BMCH2017-0142LICENSED 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 P fessions Code, and
my License is in full force and effect.
License Class: QOCQ 6 • License No.: 8759
Date: / Contra _r ,
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, 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
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
ofWworkr which this permit is issued.
ve and will maintain workers' :ompensation insurance, as required by
Seof 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: TRUCK INSURANCE EXCHANGE Policy Number: N20087119
_ I certify that in the performance cf 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 :hat, if I should become subject to the
workers' compensation provisions of Sectio of the Lab C e, I shall forthwith
comply wit those rovisions.
Date? � 1 t/ -7 Aa� nt�:
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVER 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 fiis 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, ar.d the applicant, each agrees to, and shall
defend, indemnify and hold harmless the Ci,y 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 anc state that the above information is correct.
I agree to comply with all city and county ordinances and state laws relati uilding
construction, and hereby authorize represe natives oft ' - o e r upon the bove-
mentioned pyoperty for inspection purpose:.
4
VOICE (760) 777-7125
78-495 CALLE TAMPICO
78-495 CALLE TAMPICO
D `�
FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253
DESIGN & DEVELOPMENT DEPARTMENT
INSPECTIONS
(760) 777-7153
BUILDING PERMIT
Date: 4/19/2017
Application Number:
BMCH2O17-0142
Owner:
z
Property Address:
79120 BIG HORN TRAIL
ROBERT GALA*:
6�)LJ
t
APN:
776030018
18524 SE 60TH ST
¢
Application Description:
CARROLL / HVAC CHANGOUT 14SEER/81 AFUE SPLIT SYSTEM
ISSAQUAH, WA 92253
w
Property.Zoning:
Application Valuation:
$1,200.00
N w
a
Applicant:
Contractor:
w o
PREC H & A INC
PREC H & A INC
C:) �
P O BOX 10991
P O BOX 10991
Q V o
PALM DESERT, CA 92255
PALM DESERT, CA 92255
z
z
(760776-1554
�
LIc. No.: 818739
Crn
0
---,-----------------------------------------------------------------------------------------
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 P fessions Code, and
my License is in full force and effect.
License Class: QOCQ 6 • License No.: 8759
Date: / Contra _r ,
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, 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
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
ofWworkr which this permit is issued.
ve and will maintain workers' :ompensation insurance, as required by
Seof 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: TRUCK INSURANCE EXCHANGE Policy Number: N20087119
_ I certify that in the performance cf 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 :hat, if I should become subject to the
workers' compensation provisions of Sectio of the Lab C e, I shall forthwith
comply wit those rovisions.
Date? � 1 t/ -7 Aa� nt�:
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVER 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 fiis 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, ar.d the applicant, each agrees to, and shall
defend, indemnify and hold harmless the Ci,y 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 anc state that the above information is correct.
I agree to comply with all city and county ordinances and state laws relati uilding
construction, and hereby authorize represe natives oft ' - o e r upon the bove-
mentioned pyoperty for inspection purpose:.
t
.
Date:, 4/19/2017
Application Number:
BMCH2017-0142
Owner:
Property Address:
79120 BIG HORN TRAIL
ROBERT GALAK
APN:
776030018
18524 SE 60TH ST
Application Description:
CARROLL / HVAC CHANGOUT 14SEER/81 AFUE SPLIT SYSTEM
ISSAQUAH, WA 92253
Property Zoning:
Application Valuation:
$1,200.00
J
Applicant:
�
Contractor:
PREC H & A INC
PREC H & A INC
P0BOX 10991
i
PO BOX 10991
PALM DESERT, CA 92255
4
PALM DESERT, CA 92255
(760)776-1550
Llc. No.: 818759
-----------------------------------------------------------=--------------------------------
Detail: HVAC CHANGE OUT - 14SEER/81AFUE SPLIT SYSTEM. CARBON MONOXIDE ALARM(S) TO BE INSTALLED PRIOR TO FINAL INSPECTION. 2016
CALIFORNIA BUILDING CODES.
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.
1
6
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4
l
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 - SPLIT-SYSTEM
101-0000-42402
0
$76.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
HVAC CHANGEOUT - SPLIT-SYSTEM PC
101-0000-42600
0
$38.00
Total Paid for CHANGEOUT: $114.00
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 # City of La Quinta'
Guildin. a Safety Division
Permit u 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-701.2
Building Permit Application and Tracking Sheet
Project Address: Owner's Name: kava. u /Y'D ll
A. P: Number:
Address: —7 17601- T.,
Legal Description:
City, ST, Zip:QJ VV 9 a-S
Contractor: 0 h
e �l
(� s
r
a c
Telephone:
Address: (] d
L l3 07 (3
Project Description:
City, ST, Zip: �(� 4VL
TeleP h0 c:7tv)L6, -/�-� _
o JJ
t�
State Lie. # : 'r e-7S
City Lie.
Arch.,'Engr., Designer:
Address:
City, ST, Zip:
Telephone:
.............................
:TelePh
Occupancy:
o frac tonTYPe•CPane
State Lie. #:
r
New Add'n Alter Repair-ai
Demo
P (circle one),
j�N �e.�of Ci ct�Per�'s'on: CA,-r lry o-(ti Q U �S
Sq. Ft_:
# Stories:
# Units:
tT-elephonS.Lof-Gontact-Person loo %2(p —/AS0Estimated''TiVa'lu
of;Projectv•
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Rcc'd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Cafes.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
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 Person
Plumbing
Grant Dced
Plans picked up
S.M.I.
