The URL can be used to link to this page

BMCH2016-0040LICENSED 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 LLicense No.: 879978 Date: U7 o D Contractor:JYu- .r vc. (760)449-1915 . Llc. No.: 879978 WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: I " 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. I JV_ 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: OWNER -BUILDER DECLARATION Carrier: _ Policy Number: O�i � � , �Q I certify that in the performance of the work for which this permit is issued, I 49 VOICE (760) 77.7-7125 78-495 CALLE TAMPICO city or county that requires a permit to construct, alter, improve, demolish, or repair D any structure, prior to its issuance, also requires the applicant for the permit to file a workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith LA QUINTA, CALIFORNIA 92253 comply with those.provisions. Contractor's State License Law (Chapter 9 (commencing with Section 7000) of Division FAX (760) 777-7011 3 of the Business and Professions Code) or that he or she is exempt therefrom and the D te: Applicant: COMMUNITY DEVELOPMENT DEPARTMENT INSPECTIONS (760) 777-7153 WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, ($500).: BUILDING PERMIT ( ) 1, as owner of the property, or my employees with wages as their sole ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION TO THE COST OF compensation, will do the work, and the structure is not intended or offered for sale. COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, (Sec. 7044, Business and Professions Code: The Contractors' State License Law does not INTEREST, AND ATTORNEY'S FEES. Date: 3/7/2016 Application Number: BMCH2O16-0040 APPLICANT ACKNOWLEDGEMENT Owner: IMPORTANT: Application is hereby made to the Building Official for a permit subject to Property Address: 50120 MALAGA CT CT he or she did not build or improve for the purpose of sale.). STEVEN RICHARDS (� I, as owner of the property, am exclusively contracting with licensed contractors APN: 773380029 issued as a result of this application, the owner, and the applicant, each agrees to, and 8146 EPEACOCK LN shall defend, indemnify and hold harmless the City of La Quinta, its officers, agents, and Application Description: RICHARDS / HVAC CHANGE OUT ORANGE, CA 92253 Property Zoning: 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 D Application Valuation: $6,040.00 MAR p 7 Applicant: Contractor: Z2016 SCOTT'S A / C SERVICE SCOTT'S A / C SERVICE CITY OF LA QUINTA 80-737 MOUNTAIN MESA DRIVE 80-737 MOUNTAlq r IDR1Dr6lELOPMEMDEPARTMENT INDIO, CA 92201 INDIO, CA 92201 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 LLicense No.: 879978 Date: U7 o D Contractor:JYu- .r vc. (760)449-1915 . Llc. No.: 879978 WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: I " 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. I JV_ 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: OWNER -BUILDER DECLARATION Carrier: _ Policy Number: I hereby affirm under penalty of perjury that I am exempt from the Contractor's State , �Q I certify that in the performance of the work for which this permit is issued, I License Law for the following reason (Sec. 7031.5, Business and Professions Code: Any shall not employ any person in any manner so as to become subject to the workers' city or county that requires a permit to construct, alter, improve, demolish, or repair compensation laws of California, and agree that, if I should become subject to the any structure, prior to its issuance, also requires the applicant for the permit to file a workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith signed statement that he or she is licensed pursuant to the provisions of the comply with those.provisions. 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 D te: Applicant: 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 WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, ($500).: AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ( ) 1, as owner of the property, or my employees with wages as their sole ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION TO THE COST OF compensation, will do the work, and the structure is not intended or offered for sale. COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, (Sec. 7044, Business and Professions Code: The Contractors' State License Law does not INTEREST, AND ATTORNEY'S FEES. 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 APPLICANT ACKNOWLEDGEMENT are not intended or offered for sale. If, however, the building or improvement is sold IMPORTANT: Application is hereby made to the Building Official for a permit subject to within one year of completion, the owner -builder will have the burden of proving that the conditions and restrictions set forth on this application. he or she did not build or improve for the purpose of sale.). 