BMCH2017-015378-495 CALLE TAMPICO • ' ,
4
LA QUINTA, CALIFORNIA 92253 DESIGN & DEVELOPMENT DEPARTMENT
BUILDING PERMIT
Application Number: BMCH2O17-0153
Property Address: 48123 VISTA CIELO `
APN: 646100046
Application Description: OLSER / HVAC CHANGE OUT - (1)16SEER/81AFUE SPLIT SYSTEM
Property Zoning:
Application Valuation: $8,200.00
Applicant:
MLC TESTING
77825 DELAWARE PL.
PALM DESERT, CA 92211
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: License No.: 780534
Date: �' / y Contractor:
t.f
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.).
(_) 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:
Owner:
KENNETH OLSEN
6840 OLD POST PL
LINCOLN, NE 922S3
Contractor:
ADAM SIMMOIN
P O BOX 314
LA QUINTA, CA
(760)564-7525
Llc. No.: 78053
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 4/27/2017
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.
/—P J?- 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: STATE COMPENSATION INSURANCE FUND Policy Number: 9054788
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:y 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�c./ Signature (Applicant or Agent):--
FINANCIAL INFORMATION.
DESCRIPTION ACCOUNT ' QTY AMOUNT
BSAS SB1473 FEE 101-0000-20306 0 $1.00
Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: I $1.00
.. DESCRIPTION
ACCOUNT
QTY
AMOUNT
HVAC CHANGEOUT - SPLIT -SYSTEM
101-0000-42402
0 i
$76.00
x I 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
s
CERTIFICATE OF COMPLIANCE CFiR-ALT 02-E
Alterations to Space Conditioning Systems (formerly CF -IR -ALT HVAC) (Page 1 of 3)
Project Name: Olsen Date Prepared: 2017-04-02
A. General Information
CF111-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
Olsen
02
Date Prepared
2017-04-02
03
Project Location
48123 Vista Cielo
04
Building Type
Single family
05
CA City
La Quinta
06
Dwelling Unit Name
Olsen
!
Dwelling Unit Conditioned
07
Zip Code
92253
08
Floor Area (ft)2000
°
� ;
SC System
Number of Space
CFA served
09
Climate Zone , `
TS �, �, 4 ::- ^'
10
Conditioning (SC) Systems in
1
Identification or
..F
by this SC
this Dwelling Unit:
containing
B. Space Conditioning (SC) System Informatto�n
ar
01
02
03 `
�. U4
' 6s`
�.�, 06 t
M 07 ii
-VolOB
09
10
FIs the SCr7'
Installi gaa
>
°
� ;
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
entirety new
entirely new
Name
Served
System (ft)
system?
component?
components?
feet of ducts?
dud system?
SC system?
Alteration Type
System 1 -
WHOLE HOUSE
2000
Yes
Yes
Yes
No
No _
No
Altered space
conditioning system
C. Extension of Existing Dud System, Greater Than 40 Feet (SedioniS0.2(b)1Diib)
This section does not apply to this project.
Registration Number: 217-A020104350A-000-000-0000000-0000
CA Building Energy Efficiency Standards - 2016 Residential Compliance
Registration Date/Time: 2017-04-02 07:43:29
Report Version: 2016.1.005 -
Schema Version: rev 10/16
HERS Provider: CaICERTS
Report Generated: 2017-04-02 07:43:38
CERTIFICATE OF COMPLIANCE CFiR-ALT 02-E
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
Central gas
All new
Central split
All new
Less than or
System 1
furnace
heating
AFUE
, g1
AC
cooling
SEER ,
16
Setback
equal to 40
R-8
components
components
feet -
Required Documentation: {
CF2R-MCH-01-E - Space Conditioning Systems k
-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: <= 15% 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. r
Exce do ons: '
-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 of Reffigeranf Charg'MCI 25*
- -
Existing duct systems constructed, insulated or sealed with asbestos are exempt from MCH'20 Duct1Leakage Testingrequiements.
1, 14 a.. _31 .* . AK :AT Act iV,
j " � ^s�'�.:a � "�!+a rrN'. "*awi�xA` �.-y„�,,,. ��,r.,,,.--:•iy,e, .,.:� -. � �•�.-r- �y� •.+ • � �. -`n,n"•4r'> __ .
