BMCH2017-022978-495 CALLE TAMPICO
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LA QUINTA, CALIFORNIA 92253 DESIGN & DEVELOPMENT DEPARTMENT
BUILDING PERMIT
Application Number: BMCH2O17-0229
Property Address:
80283 VIA TESORO
APN:
777011048
Application Description:
ACKELSON RESIDENCE / HVAC CHANGE OUT
Property Zoning:
Application Valuation:
$10,906.00
Applicant:
DESERT AIR CONDITIONING INC
590 WILLIAMS ROAD
PALM SPRINGS, CA 92264
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. C43 License No.: 276586
Date: O—1r — l % 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).:
(__j 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.).
(_) 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 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 Na
Lender's Address:
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Owner:
DANA ACKELSON
80283 VIA TESOR
LA QUINTA, CA 9;
1 � �
0
s q N
�a
Contractor: ''
DESERT AIR CONDI MIONING INC
590 WILLIAMS ROAD
PALM SPRINGS, CA 922641
(760)323-3383
Llc. No.: 276586
Date: 6/9/2017
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.
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: BENCHMARK INSURANCE COMPANY Policy Number: CST5008762
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: '1 f — l7 Applicant:
WARNING: FAILURE TO SECURE WORKERS' COIVIPENSATION 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 city to enter upon the
above-mentioned property for inspection purposes.
Date: — l7Signature (Applicant or Agep04/
Application Number:
BMCH2O17-0229
Property Address:
80283 VIA TESORO
APN:
777011048
Application Description:
ACKELSON RESIDENCE / HVAC CHANGE OUT
Property Zoning:
Application Valuation:
$10,906.00
Applicant:
DESERT AIR CONDITIONING INC
590 WILLIAMS ROAD
PALM SPRINGS, CA 92264
Owner:
DANA ACKELSON
80283 VIA TESORO
LA QUINTA, CA 92253
Contractor:
DESERT AIR CONDITIONING INC
590 WILLIAMS ROAD
PALM SPRINGS, CA 92264
(760)323-3383
LIC. No.: 276586
Dater 6/9/2017
Detail: HVAC CHANGE OUT - 15 SEER/80 AFUE SPLIT SYSTEM. CARBON MONOXIDE ALARM(S) TO BE INSTALLED PRIOR TO FINAL INSPECTION. PER 2016
CALIFORNIA BUILDING CODES.
FINANCIAL INFORMATION
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 ISSUANCE: $96.27
DESCRIPTION
ACCOUNT
QTY
AMOUNT
TECHNOLOGY ENHANCEMENT FEE
502-0000-43611
0
$5.00
Total Paid for TECHNOLOGY ENHANCEMENT FEE: $5.00
sin #
City Of La Quinta
Building 8L Safety Division
P.O. Box 1504,78-495 Caife Tampico
La.Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
Project Address: '7
J � '�G C�4 3 10-6b Yo
Owner's Name: .
A. P. Number.Address:LIJ
O J T'
p( o
Legal Description:
Contractor: �/ c l/
17 /
City, ST, Zip: 1 { A
Telephone: Q-
L!�5
Address:
-.-� -
Project`DeSdriptioni'
City, ST, Zip: ! i 707GK1G.7
A-
Telephone: D- Z7- pall"
<. >r ? j ;.J i
StateLic.#:
Lie. M.
Arch., Engr., Designer.
:..
f - ♦ r : �
Address:
n
City., ST, Zip:
Telephone: p
State Lic. #:cam
�. ' ' '° Construction Type:. Occupancy:
y �V Project type (circle one)• Ncw Add'n Alter
Repair Demo
Name of Contact Person:
c
Sq. ;
# Stories: #Unit;;:
Telephone # of Contact Person:
p
- �j�j' p , j Estimated Vali►e of Project:
APPLICANT: DO NOT WRITE BELOW THIS UNE
#
Submittal
Req'd
Recd
TRACICIIVG
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Cales.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance.
Title 24 Calcs.
