BMCH2016-005563
478-495 CALLE `fAM PICO VOICE (760) 777-7125
LA QUINTA, CALIFORNIA 92253 FAX (760) 777-7011
COMMUNITY DEVELOPMENT DEPARTMENT INSPECTIONS (760) 777-7153
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: Q0, CSO License No.: 286936
Date: 3/17 II 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).:
(•J I, as owner of the property, or my employees with wages as their sole
compensation,'will do the work, and the structure is ndt 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 11, 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 Name:
Lender's Address:
(760)347-3608
Llc. No.: 286936
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 rk 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:- 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: Applicant:
' PO4
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERA4 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: 3 Signature (Applicant or Agent):
Application Number:
BMCH2O16-0055
Owner:
Property Address:
43671 MESSINA CT
LEE OSBORNE cc w
APN:
609552017
43671 MESSINA CT
Application Description:
OSBORNE / CHANGE OUT (1) SYSTEM
LA QUINTA, CA 92253 cv
Property Zoning:
Application Valuation:
$4,500.00
e r
;
l Ji
Applicant:Contractor:
CAVANAUGH ELECTRIC DBA
CAVANAUGH ELECTRI
I -s
83-231 HIWAY 111
CAVANAUGH ELECTRIC DBA CAVANAUGH-EL=ECTR1--A
83-231 HIWAY 111
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: Q0, CSO License No.: 286936
Date: 3/17 II 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).:
(•J I, as owner of the property, or my employees with wages as their sole
compensation,'will do the work, and the structure is ndt 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 11, 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 Name:
Lender's Address:
(760)347-3608
Llc. No.: 286936
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 rk 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:- 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: Applicant:
' PO4
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERA4 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: 3 Signature (Applicant or Agent):
DESCRIPTION
FINANCIAL INFORMATION
ACCOUNT : QTY AMOUNT
PAID
PAID DATE
BSAS SB1473 FEE
101-0000-20306 0 $1.00
$0.00
PAID BY
METHOD:,'.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:00
Description: OSBORNE / CHANGE OUT (1) SYSTEM
Type: MECHANICAL Subtype:. Status: APPROVED
Applied: 3/17/2016 SKH
Approved: 3/17/2016 SKH
Parcel No: 609552017 Site Address: 43671 MESSINA CT LA QUINTA,CA 92253
Subdivision: TR 28458-1 Block: Lot: 36
Issued:
Lot Sq Ft: 0 Building Sq Ft: 0 Zoning:
Finaled:
Valuation: $4,500.00 Occupancy Type: Construction Type:
Expired:
No. Buildings: 0 No. Stories: 0 No. Unites: 0
NAME TYPE
Details: HVAC CHANGE OUT - 14SEER/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
CAVANAUGH ELECTRIC DBA
CAVANAUGH ELECTRI
83-231 HIWAY 111
INDIO
CA
92201
CONTRACTOR
CAVANAUGH ELECTRIC DBA
CAVANAUGH ELECTRI
83-231 HIWAY 111
INDIO
CA
92201
OWNER
LEE OSBORNE
43671 MESSINA CT
LA QUINTA
CA
92253
Printed: Thursday, March 17, 2016 2:19:48 PM 1 of 2 BAJF
SYSTEMS
ATTACHMENTS
Printed: Thursday, March 17, 2016 2:19:48 PM 2 of 2'
sysrenns
CLTD'
DESCRIPTION
ACCOUNT.'
CITY
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:0i
ATTACHMENTS
Printed: Thursday, March 17, 2016 2:19:48 PM 2 of 2'
sysrenns
CERTIFICATE OF COMPLIANCE
Alterations to Space Conditioning Systems (formerly CF -1R -ALT HVAC)
Project Name:
L. Osborne I Date Prepared:
CF1R-ALT 02-E'
(Page 1 of 3 )
2016-03-16
A. General Information
MR -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
L. Osborne
02
Date Prepared
2016-03-16
03
Project Location
43671 Messina Court
04
Building Type
Single family
05
CA City
La Quinta
06
Dwelling Unit Name
House
07
Zip Code
92253
08
Dwelling Unit Conditioned
1800
Name
Serveld
gstem-(. t2)
Floor Area (ft2)
component? K components?
-feet of ducts?
duct system?
SC system?
Alteration Type
Number of space conditioning
09
Climate Zone
15
10
(SC) systems in this dwelling
1
System 1
I
` h e
%
unit.
es„ Yes,
Y �
B. Space Conditioning (SC) System Information
01
02
03
04
05 06
07
08
09
30
r Is the SC
Installing a
SC System
Identification or
SC System' (
Location or Area
CFA served
by this SCS
systema
ducted --'l
refrigerant Installing new SC
containingsystem
Installing
more#than 40
Installing
entirely new
Installing
entirely new
Name
Serveld
gstem-(. t2)
�, system?—
component? K components?
-feet of ducts?
duct system?
SC system?
