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BMCH2017-0264LICENSED 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, C36 License No.:777794 Date: 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 o 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).: L--) 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 did not build or improve for the purpose of sale.). (1 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: 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 �k 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: MIDWEST EMPLOYERS CASUALTY COMPANY Policy Number: BNU W C0135300 _ 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 ould become subject to the workers' compensation provisions of Section 3700 s the Labor Code, I shall forthwith comply with those provisions. t Date: ApplicanMt ; 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 i ormation is correct. I agree to comply with all city and county ordinances and stat la s relating to building construction, and hereby authorize representatives of this ci t enter upon the. above-rli(elone property for inspection purposes. _ Date:- /% Signature (Applicant or Agent)' 78-495 CALLE TAMPICO D VOICE (760) 777-7125 LA QUINTA, CALIFORNIA 92253 & DEVELOPMENT DEPARTMENT FAX (760) 777-7011DESIGN INSPECTIONS (760) 777-7153 BUILDING PERMIT Date: 6/26/2017 Application Number: BMCH2O17-0264 w Owner: Property Address: 48825 AVENIDA ANSELMO RICHARD MUEHLENBRUC 2� APN: 658300012 Application Description: CHANGE OUT (1) CONDENSOR AND (1) COIL92253 z L 0Z Property Zoning: T C, Application Valuation: $4,500.00 Applicant:-5Contractor: J ANTHONY PLUMBING HEATING & AIR CONDITI 9! J ANTHONY PLUMBING HEATING & AIR CONDITI 72216 NORTH SHORE ST #101 72216 NORTH SHORE ST §1 L" � THOUSAND PALMS, CA 92276 THOUSAND PALMS, CA 92276---,- ZZ (760)328-8096 Llc. No.: 777794 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, C36 License No.:777794 Date: 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 o 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).: L--) 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 did not build or improve for the purpose of sale.). (1 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: 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 �k 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: MIDWEST EMPLOYERS CASUALTY COMPANY Policy Number: BNU W C0135300 _ 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 ould become subject to the workers' compensation provisions of Section 3700 s the Labor Code, I shall forthwith comply with those provisions. t Date: ApplicanMt ; 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 i ormation is correct. I agree to comply with all city and county ordinances and stat la s relating to building construction, and hereby authorize representatives of this ci t enter upon the. above-rli(elone property for inspection purposes. _ Date:- /% Signature (Applicant or Agent)' Date: 6/26/2017 Application Number: BMCH2017-0264 Owner: Property Address: 48825 AVENIDA ANSELMO RICHARD MUEHLENBRUCH APN: 658300012 Application Description: CHANGE OUT (1) CONDENSOR AND (1) COIL 92253 Property Zoning: . Application Valuation: $4,500.00 Applicant: Contractor: J ANTHONY PLUMBING HEATING & AIR CONDITI J ANTHONY PLUMBING HEATING & AIR CONDITI 72216 NORTH SHORE ST #101 72216 NORTH SHORE ST #101 THOUSAND PALMS, CA 92276 THOUSAND PALMS, CA 92276 (760)328-8096 -------------------------------"---------------------------- LIc. No.: 777794 ---------------------------------- Detail:-HVAC CHANGE OUT - (1)CONDENSOR AND (1)COIL 14SEER/81AFUE. CARBON MONOXIDE ALARM(S) TO BE INSTALLED PRIOR TO FINAL INSPECTION. 