BMCH2015-0431r
,J • F1
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253 COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING PERMIT
Application Number: BMCH2O15-0431 Owner:
Property Address: 79808 ARNOLD PALMER FOX FAMILY -TRUST
APN: 775241078 79808 ARNOLD PAL
Application Description: FOX / CHANGE OUT (1)SPLIT SYSTEM LA QUINTA, CA 922
Property Zoning:
Application Valuation: '$8,100.00
Applicant: Contractor: .
SUPERIOR HEATING & AIR CONDITIONING INC SUPERIOR HEATING
73510 30TH AVENUE 73510 30TH AVENU
THOUSAND PALMS, CA 92276 THOUSAND PALMS,
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 thefilVsiness and Professions Code,
and my License is in full force and effect. /^J
License Class: C20 License No.: 990826t! / ®� - A
Date: Z 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 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.).
(_J 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 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
(760)250-0694
Llc. No.: 990826
60
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 th
._e_Work for which this permit is issued.
ve 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 becpoe subject to the workers'
compensation laws of California, and agree that ' s Id become sub' ct to the
workers' compensation provisions of Section 00 he Labor Code, I h I f rt t
comply with those provisions.
Date: Applicant:
VV
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL,
AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES ANDOVIL 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 ab 94e in ation is correct.
I agree to comply with all city and county ordinances and sta a la lating to b ilding
construction, and hereby authorize representatives of this ci to ter upon
above-mentioned property for inspection purposes.
Date: 14"5Signature (Applicant or Agent):
Date: 111/12/2015
2Nrsz;�
0[
0R CONDITIONING
92276
:=
INC
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 th
._e_Work for which this permit is issued.
ve 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 becpoe subject to the workers'
compensation laws of California, and agree that ' s Id become sub' ct to the
workers' compensation provisions of Section 00 he Labor Code, I h I f rt t
comply with those provisions.
Date: Applicant:
VV
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL,
AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES ANDOVIL 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 ab 94e in ation is correct.
I agree to comply with all city and county ordinances and sta a la lating to b ilding
construction, and hereby authorize representatives of this ci to ter upon
above-mentioned property for inspection purposes.
Date: 14"5Signature (Applicant or Agent):
Yi� r�."S �{" Ca��� �'
r ' DESCRIPTIONS §�� c'4` ACCOUNT�q 'iQTY Y, PAID PAID DATE
y�`lt;AMOUNT
<Sn ♦y,..s i<''. ..,n>b, .....�J ^i,L-:� .6....tS'•.w`:.-- F,£:z'.,- 'i.« 'F.cw
BSASSB1473'FEE 101-0000-20306' 0 $1.00 $0.00
a{' -k "WII i:y9e 4:i a...,.
PAID BY RECEIPT#HECK# s kCLTDBY
,METHODS
1 _..§_`i,1_tt3':.k..w ,. ..,,,
k
Total Paid for BUILDING STAN DARDS.ADMINISTRATION BSA: $1.00 • $0.00
y' ; % T - t 6' 2•,
DESCRIPTION `
.: L i ^i*'ri'*4: oi.
m cW ACCOUNT' s
..ir.'.. Y
QTY
k 'y,'k Sp,YX
AINIOUNTPAID
s.ryw.� KY�q . d3.-i'f."k
PAID DATE
HVAC CHANGEOUT.- SPLIT -SYSTEM
101-0000-42402..
0
$72:52,
$0.00
PAID. BY
METHOD
RECEIPT #
CHECK #
CLTD BY
_ r £,..h'
n 'DESCRIPTION
rs �'. �*: F -5%� .
i
' �
QTYxAINIOUNT
,y. E"rk•'�'.�+;g y �.t'h�
�t, �+-E :S.?'aa" ,�`�: -��,a�
PAIf) ((_,
.
PLAID
key iACGOUNT
,
t
DATE„
HVAC CHANGEOUT - SPLIT -SYSTEM PC
101-0000-42600
0
$36.26
$0.00
n z
PAI D
METHOD orf
RECEIPT #
P 3 CCTD BY
- n ;„
�� , r f
Total Paid for CHANGEOUT: $108.78 $0.00
a bESCitIPTION>
'
AMOUNT
AID
PAIDDAT£-
..
�m
PERMIT
PERMIT ISSUANCE
10v1�-0000-42404
0
$91.85
$0.00
Rj t. iE' R. 1 �
PAIDfBY
%: pyE dF� �' 31.`S° ZI> Wy *f .,➢ yP Sea ., �..�
METHODy4
5 ��
� _ E -v yh: � ,�,t
RECEIPT # _
X -�A �... �. � �. .�
I CHECK#3
tSLy.r 4y; .
CLTD BY �%
f
Vc 4
Total Paid for PERMIT'ISSUANCE: ' $91.85 $0.00 .