1. Each person upon whose behalf this application is made, each person at whose (� I, as owner of the property, am exclusively contracting with licensed contractors request and for whose benefit work is performed under or pursuant to any permit to construct the project. (Sec. 7044, Business and Professions Code: The Contractors' issued as a result of this application, the owner, and the applicant, each agrees to, and State License Law does not apply to an owner of property who builds or improves shall defend, indemnify and hold harmless the City of La Quinta, its officers, agents, and thereon, and who contracts for the projects with a contractor(s) licensed pursuant to employees for any act or omission related to the work being performed under or the Contractors' State License Law.). following issuance of this permit. LJ I am exempt under Sec. . B.&P.C. for this reason 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'. 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 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: Signature (Applicant or Agent): DESCRIPTION FINANCIAL •• • ACCOUNTQTY AMOUNT PAID PAID DATE BSAS SB1473 FEE 101-0000-20306 0 $1.00 $1.00 3/7/16 PAID BY METHOD :. RECEIPT.# CLTD BY SCOTT'S A / C SERVICE CHECK R13593 4219 RSE Total Paid'for BUILDING STANDARDS ADMINISTRATION BSA: $1.00 $1.00 . DESCRIPTION ACCOUNT QTY AMOUNT ` PAID PAID DATE HVAC CHANGEOUT - SPLIT -SYSTEM 101-0000-42402 0 $72.52 $72.52 3/7/16 PAID BY METHOD RECEIPT# CHECK #.. CLTD BY SCOTT'S A / C SERVICE CHECK R13593 4219 RSE DESCRIPTION ACCOUNT QTY AMOUNT. PAID PAID DATE HVAC CHANGEOUT - SPLIT -SYSTEM PC 101-0000-42600 0 $36.26 $36.26 3/7/16 PAID BY METHOD. RECEIPT # >:: CHECK # CLTD BY SCOTT'S Al C SERVICE CHECK R13593 4219 RSE Total Paid for CHANGEOUT: $108.78. $108.78 DESCRIPTION -ACCOUNT • QTY AMOUNT. _ , s PAID PAID DATE PERMIT ISSUANCE 101-0000-42404 0 $91.85 $91.85 3/7/16 PAID BY METHOD RECEIPT # CHECK # CLTD BY SCOTT'S A / C SERVICE CHECK R13593 4219 RSE Total Paid for PERMIT ISSUANCE: $91.85 $91.85 TOTALS: Description: RICHARDS / HVAC CHANGE OUT Type: MECHANICAL Subtype: Status: UNDER REVIEW Applied: 3/7/2016 RSE Approved: Parcel No: 773380029 Site Address: 50120 MALAGA CT CT LA QUINTA,CA 92253 Subdivision: TR 30125-1 Block: Lot: 29 Issued: . Lot Sq Ft: 0 Building Scl Ft: 0 Zoning: Finaled: Valuation: $6,040.00 Occupancy Type: Construction Type: Expired: No. Buildings: 0 No. Stories: 0 No. Unites: 0 Details: HVAC CHANGE OUT-14.OSEER/80AFUE SPLIT SYSTEM [2013 ENERGY) CARBON MONOXIDE ALARM(S) TO BE INSTALLED PRIOR TO FINAL INSPECTION. 2013 CALIFORNIA BUILDING CODES. Printed: Monday, March 07, 2016 8:52:58 AM 1of2 CSYSTrmS ADDITIONAL CHRONOLOGY CONDITIONS CONTACTS NAME TYPE NAME ADDRESSI CITY STATE ZIP PHONE . FAX EMAIL APPLICANT. SCOTT'S A / C SERVICE 80-737 MOUNTAIN MESA DRIVE INDIO CA 92201 CONTRACTOR SCOTT'S A / C SERVICE 80-737 MOUNTAIN MESA DRIVE INDIO CA 92201 OWNER STEVEN RICHARDS 8146 E PEACOCK LN I ORANGE I CA 92253 Printed: Monday, March 07, 2016 8:52:58 AM 1of2 CSYSTrmS INSPECTIONS PARENT PROJECTS REVIEWS RETURNED STATUS REMARK_ S REVIEW TYPE REVIEWER SENT DATE DUE DATE DATE NOTES. BOND INFORMATION ATTACHMENTS CLTD. DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE RECEIPT # CHECK # METHOD PAID BY BY, BSAS SB1473 FEE 101-0000-20306 0 $1.00 $1.00 3/7/16 R13593 4219 CHECK SCOTT'S A / C SERVICE RSE Total Paid for BUILDING STANDARDS ADMINISTRATION $1.00 $1.00 BSA: HVAC CHANGEOUT - 101-0000-42402 0 $72.52 $72.52 3/7/16 R13593 4219 CHECK SCOTT'S A / C SERVICE RSE SPLIT -SYSTEM HVAC CHANGEOUT - 101-0000-42600 0 $36.26 $36.26 3/7/16 R13593 4219 CHECK SCOTT'S A / C SERVICE RSE SPLIT -SYSTEM PC Total Paid for CHANGEOUT: $108.78 $108.78 PERMIT ISSUANCE 101-0000-42404 0 $91.85 $91.85 3/7/16 R13593 4219 CHECK SCOTT'S A / C SERVICE RSE Total Paid for PERMIT ISSUANCE: $91.85 $91.85 TOTALS: INSPECTIONS PARENT PROJECTS REVIEWS RETURNED STATUS REMARK_ S REVIEW TYPE REVIEWER SENT DATE DUE DATE DATE NOTES. BOND INFORMATION ATTACHMENTS Printed., Monday, March 07, 2016 8:52:58 AM 2 of 2 Aff CBM SYSTEMS ain #City of La .Quinta Building 81: Safety Division 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 beta Building Permit Application and Tracking Sheet Permit 1# �fvy d Project Address: Q —�, 0 Q C Owner's Name: Ste V A. P. Number: Address :�Q' ^ Legal Description: City, ST, Zip: Ly 6ty , r �. Contract r• Telephone: 7 de Address: • p� Q &0 OG Project Description: City, ST, Zip: r r Z 7— L-7 V yf r Telephone: 'o r o� a State Lie. # : 7 City Lie_ #.: Arch., Engr., Designer: Address: City., ST, Zip: Telephone: Construction Type: Occupancy: State Lie. Project type (circle one). New Add'n Alter Repair Demo Name of Contact Person: Sq. Ft.: # Stories:# Units: Telephone # of Contact Person: Estimated Value of Project: LO 010 APPLICANT: DO NOT WRITE BELOW THIS LINE H Submittal