BMCH2017-0415LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I 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.: 630503
t ate:' 1Eo'nt actor
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. . BAP.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 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 performance of the work for which this permit
is issued. My workers' compensation insurance carrier and policy number are:
Carrier: ARCH INSURANCE COMPANY Policy Number: ZAWC12536600
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 subjectto 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' a1 t9 li —Applicant
—A
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 186 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 tff 14 —I Signature:(Applicant or Agent): 52—�
VOICE (760) 777-7125
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
FAX (760) 777-7011
DESIGN & DEVELOPMENT DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date' 9/18/2017
Application Number: BMCH2O17-0415
Owner:
Property Address: 78635 BRADFORD CIR
n \`
MARY KIREJIAN
APN: 604225005 t✓ ��-
1 "
78635 BRADFORD CIR
Application Description: KIREJIAN RESIDENCE / HVAC
CHANGE OU ��`1E�
/LA QUINTA, CA 92253
1
Property Zoning:1
Application Valuation: $13,000.00
!
SEP l 8
20%%
Applicant:
C!
CO�MUNI 0/4 Qllilif�Al -
MVTDFNRp
Contractor:
EIN
TMENi
A AVIS PLUMBING HEATING & AIR CONDITIO
31225 LA BAYA
600 EAST VALLEY BLVD
WESTLAKE VILLAGE, CA 91362
COLTON, CA 92324
(909)825-3600
• Llc. No.: 630503
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I 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.: 630503
t ate:' 1Eo'nt actor
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. . BAP.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 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 performance of the work for which this permit
is issued. My workers' compensation insurance carrier and policy number are:
Carrier: ARCH INSURANCE COMPANY Policy Number: ZAWC12536600
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 subjectto 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' a1 t9 li —Applicant
—A
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 186 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 tff 14 —I Signature:(Applicant or Agent): 52—�
f
Date: 9/18/2017
Application Number: BMCH2O17-0415
Owner:
Property Address: 78635 BRADFORD CIR
MARY KIREJIAN
APN: .. 604225005
78635 BRADFOFD CIR
Application Description: KIREJIAN RESIDENCE / HVAC CHANGE OUT
LA QUINTA, CA 422S3
Property Zoning:
Application Valuation: $13,000.00
Applicant:
Contractor:
IE INC
A - AVIS PLUMBING HEATING & AIR CONDITIO
31225 LA BAYA
600 EAST VALLEY BLVD
WESTLAKE VILLAGE, CA 91362
COLTON, CA 92=24
(909)825-3600
-------------------------- -------------------------------------------------------------------
Llc. No.: 630503
Detail: HVAC CHANGE OUT - 16 SEER/80 AFUE SPLIT SYSTEM. CARBON MONOXIDE ALARM(S) TO BE INSTALLED PRIOR TO FINAL INSPECTION. PER 2016
CALIFORNIA BUILDING CODES.
f
FINANCIAL
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 ENHANCEMEMT FEE: $5.00
Bin.#
Qty'. of,.La QuInta
Building 8r Safety Division
L"', . P.O. Box 1504,78-495 Calie Tampico
la.Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
ProjectAddcess: 78635 Bradford Circle
Owner'sName:.Mary Kirejian
A_ P. Number.
Address: 78635 Bradford Circle
Legal Description:
City, ST, Zip; La Quinta, CA 92253
Contractor A -Avis Plumbing, Heating,'& Air
Telephone:
,;,. �;5 �;x.
Address: 600-E Valley Blvd
Project Description: Replace 5 ton A/C coil; & 80,000 BTU
City, ST, Zip: Colton, CA 92324
furnace
MIX
Telephone: 909-825-3600 0
::�
State Lic. #: 630503City Lie. M.
Arch, Engr., Designer:
Address:
City., ST, Zip:
Telephone:
State Lia #:
Name of Contact Person: Steven Schnierer
Construction Type:. Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
Sq. Ft.: # Stories: #Units:
Telephone # of Contact Person: 818-735-7876
Estimated Value of Project: $13,000.00
APPLICANT: DO NOT WRITE BELOW THIS LINE
It
Submittal
Req'd
Reed
TRACKING
PERMIT FEES
Plan Sets
Pian Check submitted'
"
Item Amount
Structural Cales.
Reviewed, ready for corrections
Plan Check Deposit. .
Truss Calcs.
Called Contact Person
Plan Check Balance
Title 24 Cates.
