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BMCH2016-003278-495•CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Twr 4 4 Q COMMUNITY DEVELOPMENT DEPARTMENT BUILDING PERMIT 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, C36 License No.: 686310 Date: ?— 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).: U 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 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 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: 11111111111.11111111 31 VOICE (760) 777-7125 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Owner., BLAKE MIRAG'LIA \ Application Number: BMCH2O16-0032 Property Address: 78370 COYOTE CANYON CT CT APN: 770240009 Application Description: MIRAGLIA / HVAC CHANGE OUT 20SEER/80AFUE Property Zoning: Application Valuation: $19,820.00 Applicant: IE INC cn 31225 LA BAYA x WESTLAKE VILLAGE, CA 91362 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, C36 License No.: 686310 Date: ?— 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).: U 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 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 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: 11111111111.11111111 31 VOICE (760) 777-7125 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Owner., BLAKE MIRAG'LIA n o � � I -r; M Q y� cn . x Contractor: HARRISON ENTERPRISES INC D 31170 RESERVE DRIVE THOUSAND PALMS, CA 92276 (760)343-7488 LIC. 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. SS 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: Z1 Applicant: ---� 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, 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: Z Z Ib Signature (Applicant or Agent): A FIN NOAC 1NFORIVIATION" bE5C BSAS S81473 FEE .101-0000-20306 0 $1.06, Hm m - Tbi 5 Ogg _"g, NOR M L xv �,g I g u�a_� R, n 1,4 7"Z I Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $1.00 $0.00 - N 4, CCOU, W mg ACCa. OUNTS g, RMPAID" TAIQ40ATEO, 11TY HVAC CHANGEOUT - SPLIT-SYSTEM 101-0000-42402 0 $72.521 72.52 $0.00 663 1, 0 Mv MEN N , - , ., I RECEIPT CHECK # CL=TD BY lb, 'A", W, 5 I' DESCRIPTION TIONc` Nr.�,. ; r 0, "PAIMI)ATE,', , 4 YAMOU�NT HVAC CHANGEOUT SPLIT-SYSTEM PC 101-0000-42600 0 $36.26 $0.00 :i-..AY PAI METHODS ET DR H El c-t,, if tw—, fff Ww, %,CL-TD-BY! Total Paid for CHANGEOUT: $108.78 $0.00- ...... . ... �, D g M 0 U N Ti�y, PERMIT ISSUANCE 101-0000-42404 0 $91.85 $0.00 aJ w- U UPA! 'BY, RECEIPT g S LT) 'Total Paid for PERMIT ISSUANCE: $91.85 $0.00 'TOTALS: :$20 Description: MIRAGLIA / HVAC CHANGE OUT 20SEER/80AFUE Type: MECHANICAL Subtype: Status: UNDER REVIEW Applied: 2/24/2016 SKH Approved: Parcel No: 770240009 Site Address: 78370 COYOTE CANYON CT CT LA QUINTA,CA 92253 Subdivision: TR 28470-1 Block: Lot: 51 Issued: Lot Sq Ft: 0 Building Sq Ft: 0 Zoning: Finaled: Valuation: $19,820.00 Occupancy Type: Construction Type: Expired: No. Buildings: 0 No. Stories: 0 No. Unites: 0 NAME TYPE Details: HVAC CHANGE OUT - 20SEER/80AFUE SPLIT SYSTEM [2013 ENERGY] CARBON MONOXIDE ALARM(S) TO BE INSTALLED PRIOR TO FINAL INSPECTION. 2013 CALIFORNIA BUILDING CODES CHRONOLOGY CONDITIONS CONTACTS NAME TYPE NAME ADDRESSI CITY ' STATE ZIP PHONE' FAX EMAIL APPLICANT IE INC 31225 LA BAYA WESTLAKE VILLAGE CA 91362 CONTRACTOR HARRISON ENTERPRISES INC DBA GENERAL AIR 31170 RESERVE DRIVE THOUSAND PALMS CA 92276 OWNER BLAKE MIRAGLIA . 50855 WASHINGTON STE 2C LA QUINTA CA 92253 FINANCIAL INFORMATION Printed: Wednesday, February 24, 2016 1:37:39 PM.' 1 of 2 IWEY SYSTEMS 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 Printed:. Wednesday, February 24, 2016 1:37:39 PM 2 of 2 Ori SYSTEIv1S Bin # City of La Quinta Building 8r Safety Division _ 78-495 Calle Tampieo La Quinta, CA 92253 - (760) 777-7012 Building Permit' Application and Tracking Reet Permit # lwuf zjl(o—OO Project Address: 7$3%0 C1) o � � Co�Y, o C}'. Owner's Name: Lori `� i.t a A. P. Number: Address: 7Z -S-70 C a y ok e C c ,r, c n C:}-. Legal Description: City, ST, Zip: Le (2>uCA 9Zz53 Co ntract r• Gam,er� o- � Y"\ Telephone: n e. Address: 3\\-7C> Project Description: City, ST, Zip: