BMCH2015-043978-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
c&�t 4 X� Q914ro
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING PERMIT
Application Number: BMCH2O15-0439
Property Address:48010 PASO TIEMPO LN LN
APN: 646350010
Application Description: DECASTRO / HVAC CHANGEOUT
Property Zoning:
Application Valuation: $5,000.00
Applicant:
ADAM SIMMONS
P 0 BOX 314
LA QUINTA, CA 92247
Owner:
JAMES DECASTRO
695 SHERIDAN RD
WINNETKA, IL 92253
111111111111 IN IN
67
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Contractor:
ft ADAM SIMMONS
NOV 210 2015 P 0 BOX 314
LA QU I NTA, CA 92247
CIT ! Gr LA QUINTA
COt0MUNITYDECE!D°h1ErNT (760)564-7525
Llc. No.: 780534
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 License No.: 780534
Date: Z.>r J 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).:
(1 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:
Date: 11/20/2015
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 19)york for which this permit is issued.
,7:>— 1 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 polity 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: I ZZt~3 S� Applicant: Agtg=�
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 elate 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 nter upon the
above-mentioned property for inspection purposes.
Date: 2;fl Signature (Applicant or Agent):
h ,,
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' fk� PAID;DATE
DESCRIPTION ACCOUNT AMOUNT f PAID
;r� , R ,QTY ,+ x
.z-PO.�,� ,.�,.�a..
BSAS SB1473 FEE 101-0000-20306 $1.00 $0.00
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". P PAIUj BY METHOD' RECEIRT.# CHECK BYf t
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Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $1.00 $0.00.
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AMOUNT 4
f ..
PAID DATE,
.. x
_ ..:��
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��PAID
: _. W
HVAC CHANGEOUT - SPLIT-SYSTEM
10110000-42402
0
$72.52
$0.00
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� AMOUNT
.3`EC,}
r PAID
PAID DATE
,f $
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HVAC CHANGEOUT - SPLIT-SYSTEM PC
101-0000-42600
0
$36.26
$0.00
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Total Paid for CHANGEOUT: $108.78 $0.00.
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DESORIPTION
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PAID DATE::
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PERMIT ISSUANCE
101-0000-42404
0
$91.85
$0.00
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CLTD BY
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Total Paid for.PERMIT ISSUANCE: $91.85 $0.00
• ••
Description: DECASTRO / HVAC CHANGEOUT
Type: MECHANICAL Subtype: Status: APPROVED Applied: 11/20/2015 SGU
Parcel No: 646350010 Site Address: 48010 PASO TIEMPO LN LN LA QUINTA,CA 92253 Approved: 11/20/2015 SGU
Subdivision: TR 27840 Block: Lot: 43 Issued:
Lot Scl Ft: 0 Building Sq Ft: 0 Zoning: Finaled:
Valuation: $5,000.00 Occupancy Type: Construction Type: Expired:
No. Buildings: 0 No. Stories: 0 No. Unites: 0
Details: HVAC CHANGE OUT-16SEER/78AFUE CENTRAL SPLIT SYSTEM. LIVING ROOM UNIT [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
ADAM SIMMONS
P 0 BOX 314
LA QUINTA
CA
92247
Simmonscda@yahoo.c
om
CONTRACTOR
ADAM SIMMONS
P O BOX 314
LA QUINTA
CA
92247.
Simmonscda@yahoo.c
om
OWNER
JAMES DECASTRO
695 SHERIDAN RD
WINNETKA
IL
92253
Printed: Friday, November 20, 2015 2:32:19 PM 1 of 2
SYSTEMS
PARENT PROJECTS
ATTACHMENTS
Printed: Friday, November 20, 2015 2:32:19 PM 2 of 2 Orp _,
SYS7EiNS
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:
HVACCHANGEOUT-
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
PARENT PROJECTS
ATTACHMENTS
Printed: Friday, November 20, 2015 2:32:19 PM 2 of 2 Orp _,
SYS7EiNS
Bin #
City of La Q uin to
Building &r Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit
B rl
Project Address: czw 4 �
Owner's Name: "
A. P. Number:
Address: 4Y'0/
City, ST, Zip: f t Z Z Sw3
Legal Description:
Contractor: i
TeleP hone:
Address: ,0 8XZZI/
Project Description: of C�,
City, ST, Zip• e ?2—z5,-5
Tele ho ne-
P . b
..............................................
State Lic. # :
City Lic. #t
Arch., Engr., Designer:
Address:
City, ST, Zip:
e.