2016 CALIFORNIA BUILDING CODES. FINANCIAL INFORMATION DESCRIPTION ACCOUNT QTY AMOUNT BSAS SB1473 FEE 101-0000-20306 0 $1.00 Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $1.00 DESCRIPTION ACCOUNT QTY AMOUNT HVAC CHANGEOUT- CONDENSER ONLY 101-0000-42402 0 $38.00 DESCRIPTION ACCOUNT QTY AMOUNT HVAC CHANGEOUT - CONDENSER ONLY PC 101-0000-42600 0 $25.33 DESCRIPTION ACCOUNT QTY AMOUNT HVAC CHANGEOUT- REPAIR/ALTERATION 101-0000-42402 0 $12.67 DESCRIPTION ACCOUNT QTY AMOUNT HVAC CHANGEOUT - REPAIR/ALTERATION PC 101-0000-42600 0 $5.07 Total Paid for CHANGEOUT: $81.07 DESCRIPTION ACCOUNT QTY AMOUNT PERMIT ISSUANCE 101-0000-42404 0 $96.27 Total Paid for PERMIT ISSUANCE: $96.27 DESCRIPTION ACCOUNT QTY AMOUNT TECHNOLOGY ENHANCEMENT FEE 502-0000-43611 0 $5.00 Total Paid for TECHNOLOGY ENHANCEMENT FEE: $5.00. Bin # ' Permit # �n LP -Building Project Address: He, Clty'af b Qu«ita Building 8t Safety Division 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-701,2 Permit Application and Tracking Sheet 14V� Owner's Name: A. P. Number: Address: Legal Description: City, ST, Zip: Contractor: Telephone: Address: J ANTHONY SERVICES HqHQRFqTqT I. Project Description: AC e _city_ ST, zip: THOUSAND PALMS, CA 92276 TbO� COO 0410 BAA (fo-4/L_ Telephone:. h one: State Lic. # :77? City Lic.. #; A rb sy Arch., Engr., Designer: Address: City, ST, Zip: Telephone: h one: Construction n TY aneY Pe: Occupancy: • to S toLic . # Project tYPa (circle one): New Add'n Alter r• Repair.ai Demo �.. Name of Contact Person: 171 ktio��' Sq. Ft.: # Stories: # Units: Telephone # of Contact Person: Tho 3Y,03 -za/ Estimated Value of Project: APPLICANT: DO NOT WRITE BELOW THIS LINE N 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 Cafes. Called Contact Person Plan Check Balance Title 24 Calcs. Plans picked up Construction ' Flood plain plan Plans resubmitted Mechanical Grading plan 2°" Review, ready for corrections/issue Electrical . Subcontactor List Called Contact Pcrson Plumbing Grant Deed Plans picked up S.M.I. II.O.A. Approval flans resubmitted Grading IN ROUSE:- '"! Revicw, 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: MUEHLENBRUCH I Date Prepared: CF1R-ALT 02-E (Page 1 of 3) 2017-06-26 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 CF1R-ALT-02 document for each dwelling unit. O3 Project Name MUEHLENBRUCH 02 Date Prepared 2017-06-26 03 Project Location 48825 AVENIDA ANSELMO 04 Building Type 5ingle family 05 CA City La Quinta 06 Dwelling Unit Name MUEHLENBRUCH X08 Dwelling Unit Conditioned 07 Zip Code 92253 08 Floor Area (ft) 2000 SC System SC System CFA served Number of Space refrigerant 09 Climate Zone ;" 15 =-' 10 Conditioning (SC) Systems in 1 Location or Area by this SC ducted containing this Dwelling Unit: more than 40 Space Conditioning SCS stem Information B. S p g ( ) Y fir` Ol 02 03 04 05 06 07 09 10 »: X08 Is the SCM.' I stalli g a 0 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 (ft2) system? component? components? feet of ducts? dud system? SC system? Alteration Type System 1 Location 1 2000 Yes Yes Yes No No No Altered space conditioning system C. Extension of Existing Dud System, Greater Than 40 Feet (Section150.2(b)iDiib) This section does not apply to this project. Registration Number: 217-A020215929A-000-000-0000000-0000 CA Building Energy Efficiency Standards - 2016 Residential Compliance Registration Date/Time: 2017-06-26 10:09:51 HERS Provider: CaICERTS Report Version: 2016.1.005 Report Generated: 2017-06-26 10:09:48 Schema Version: rev 10/16 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)3E and F) 01 02 03 04 05 06 07 08 09 10 it 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 Central split Outdoor This field or This field or System 