian Duffy A. P. Number: Address: 11087 Arroyo Beach Place SW Legal Description: City, ST, Zip: Seattle, WA 98146 Contractor: General Air Conditioning 'telephone: 206-355-3302 11teats x��: Address: 31170 Reserve Drive l Project Description: Replace 3.5ton Evaporative Coil City, ST, Zip: Thousand Palms, CA 92276 Telephone: 760-343-7488 IRM-11 31, imp State Lic. # : 686310 City Lie'. #•: Arch., Engr., Designer Address: City., ST, Zip: Telephone: v State Lic. #:.- ` ^; �.�q��y���..'.� ' ` H Construction Type: Occupancy: Project type (circle one): New Add'n Alter .Repair Demo Name of Contact Person: Steven Schnierer Sq. Ft.: #Stories: #Units: Telephone # of Contact Person: 818-735-7876 x 1 Estimated Value of Project: $1,019.00 APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Req'd Recd TRACICIIVG PERMIT FEES Plan Sets Plan Check submitted Item Amoutt Structural Calcs. Reviewed, ready for corrections Plan Check Deposit. . Truss Cales. Called Contact Person Plan Check Balance. Title 24 Cates. Plans picked up Construction Flood plain plan Plans resubmitted Mechanical Grading plan 2a0 Review, ready for correctiomMaue Electrical Subcostactor List Called Contact Person Plumbing Grant Deed Plans picked up S.M.L H.O.A. Approval Plans resubmitted Grading IN HOUSE:- '^` Review; ready for correctionsrissae Developer Impact Fee Planning Approval. Called Contact Person A.I.P.P. Pub.'Wks. Appr Date of permit Issue School Fees Total Permit Fees