Telephone:hon
aneY
Construction Type: Occupancy:
Lic. #: 53
'n Alter RepairairDemoState
Project type circle one): Add
Name of Contact Person: S/Ine��
Sq. Ft.:
# Stories:
# Units:
Telephone # of Contact Perso 1p
I Estimated Value of Project:
APPLICANT: DO'NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
Called Contact PersonPlan
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
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
CERTIFICATE OF COMPLIANCE CFlh-ALT 02-E
Alterations to Space Conditioning Systems (formerly CF -1R -ALT -HVAC) (Page 1 of 3 )
Project Name: DeCastro I Date Prepared: 2015-09-23
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
DeCastro
02
Date Prepared
2015-09-23
03
Project Location
48-0109esEamse Pasu N-icrw..ru Ln
04
Building Type
Single family
05
CA City
La Quinta
06
Dwelling Unit Name
DeCastro
07
Zip Code
92253
08
Dwelling Unit Conditioned
2000
1 Installing
Installing
Installing
Floor Area (ft2)
Location or Area
by this SC
ducted
containing
system
Number of space conditioning
entirely new
09
Climate Zone
15
10
(SC) 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
05
06
07
08
09
10
Is the SC
Installing a
SC System
SC System
CFA served
system a
refrigerant
Installing new SC
1 Installing
Installing
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?
duct system?
SC system?
Alteration Type
System 1
Living Area
2000
Yes
Yes
Yes
No
No
No
Altered space
conditioning system
C. Extension of Existing Duct System, Greater Than 40 Feet (Section150.2(b)lDiib)
This section does not apply to this project.
Registration Number: 215-A6335897A-000000000-0000
Registration Date/Time: 2015-09-23 17:52:03
HERS Provider: CalCERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013-1.006 Report Generated: 2015-09-23 17:51:11
Schema Version: 0.555SDD
CERtIFICATE OF COMPLIANCE CF1R-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)
01
02
03
04
05
06
07
08
09
30
11
12
Heating
Cooling
S, Fstem
Heating
Altered
Heating
Minimum
Altered
Cooling
Minimum
Required
New or
Idenf tification
System
Heating
Efficiency
Efficiency
Cooling
Cooling
Efficiency
Efficiency
Thermostat
Replaced
New Dud
or Name
Type
Components
Type
Value
System Type
Components
Type
Value
Type
Dud Length
R -Value
Central gas
All new
Central split
All new
Less than or
Sy stem 1
furnace
heating
AFUE
0.78
AC
cooling
SEER
16
Setback
equal to 40
R-8
components
components
feet
-Duct if
Cf2R-M1
CF2RCF
LE110 s-
r
EEr
En
!d Documentation:
4CH-01-E - Space Conditioning Systems Ducts and Fans
isulation requirement for new plenums: R6.
4CH-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.
;e rate compliance: s 15%, ors 10% leakage to outside, or seal all accessible leaks.
ICH -25-H & CF3R-MCH-25-H Refrigerant Charge Verification required when refrigerant containing components are installed or altered (applicable in CZ 2, 8-15).
:3R -MCH -23 & CF311-MCH-23 Air Flow i 300 CFM/ton required when MCH -25 is required.
ons:
ystems registered with HERS provider as previously sealed are exempt from MCH -20 Duct Leakage Testing requirements.
ig-only systems and Air Handler/Furnace changes do not require verification of Air Flow MCH -23, or Refrigerant Charge MECH-25.
,g duct. systems constructed, insulated or sealed with asbestos are exempt from MCH -20 Duct Leakage Testing requirements.
Airely New or Complete Replacement Duct System, with or without Equipment Changeout (Sections 150.2(b)iDiia and 150.2(b)1E, F)
This section does not apply to this project.
itirely New or Complete Replacement Space Conditioning System (Section 150.2(b)1C)
This section does not apply to this project.
tration Number: 215-A6335897A-000000000-0000
iilding Energy Efficiency Standards - 2013 Residential Compliance
Registration Date/Time: 2015-09-23 17:52:03
Report Version: 2013-1.006
Schema Version: 0.555SDD
HERS Provider: CaICERTS
Report Generated: 2015-09-23 17:51:11
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:
Bachus, Tom
Company:
Signature Date:
MLC Building Performance
2015-09-23 17:51:13
Address:
CEA/ HERS Certification Identification (if applicable):
77825 Delaware Place
City/State/Zip:
Phone:
Palm Desert CA 92211
1760-836-0066
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 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.
5. 1 will ensure that a registered copy of this Certificate 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
inspections. 1 understand that a registered copy of this Certificate of Compliance is required to be included with the documentation the builder provides to the building owner at occupancy.
Responsible Designer Name:
Responsible Designer Signature:
%���GslR�Kdll.O'
Simmons, Donna
Company:
Date Signed:
ADAM SIMMONS
2015-09-23 17:52:03
Address:
License:
54440 AVENIDA CARRANZA
780534
City/State/Zip:
Phone:
LA QUINTA CA 92253
1760-564-7525
Digitally signed by Ca/CERTS. 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: 215-A6335897A-000000000-0000 Registration Date/Time: 2015-09-23 17:52:03 HERS Provider: CalCERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013-1.006 Report Generated: 2015-09-23 17:51:11
Schema Version: 0.555SDD