1 furnace Indoor coil AFUE 81 AC condensing SEER 14 Setback section is not section is not unit applicable applicable Reauired 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 CF311-MCH-20-1­1 - 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 <= 10% leakage to outii,cli';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.. Exceptions: Duct systems registered with HERS provider as previously sealed areexempt from MCH -20 Duct Leakage Testing requirements. Heating Air Handler Furnace do verification Air Flow. MCH Refrigerant Charge MCH`25 -only systems and changes not require of -23 or - dti r Existing duct systems constructed, insulated or sealed with asbestos are exemptrfrom MC 1 2Q Du5Leakage Testyng requirements. i J( it IT XN: 1.1 I 1 � I is f. 11 1 t '1 v . E. Entirely New or Complete Replacement Duct System, with or withoutgEquipment Changeo.pt (Secti ns-150.2(b)1Dnaand 150.2(b)1E, F) This section does not apply to this project. F. Entirely New or Complete Replacement Space Conditioning System (Section 150.2(b)iC) This section does not apply to this project. Registration Number: 217-A020215929A-000-000-0000000-0000 Registration Date/Time: 2017-06-26 10:09:51 HERS Provider: CaICERTS CA Building Energy Efficiency Standards - 2016 Residential Compliance Report Version: 2016.1.005 Report Generated: 2017-06-26 10:09:48 Schema Version: rev 10/16 CERTIFICATE OF COMPLIANCE CF111-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: // Robinson, Kevin I�A//W&;If19AA;w~ Company: Signature Date: J ANTHONY PLUMBING HEATING & AIR CONDITIONING 2017-06-26 10:09:51 Address: CEA/ HERS Certification Identification (if applicable): 72216 NORTH SHORE ST #101 City/State/Zip: Phone: THOUSAND PALMS CA 92276 760-343-2121 Responsible Person's Declaration statement. a 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.resporisibilityfor 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 buildin design or system design identified on this Certificate of Compliance conform to the ' requirements of Title 24, Part 1 and Part;6 of the Califomia.Code of Regulations. ate of '' r 4 4. The building design features or system design features identified ori this Certifi Compliance are consistent wwiith4he informMgn..provided on-othe plicalile pliance documents, worksheets, calculations, plans and specifications submitted to the enforcement agency forapproval,with this building application. permtt t t '� l c t �'+' 4 ' 4 ti * v.. . S. I will ensure that a registered copy of this Certificate of�Rmpliance shall-,be;made,available Afrth'e building1l5 t(s)issued for4the building, and made available to the. enforcement agency for all applicable inspections. I understand that a registered copy of this Certificate of Com pl,�ance)s�requiced to be included w r h thedcumentationtthbuiider Pfovdes to the building owner at occupancy. .x . Responsible Designer Name: ' X11 �; � t�fl5f 'F'jr Responsible Designer Signature: V t*,,ot Robinson, Kevin Company: Date Signed: J ANTHONY PLUMBING HEATING & AIR CONDITIONING 2017-06-26 10:09:51 Address: License: 72216 NORTH SHORE ST #101 777794 City/State/Zip: Phone: THOUSAND PALMS CA 92276 760-343-2121 Easy to Verify Oa.m "at CaICERTS.com Digitally signed by Ca10ERTS. This digital signature is provided in order to secure the content of this registered document, and in noway implies Registration Provider responsibility f the accuracy of the infolm Registration Number: 217-A020215929A-000-000-0000000-0000 Registration Date/Time: 2017-06-26 10:09:51 HERS Provider: CaICERTS CA Building Energy Efficiency Standards - 2016 Residential Compliance Report Version: 2016.1.005 Report Generated: 2017-06-26 10:09:48 Schema Version: rev 10/16