Plans picked up
Construction
'Flood plain plan
Plans resubmitted
Mecharilcal
Grading plan
2'a Review, ready for corrections/issue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
SALL
H.O.A. Approval
Plans resubmitted
Grading
IPI ROUSE:-
'^` Rgview; 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
Total Permio Fees
CERTIFICATE OF COMPLIANCE
Alterations to Space Conditioning Systems (formerly Cf -1R -ALT -HVAC)
Project Name:
80-283 VIA TESORO I Date Prepared:
LR -ALT 02-E
gage 1 of 3)
2017-06-07
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
80-283 VIA TESORO
02
Date Prepared
2017-06-07
03
Project Location
80-283- VIA TESORO
04
Building Type
Single family
05
CA City
La Quinta
06
Dwelling Unit Name
80-283 VIA TESORO
SC System
SC System
CFA served
Dwelling Unit Conditioned
refrigerant
07
Zip Code
92253
08
Floor Area (ft)2013
Identification or
Location or Area
by this SC
ducted
containing
Number of Space
more than 40
09
Climate Zone
15
30
Conditioning (SC) Systems in
1
system?
component?
components?
feet of ducts?
this Dwelling Unit:
SC system?
B. Space Conditioning (SC) System Information
01
02
03 '�
04
-0S'
06
07
08
'09
10
'Is the SC.
Installing a
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
Altered space
System 1
Location 1
2000
Yes
Yes
Yes
No
No
No
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-A020191862A-000-000-0000000-0000
Registration Date/Time: 2017-06-07 15:07:59
HERS Provider: CaICERTS
CA Building Energy Efficiency Standards - 2016 Residential Compliance Report Version: 2016.1.005 Report Generated: 2017-06-07 15:08:14
Schema Version: rev 10/16
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
11
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
All new
All new
I
This field or
This field or
System 1
Central gas
heating
AFUE
81
Central split
cooling
SEER
15
Setback
section is not
section is not
furnace
components
AC
components
i
applicable
applicable
Required 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: <= 1S% 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. r
Heating -only systems and Air Handler Furnace changes do not require verification of Air Flow MCH -23; or Refrigerant Charge MCH -25.
Existing duds stems constructed, insulated or sealed with asbestos are exempt from MCH -20 Duct Leakage Testing requirements.
i 1
E. Entirely New or Complete Replacement Duct System, with or without Equipment Changeout (Sections 150.2(b)1Diia 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. I
Registration Number: 217-A020191862A-000-000-0000000-0000 Registration Date/Time: 2017-06-0115:07:59 HERS Provider: CalCERTS
CA Building'Energy Efficiency Standards - 2016 Residential Compliance Report Version: 2016.1.005 Report Generated: 2017-06-07 15:08:14
Schema Version: rev 10/16
CERTIFICATE OF COMPLIANCE CF1R-ALT-02-E
Alteration's 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: ��/ /?
Trefun, Michael
is ae[ re un
Company:
Signature Date:
Desert Air Conditioning Inc.
2017-06-07 15:07:59
Address:
CEA/ HERS Certification Identification (if applicable):
590 Williams Road
8256454
City/State/Zip:
Phone:
Palm Springs CA 92264
1760-323-3383
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 of Regulations. f
4. The building design features or system design features identified ori 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. � ',
5. 1 will ensure that a registered copy of this Certificate of Compliance shall be made available�with the building permit(s) issued for.the Building, and made available to the enforcement agency for all applicable
inspections. I understand that a registered copy of this Certificate of Compliance is required to be included with the documentation the builder provides to the building owner at occupancy.
Responsible Designer Name: `l �'
Responsible Designer Signature: z— J� /' /
Trefun, Michael
is ae re uit
Company:
Date Signed:
Desert Air Conditioning Inc.
2017-06-07 15:07:59
Address:
License:
590 Williams Road
276586
city/StdtB/Zip:
Phone: I
Palm Springs CA 92264
7GO-323-3303
Easy to Verify 91
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
1
the accuracy of the infor'IM
Registration Number: 217-A020191862A-000-000-0000000-0000
_ Registration Date/Time: 2017-06-07 15:07:59
HERS Provider: CaICERTS
CA Building Energy Efficiency Standards - 2016 Residential Compliance Report Version: 2016.1.005 - Report Generated: 2017-06-07 15:08:14
Schema Version: rev 10/16