M.O.A. Approval
Plans resubmitted
Grading
IN IiOUSE:-
Review, ready for corrections/issue
Developer Im"pact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date or permit issue
School Fees,
Total Permit Fees
CERTIFICATE OF COMPLIANCE CF1R-ALT-02-E
Alterations to Space Conditioning Systems (formerly CF -1R -ALT -HVAC) (Page 1 of 3)
Project Name: Marilu Carroll Date Prepared: 2017-04-17
A. General Information
CF1R-ALT-02 is applicable to multiple space conditioning systems contained within a single dwelling unit. When multiple dwelling units mL st be documented, use one
CFIR-ALT-02 document for each dwelling unit.
01
Project Name
Marilu Carroll
02
Date Prepared
2017-04-1'
03
Project Location
79120 Big Horn Trl
04
Building Type
Single fam ly
05
CA City
La Quinta y�y
06
Dwelling Unit Name
House
07
Zip Code
` t
92253
J --'
08A
Dwelling Unit Conditioned
3750
system
more than 40
entirely new
entirely new
Floor Area (ft)
Name
Served
System (ft2)
system?
component?
Number of Space
feet of duds?
09
Climate Zone
15 f,w
ei
Conditioning (SC) Systems in
1
Yes
Yes
Yes
j10
this Dwelling Unit:
No
B. Space Conditioning (SC) System Information
#*Ik I g R"* 1" M C4
01
02
03
04 `
OS www
06t
07
08
09
10
SC System
SC System
CFA served
Is the SC
system`anpl
Installing a
llrefrigerant
' Ins all ng 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 duds?
duct system?
SC system?
Alteration Type
Unit f!1
home
3750
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: 417-A020090023A-000-000-0000000-0000 Registration Datefrime: 2017-04-17 12:36:13 HERS Provider: CHEERS
CA Building Energy Efficiency Standards - 2016 Residential Compliance Report Version: 2016.1.005 Report Generated: 2017-04-17 12:36:14
Schema Version: rev 10/16
CERTIFICATE OF COMPLIANCE CF1R-ALT-02-E
Alterations to Space Conditioning Systems (formerly CF -IR -ALT -HVAC) (Page 2 of 3)
D. Altered Space Conditioning System (Sections 150.2(b)lE 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 Dud
or Name
Type
Components
Type
Value
System Type
Components
Type
Value
Type
Duct Length
R -Value
Unit #1
Central gas
furnace
Indoorcoil
AFUE
0.81
Central split
Indoorcoil
SEER
14
Setback
Less than or
equal to 40
R-8
AC
feet
Reouired Documentation:
CF2R-MCH-01-E -Space Conditioning Systems 3'�r ,
- Duct insulation requirement for the new portions of supply -air and return -air ducts or plenums:'R6.(CD1;11 212`andjl3) 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 aucted.systems, or when more than 40 ft of duct length is repla:ed
-Leakage rate compliance: <= 15% or r- 10% leakage to outside, or seal all accessible leaks. 0<4
CF2R and CF3R-MCH-25-H Refrigerant Charge verification required when refrigerant containing componentsate,ins[alled 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 are exempt from MCH -20 Duct LeakageTesting requirements.
- Heating -only systems and Air Handler Furnace changes do not require verification of Air Flow MCH -23, or Refrigerant Charge MCH -25.
-Existing duct systems constructed, insulated or sealed with asbestos are exempt from MCH -20 Duct Leakage Testing requirements.
y p p y -.h it hii p g - dt ( () )
E. Entirely New or Complete Replacement Duct System, with or wlthouYE ui ment Chan eout Sections 150.2(b)1Diia and 150.2 b lE, F
lldr+ ?tv, ft-xt i nr tre9 Wises. €n'ruvc.t: s
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: 417-A020090023A-000-000-0000000-0000 Registration Date/Time: 2017-04-17 12:36:13 HERS Provider: CHEERS
CA Building Energy Efficiency Standards - 2016 Residential Compliance Report Version: 2016.1.005 Report Generated: 2017-04-17 12:36:14
Schema Version: rev 10/16
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:
Albert Aceves
t4UwevtAceVeb
Company:
Signature Date:
Precision Heat & Air, Inc.
2017-04-17
Address:
CEA/ HERS Certification Identification (if applicable):
PO Box 11090
City/State/Zip:
Phone:
Palm Desert CA 92255
60 275-2362
Responsible Person's Declaration statement 01
I certify the following under penaltyof perjury, under the laws of the State of California:ll ""'
1. The information provided on this Certificate of Compliance is true and correct. `"r ,,fi-'
2. lam eligible under Division 3 of the Business and Professions Code to accept responsibility for the buiillding design or system design identified an 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.
w.._ yr11�
5. I will ensure that a registered copy of this Certificate of Compliance shall be made available with Ad-,building:permlt( ) issued 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 requite d�io be luded wihPthe duc mentation the builder provides to the building owner at occupancy.
Responsible Designer Name:Responsible
etiArt",gjbe°3Ceview
Designer Signature:
Albert AcevesUtSn1F0
Company:
Date Signed:
Precision Heat & Air, Inc.
2017-04-17
Address:
License:
PO Box 11090
818759
City/State/Zip:
Phone:
Palm Desert CA 92255
760-275-2362
Digitally signed by CHEERS'". 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 Number: 417-A020090023A-000-000-0000000-0000 Registration Date/Time: 2017-04-17 12:36:13 HERS Provider: CHEERS
CA Building Energy Efficiency Standards - 2016 Residential Compliance Report Version: 2016.1.005 Report Generated: 2017-04-17 12:36:14
Schema Version: rev 10/16