BMCH2017-0275Applicant: Contractor:
JOHN BORDEN HEATING AND AIR CONDITIONING. III JOHN BORDEN HEATING AND AIR CONDITIONING
P 0 BOX 459 P 0 BOX 459
YUCAIPA, CA 92399 JUN 3 ® 2017 YUCAIPA, CA 92399
CITY O{= QUINTA (951)797-5663
Llc. No.: 71950
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 7000) of Division 3 of the Business and Professions Code, and
my License is in full force and effect.
License Class: C20 License No.: 719570
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 fora 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.).
(� 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 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:
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
o the wor or which this permit is issued.
ave 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: INSURANCE COMPANY OF THE WE,T Polity Number: WSD5031288
_ I certify that in the performance of the work for which this permit is issued, I
shall not employ any person in any mannerso 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 Lab"cle, I s Il forthwith
comply with those provisions.
WARNING: FAILURE'TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL,
AND SHALL SUBJECT AN EMPLOYER TO CRI -ANAL PENALTIES AND CIVIL FINES UP TO
ONE HUNDRED THOUSAND DOLLARS ($10C,000). IN ADDITION TO THE COST OF
COMPENSATION, DAMAGES AS PROVIDED =OR IN SECTION 3706 OF THE LABOR CODE,
INTEREST, AND ATTORNEY'S FEES.
APPLICANT ACINOWLEDGEMENT
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 C ty of La Quinta, its officers, agents, and
employees for any act or omission related m 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 o-dinances and state laws relating to building
construction, and hereby authorize representatives of this city to enter upon the above-
mentioned property for inspection purpose. /-)
D�te'WJI�' ��. /� Sienture (Ap-plicLito� Agenf
VOICE (760) 777-7125
78-495 CALLE TAMPICO
D
LA QUINTA, CALIFORNIA
92253
FAX
FAX (760) 777-7011
DESIGN &DEVELOPMENT DEPARTMENT
(760) 777-7153
BUILDING PERMIT
Date: 6/30/2017
Application Number:
BMCH2O17-0275
Owner:
Property Address:
48365 VISTA CALICO
JOHN BENSOW
APN:
602190007.
48365 VISTA CALICO
Application Description:'
BENSON / HVAC CHANGEOUT
- NEW COOLING COMPONENTS 14 SEER
LA QUINTA, CA 92253
Property Zoning:
Application Valuation:
$3,305.00
Applicant: Contractor:
JOHN BORDEN HEATING AND AIR CONDITIONING. III JOHN BORDEN HEATING AND AIR CONDITIONING
P 0 BOX 459 P 0 BOX 459
YUCAIPA, CA 92399 JUN 3 ® 2017 YUCAIPA, CA 92399
CITY O{= QUINTA (951)797-5663
Llc. No.: 71950
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 7000) of Division 3 of the Business and Professions Code, and
my License is in full force and effect.
License Class: C20 License No.: 719570
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 fora 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.).
(� 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 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:
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
o the wor or which this permit is issued.
ave 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: INSURANCE COMPANY OF THE WE,T Polity Number: WSD5031288
_ I certify that in the performance of the work for which this permit is issued, I
shall not employ any person in any mannerso 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 Lab"cle, I s Il forthwith
comply with those provisions.
WARNING: FAILURE'TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL,
AND SHALL SUBJECT AN EMPLOYER TO CRI -ANAL PENALTIES AND CIVIL FINES UP TO
ONE HUNDRED THOUSAND DOLLARS ($10C,000). IN ADDITION TO THE COST OF
COMPENSATION, DAMAGES AS PROVIDED =OR IN SECTION 3706 OF THE LABOR CODE,
INTEREST, AND ATTORNEY'S FEES.