E. Entirely New or Complete Replacement DuctSystem, with or without, Equipment Chang�eoyut(Se�cttioyns<�l50.2(b)lDiia:and,150.2(b)lE, F)
Y 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.
Registration Number: 217-A020304350A-000-000-0000000-0000
CA Building Energy Efficiency Standards - 2016 Residential Compliance
Registration Date/Time: 2017-04-02 07:43:29 HERS Provider: CalCERTS
Report Version: 2016.1.005 Report Generated: 2017-04-02 07:43:38
Schema Version: rev 10/16
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: T
Bachus, Tom
/i�Yffi��Crlll�4'
Company:
Signature Dater
MLC Building Performance
2017-04-02 07:43:29
Address:
CEA/ HERS Certification Identification (if applicable):
77825 Delaware Place j
s -•
City/State/Zip:
Phone: 4 .
Palm Desert CA 92211
760-836-0066
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 ot�R g lat ons
4. The building design features or system design features identified on this Certificate of Compliance are consistent with -the information.provided on otherdapplicable'compliance documents, worksheets,
' # �.
}' t t Taro' F k G -,�..� k.—'I
calculations, plans and specifications submitted't he enforcement agency for approval,wrth this bwlding permit application. `
''
b' i a •Ia *W , b a' ''
5. I will ensure that a registered copy of this Certificate of,Compliance shall be.made available with the building permits) issued for3thd:buiidl g, and•ma a av Ilab e.to the ehforcement agency for all applicable
inspections. I understand that a registered co of this Certificate of Com liance.is re uired to be.included with the-documentation.the builder rovides to.the buildingowner at occupancy.
Responsible Designer Name: w
Responsible De's'igner Signature: V U -t C4 VA
/
Bachus, Tom
Company:
Date Signed:
MLC Building Performance
2017-04-02 07:43:29
Address:
License:
77825 Delaware Place
City/State/Zip:
Phone:
Palm Desert CA 92211
760-836-0066 '
Digitally signed by Ca10ERTS. This digital signature is provided in order to secure the content of this registered document and in noway implies Registration Provider
responsibility for the accuracy of the information.
Registration Number: 217-A020304350A-000-000-0000000-0000 Registration Date/Time: 2017-04-02 07:43:29
CA Building Energy Efficiency Standards - 2016 Residential Compliance Report Version: 2016. 1.005
Schema Version: rev 10/16
HERS Provider: CaICERTS
Report Generated: 2017-04-02 07:43:38
r
BIR #
Qty. Of %a QU1f:td
Building 8r Safety Div[sion
P.O. Box 1504, *78-495 Calle Tampico
La.Qidnta, CA 92253 - (760) 777-7012
Building Permit Application* and Tracking Sheet
Permit #
Project Add, e- b
Owner's Name:. A4,4.
A. P. Number.
Address: G
Legal Description:
City. ST, Zip:
Contractor. Si � t o 0.+y Al A—
' L
Telephone: 0 7,36 Z' l7j�,l
Project Description: �11�%"&;,�
Address: ?d 3 �.
City, 4T, Zip �v C44
r
Telephone: o -- 5� 1/'%�7--.� `
State Lic. #:7- W-5 City Lie. #,
Arch., EW., Designer
Address:
City, ST, Zip.
Telephone:
Construction Type:. Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
Sq. Ft : # Stories: #Univ
Statc Lic. #:
Name of Contact Penson: -
Telephone # of Contact Person: 6 ' oz, evw
Estimated Value of Proj Zoo.
APPLICANT: DO NOT WRITE BELOW THIS UNE
#
Submittal
Req'd
Reed
TRACKMG
PERMIT FEFS
Plan Sets
Plan Cheek submitted
Item Amount
Structural Cales.
Reviewed, ready for corrections
Plan Check Deposit. .
Truss Cal".
Called Contact Person
Plan Check Balance
Mde 24 Cates.
Plans picked up
Construction
Flood plata plan
Plans raubmitt.e .
Mechanical
Ginding plan
2,'6 Review, ready for correctionsfissue
Electrical
Subcontactor List
Called Contact PersonPlumbing
Grant Deed
Plana plciced up
S3U
H.O.A. Approval
Phos resubmitted
Grading
114 HOUSE:-
''" Review; ready for eorreedons/issae
Developer Impact Fee
Planning Approval.
Called Contact Person
A.LP.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees