BMCH2017-039278-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
DESIGN & DEVELOPMENT DEPARTMENT
BUILDING PERMIT
Application Number:
BMCH2O17-0392
Property Address:
78991 BRECKENRIDGE DR
APN:
770320040
Application Description:
RANDALL RESIDENCE / HVAC CHANGE OUT
Property Zoning:
Application Valuation:
$13,303.00
Applicant:
CERTIFIED COMFORT SYSTEMS INC DBA HYDES
42-949 MADIO STREET
INDIO, CA 92201
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 C 6 License No.: 906115
Date: Contractor. 1
L IV
OWNER-BUILDE"ECLARgON
I hereby affirm under penalty of perjury that I am ex pt 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
(_) 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 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 Add
VOICE (760) 777=7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 8/31/2017
Owner:
CAROLINE RANCALL
�Wl 78991 BRECKENRIDGE
LA QUINTA, CA 92253
�G
912� Contractor:
0 CERTIFIED COM=ORT SYSTEMS INC DBA HYDES
\" 42-949 MADIO REET
INDIO, A 92201
(760)360-2202
Llc. No.: 906115
WORKER'S COMPENSATION DECLARATION
I.hereby affirm under penalty of perjury one of the following declarations:
I have and will maintain a certific.—te 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' :ompensation insurance, as required by
Section 3700 of the Labor Code, for the perfc rmance of the work for which this permit
is issued. My workers' compensation insurance carrier and policy number are:
Carrier: EVEREST NATIONAL INSURANCE COMPANY Policy Number: 7600015264
I certify that in the performance cf'the work for which this permit is issued, I
shall not employ any person in any manner sa as to become'subject to the workers'
compensation laws of California, and agree t.iat, if I should become subject to the
workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith
comply with thosXprvi sions.'
Date: 1 Applica
WARNING: FAILURE TO SECURE RK
COVERAGE IS UNLAWFUL,
AND SHALL SUBJECT AN EMPLO ER AND CIVIL FINES UP TO
ONE HUNDRED THOUSAND DO RS ($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 -he Building Official for a permit subject to
the conditions and restrictions set forth on this application.
1. Each person upon whose behalf this apg..lication 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 tothe 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 cf 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 ;tate 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 represencatives of this city to enter upon the
above -menti need roperty for inspection purposes.
Date: ! Signature (Applicant or Agent):
r
Date: 8/31/2017
Application Number: BMCH2O17-0392
Owner:
Property Address: 78991 BRECKENRIDGE DR
CAROLINE RAN CALL
APN: 770320046
78991 BRECKENRIDGE
Application Description: RANDALL RESIDENCE / HVAC CHANGE OUT
LA QUI NTA, CA 42253
Property Zoning:
Application Valuation: $13,303.00
Applicant:
'Contractor:
CERTIFIED COMFORT SYSTEMS INC DBA HYDES
CERTIFIED COW -'ORT SYSTEMS INC DBA HYDES
.42-949 MADIO STREET
42-949 MADIO STREET
INDIO, CA 92201
INDIO, CA 9220!
(760)360-2202
---------------------------------------------------------------------------------------------
Uc. No.: 906115
Detail: HVAC CHANGE OUT - 20 SEER/80 AFUE SPLIT SYSTEM. CARBON MONOXIDE ALARM(S) TO BE INSTALLED PRIOR TO FINAL INSPECTION. PER 2016
CALIFORNIA BUILDING CODES.
DESCRIPTION
ACCOUNT CITY AMOUNT
BSAS SB1473 FEE 101-0000-20306 0 $1.00
Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $1.00
DESCRIPTION
ACCOUNT
CITY
AMOUNT
HVAC CHANGEOUT - SPLIT -SYSTEM
101-0000-42402
0
$76.00
DESCRIPTION
ACCOUNT
CITY
AMOUNT
HVAC CHANGEOUT - SPLIT -SYSTEM PC
101-0000-42600
0
$38.00
Total Paid for CHANGEOUT:
. $114.00
DESCRIPTION
ACCOUNT
CITY
AMOUNT
PERMIT ISSUANCE
101-0000-42404
0
$96.27
Total Paid for PERMIT ISSUANCE: $96.27
DESCRIPTION
ACCOUNT
CITY
AMOUNT
TECHNOLOGY ENHANCEMENT FEE
502-0000-43611
0
$5.00
Total Paid for TECHNOLOGY ENHANCEMENT FEE: $5.00
Bin #
Permit •#
Project Address` 14G�' I
A. P. Number: —F�
Legal Description:
Contractor:
Address:
_%,?_ `I �
City, ST, Zip:
Telephone: 3 6c, _ ZZdZ
State Lie. # : q (7C, 1
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone:
State Lic. #:
Name of Contact Person:
Telephone # of Contact Person:
# Submittal
Plan Sets
Structural Calcs.
Truss Calcs.
Energy Calcs.
Flood plain plan
Grading plan
Subcontactor List
Grant Deed
ELO.A. Approval
IN HOUSE:-
Planning Approval
Pub. Wks. Appr
tS;hooJFces
City of La QuInta
Building 8[ Safety Division
P.O. Box 1504, 78-495 Calle Tarnpito
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
V Owner's Name: Y
Address:
v
City, S.T. Zip: LCA (z r 10.
