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BMCH2016-00182, Applicant: IE INC 31225 LA BAYA WESTLAKE VILLAGE, CA 91362 LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that l 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: C20, C36 License No.: 686310 Date: Z t 1 ContractoiF: 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, 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 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 Addre! t5 5 ►." Contractor: 9p b HARRISON ENTERPRISES INC D IERAL-Al R 31170 RESERVE DRIVE 'D o THOUSAND PALMS, CA 92276 rn (760)601-3500 Llc. No.: 686310 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. I!E:� 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, 1 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: 10 1b Applicant:(-:: �.t. 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 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:Signature (Applicant orAgent):,___-Xnc�� VOICE (760) 777-7125 78-495 CALLE TAMPICO D LA QUINTA, CALIFORNIA 92253 FAX (760) 777-7011 COMMUNITY DEVELOPMENT DEPARTMENT INSPECTIONS (760) 777-7153 BUILDING PERMIT Date: 2/10/2016 Application Number: BMCH2O16-0018 Owner: Property Address: 81205 SHINNECOCK HILLS KARL GITTELMAN APN: 762350020 81205 SHINNECOCK HILLS CC? Application Description: GITTELMAN / CHANGE OUT COIL LA QUINTA, CA 92253 c Property Zoning: n Application Valuation: $1,019.00 Applicant: IE INC 31225 LA BAYA WESTLAKE VILLAGE, CA 91362 LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that l 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: C20, C36 License No.: 686310 Date: Z t 1 ContractoiF: 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, 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 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 Addre! t5 5 ►." Contractor: 9p b HARRISON ENTERPRISES INC D IERAL-Al R 31170 RESERVE DRIVE 'D o THOUSAND PALMS, CA 92276 rn (760)601-3500 Llc. No.: 686310 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. I!E:� 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, 1 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: 10 1b Applicant:(-:: �.t. 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 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:Signature (Applicant orAgent):,___-Xnc�� FINANCIAL • 1 DESCRIPTION ,. 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 - REPAIR/ALTERATION 101-0000-42402 0 $12.09 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE HVAC CHANGEOUT - REPAIR/ALTERATION PC 101-0000-42600 0 $4.83 $0.00 PAID BY METHOD. RECEIPT # CHECK # CLTD BY Total Paid for CHANGEOUT: $16.92 $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 Permit Details PERMIT NUMBER City of La Quinta BMCH2O1(6'00 8 • y =-- Description: GITTELMAN / CHANGE OUT COIL Type: MECHANICAL Subtype: Status: UNDER REVIEW Applied: 2/10/2016 SKH Approved: Parcel No: 762350020 Site Address: 81205 SHINNECOCK HILLS LA QUINTA,CA 92253 Subdivision: TR 29147-2 Block: Lot: 31 Issued: Lot Sq Ft: 0 Building Sq Ft: 0 Zoning: Finaled: Valuation: $1,019.00 Occupancy Type: Construction Type: Expired: No. Buildings: 0 No. Stories: 0 No. Unites: 0 NAME TYPE Details: HVAC CHANGE OUT - (1) COIL [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 IE INC 31225 LA BAYA WESTLAKE VILLAGE CA 91362 CONTRACTOR HARRISON ENTERPRISES INC DBA GENERAL AIR 31170 RESERVE DRIVE THOUSAND PALMS CA 92276 OWNER KARL GITTELMAN 81205 SHINNECOCK HILLS LA QUINTA CA 92253 Printed: Wednesday, February 10, 2016 10:33:27 AM 1 of 2 CR -w- SYSTEMS Y ^ACCOUNT` `^ T 'PAID T Y CLTD DESCRIPTION QTY AMOUNT PAID DATE RECEIPT # CHECK #� METHOD PAID BY �... BY SSAS 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 $12.09 $0.00 REPAIR/ALTERATION HVAC CHANGEOUT - 101-0000-42600 0 $4.83 $0.00 REPAIR/ALTERATION PC Total Paid for CHANGEOUT: $16.92 $0.00 PERMIT ISSUANCE 101-0000-42404 T0 $91.85 $0.00 Total Paid for PERMIT ISSUANCE: $91.85 $0.00 TOTALS:•• • 00 Printed: Wednesday, February 10, 2016 10:33:27 AM 2 of 2 I?W.IYS TfMS ern.# Cj/ Oi1l,hta Building a Safety Division P.O. Box 1504,78-495 Calle Tampico 14.Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Permit # Project Address: 81205 Shinnecock Hill Owner's Name:. Joann Gittelman A. P. Number. Address: 81205 Shinnecock Hill Legal Description: City, ST, Zip: La Quinta, CA .92253 Contractor: General Air Conditioning Telephone: 949-412-41283,s� Address: 31170 Reserve Drive Project Description: Replace Evaporative Coil City, ST, Zip: Thousand Palms, CA 92276. Telephone: 760-343-7488 �'° -;r>• -"i State Lic. # : 969(031C)'City Lic. M. Arch., Engr., Designer. Address: City., ST, Zip: Telephone: MY- a : '�" ^�• ��:ua�•. , Construction Type-,. Occupancy: State Lic. #:� Project type (circle one): New Add'n Alter Repair Demo Name of Contact Person: Steven Schnierer Sq. Ft.: # Stories: # Units: Telephone # of Contact Person: 818-735-7876 Estimated Value of Project: $1,019.00 APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Req'd Recd TRACMG 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 • Tide 24 Calci. Plans picked up Construction Flood plain plan Plans resubmitted.'