•TA'LS.'� i�,":061.63 $0.00
Description: FOX / CHANGE OUT (1)SPLIT SYSTEM
Type: MECHANICAL Subtype: Status: UNDER REVIEW
Applied: 11/12/2015 SKH
Approved:
Parcel No: 775241078 Site Address: 79808 ARNOLD PALMER LA QUINTA,CA 92253
Subdivision: TR 21381-3 SEE ASSESSORS MB 769-41 Block: Lot: 2
Issued:
40 FOR CMS
Lot Sq Ft: 0 Building Sq Ft: 0 Zoning:
Finaled:
Valuation: $8,100.00 Occupancy Type: Construction Type:
Expired:
No. Buildings: 0 No. Stories: 0 No. Unites: 0
ADDRESSI
Details: HVAC CHANGE OUT - 14SEER/80AFUE SPLIT SYSTEM [2013 ENERGY] CARBON MONOXIDE ALARM(S) TO BE INSTALLED PRIOR TO
FINAL INSPECTION. 2013 CALIFORNIA BUILDING CODES.
ADDITIONAL SITES
CHRONOLOGY
CONDITIONS
CONTACTS
NAME TYPE
NAME
ADDRESSI
CITY
STATE
ZIP.
PHONE-
FAX
EMAIL "
APPLICANT
SUPERIOR HEATING & AIR
73510 30TH AVENUE
THOUSAND
CA
.92276
CONDITIONING INC
PALMS
CONTRACTOR
SUPERIOR HEATING & AIR
73510 30TH AVENUE
THOUSAND
CA
92276
CONDITIONING INC
PALMS
OWNER
FOX FAMILY TRUST
79808 ARNOLD
LA QUINTA
CA
92253
PALMER
Printed: Thursday, November 12, 2015 3:05:32. PM 1 of 2 CB?
SYST@tits
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
RECEIPT #
CHECK -#-
METHOD
PAID BY
CLTD
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
$72.52
$0.00
SPLIT -SYSTEM
HVAC CHANGEOUT -
101-0000-42600
0
$36.26
$0.00
SPLIT -SYSTEM PC
Total Paid for CHANGEOUT: $108.78 $0.00
PERMIT ISSUANCE
101-0000-42404
0
$91.85
$0.00
Total Paid for PERMIT ISSUANCE: $91.85 $0.00
TOTALS:• 00
INSPECTIONS
PARENT PROJECTS
REVIEWS
REVIEW TYPE REVIEWER . SENT DATE DUE DATE RETURNED STATUS REMARKS NOTES
DATE
Printed: Thursday, 'November 12, 2015 3:05:32 PM 2 of 2 0
srsrr-Ms
Bin #
Permit #
`ou���5�n 3j
Pr • et Address:
City ofTa La Quin to
Building 82- Safety Division
78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
, wner's Name:
A. P. Number:
Address: -7 d 6
Legal Description:
ntract r
o. tO
City, ST, Zip: z Z Jrr Sj
eh
elP
Address: 7-1� Project Description: Gly
City, ST, Zip: !nS �v2a2 �t�o ce /Gill L�
Tele hone:7 D Z
P r/ D i
tate Lie. # :
Arch., Engr., Designer:
City Lie. #;
Address:
City., ST, Zip:
Telephone:MENEM
State Lie. #.
TKme of Contact Person:
:
ConstructiontructionTY Occupancy.:cY
type:
one): New Alter Repair ai
r DemoProJ
type (circle
Sq.Ft.: # Stories: # Units:
elephone # of Contact Person:�O
--06 Estimated Value of Project•
APPLICANT: DO NOT WRITE BELOW THIS LrfE
#
Submittal
Req'd
Rcc'd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance.
Title 24 Cates.
Plans picked up
Construction '
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2" Review, ready for corrections/issue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
1{.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
'"! Review, ready for corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person
A.LP.P.
Pub. Wks. Appr
Date of permit issue
sC11061 Fees,
Total Permit Fees
t4
CERTIFICATE OF COMPLIANCE
CF1R-ALT 02-E
1, Alterations to Space Conditioning Systems (formerly CF -IR -ALT -HVAC) (Page 1 of 3 )
Project Name: W.Fox I Date Prepared: 2015-11-12
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
W. Fox
02
Date Prepared
2015-11-12
03
Project Location
79808 Arnold Palmer
04
Building Type
Single family
05
CA City
La Quinta
06
Dwelling Unit Name
House
07
Zip Code
92253
OS
Dwelling Unit Conditioned
1480
Installing
ore than 40
Installing
entirely new
Installing
entirely new
Floor Area (ft2)
Served
System ( 2)
system.
component?
components?'
Number of space conditioning
duct system?
09
Climate Zone
15
10
(SC) systems in this dwelling
1
unit.
Entirely new or
B. Space Conditioning (SC) System Information
01
02
03
04
05
06
07
08
09
10
r Is the'SC
system
;Installing a
refrigerant
tg.new
SC System
Identification or
SC System.
ocation o —ea
GFA served
by thls 5C
a
1ducfed` "i
containing
In SC
- `system
Installing
ore than 40
Installing
entirely new
Installing
entirely new
Name
Served
System ( 2)
system.
component?
components?'
-feet ofpducts?
duct system?
SC system?