APPLICANT ACINOWLEDGEMENT
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 C ty of La Quinta, its officers, agents, and
employees for any act or omission related m 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 o-dinances and state laws relating to building
construction, and hereby authorize representatives of this city to enter upon the above-
mentioned property for inspection purpose. /-)
D�te'WJI�' ��. /� Sienture (Ap-plicLito� Agenf
Date: 6/30/2017
Application Number: BMCH2O17-0275
Owner:
Property Address: 48365 VISTA CALICO
JOHN BENSON
APN: 602190007
.48365 VISTA CALICO
Application Description: BENSON / HVAC CHANGEOUT - NEW COOLING COMPONENTS 14 SEER
LA QUINTA, CA 92253
Property Zoning: ,
Application Valuation: $3,305.00
Applicant:
Contractor:
JOHN BORDEN HEATING AND.AIR CONDITIONING
JOHN BORDEN HEATING AND AIR. CONDITIONING.
P 0 BOX 459
P 0 BOX 459
YUCAIPA, CA 92399
YUCAIPA, CA92399
(951)797-56E9
Llc. No.: 719370
-------------------------------------------------------------------------------------------------
Detail: HVAC CHANGE OUT-.14SEER/ SPLIT SYSTEM NEW CONDENSOR AND MATCHING EVAP COIL. CARBON MO,MOXIDE ALARM(S) TO BE INSTALLED
PRIOR TO FINAL INSPECTION. 2016 CALIFORNIA BUILDING'CODES.
FINANCIAL 0
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
i
Bin. #
C[ / Outhta
BtdWg 8t Safety Division
i
Perinit #
P.O. Box 1504,-78-495 Calle Tampico
La.Qulnta, CA 92253 -:(760) 777 7012
Building Permit Application' and Tracking Sheet
Project Add[css: L g 3 .S
Owner's Name:.*
Tp ellsn
i
A. P. Number.
Address: ° L 93(0, Z.� i CZ
Legal Description:
City, ST, Zip: 'S3
Contractor.
Telephone:
Address:
Project Description: 1 [I
-
City, $T, Zip: U
i
Telephone: q69- Z7q-
e t
iState
Lie. #: - -41 q d
CityLi #: boy �S
--r
Arch, Bngr., Designer
i
Address:
-ST, Zip
Bleph e:
Construction Type: C Occa PAY• .
ate Lic. #:
Project type (circle one): New Add'n Alter Repair Demo
i
Name of Contact Person:
Sq. FL: a I (y35'
# Stories: Si �Q,
# Units:
Telephone # of Contact Person:
- )(r QQ
Fstiu a ! Value of Project:
j
APPLICANT:
DO NOT WRITE BELOW THIS UNE
#
Submittal
Req'd
'Reed
TRAC[QNG
Pls'RhIIT FEES
'
Place Sets
Plan Check submitted
-
Item
Amount
.
�
Structural Coles.Reviewed,
f
ready or corrections
Plan Chem De posit
(
i
Truss Cates.
Called Contact Person
Plan Check Balance-
Mae 24 Calce.
Plans picked up
Construct-on
Flood plain plan
Plans resubm[tted
Mecharitul
Giadlag play
2'! Review, ready for correctionsfisstte
Electrical,
'
j
Sabeontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
SALL
ILOA. Approval
Plans resubmitted
Grading
IN $t)t7SE:-
7i8 Review; ready for corrections/issue
Developer Impact Fee
Planning Approval.
Called Contact Person
A.LP.P.
4
Pub. Wks. Appr
Date of permit Issue
School Fees
}
Total Permit Fees
CERTIFICATE OF COMPLIANCE CF1R-ALT 02-E
Alterations to Space Conditioning Systems (formerly CF -1R -ALT -HVAC) (Page 1 of 3)
Project Name: John Benson Date Prepared: 2017-06-29
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
John Benson
02
Date Prepared
2017-06-29
03
Project Location
48365 vista calico
04
Building Type
Single family
05
CA City
La Ctuinta
06
Dwelling Unit Name
SYSTEM
07
Zip Code
92253 },
08
Dwelling Unit Conditioned
2635
system -
more than 40
entirely new
entirely new
Floor Area (ftZ)
Name
09
Climate Zone
wfr�C.
15 `
��
Number of Space
feet of ducts?
duct system?
SC system?