Plans picked up
Construction
Flood plain plan '
Plans resubmitted
MechatilcaL
Grading plan
V Review, ready for correctionstissue
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 =mpact Fee
Planning Approval
Called Contact Person
A.LP.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:
MARY KIREJIAN Date Prepared:
CF1R-ALT-02-E
(Page 1 of 3)
2017-09-18
J
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.
01
Project Name
MARY KIREJIAN
02
Date Prepared
2017-09-18
03
Project Location
78635 BRADFORD CIRCLE
04
Building Type
Single family
05
CA City
La Quintan
06
Dwelling Unit Name
HOME
07
Zip Code
i ` 'r
92253
08
Dwelling Unit Conditioned
2778
.
Installing new`SC
Installing
,
-
-
Floor Area (ft)
Identification or
Location or Area
by this SC
_-
containing
system
more than 40
entirely new
entirely new
f :
'
Name
Number of Space
System (ftz)
09
Climate Zone
15
10
Conditioning (SC) Systems in
1
Alteration Type
SYSTEM 1
WHOLE HOME
2778
this Dwelling Unit:
Yes
B. Space Conditioning (SC) System Information
r—,
01
02
03
04
05
Ifs 66-4,
07
08.
09
10
Is the SC
Installing ar
V
:-rX With jttigAei•
�
SC System
SC System
CFA served
systema
refrigent
ra
.
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 (ftz)
system?
component?
components?
feet of ducts?
duct system?
SC system?
Alteration Type
SYSTEM 1
WHOLE HOME
2778
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-A020116723A-000-000-0000000-0000 Registration Date/Time: 2017-09-18 07:26:01 HERS Provider: CHEERS
CA Building Energy Efficiency Standards - 2016 Residential Compliance Report Version: 2016.1.006 Report Generated: 2017-09-18 07:26:02
Schema Version: rev 10/16
f
'
•
02
03
04
r
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
v '
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
'AFUE
Central split
All new
This field or
This field or
SYSTEM 1
furnace
heating
0.8 -
AC
cooling
'SEER
16
Setback
section is not
section is not
components
components
applicable
applicable
Required 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 q. -Z 1,10; 12 and113) 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 <= 10% leakage to outside, or seal all accessible leaks. R,.
CF2R and CF3R-MCH-25-H Refrigerant Charge verification required when refrigerant containing co ponents.areinsfalled 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.• FV
,
Exceptions: t�, '
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. .
E. Entirely New or Complete Replacement Duct System, with or_without Equipment Changeoat (Sections 150.2(b)1Diia and 150.2(b)lE, F) _
t I`This sectio dJ esnot apply torth s proiect.
F. Entirely New or Complete. Replacement Space'Conditioning System (Section 150.2(b)lC)
This section does not apply to this project.
Registration Number: 417-A020116723A 000 000 0000000 0000'4 Registration Date/Time: 2017-09-18 07:26:01 HERS Provider: CHEERS
CA Building Energy Efficiency Standards - 20.16 Residential Compliance' Report Version: 2016.1.006 Report Generated: 2017-09-18 07:26:02
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 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:
Stephanie Shryock
stephavu,e,shyockv
Company:
Signature Date: ,
I Permit E Raters
2017-09-18
Address:
CEA/ HERS Certification Identification (if applicable):
31225 La Baya Drive
City/State/Zip:
Phone:
Westlake Village CA 91362 V i';)
818-:735-7876
Responsible Person's Declaration statement4
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. ......,„;
F:: r
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-Lapprovalwith this building permit application.
3,�
S. I will ensure that a registered copy of this Certificate.of Compliance shall be made available with the bwlding.permit(s) 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 isArequired'to be included with�'the do umentation the builder provides to the building owner at occupancy.
Responsible Designer Name: [
fiif i €3:1i?P"5ft4
Katie Bunker
Responsible,Designer_Signature:
'S{;`hca#riPifiShvy'ock.(autYwri�ecL) ,
Company:
Date Signed:
A -Avis Plumbing Heating & Air Conditioning, Inc.
2017-09-18
Address:
License:
600 East Valley Blvd
630503
city/slate/zips
Phono:
Colton CA 92324
909-825-3600
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-A020116723A-000-000-0000000-0000
Registration Date/Time: 2017-09-18 07:26:01
HERS Provider: CHEERS
CA Building Energy Efficiency Standards - 2016 Residential Compliance Report Version:.2016.1.006 Report Generated: 2017-09-18 07:26:02
Schema Version: rev 10/16
iZ