Alteration Type
*mow
mkvmv�s
Entirely new or
System 1
House
1480
GYee,,��,,�+
U.a�.:. Erb
filters
Y
Also
Ygs .
iatiy �
Yes
Yes
complete
re lacement s ace
P P
conditioning system
C. Extension of Existing Duct System, Greater Than 40 Feet (Section150.2(b)1Diib)
This section does not apply to this project.
Registration Number: 315-A1015469A-000000000-0000
Registration Date/Time: 2015-11-12 11:12:20
HERS Provider: USERA
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013-1.006 Report Generated: 2015-13-12 11:12:38
Schema Version: 0.55SSDD
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)
This section does not apply to this project.
E. Entirely New or Complete Replacement Duct System, with or without Equipment Changeout (Sections 150.2(b)1Diia and 150.2(b)lE, F)
This section does not apply to this project.
F. Entirely New.oc Complete Replacement Space Conditioning System (Section 150.2(b)1C)
01
02
03
04
05
06
07
08
09
10
11
Heating
Cooling
System
Heating
Minimum
Cooling
Minimum
Required
Identification or
Heating System
Altered Heating
Efficiency -
Efficiency
Cooling
Altered Cooling
Efficiency
Efficiency
Thermostat
New Duct
Name
Type
Component
Type
Value
System Type
Component
Type
Value
Type
R -Value
System 1
Central gas
All new heating
AFUE
80.00
Central split.
All new cooling
SEER
14
SetbackTher
R-8
furnace
components
AC
components
mostat
Required Documentation:
CF2R-MCH-01-E - Spaenditioning .'stens Ducts and+Fap's-
Duct insulation requirement for new p enukms: R6.
CF2R & CF3R-MCH-20H.Duct Leakage efif'cation rQciui ed. t rq t
-Leakage rate complia 6%. t . ''
fficacy
CF2R & CF3R-MCH-22 Fan Veri.,icdtl',on z e,
CF2R & CF3R-MCH-23 ysAir FlowRat Verifgtion
Compliance: Fan Efficacy+50;5 W% mond cyst low t 350 efm/ton
- Alternative Compliance: CF2R & eF�3R-MCH-28 Return D,uectrg
p Desi n VenflcatiorY is ori alternative io'MCH-22 and MCH`23"verification.
CF2R & CF3R-MCH-25-H Refrigerant Charge Verification required when rfr$e�dwt c i nem d c a �d,(�ggl 8-15).
Exceptions:.%.�3�!� 'rigs 1i�7fJis'IiLJg'!
'
Heating -only systems are exempt from the 0.58 W/cfm and 350 cfm/ton requirements.
Note:
An "entirely new or replacement duct system" means 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) if the reused parts are accessible and can be sealed to prevent leakage
Registration Number: 315-A1015469A-000000000-0000 Registration Date/Time: 2015-11-12 11:12:20 "' HERS Provider: USERA
CA Building Energy Efficiency Standards - 2013 Residential Compliance . Report Version: 2013-1.006 Report Generated: 2015-11-12 11:12:38
Schema Version: 0.555SDD
CERTIFICATE OF COMPLIANCE CFiR-ALT 02-E
Alterations to Space Conditioning Systems (formerly CF -1R -ALT -HVAC) (Page.3'of 3 )
Documeniation Author's Declaration Statement
1. 1 certify that this Certificate of Compliance documentation is accurate and complete. -
Documentation Author Name:
Documentation Author Signature:
Shawn Malette✓',cis
(C�.� .
Signature Date:
Company:
Superior Heating and Air Conditioning, Inc.
2015-11-12 r
Address:
CEA/ HERS Certification Identification (if applicable):
73510 30TH Ave.
990826
City/State/Zip:.
Phone:
THOUSAND PALMS CA 92276
760-250-0694
Responsible Person's Declaration statement
I certify the following under penalty of perjury, under the laws of the State of Californian
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 land 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 for approval with this building permit application.
S. I will ensrm epi_ t a registered mpy of is" ---ti catte of Compl',iangj� hhallkbe mace available with he bu i ng permits),iiss for the building, and made available to the enforcement agency for all applicable
inspectio nderstand th d
. iregi ter EoPY=oft ertrflcateof*Comphaneeis reQ xedrto+be9mdude�dwith the do�cu entation the builder provides to the building owner at occupancy.
- e
'Responsible Designer Nartie: � .; ;
Shawn Malette
Responsible Designer Signature:
Company:
"
DaYe�Signed
Superior Heating a"; d A'Ir Cond't'i ing Ic.
Address: U.S.p
73510 30TH Ave. USEnergy Ra
License:
emAssoclation
City/State/Zip:
Phone:
THOUSAND PALMS CA.92276
760-250-0694
"This digital signature is p Wded in, order to secure
the content of this registered document,. and in no
.U-S'E-.RA' way implies Registration Provider responsibility for
U.S. Itnergy Raters Assoctatlon the accuracy of the information."
•
Registration Number: 315-A1015469A-000000000-0000 Registration Date/Time: 2015-11-12 11:12:20 HERS Provider: USERA
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013-1.006 Report Generated: 2015-11-12 11:12:38
Schema Version: 0.555SDD,