BMCH2018-0075• �G�(�/ O.�i � auuclw
78 495 CALLE TAMPICO
LA gUINTA, CALIFORNIA 92253 DESIGN & DEVELOPMENT DEPARTMENT
BUILDING PERMIT
Permit Type/Subtype:
Application Number:
Property Address:
APN:
Application Description:
Property Zoning:
Application Valuation:
MECHANICAL/
BMCH2O18-0075 t
54455 ALYSHEBA DR
767780006
PETERSON / 5 HVAC UNIT REPLACEMENT
$49,000.00
1
Applicant:
VIC'S AIR CONDITIONING INC
POBOX 21-5
THOUSAND PALMS, CA 92276
MAR 2 0 2018
CITY OF LA QUINTA
COMMUNITY DEVELOPMENT DEPARTMENT
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.: 756658
Dates / a Contra a_ etorY(�/�,
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; Busiriess 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 contra cting'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:
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 3/20/2018
Owner:
CAROLINE PETERSON
54455 ALYSHEBA DR
LA QUINTA, CA 92253
Contractor:
VIC'S AIR CONDITIONING INC
P 0 BOX 215 -
THOUSAND PALMS, CA 92276
(760)343-503:3
Llc. No.: 756658
WORKER'S COMPENiATION 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 3100 of the Labor Code, for the performance
of the work 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 perormance of the work for which this permit is
issued. My workers' compensation insuran•:e carrier and policy number are:
Carrier: EVEREST NATIONAL INSURANCE CCMPANY Policy Number: 7600018118
_ 1 certify that in the performance of the work for which this permit is issued, I
II not employ any person in any manner so as to become subject to the workers'
ipensation laws of California, and agreesthat, if I should become subject to the
kers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith
iply with those provisions.
e: `ZC Applicant: C/!'u
WARNING: FAILURE TO SECURE WORKERS' =OMPENSATION COVERAGE IS UNLAWFUL,.
AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO
ONE HUNDRED THOUSAND DOLLARS ($100000). 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 :his 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, a id 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 b the work being performed under or
following issuance of this permit.
2. Any permit issued as a result of this ap plication 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 cancella-ion.
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 a ter upon the above-
mentioned property for inspection purposes.
DateD L7 Sig2atu7e (Applicant or Agent): v��
Date: 3/20/2018
Application Number: BMCH2018-0075
Owner:
Propetty'Addressr' 54455 ALYSHEBA DR
CAROLINE PETERSON
APN: 767780006
54455 ALYSHEBA DR
Application Description: PETERSON / 5 HVAC UNIT REPLACEMENT
LA QUINTA, Ca 92253
Property Zoning:
Application Valuation: $49,000.00
Applicant:
Contractor:
VIC'S AIR CONDITIONING INC
VIC'S AIR CONDITIONING INC
P0BOX 215
P0BOX 215
THOUSAND PALMS, CA 92276
THOUSAND PALMS, CA 92276
(760)343-5033
Llc. No.: 756658
Detail: 1. HVAC CHANGE OUT - [5] 14 SEER/81AFUE SPLIT SYSTEMS. CARBON MONOXIDE ALARM(S) TO BE INSTALLED PRIOR TO FINAL INSPECTION. 2016
CALIFORNIA BUILDING CODES.
,.:7.;,,,::, :•;,, DESCRIPTION ACCOUNT QTY AMOUNT
BSAS SB1473 FEE 101-0000-20306 0 $2.00
Total Paid for BUILDING STANDARDS ADMINISTRAT-iON BSA: $2.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
HVAC CHANGEOUT - SPLIT -SYSTEM
101-0000-42402
0
$195.05
DESCRIPTION
ACCOUNT
QTY
AMOUNT
HVAC CHANGEOUT- SPLIT -SYSTEM PC
101-0000-42600
0
$390.10
Total Paid for CHANGEOUT: $585.15
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PERMIT ISSUANCE
101-0000-42404
0
$98.83
Total Paid for PERMIT ISSUANCE: $98.83
DESCRIPTION
ACCOUNT
QTY
AMOUNT
RECORDS MANAGEMENT FEE
101-0000-42416
0
'$10.00
E]
Total Paid for RECORDS MANAGEMENT FEE: $10.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
TECHNOLOGY ENHANCEMENT FEE
502-0000-43611
0
$5.00
Total Paid for TECHNOLOGY ENHANCEMENT FEE: $5.00
TOTALS:0i
Bfn.#
City Of Lel Quints
Budding, ar Safety Duron
P.O. Box 1504,78-495 Calle Tampico
IA.Quinta, CA 92253 -:(760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
p-UicrY'�1S
Project Address:
Owner's Name:.(2,6-r O
A. P. Number.
Address: 5" _ $ ° G
Legal Description:
Contractor. `/ �S
City, ST, Zip:LA,t) A2P,5 3
Telephone: -
Address:
Project Description:
City, ST, Zip: Poi lk f
6r, `f
Telephoner
7(i� 0
State Lic. # : J City Lic, #, 000 ��
♦��[ 7��� _ 3 n.