Req'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 Flood plain plan Plans resubmitted Mechanical Grading plan 2nd Review, ready for corrections/issue Electrical Subconlactor List Called Contact Person Plumbing Grant Dced Plans picked up S.M.I. I-I.O.A. Approval Plans resubmitted Grading IN HOUSE:- '"' 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 Simplified Prescriptive Certificate of Compliance: 2008 Residential HVACAIterations CF -IR -ALT -HVAC Climate Zones 10 to 15 Site Address` Enforcement Agency: DUrat: -)Permit #: C 0, Conditionefd Floor Equipment T el List Minimum Efficiency 2 Duct insulation requirement Area Thermostat Packaged Unit F ace � AFUE � COP Over 40 ft of ducts added or � Setback Coil Coosin SEER HSP- replaced in unconditioned space Served by system (If not already rn� g Unit EER Resistance R 6 (CZ 10-13) R 8 (CZ 14-15) sf present, must be installed) L Equipment Type: Choose the equipment being installed; if more than one system, use another CF -1 R -ALT -HVAC for each system. 2. Minimum Equipment Efficiencies: 13 SEER, 78% AFUE, 7.7HSPF for typical residential systems. HERS VERIFICATION SUMMARY Listed below are four HVAC alteration Options. The installer decides what work is being done and picks one of the appropriate Options. Each Option lists the HERS measures that must be conducted. A copy of the forms shall be left on site for final inspection and a copy given to the homeowner. At final, the inspector verifies that the work listed on this form was in fact the work completed by the installer. The inspector also verifies that each appropriate CF -6R and registered CF -4R forms (no hand filled CF-4Rs allowed) are filled out and signed. Beginning October 1, 2010, a registered copy of the CF -111 and CF -6R shall -also be on site for final inspection.' 1. HVAC Changeout Required Forms: • All HVAC Equipment replaced CF -6R forms: MECH-04, MECH-2I-HERS and (for split systems) MECH-25-HERS CF -4R forms: MECH-21 and fors lits stems MECH-25 • Condenser Coil and/or CF -6R forms: MECH-2I-HERS and (for split systems) MECH-25-HERS • Indoor Coil and/or CF -4R forms: MECH-21 and (for split systems) MECH-25 • Furnace For Split Systems: Duct leakage < 15 percent; RC, CCA > 300 CFM/ton(Minimum Air Flow Requirement), TMAH For Packaged Units: Duct leakage < 15 percent Exempted from duct leakage testing if: 1. Duct system was documented to have been previously sealed and confirmed through HERS verification, or 2. Duct systems with less than 40 linear feet in unconditioned space, or 3. Existing ducts stems are constructed, insulated or sealed with asbestos 2. New HVAC System Required Forms: • Cut in or Changeout with new CF -6R forms: MECH-04, MECH-20-HERS,and (for split systems) MECH-22-HERS, and MECH-25-HERS ducts: (all new ducting and all CF -4R forms: MECH-20, and (for split systems) MECH-22, and MECH-25 new equipment) For Split Systems: Duct leakage < 6 percent; RC, CCA > 350 CFM/ton, FWD, TMAH, STMS, and either HSPP or PSPP. For Packaged Units: Duct leakage < 6 percent 3. New Ducts with Replacement Required Forms: • Includes replacing or installing all new ducting CF -611 forms: MECH-04, MECH-20-HERS,and (for split systems) MECH-25-HERS and/or outdoor condensing unit and/or indoor CF -4R forms: MECH-20 and (for split systems) MECH-25 coil and/or furnace. Not all equipment changed. For Split Systems: Duct leakage < 6 percent, RC, CCA > 300 CFM/ton, TMAH For Packaged Units: Duct leakage < 6 percent -: 4. New Ducting over 40 feet Required Forms: • Includes adding or replacing more than 40 CF -6R forms: MECH-04, MECH-2I-HERS CF -4R forms: MECH-21 linear feet of duct in unconditioned space. For split s stem or packaged units: Duct leakage < 15 percent split Existing ducts stems constructed, insulated or sealed with asbestos. Contractor (Documentation Author's /Responsible Designer's Declaration Statement) • I certify that this Certificate of Compliance documentation is accurate and complete. • 1 am eligible under Division 3 of the California Business and Professions Code to accept responsibility for the design identified on this Certificate of Compliance. • 1 certify that the energy features and performance specifications for the design identified on this Certificate of Compliance conform to the requirements of Title 24, Parts I and 6 of the California Code of Regulations. • The design features identified on this Certificate of Compliance are consistent with the information documented on other applicable compliance forms, worksheets, calculations, plans and specifications submitted to the enforcement agency for approval with the permit application. Name: CU t/ Signature: Company , I V / C P--te: —� i��— IL fz�& —f�y O0–..?0 Addre : r r ,/J G ` C)a / License: City/State/Zip: 4D14 d d Z ZO 'e-- Phone: (,o�- 2008 Residential Compliance Forms July 2010