Project Description:
Lic. #:
k
Total Permit Fees
Construction Type:
Occupancy:
Project type (circle one):
New Add'n Alter Repair. Demo
Sq. Ft.:
# Stories:
# Units:
Estimated Value of Project: 0
APPLICANT: DO NOT WRITE BELOW THIS UNE
RecdFbickedup
TRACKING
PERMIT FEES
Ped
Item
Amount
Rr corrections
Plan Check Deposit
Cson
Plan Check Balance
Pl
Construction
Plans resubmitted
Mechanical
2" Review, ready for correctionstissue
Electrical
Called Contact Person
------------
Plumbing
Plans picked up
SALL
Plans resubmitted
Grading
Review, ready for corrections/issue
Developer Impact Fee
Called Contact Person
A.LP.P.
Date of permit issue
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: 78991 Breckenridge Drive Date Prepared: 2017-08-22
A. General Information
CF1R-ALT-02 is applicable to multiple space'conditioning systems contained withina single, dwelling unit. When multiple dwelling units must be documented, use one
CF1•R-ALT-02 document for each dwelling unit.
01
Project Name
78991 Breckenridge Drive
02
Date Prepared
2017-08-22
03
Project Location
78991 Breckenridge Drive
04
Building Type
Single family
05
CA City
La Quinta
06
Dwelling.Unit Name
78991 Breckenridge Drive
SC System
SC System
CFA served
Dwelling Unit Conditioned
refrigerant
07
Zip Code
92253
08
Floor Area (ft)
2002
Location or Area
by this SC
ducted
containing
Number of Space
more than 40
09
Climate Zone
15
10
Conditioning (SC) Systems in
1
system?
component?
components?
feet of ducts?
this Dwelling Unit:
SC system?
B. Space Conditioning (SC) System Information �">?� y �;'
01
02
03 '`n
04
�05T
-- �06 '
07
_ 08
09
10
s the SC
Installi g a
:1 �"
-.. ,g '' `
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?
duct system?
SC system?
Alteration Type
System 1
Location 1
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)1Diib)
This section does not apply to this project.
Registration Number: 217-A020288294A-000-000-0000000-0000 Registration Date/Time: 2017-08-22 16:05:01 HERS Provider: CaICERTS
CA Building Energy Efficiency Standards 2016 Residential Compliance Report Version: 2016.1.006 Report Generated: 2017708-22 16:05:03
Schema Version: rev 10/16
CERTIFICATE OF COMPLIANCE CF1R-ALT 02-E
Alterations to Space Conditioning Systems (formerly CF71R-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
Cobllhg
u tltlency
EfilCiency
fhermostat
Keplaced
Iuew uuct
or Name
Type
I.Components
Type
Value
System Type
Components
Type
Value
Type
Duct Length
R -Value
Central split
All new
�
Central split
All new
This field or
This field or
System.l
heating
AFUE
81
AC
cooling
SEER
20
Setback
section is not
section is not
HP
components
components
applicable
applicable
Required Documentation:
CF213-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)
CF211 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.
CUR and CF3R-MCH-25-H Refrigerant Charge verification required when refrigerant containing components are installed or altered (applicable in CZ 2, 8-15).
CF211 and CF311-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 Leakage Testing requirements.
of Air Refrigerant""
Heating -only systems and Air Handler Furnace changes do not require verification Flow MCH, -23 of Charge MCH 25
Existing duct systems constructed, insulated or sealed with asbestos are exempt'from m MCH 20 Duct Leakage Testing requiremerits.
E: Entirely New or Complete Replacement D cu t $y.iptem; with or w.]�ithout EquipmenttCChangeout (Sections,,150.2(b)iDiia and 150.2(b)1E, F)
r. 1. 4 F"$..rneL^`S Y• Y "y,N ` t / r •" �..7
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: 217-A020288294A-000-000-0000000-0000 Registration Date/Time: 2017-08-22 16:05:01 HERS Provider: CalCERTS
CA Building Energy Efficiency Standards - 2016 Residential Compliance Report Version: 2016.1.006 Report Generated: 2017-08-22 16:05:03
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: ,�A
Hyde, Mork
l rffJj4
Company:
Signature Date:
CERTIFIED COMFORT SYSTEMS INC
2017-08-22 16:05:01
Address:
CEA/ HERS Certification Identification (if applicable):
42949 Madio
City/State/Zip:
Phone:
Indio CA 92201
760-360-2202
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 ors ystem 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 Certificaae of Compliance are -'consistent with the in formation, provided on-other'applicable compliance documents, worksheets,
calculations, plans and specifications submitted to the enforcement. agency for,bpproval with this building permit application.
t L .F,S .
5. 1 will ensure that a registered copy of this Certificate of.Compliance'shall.be'made-available with the building petmit(,s!) issued for-the.bdilding, andrade available.to the enforcement agency for all applicable
inspections. I understand that a registered copy of this Certificate of Compliance is required to be,included with the documentation the builder provides to -the building owner at occupancy.
Responsible Designer Name: } + ".
Responsible Designer Signature:
Hyde, Mark
Company:
Date Signed:
CERTIFIED COMFORT SYSTEMS INC
2017-08-22 16:05:01
Address:
License:
42949 Madio
906115
City/State/Zip:
Phone:
Indio CA 92201
760-360-2202
'
Easy to Verify
o . TA
at CaICERTS.com f '� '�
�w
Digitally signed by CaICERTS. 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: 217-A020288294A-000-000-0000000-0000
Registration Date/Time: 2017-08-22 16:05:01
HERS Provider: CaICERTS
CA Building Energy Efficiency Standards - 2016 Residential Compliance Report Version: 2016.1.006 Report Generated: 2017-08-22 16:05:03
Schema .Version: rev 10/16