Arch, l3agr., Designer:
Address:
City, ST, Zap:
Telephone: Construction Type: • Occupancy:
State Lie. #: Project type (circle one): New Add'n Alter Repair Demo
Name of Contact Person: Sq. FL: # Stories: # Units
Telephone # of Contact Person: Estimated Value of Project q, 0�j
APPLICANT: DO NOT WRITE BELOW THIS UNE
N
Submittal
Req'd
Reed
TRACKING
PERMIT FEES
Plan Sets
Plan Cheek submitted
Item Amount
Structural Calfs.
Reviewed, ready for corrections
Plan Check Deposit, .
Truss Calca,
Called Contact Person
Pian Check Wance
Mile TA Cake.
Plane picked up
Construction
Flood plain plan
Plane resubmift d..
Mechanical
Grading plan
2' Review, ready for cormetionsfissue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plana picked up
S.M.I.
&O A Approval
Plans resubmitted
Grading
IN ROUSE:-
''" Review; ready for torrectiona/issae
Developer Impact Fee
Planning Approval-
Called Contact Person
ALP.P.
Pub. Wks. Appr -
Date of permit issue
School Fees
Total Permit Fees
w
CERTIFICATE OF COMPLIANCE . CF1R-ALT 02-E
Alterations to Space Conditioning Systems (formerly CF -1R -ALT -HVAC) (Page 1 of 4)
Project Name: 54-455 Alysheba Dr I Date Prepared: .2018-03-20
A. General Information
!r
Cf1R ALT. -02 is applicable to multiple space conditioning systems contained within a single dwelling unit. When multiple dwelling units must hP rinr.itmPntPri, iisP nna
CF1R-ALT-02 document for each dwelling unit.
01
Project Name
54-455 Alysheba Dr
02
Date Prepared
2018-03-20
03
Project Location
54-455 Alysheba Dr
04
Building Type
Single family
05
CA City
La Quinta
06
Dwelling Unit Name
54-455 Alysheba Dr
- f
"
SC System
Dwelling Unit Conditioned
CFA served
07
Zip Code
92253'
08
Floor Area (ftZ)
5009
Identification or
Location or Area
by this SC
Number of Space
containing
09
Climate Zone
15
10
Conditioning (SC) Systems in
5
Served
System (ft)
system?
component?
this Dwelling Unit:
feet of ducts?
If 41 -- 3—.R_.. it 1% , -r r " fe' P
B. Space Conditioning (SC) System Information
01
02
03 �`«;
~�; ` 04
0s
06 r .
w 07 µ �f
~
08
09
10
1s the SC'
I nstalls g=a
f ,
— t
- f
"
SC System
SC System
CFA served
system a'
refrigerant
Installing new SC
Installing
Installing
Installing
Identification or
Location or Area
by this SC
ducted
containing
system
more than 40
entirely new
entirely new
Name
Served
System (ft)
system?
component?
components?
feet of ducts?
duct system?
SC system?
Alteration Type
System 1
whole House
1200
Yes
Yes
Yes
No
No
No
Altered space
conditioning system
System 2
Bedroom 2
800
Yes
Yes
Yes
No
No
No
Altered space
conditioning system
System 3
Bedroom 3
1200
Yes
Yes
Yes
No
No
No
Altered space
conditioning system
System 4
bedroom 4
1600
Yes
Yes
Yes
No
No
No
Altered space
conditioning system
Registration Number: 218-A020080622A-000-000-0000000-0000
Registration Date/Time: 2018-03-20 13:04:41
HERS Provider: CaICERTS
CA Building Energy Efficiency Standards - 2016 Residential Compliance Report Version: 2016.1.006 Report Generated: 2018-03-20 13:04:12
Schema Version: rev 10/16
t
CERTIFICATE OF COMPLIANCE CF111-ALT-02-E
Alterations to Space Conditioning Systems (formerly CF-lR-ALT HVAC) (Page 2 of 4)
B. Space Conditioning (SC) System Information
01
02
03
04
05
06
07
08
09
10
11
12
Is the SC
Installing a
SC System
SC System
UA SeMe6
system a
refrigerant
Installing new SC
Installing
Installing
Installing
(
Identification or
Location or Area
by this SC
ducted
containing
system
more than 40
entirely new
entirely new
Efficfe ry
Name
Served
System (ft)
system?
component?
components?
feet of ducts?
duct system?
SC system?
Alteration Type
System 5
bedroom 5
2000
Yes
Yes
Yes
No
No
No
Altered space
conditioning system
C. Extension of Existing Duct System, Greater Than 40 Feet (Section 150.2(b)1Dilb)
This section does not apply to this project.
D. Altered Space Conditioning System (Sections 150.2(b)lE and F)
01
02
03
04
405
06,
07yy
OS
091
10
11
12
System
Heating
Altered
Heatingy:
Heating
Minimum'
(
:'FHE.
tAltered
a Cogling�-„r='
Cooling
IVlinimumRequired).
{{
New or
Identification
System
y
Heating
g
Efficfe ry
Efficiency
y
-- Cooling
g,
Co ling
x Efficiency
Efficiency
Thermostat
.