vSa wc� �� MS . CA 9 22 7 (0 � A aG- 5 For. A c Cpt� 1 � 90 0th ne Tele h o . (o 7 P O-3 3 y 4 rr. ce 3 iv State Lic. # O City Lie. #; Arch., Engr., Designer: Address: City, ST, Zip: ne: Telephone:h o ................................... Construction nTY Pe: Occupancy: State Lid. #. Project type (circle one):: New AlterRe air Demo Name of Contact Person: w�� n�eY e Sq. Ft.: # Stories: # Units: Telephone # of Contact Person: $1`a�- 73 S -%S 7(o Estimated Value of Project: APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Req'd Recd 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 Calcs. Plans picked up Construction Flood plain plan Plans resubmitted Mechanical Grading plan 2nd Review, ready for corrections/issue Electrical Subcoutact'or List Called Contact Person Plumbing Grant Dccd Plans picked up S.M.I. Ii.O.A. Approval Plans resubmitted Grading IN 14OUSE:- '"! Review, 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 Permit Fees STATE OF CALIFORNIA AIJERA,TIONS - HVAC is f c CEC-CF1 R -ALT -04-E Revised 03/15 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: 7F370 e Car an G} Enforcement Agency: C;DO, lkc— Dae Pr pared: z z1+ )lo Permit#: Equipment Type Equipment Efficiency New Ducting, Plenums, Lineset: Required R -value Conditioned Floor Area (sq ft) Thermostat ❑ Packaged System y Split System ❑ Mini Split $( Furnace J%Evaporator Coil ,13( Condensing Unit ❑ Compressor ❑ Linesetbe ❑ TXV &0% AFUE SEER EER COP HSPF ❑ R-6 (CZ 2, 8-13) Ducting ❑ R-8' (CZ 11, 14, 15) Ducting ❑ R-6 (all CZ's) Plenums ❑ R-5 or R7.5) Lineset' Served by system ID4Z 13 sqft .Setback (if not already present, must installed) 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, Condenser Unit, Evaporator Coil, Compressor, TXV, Lineset, Air Handler/Furnace' (Can include new ducting) CF1R-ALT-02-E . CF2R: MECH-01, MECH-20-HERS, MECH-(23 or 24)' -HERS, MECH-25-HERS' CF3R: MECH-20-HERS, MECH-(23 or 24) -HERS', MECH-25-HERS' Installer Requirement: Duct leakage (< 15%, or < 10% to outside, or seal all accessible leaks), Air Flow >_ 300 CFM/ton, Refrigerant Charge. Exempted from dud leakage testing if: 111. Dud system registered with HERS provider as previously sealed, or 112. There is less than.40 linear feet of dud in unconditioned space, or ❑ 3. Existing dud systems are constructed, insulated or sealed with asbestos (list manufacture date of building ....... I ❑ 2. New HVAC System Required Compliance Documents to be left on site for Final: All new equipment and All New Ducts' including Mini Split CF1R-ALT-02-E CF2R: MECH-01, MECH-20-HERS, MECH-22-HERS, MECH-(23 or 24) -HERS', MECH-25-HERS' CF3R: MECH-20-HERS, MECH-22-HERS, MECH-(23 or 24)-HERS2, MECH-25-HERS' Mini Splits require CF1R-ALT-02-E, CF2R-MECH-01, and (CF2R-CF3R) MECH-25-HERS Installer Requirement: Duct leakage < 6%, Fan Efficacy (.58W/CFM), Air Flow z 350 CFM/ton (or alternative), Refrigerant Charge ❑ 3. All New Duds with Replacement Required Compliance Documents to be left on site for Final: All New Duds' and one or more of the following replaced: Condenser Unit, Evaporator Coil, Compressor, TXV, Lineset, Furnace' CF1R-ALT-02-E CF2R: MECH-01, MECH-20-HERS, MECH-(23 or 24) -HERS, MECH-25-HERS CF3R: MECH-20-HERS, MECH-(23 or 24) -HERS, MECH-25-HERS Installer Requirement: Duct leakage < 6%, Air Flow >_ 350 CFM/ton.(or alternative), Refrigerant Charge Exempted from duct leakage testing if: ❑ 1. Existing duct systems are constructed, insulated or sealed with asbestos 114. New Ducting over 40 feet I Required Compliance Documents to be left on site for Final: New ducting but less than All New Duds' 1 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. ' Heating only systems and Air Handler/Furnace changes do not require Air Flow MECH-(23 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) ° 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%", 2.5-3T-2%", 3.5 to 4T-2%", 5T-4%" 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 of the 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 gned: ��' License: Company: 6Cr.e(-c-I )r- Address: 311-7u Cit State/Zip: 5gi22-)L Phone: -7b0--3y3-7148a