BMCH2016-034778=495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
DESIGN & DEVELOPMENT DEPARTMENT
Application Number: BMCH2O16-0347
Property Address: 49110 VISTA ESTRELLA
APN: 602240009
Application Description: RONALD SIMMONS / HVAC CHANGE OUT
Property Zoning:
Application Valuation: $6,000.00
Applicant:
ADAM SIMMONS
P 0 BOX 314
!A 0?III1,IT.4%, CA -92247
ING PERMIT
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 9/14/2016
' Owner:
RONALDSIMMONS-
-SEP 14 216 J 92253
CiTy
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter
9 {commencing with Section 70001 of Division 3 of the Business and. Professions Code,
and my License is in full force and effect.
License Class: C�2-0/ License No.: 780534 "
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).:
(� 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 t6 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 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
.):
Lender's Na
Lender's Address:
Contractor:
ADAM SIMMONS
P O BOX 314
• .. • • ' LA QUINTA, CA 92247
(760)564-7525
Llc. No.: 780534
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 t Iwork 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: 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 f the Labor Code, I shall forthwith
comply wit those provisions. /
Date: b 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 3766 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 ter upon the
above-mentioned property for inspection purposes.
Date:L' Signature (Applicant or Agent�-Zzzl���
'
Date: 9/14/2016
Application Number:
BMCH2016-0347.
Owner:
Property Address:
49110 VISTA ESTRELLA
RONALD SIMMONS
APN:
602240009
Application Description:
RONALD SIMMONS / HVAC CHANGE OUT
92253
Property Zoning: -
Application Valuation:
$6,000.00
Applicant:
Contractor:
ADAM SIMMONS
ADAM SIMMONS
PO BOX 314
PO BOX 314
LA QUINTA, CA 92247
LA QUINTA, CA 92247
(760)564-7525
Llc. No.: 780534
' uettila HVAC' CHANGE OUT-.16.5SEER/80AFUE SPLIT SYSTEM 12013 ENERGY] CM030 MONOXIDLARfvI(S) TO BE INSTALLED PRIOR'TO FINAL INSPECTION,
2013 CALIFORNIA BUILDING
CODES.
DESCRIPTION
-FINANCIAL • •
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
$72.52
DESCRIPTION
ACCOUNT
QTY
AMOUNT
HVAC CHANGEOUT - SPLIT -SYSTEM PC
101-0000-42600
0
$36.26
-
Total Paid for CHANGEOUT:
$108.78'
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PERMIT ISSUANCE
101-0000-42404
0
$91.85
a
1*dtal.P4idf6r PERM'IT•ISSUANCEr
•$201.63
$91:85
,
a
a
Bin # .
Permit ,#
-
Project Address. 1
pity of La Quinta
Building &• Safety Division
.78-495 Calle Tampico.
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet.
Owncr's Name: r
7
A. P. Number:
Address: ` `-
City, ST, Zip: �� J
Legal Description:
rloom
Tele honeCortract
Address: ;i/
Project Description: Ju. Ic z
City, "ST, Zip:
Telephone-
:
State Lic. # :
City Lie. #•:
Arch., Engr., Designer:
Address:
City, ST, Zip:
CoTelephone: n tructi n Type: u an cY•
Project ect tYPe(circle one): .'New Add'n Alter Repair Demo
fate Li
c. Lc.#.
Name of Contact Person:r
Sq. Ft.:
# Stories:
# Units:
# of Contact Person`.
lyTelephone
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
tl
Submittal
Rcq'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 Calcs.
Plans picked up
Construction '
Floodplain 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.
H.O.A. Approval
Plans resubmitted'
Grading
Il`t HOUSE:-
Jrd. Reyieav, ready for corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person
A.1.P.P.
Pub. Wks. Aper
Date of permit issue
School Fccs,
'
1
.
Total Permit Fees
CERTIFkATE OF COMPLIANCE, CF1R-ALT-02-E
Alterations to Space Conditioning Systems (formerly CF -1R -ALT HVAC) (Page 1 of 3 )
Project Name: Simmons Date Prepared: 2016-04-14
A. General Information
CF1R-ALT=02 is applicable to multiple space conditioning systems contained within a single dwelling unit. When muiriple dwelling units must be documented,
use one CF1R-ALT-02 document for each dwelling unit.
01
Project Name
Simmons
02
Date Prepared.
2016-04-14
03
Project Location
49110 Vista Estrella
04
Building Type
Single family ..
05
CA City
La Quinta
06
Dwelling Unit Name
Simmons
07
Zip Code
92253 •
08
Dwelling Unit Conditioned
2000
JV
=
f4
Floor Area (ft2)
SC System
SC System
CFA'served
-
refrige nt t
Number of space conditioning
09
Climate Zone
15
10
(SC) systems In this dwelling
is
ducted
containing
system
more than 40
unit.
entirely new
B. Space.Conditioning (SC) System Information
01
02
04
05R06k
07s
) . 08
09
10
.03
4Is the SC*.