Replaced
New Duct
or Name
Type
Components
Type
*
Valued
=System}Type-:
Components
s
{
� Type
Value
- Type
Duct Length
R -Value
Central gas
All new
Central split
All new
Less than or
System 1
furnace
heating
AFUE
81
AC
cooling
SEER
14
Setback
equal to 40
R-8
components
components
feet
Central gas
All new
Central split
All new
Less than or
System 2
furnace
heating
AFUE
81
AC
cooling
SEER
14
Setback
equal to 40
R-8
components
components
feet
Central gas
All new
Central split
All new
Less than or
System 3
furnace
heating
AFUE
81
AC
cooling
SEER
14
Setback
equal to 40
R-8
components
components
feet
Central gas
All new
Central split
All new
Less than or
System 4
furnace
heating
AFUE
81
AC
cooling
SEER
14
Setback
equal to 40
R-8
components
.
components
feet
Registration Number: 218-A020080622A-000-000-0000000-0000
Registration Date/Time
2018-03-20 13:04:41
HERS Provider: CaICERTS
CA Building Energy Efficiency Standards - 2016 Residential Compliance Report Version: 2016.1.006 Report Generated: 2018-03-20 13:04:12
Schema Version: rev 10/16
CERTIFICATE OF COMPLIANCE CF111-ALT 02-E
Alterations to Space Conditioning Systems (formerly CF -1R -ALT -HVAC) (Page 3 of 4)
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
All new
Central split
All new.
Less than or
System 5
furnace
heating
AFUE
81
AC
cooling
SEER
14
Setback
equal to 40
R 8
components
components
feet
Reouired Documentation:
CF2R-MCH-01-E - Space Conditioning Systems
- Duct insulation requirement for the new portions of supply -air and return -air ducts or plenums: R6 (CZ 1-10, 12 and 13) and R8 (CZ 11 and 14-16)
.
CF2R and CF3R-MCH-20-H - Duct Leakage Test 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 <= 30% leakage to outside, or seal all accessible leaks.
CF2R and CF3R-MCH-25-H Refrigerant Charge verification required when refrigerant containing components are installed or altered (applicable in CZ 2, 8-15).
CF2R and CF3R-MCH-23 Airflow Rate >= 300 CFM per ton required when MCH -25 Is required.
ExcQ do ons:
-Duct systems registered with HERS provider as previously sealed are exempt fro�m,.MCH-20 Duct Leakage Testing feLquiremennts,_
- Heating systems and Air Handler Furnace changes do not require verificat( n of Air Flow MCH 23 orRefrigerant Charge M,CHI 25,
-only
-Existing duct systems constructed, Insulated or sealed with asbestos are exempt from MCH=20 putrtgleakage Testing rgqufrements
F*x �"�1 $1 it 3C3 i4� i3 S3 i 3f .,n 0
E. Entirely New or Complete Replacement D ctSystem, wi h .or without�Equipment Changeout (Sections 150.2(b)1Diia:andr150.2(b)1E, F)
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: 218-A020080622A-000-000-0000000-0000 Registration Date/Time: 2018-03-20 13:04:41 HERS Provider: CaICERTS
CA Building Energy Efficiency Standards - 2016 Residential Compliance Report Version: 2016.1.006 Report Generated: 2018-03-20 13:04:12
Schema Version: rev 10/16
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:
Documentation Author Signature: m / T
Victoria, Blanca
nca tctoria
Company:
Signature Date:.
VIC'S AIR CONDITIONING INC
2018-03-20 13:20:01
Address:
CEA/ HERS Certification Identification (if applicable):
P O BOX 215
City/State/Zip:
Phone:
THOUSAND PALMS CA 92276
1760-343-5033
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 Mpnufactured 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. # j t
4. The building design features or system design features identified o this Certlflcate of ryom Mance are cpnsistent With'the information -provided on otherapplicatile`compllance documents, worksheets,
calculations, plans and specifications submitted to the enforcement agency for approvaLwith this building permit application.
5. 1 will ensure that a registered copy of this Certificate, of Compliance shall.be.made.avallable with the building permit(s),Issued for,the bullging, and 'ma de avallable,to.the enforcement agency for all applicable
inspections. I understand that a registered copy of tl ]'s Certificate of Compliance, is required to be included with the. documentation.the,builoer provides to -the building owner at occupancy.
Responsible Designer Name: 6 — t =
Responsible Designer Signature: Vt �.:�+' €
Blanca Tictoria
Victoria, Blanca
Company:
Date Signed:
VIC'S AIR CONDITIONING INC
2018-03-20 13:20:01
Address:
License:
P 0 BOX 215
756658
City/State/Zip:
Phone:
THOUSAND PALMS CA 92276
760-343-5033
Easy to Verify �� O
`
at CaICERTS.com
L
Digitally signed by CaICERTS. 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: 218-A020080667A-000-000-0000000-0000 Registration Date/Time: 2018-03-20 13:20:01 HERS Provider: CaICERTS
CA Building Energy Efficiency Standards - 2016 Residential Compliance Report Version: 2016.1.006 Report Generated: 2018-03-20 13:19:46
Schema Version: rev 10/16