BMCH2015-043878-495 CALLE TAMPICO
LA'QUINTA, CALIFORNIA 92253
ce4t y, 4 4v Qu!Kr(u
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING PERMIT
Application Number: BMCH2O15-0438
Property Address: 78269 HACIENDA AVE
APN: 646280020
Application Description: SHUMA / CHANGE OUT (1) 14SEER/78AFUE SPLIT SYSTEM
Property Zoning:
Application Valuation: $10,081.00
Applicant:
A R S AMERICAN RESIDENTIAL SERVICES OF C
965 RIDGE LAKE BLVD SUITE 201
MEMPHIS, TN 38120
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:::C36, 30, C20 License No.: 765074
Date: i,\�\gA 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 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 Na
Lender's Address:
r� �N
U-111
1111
IN
66
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Owner:
NANCY SHUMA
78269 HACIENDA
LA QUINTA, CA 92253
Contractor:
A R S AMERICAN RESIDENTI/
965, RIDGE LAKE BLVD SUITE
MEMPHIS, TN 38120 ,
(951)276-9744
Llc. No.: 765074
Date: 11/18/2015
n
Z
O
Q
Owl!
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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.
e and will maintain workers' compensation insurance, as required by
Sectio 700 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: lam« 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. .1
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 1 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: 7 Signature (Applicant or Agen
FINANCIAL •1•
DESCRIPTION
ACCOUNT QTY. , 1. AMOUNT PAID
PAID DATE
BSAS SB1473 FEE 101-0000-20306 0 $1.00 $0.00
PAID BY METHOD 4 RECEIPT # CHECK #
CLTD BY
Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $1.00 $0.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
HVAC CHANGEOUT - SPLIT -SYSTEM
101-0000-42402
0
$72.52
$0.00
PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
HVAC CHANGEOUT - SPLIT -SYSTEM PC
101-0000-42600
0
$36.26
$0.00
PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY
Total Paid for CHANGEOUT: $108.78 $0.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
PERMIT ISSUANCE
101-0000-42404
0
$91.85
$0.00
PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY
Total Paid for PERMIT ISSUANCE: $91.85 $0.00
TOTALS:i 00
Description: SHUMA / CHANGE OUT (1) 14SEER/78AFUE SPLIT SYSTEM
Type: MECHANICAL Subtype: Status: UNDER REVIEW
Applied: 11/18/2015 SKH
Approved:
Parcel No: 646280020 Site Address: 78269 HACIENDA AVE LA QUINTA,CA 92253
Subdivision: TR 8792 & INT IN COMMON AREAS Block: Lot: 9
Issued:
Lot Sq Ft: 0 Building Sq Ft: 0 Zoning:
Finaled:
Valuation: $10,081.00 Occupancy Type: Construction Type:
Expired:
No. Buildings: 0 No. Stories: 0 No. Unites: 0
NAME TYPE
Details: HVAC CHANGE OUT - (1) 14SEER/78AFUE SPLIT SYSTEM [2013 ENERGY] CARBON MONOXIDE ALARM(S) TO BE INSTALLED PRIOR TO
FINAL INSPECTION. 2013 CALIFORNIA BUILDING CODES
ADDITIONAL SITES
CHRONOLOGY
CONDITIONS
CONTACTS
NAME TYPE
NAME
ADDRESSI
CITY
STATE
ZIP
PHONE
FAX
EMAIL
APPLICANT
A R S AMERICAN RESIDENTIAL
SERVICES OF C
965 RIDGE LAKE BLVD
SUITE 201
MEMPHIS
TN
38120
CONTRACTOR
A R S AMERICAN RESIDENTIAL
SERVICES OF C
965 RIDGE LAKE BLVD
SUITE 201
MEMPHIS
TN
38120
OWNER
NANCY SHUMA
78269 HACIENDA
LA QUINTA
CA
92253
771
Printed: Wednesday, November 18, 2015 4:44:49 PM 1 of 2
' RWYSTfMS
Permit Details PERMIT NUMBER
City of La Quinta BMCH2O15-0438
ATTACHMENTS
Printed: Wednesday, November 18, 2015 4:44:49 PM 2 of 2 CR
SYSTEMS
CLTD
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
RECEIPT #
CHECK #
METHOD
PAID BY
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
ATTACHMENTS
Printed: Wednesday, November 18, 2015 4:44:49 PM 2 of 2 CR
SYSTEMS
#
i
Clty Of� La QuIntd
Building at Safety Division
Permit #
P.O. Box 1504, 78.495 Calle Tampico
'
14.Quinta, CA 92253 -'(760) 777-7012
Building
Permit •Application• and Tracking Sheet
Projeet.Addtcsa•
r's Name•
ij
A P. Number : l'¢
jAddrcss:fiuencL
l
Legal Description:
ST, Zip:
Contractor. Ri htime Home Services
Telephone. -1 -
a
,
Address: 3080 Myers St
Project Description:
City.sr,zip: (Riverside CA 92503
tom, 2
`i
Telephone: -9744
�Ln LA
State Lie, 4: 76507.4'
City Lie. tl: 04
I ,
i
At&, Engr., Designer N/A
i�
i
Address: ,
h
I
City' ST, Zip: i'
Telcphonc: (
Construction type: occupancy:
StatcLie. #:
Project type (circle one): New Add'n Alter Repair Demo
NameofContactPerson: Jane Recktenwald'
Sq. Ft.: it stories; pUnitp:
j
'Ccicphoac fi of Contact Pecson; 714-336-6159
]rstimatcd vaiue of Pmjtct
APPLICANT:
DO HOT WRITE BELOW THIS UNE
#
Submittal
Req'd
-Reed
TRACMG PERMIT FEES,
i
'
P142 Sea
Plan Check tubmtlted Item Amount
Struct.61Caict.