Installin a,
JV
=
f4
SC System
SC System
CFA'served
system a
refrige nt t
ZInstalling new; SCInstalll4
:I stalls g
Installing
Identification or
Location or Area
by this SC .
ducted
containing
system
more than 40
entirely new
entirely new
Name
Served
System (ft2)
system?_
component?
components?
feet of ducts?
ductsystem?
SC system?
Alteration Type
System 1
whole house
2000
Yes
Yes
Yes
No
:'No.
No
Altered space
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: 216-A0140210A-000000000-0000
CA Building Energy Efficiency Standards - 2013 Residential Compliance
Registration Date/Time: 2016-04-14 19:14:53
Report Version: 2013 Rev 1.007
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HERS Provider: CaICERTS
Report Generated: 2016-04-14 19:13:49
CERTIFICATE OF COMPLIANCE Cl`l -ALT 02-E
Alterations to Space Conditioning Systems (formerly CF -1R -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
Central gas
All new
Central split
All new
Less than or
System 1
furnace
heating
AFUE
0.78
AC .
cooling
SEER
16
Setback
equal to 40
R-8
components
components
feet -
Required Documentation:
CF2R-MCH-01-E - Space Conditioning Systems Ducts and Fans
-Duct Insulation requirement for new plenums: R6.
CF2R-MCH-20-H & CF3R-MCH-20-H — Duct Leakage testing.required when heating or cooling components are installed in ducted systems, or when more than 40 it of duct length is replaced.
-Leakage rate compliance::5 15%, or 510% leakage to outside;: or seal all accessible leaks.
CF2R-MCH-2S-H & CF3R-MCH-25-H Refrigerant Charge Verification required when refrigerant containing components are installed or altered (applicable in CZ 2,-15).
CF2RCF3R-MCH-23 & CF3R-MCH-23 Air Flow 2300 CFM/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
`6r'Refngerant Ii�
-Heating-only systems and Air Handler/Furnace changes do not require Verification`of Air Flow MCH 23 Charge MECH
insulated t from MCH 20 Duct Leaka a Testing, re wremenYs
-Existingdud systems constructed, or sealed with asbestos;are exem
y: - ...G`re
P. g g q ..a
4
.. _ ..._'ga...'�'� :'% - 're. --ice ',i,.=',.s zas azo' ;+.ax:•.:..;x ».. sxa,: ^.x-+aw' y� .�.s ,,:; .... '�.se�r 'ryF'
E. Entirely New or Complete Replacement Duct Sy',stem, with or without Equipment Changeout (Sections 150.2(b)YDiia and• 150.2(b)lE, F)
«� W i
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: 216-A0140210A-000000000-0000
CA Building Energy Efficiency Standards 2013 Residential Compliance.
..
Registration Date/Time: 2016-04-14 19:14:53 HERS Provider: CaICERTS
Report Version: 2013 Rev 1.007 Report Generated: 2016-04-14 19:13:49
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r
CERTIFICATE OF COMPLIANCE CF111-ALT-02-E
r
Alterations to Space Conditioning Systems (formerly CF-iR-ALHVAC)
T (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:
Bachus, Tom
/�l�
Company:
Signature Date:
MLC Building Performance
2016-04-14 19:13:20
Address:
CEA/ HERS Certification Identification (if applicable):
77825 Delaware Place
City/State/Zip:
Phone:
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 Conipliance.is true and correct.
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.''
of
4. The building design features or system design features identified on this Certificate of Compliance are consistent with the informatl'on,provided on otk�er,.applicablecompliance documents, worksheets,
onsi. n
.th .
r +'
calculations, plans and specifications submitted,to the enforcement agency for;approval',with this building permit application. .
S. I will ensure that a registered copy of this Certificate of,Compliance shalhbe:made,availabie with`,the bulldingipecmit(s).issued for the builduig, and -,Made available tgthe enforcement agency for all applicable
inspections. I understand that a registered copy of this Certificate of Compliance is requ red to beincluded with the documentation tti Wbulider prow des to the building owner at occupancy.
Responsible Designer Name:
Responsible Designer Signature: :'�.•
Simmons, Donna
Company:
Date Signed:
ADAM SIMMONS
2016-04-14 19:14:53 -
Address:
License:
54440 AVENIDA CARRANZA
780534
City/State/Zip:
Phone:
LA QUINTA CA 92253
760-564-7525
Digitally signed by Ca10ERTS. 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: 216-A0140210A-000000000-0000• Registration Date/Time: 2016-04-14 19:14:53 - HERS Provider: CaICERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013 Rev 1.007 Report Generated: 2016-04-14 19:13:49
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