-
X10
Conditioning (SC) Systems in
1
Yes
Yes
Yes
No
this Dwelling Unit:
No
B. Space Conditioning (SC) System Information
01
02
03
04%-0
DOS 11�w-
1" 064 4,;�,
07
08
09
10
SC System
SC System
CFA served
Is the SC
Unt'Y
system a
Installing.a
att:0-6 z.arVq
refrigerant
.4 Wirh IrttoMrit�
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
HOUSE
2635
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: 417-A020100625A-000-000-0000000-0000 Registration Date/Time: 2017-06-29 12:54:07 HERS Provider: CHEERS
CA Building Energy Efficiency Standards - 2016 Residential Compliance Report Version: 2016.1.005 Report Generated: 2017-06-29 12:54:07
c ► o.,� 1ie�� .,. • .o., 10/1 a
CERTIFICATE OF COMPLIANCE
CFiR-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
108
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
Central gas
No heating
This field or
This field or
Central split
All new
Less than or
SYSTEM
furnace
component
section is not
section is not
AC
cooling
SEER
14
Setback
equal to 40
R-8
altered
applicable
applicable
components.
feet
Required Documentation:
��wr
CF2R-MCH-03-E - Space Conditioning Systems
Duct insulation requirement for the new portions of supply -air and return -air ducts or plenums: R6 (CZ 1--10, 42 and 13) and R8 (CZ 11 and 14-16)
CF2R and CF3R-MCH-20-H -Duct Leakage Test required when heating or cooling components areinstalled 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. L__- l...j 2
x —, C-1 r---�+
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 MCH -23, or Refrigerant Charge MCH -25.
-Existing duct systems constructed, insulated or sealed with asbestos are exempt from MCH -20 Duct Leakage Testing requirements.
E. Entirely New or Complete Replacement Duct System, with orlwithoutt'quipent Can eot (Sections 150.2 b 1Diia and 150.2 b lE, F)
U;w�':tt I-nmcsrity
This Section does not'apply to this -project.
F. Entirely New or Complete Replacement Space Conditioning System (Section 150.2(b)lC) '
This section does not apply to this project.
Registration Number: 417-A020100625A-000-000-0000000-0000
CA Building Energy Efficiency Standards - 2016 Residential Compliance
Registration Date/Time: 2017-06-29 12:54:07
Report Version: 2016.1.005
1
HERS Provider: CHEERS
Report Generated: 2017-06-29 12:54:07
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:
Connie Goe
ConvuzGoe,
Company:
Signature Date:
Russells Heating & Air Conditioning
2017-06-29- i
Address:
CEA/ HERS Certification Identification (if applicable):
33145 Yucaipa Boulevard
City/State/Zip:
Phone:
Yucaipa CA 92399
k)9797-5669
Responsible Person's Declaration statement
I certify the following under penalty of perjury, under the laws of the State of California: ••�,� �. �
Jr 7,
1. The information provided on this Certificate of Compliance is true and correct. i "
2. I 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.
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 fo#gapp%oval with this building permit application.
5. I will ensure that a registered copy of this Certificate of Compliance shall be madejavailablle'with th buildingpe mitO 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 isrequired to be included with the documentation the builder provides to the building owner at occupancy.
Responsible Designer Name:
Connie Goe Ur�truCct3ec�et'vl�t
Responsible, Designer Signature:
�Q�Grrty
Company - !
Date Signed:
i+
Russells Heating & Air Conditioning
2017-06-29
Address:
License:
33145 Yucaipa Boulevard
719570
rity/5tlt0/ZiP1
Phone:
Yucaipa CA 92399
_
909-797-5669
Digitally, signed by CHEERS TM This digital signature is provided in order to secure the content of this registered
document, and in no way implies Registration Provider responsibility for the accuracy of the information.
Registration Number: 417-A020100625A-000-000-0000000-0000 Registration Date/Time: 2017-06-29 12:54:07 HERS Provider: CHEERS
CA Building Energy Efficiency Standards - 2016 Residential Compliance Report Version: 2016.1.005' Report Generated: 2017-06-29 12:54:07
- frL.em� \/a reinn• rc.. 1/1/1G