Alteration Type
,
System 1
I
` h e
%
r
Yes
es„ Yes,
Y �
No
No
No
Altered space
conditioning system
&--I ICF 1-1 ILVI 0/1.7�7V�tQlIV11
C. Extension of Existing Duct System, Greater Than 40 Feet (Section 150.2(b)1Diib) -
This section does not apply to this project.
Registration Number: 316-A1021886A-000000000-0000
Registration Date/Time: 2016-03-16 21:52:55
HERS Provider: USERA
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013 Rev 1.007 Report Generated: 2016-03-16 21:54:57
Schema Version: 0.555SDD
CERTIFICATE OF COMPLIANCE CF111-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)1E and F)
O1
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
80.00
AC
cooling
SEER
14
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 ft of duct length is replaced.
-Leakage rate compliance: 515%, ors 10% leakage to outside, or seal all accessible leaks.
CF2R-MCH-25-H & CF3R-MCH-25-H Refrigerant Charge Verification required when refrigerant containing components are installed or altered (applicable in CZ 2, 8-15).
CF2RCF3R-MCH-23 & CF3R-MCH-23 Air Flow z 300 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.
-Heating-only systems and Air Handler/Furnace changes do not require verification of Air Flow MCH -23, or Refrigerant Charge MECH-25.
-Existing duct systems constructed, insulated or sealed with asbestos are exempt from MCH -20 Duct Leakage Testing requirements.
Registration Number: 316-A1021886A-000000000-0000 Registration Date/Time: 2016-03-16 21:52:55 HERS Provider: USERA
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013 Rev 1.007 Report Generated: 2016-03-16 21:54:57
Schema Version: 0.555SDD
CERTIFICATE OF COMPLIANCE CF1R-ALT 02-E
Alterations to Space Conditioning Systems (formerly CF -1R -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:
Rod Cavanaugh
Documentation Author Signature: � ��
Signature Date:
Company:
Cavanaugh Electric & Air Conditioning
2016-03-16
Address:
CEA/ HERS Certification Identification (if applicable):
83-231 Highway 111
286936
City/State/Zip:
Phone:
Indio CA 92201
760-347-3608
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 of Regulations.
4. 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.
S. I will ensure -that a registered -copy of this-Certiflcate,of Compliance•shall-be•made available -with -the -building permit(s),issued-for the building, and made available to the enforcement agency for all applicable
inspection,s. I that ¢ertifFwte,of-Compliance�is regwred•to•be•includedwith the doeumen the builder to the building owner at occupancy.
understand a regi }tered.copy-of,this ation provides
Responsible Designer Name:
Responsible Designer •Sgnat�ure:
Rod Cavanaugh
n
Com an
A1r ring
Dat' Si ned:
Cavanaugh Electrii � Conditio �)
2016=03-'6
Address:
83-231 Highway 111 U.S. Energy Rai
License:
WfElAssociation
City/State/Zip:
Phone:
Indio CA 92201
760-347-3608
U RA
U.S. Energy Raters Assoctatlon
Registration Number: 316-A1021886A-000000000-0000
CA Building Energy Efficiency Standards - 2013 Residential Compliance
"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 Date/Time: 2016-03-16 21:52:55
Report Version: 2013 Rev 1.007
Schema Version: 0.555SDD
HERS Provider: USERA
Report Generated: 2016-03-16 21:54:57
Kiri # City of La Quinta
Building & Safety Division
Pennit # P.O. Box 1504, 78-495 Calle Tampico
OSS La Quints, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Project Address: 3 — 6 / M $/tea C owner's Name: Lee 0,5/601-1?e
A. P. Number:
Address: 43 -- 6 -71 He-
eLegal
LegalDescription:
City, ST, Zip:
Contractor: C ��
f j l r/G
Telephone: — 772— 65.59
Address: 83-,-231
.ylu .q� ��
Project Description:
City, ST, Zip:
/
Telephone:
ro
City Lic. C
State Lic.
Arch., Engr., Designer.
Address:
City, ST, Zip:
Telephone:
State Lic. #:
Construction Type: Occupancy:
Projed type (circle one): New Add'n Alter Repair Derno
Name. of Contact Person:
Sq. Ft.: # Stories: # Units:
Telephone # of Contact Person: 10 -, -0/47 Estimated Value of Project: 44 5O0
APPLICANT: DO NOT WRITE BELOW THIS UNE
N Submittal Req'd Recd TRACKNG PERMIT FEES
Plan Sets Plan Check submitted Item Amount
Stractaral Cala.
Reviewed, ready for corrections Plan Check Deposit
Truss Cala.
Called Contact Person Plan Check Baku" .
Title 24 Cala.
Pians picked up Construction
Flood plain plan
Plana resubmitted Mechanical
Grading plan
2'' Review, ready for corrections/issue Electrical
Subeootactor hist
Called Contact Person Plumbing
Grant Deed
Plans picked rap S.M.L
H.O.A. Approval
Pians resubmitted Grading
IN HOUSE:-
3" Review, ready for correctlomlissue Developer Impact Fee
Planning Approval
Called Contact Person A.LP.P.
Pub. Wks. Appr
Date of permit Issue
School Fees
Total Permit Fees