Revlewed,rtady'forcorrections PlanCkekDeposit• .
I1vst Cala.
Called Contact Person PlanChtck'Salance• ;
Titlt44 Calci.
Plans picked up Construction
Flood plain pian
Plant rdubrottted • Mechanical
{
i
Giadtng plea
2 ! Rtview, ready for correctionvIssuc . Etecoical
kSubcotttactor
ust
Called Contact Person Plumbing
f
Grant Deed
Plaut kicked up S.KL
lwO Approval
Pious resubmitted Crradlog
F
IN tIO SE:-
"' Review; ready for.eormetionsAssoe Developer Impact Pee
i
Planning Approval,
Called Contact Person A.I.P P.
i •
111
Pub. Nyb. Appr
Datt,of permit Issue
_
,
School Fees
i
.
Total Permit Fees
Stwhanie Khatami
From: Jane Recktenwald <janerccps@att.net>
Sent: Wednesday, November 18, 2015 2:29 PM
To: Stephanie Khatami
Subject: Re: 2 orders
Use what is on the MR please.
Thankyou!
From: Stephanie Khatami
Sent: Wednesday, November 18, 2015 2:08 PM
To: mailto:janerccps@att.net
Subject: FW: 2 orders
The Hacienda is off on the application and energy form too...
Stephanie Khatami I Permit Technician
City of La Quinta
78495 Calle Tampico - La Quinta, CA.92253
Ph. 760.777.7019
skhatami@la-guinta.org
From: Stephanie Khatami
Sent: Wednesday, November 18, 2015 2:08 PM
To: 'Jane Recktenwald'
Subject: RE: 2 orders
Hi Jane,
The application for Via Montesa documents �17seer but the energy form is 14. I need to know what one to
use and if it's 17 please send a new energy doc.
Thank you, I .
Stephanie Khatami 1 ,Permit Technician
City of La Quinta
78495 Calle Tampico - La Quinta, CA 92253
Ph. 760.777.7019
skhatami@la-guinta.ore
From: Jane Recktenwald [mailtoJanerccps(5)att.net]
Sent: Wednesday, November 18, 2015 1:26 PM
To: Stephanie Khatami; Philip Juarez
Subject: 2 orders
Hello!
1
I have two orders and I will be in tomorrow (Thursday) hopefully before lunch.
Thankyou!
Jane Recktenwald
Contractor's Choice Permit Service
714-336-6159
CERTIFICATE OF COMPLIANCE CF1R-ALT-02-E
Alterations to Space Conditioning Systems (formerly CF-iR-ALT=HVAC) (Page 1 of 3 )
Project Name: SHUMA Data Prepared: 2015-11-05
A. General Information
CFIR-ALT-02 is applicable to multiple space conditioning systems contained within a single dwelling unit. When multiple dwelling units must be documented,
use one MR -ALT -02 document for each dwelling unit.
01
Project Name
SHUMA
02
Date Prepared
2015-11-05
03
Project Location
78269 HACIENDA LA QUINTA DR
04
Building Type
Single family
05
CA City
La Quinta
06
Dwelling Unit Name
HOME
07
Zip Code
92253
08
Dwelling Unit Conditioned
2926
installing
Installing
Installing
Floor Area (ft2)
location or Area
, b'y thlkSCp
ducted
containing
- system
Number of space conditioning
entirely new
09
Climate Zone
15
10
iSC) systems in this dwelling
1
component?
components?
feet of ducts?
duct system?
unit
Alteration Type
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 i
CFA served:
system a
refrigerant
Installing new SC
installing
Installing
Installing
Identification or;
location or Area
, b'y thlkSCp
ducted
containing
- system
more than 40
entirely new
entirely new
Name t
Served.
tSistem (ft2j;
. system?
component?
components?
feet of ducts?
duct system?