. Mechanical Grading plan tad Review, ready for correctionslissue Electrical Subcontactor List Called Contact Person Plumbing Grant Deed Plans picked up S.M.L H.O.A. Approval Plans resubmitted Grading IN HOUSE:- 30 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 Alterations to Space Conditioning Systems (formerly CF -1R -ALT -HVAC) Project Name: JOANN GITTELMAN I Date Prepared: CF1R-ALT-02-E (Page 1 of 3 ) 2016-02-09 A. General Information CF1R-ALT-02 is applicable to multiple space conditioning systems contained within a single dwelling unit. When multiple dwelling units must be documented, use one CF111-ALT-02 document for each dwelling unit. 01 Project Name JOANN GITTELMAN 02 Date Prepared .. 2016-02-09 03 Project Location 81205 SHINNECOCK HILL 04 Building Type Single family 05 CA City La Quinta 06 Dwelling Unit Name JOANN GITTELMAN 07 Zip Code 92253 08 Dwelling Unit Conditioned 2844 Floor Area (ft2) SC System SC System ' CFA served system a-- refrige nt { Number of space conditioning Installing 09 Climate Zone 15 10 (SC) systems in this dwelling 1 ~ducted containing x system more than 40 unit. . entirely new B. Space Conditioning (SC) System Informationti .« 01 02 03 k 04&1� OS 11 07) 08 fl t 09 10 \�6M y � Nis the SC""'"` -Insta-`sta +lling a --•t SC System SC System ' CFA served system a-- refrige nt { Installing new SC Installing 1 staIIing RIInstalling Identification or Location or Area by this SC ~ducted containing x system more than 40 entirely w entirely new Name Served System (ft2) system? component? componentse feet of ducts? ductsystem? SC system? Alteration Type System 1 Location 1 2844 Yes Yes Yes No No No Altered space conditioning system 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: 216-A0052588A-000000000-0000 Registration Date/Time: 2016-02-09 21:31:55 HERS Provider: CaICERTS CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013 Rev 1.007 Report Generated: 2016-02-09 21:31:34 r,rhpma Vprcinn• n SSSCnn 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)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 No heating This field or This field or Central split This field or This field or System 1 furnace component section is not section is not AC Indoor coil SEER 14 Setback section is not section is not altered applicable applicable applicable applicable Required Documentation: MR -MCH -01-E - Space Conditioning Systems Ducts and Fans -Duct insulation requirement for new plenums: R6. MR -MCH -20-H &'MR -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: <-15%, or 510% 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 & MR -MCH -23 Air Flow >_ 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�r Ref�igeranL Charge MECH-2( Testing -Existing dud systems constructed, insulated or sealed with asbestos are exemptrfrom MCH=20 Duct�Leakage require�men'ts. ti E. Entirely New or Complete Replacement Duct=System, with or without, Equipment Changeout (Sections,150.2(b.)1Diia-and 150.2(b)1E, F) t Z__4 l- V4 6--v �4 i i Yv it A P y This section does not apply to this project. F. Entirely New or Complete Replacement Space Conditioning System (Section 150.2(b)1C) This section does not apply to this project. Registration Number: 216-A0052588A-000000000-0000 Registration Date/nme: 2016-02-09 21:31:55 HERS Provider: CaICERTS CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013 Rev 1.007 Report Generated: 2016-02-09 21:31:34 r,rhpma Vprcinn• 0 SSSCnn CERTIFICATE OF COMPLIANCE CF111-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: Documentation Author Signature: �/ Jacoby, Ian cyan loco Jt Company: Signature Date: i PERMIT E RATERS 2016-02-09 21:31:17 Address: CEA/ HERS Certification Identification (if applicable): . 31225 La Baya Drive #213 City/State/Zip: Phone: West Lake Village CA 91362 818-735-7876 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. �� t r Il Ji.:I �i I, �� I 5. 1 will ensure that a registered copy of this Certificate of Compliance shall be made:available with the building permit(s)Jssued for•the building, and made available to the enforcement agency for all applicable inspections. I understand that a registered copy of this Certificate of Compliance., is required to b_e.,.included with the document'tionwthebuilder poovides to the building owner at occupancy. Responsible Designer Name: .17 Responsible Designer Signature: Shanley, Barbara Company: Date Signed: HARRISON ENTERPRISES INC dba GENERAL AIR CONDITIONING 2016-02-09 21:31:55 Address: License: 31-170 RESERVE DRIVE STE A 686310 City/State/Zip: Phone: THOUSAND PALMS CA 92276 760-343-7488 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: 216-A0052588A-000000000-0000 Registration Date/Time: 2016-02-09 21:31:55 HERS Provider: CaICERTS CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013 Rev 1.007 Report Generated: 2016-02-09 21:31:34 grhpma Vprcinn• n SSSCnn