SC system?
Alteration Type
S
��---•' r% !
�
Yes
Yes
'
Altered space
System 1
_2926
2926�
Yes
..
No
No
No
conditioning system
LJ.%J- L.ric1yLP F-IQLCIO HOCIVLAOLIVIt
C. Extension of Existing Dud System, Greater Than 40 Feet (Section1S0.2(b)iD11b)
This section does not apply to this project.
Registration Number: 315-A3015103A400000000-00W Registration Date/rime: 20151105 13:24-05 HERS Provider. USERA
CA Building Energy Eifidency Standards - 2013 Residential CompUnce Report Version: 2013-1.006 Report Generated: I015-11-05 13:24:40
Schema Version: 0.555SDD
CERTIFICATE OF COMPLIANCE CFIR-ALT-02-E
Alterations to Space Conditioning Systems (formerly CF-lR-ALT=HVAC) (Page 2 of 3 )
D. Altered Space Conditioning System (Sections 1SOZ(b)1E and F)
01
02
03
04
0S
06
07
09
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
.80
AC
cooling
SEER
14
Setback
equal to 40
R-8
components
components
feet
CF211-MCH-014 - Spam Conditioning Systems Ducts and fans
-Duct insulation requirement for new plenums: R6.
CFIR4AcH-204f & CF3R-MC4-20-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: S 15%, or S 10% leakage to outside, or seal all accesslbie leaks.
CFZR-MCH-2S-H & CF3R-MCH-25-H Refrtgeiant charge verification required when refrigerant containing components are Installed or altered +applicable in t? 2, 8 -1St
CF2RCF3R-MCH-23 & CF3R-MCH-23 Air Flow a 300 CFM/ton requited 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 Alr Flaw MCH -23. or Refrigerant Charge ME04-25.
-Existing duct systems constructed, Insulated or sealed with asbestos are exempt from MCH -20 Duct Leakage Testing requirements.
Registration Number: 315-A3015103A-000000000-0000 Registration Date/Time: 2015-11-05 13:24:05 HERS Provider: USERA
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013-1.006 Report Generated: 2015-11.05 13:24:40
Schema Version: 0.555SDD
+c
CERTIFICATE OF COMPLIANCE CFIR-ALT 02-E
Alterations to Space Conditioning Systems (formerly CF -IR -ALT -HVAC) (page 3 of 3 )
Documentation Author's Declaration Statement
L 1 certify that this Certificate of Compliance documentation is accurate and complete.
Documentation Author Name:
Documentation Author signature:
Jim McEligot
Signature Date: ,/w, `
Company.
RighTime Home Services
2015-11-05
Address:
CEA/ HERS Certification identification (if applicable):
3030 Myers St
765074
aty/sato/zip:
Phone:
Riverside CA 92503
951-276-9744 `
Responsible Person's Declaration statement
1 certify the following under penalty of perjury, under the laws of the State of Calfomia:
1. The Information provided on this Certificate of Compliance, h true and correct.
2, I am eligible under Division 3 of the Buskmess and Professions Cade to accept responsibiiity 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 Comptlance conform to the
requirements of idle 24, Part 1 and Part 6 of the California Code of Regulations.
4. The building design features or system design features identNled on Mk Certificate of Compliance arc 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.
S. I will ensure that a registered copy of this Certt�fkgte of Compliance stall be mma�de available withthebuilding permitisi Issued for the building, and made available to the enforcement agency for all applicable
ImpectbrXII understand that a registaed`oopy of this Certificate of Compliance h requii2d to be includmad with the docvmentatbn the builder provides to the building owner at occupancx
Responsible Designer Namei�p�
NAt,
ble Designer Signature: l/'M^
Jim McEligot 1✓-� '4( = -+.,,Mr.'+
f3I )T!`L�Ir nr (�!n., x7nt Sl
Company :,. "
:`
Date Signed:
20-15-11-05
Righlime Home Se tea"
U.S. Energy Rai
M&Association
3030 Myers St
CiN/State/zlp.
Phone:
Riverside CA 92503
951-276-9744
u
'iftra digfW signature is provided fn order to secure '
the content of this registered documoM. and in no j
1,` vreyrimpflea•Regiatr�ron-Pra»decresponsr0ility_far � Y''
the accaracy of the information,''..
U.5. Energy Hater_ Aor=Iatfon 4ZE
Y`
•• s
Registration Number. 315-A1015303A-0000000000000 Registration Date/Time: 2015-11-05'13:24:05 HERS Provider. USERA
i,
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013-1.006 Report Generated: 2015-11-05 13:24:40 �`•_". c
Schema Version: O.SSSSDD v'
x..
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