BMCH2018-0069--
78-495 CALLE TAMPICO 4
LA QUINTA, CALIFORNIA 92253 DESIGN & DEVELOPMENT DEPARTMENT
BUILDING PERMIT •
Permit Type/Subtype: MECHANICAL/
Application Number: BMCH2O18-0069
Property Address: 58103 CARMONA
APN: 764480008
Application Description: HANSEN RESIDENCE / C NG O
Property Zoning:
Application Valuation: $11,714.00
MAR Q
M n 9 2018
Applicant:
A R S AMERICAN RESIDENTIAL SERVICES OF C CITY OF LA QUINTA
965 RIDGE LAKE BLVD #201 DESIGN AND DEVELOPMENT DEPARTMENT'
MEMPHIS, TN. 38120
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 rofessions Code,
and my License is in full force and effect.
Licensee CI ss: C3 CSO C20 �.Lice�nsee No 6 74
Dom: Contractor:
OWNER -BUIL E CLARATION
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 11, 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 Name:
Lender's
VOICE (760) 777-7125
FAX (760).777-7011
INSPECTIONS (760) 777-7153
Date: 3/19/2018
Owner:
STIG HANSEN
58103 CARMONA
LA QUINTA, CA 9253
Contractor:
A R S AMERICAN RESIDENTIAL SERVICES OF C
965 RIDGE LAKE E'LVD #201
MEMPHIS, TN 38=20
(951)276-9744
Llc. No.: 765074
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 370C 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 insuranc-e carrier and policy number are:
Carrier: LIBERTY INSURANCE CORPORATION Policy Number:
WA763DS08631017
I certify that in the performance of -he 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 s ould become ct to the
worke*ING:FAI
'atio provisions of Section 3, of a Labor C e shall i
complpr isions.
�e Applicant:
WARNLURE 0 SECURE WORK PAPENSATION 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 FOF 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 thi= application.
1. Each person upon whose behalf this appli.ation 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 ::ity of La Quinta, its officers, agents, and
employees for any act or omission related to tE a 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 ssuance of such permit, or cessation of
work for 180 days will subject permit to cancel ation.
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 Jakiilcli
construction, and 7pr
by authorize representatives of this city epL�r upo e
above -menti ned erty for inspection purposes.
Date: Signature (Applicant or Age
Applicant: Contractor.
A R S AMERICAN RESIDENTIAL SERVICES OF C A R S AMERICAN RESIDENTIAL SERVICES OF C
965 RIDGE LAKE BLVD #201 965 RIDGE LAKE BLVD #201
MEMPHIS, TN 38120 MEMPHIS, TN 38120
(951)276-9744
Lic. No.: 765074
---------------------------------------------------------------------------------------------
Detail: HVAC CHANGE OUT - 14 SEER/80 AFUE SPLIT SYSTEM. CARBON MONOXIDE ALARM(S) TO BE INSTALLED PRIOR TO FINAL INSPECTION. PER 2016
CALIFORNIA BUILDING CODES.
Date: 3/19/2018
Application Number:
BMCH2O18-0069
Owner:
'Property Address:
58103 CARMONA
STIG HANSEN
APN:
764480008
58103 CARMONA
Application Description:
HANSEN RESIDENCE / HVAC CHANGE OUT
LA QUINTA, CA 92253
Property Zoning:
Application Valuation:
$11,714.00
Applicant: Contractor.
A R S AMERICAN RESIDENTIAL SERVICES OF C A R S AMERICAN RESIDENTIAL SERVICES OF C
965 RIDGE LAKE BLVD #201 965 RIDGE LAKE BLVD #201
MEMPHIS, TN 38120 MEMPHIS, TN 38120
(951)276-9744
Lic. No.: 765074
---------------------------------------------------------------------------------------------
Detail: HVAC CHANGE OUT - 14 SEER/80 AFUE SPLIT SYSTEM. CARBON MONOXIDE ALARM(S) TO BE INSTALLED PRIOR TO FINAL INSPECTION. PER 2016
CALIFORNIA BUILDING CODES.
'FINANCIAL •R •
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
$39.01
DESCRIPTION
ACCOUNT
CITY
AMOUNT
HVAC CHANGEOUT - SPLIT -SYSTEM PC
101-0000-42600
0
$78.02
Total Paid for CHANGEOUT: $117.03
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
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:
Bill #
City 0if 4. Qu%nta
Building at Safety Division
P.O. Box 1504,78-495 Calle Tampico
La.Quinta, CA 92253 -:(760) 777-7012
Building Permit Applicatlon and Tracking Sheet
Permit #
Project Address:
Owner's Name:.��
A. P. Number.
Address: S M
Legal Description: tivc,City,
ST, Zip: La. Q V 1 Z2s3
Telephone ? — (( ;r.x i'�c.3:
Project Description: Z �`
Contractor: �.sH,,Q,,
Address:
City,ST, ZiW%AA
Telephone:
State Lie. #: Q City Lie*. M.
Arch., Engr., Designer:
CAXV1I�rV�'
Address:
City., ST, Zip:
Telephone: 'Cons
State Lic. #: ; f �.
:.<:... '
Name of Contact Person:
truction Type:.M V C Occupancy:
Project type (circle one): New Add'n. Alter Repair Demo
Sq. Ft.: #Stories: #Units:
Telephone # of Contact Person:
Estimated Value of Project: `k .114
APPLICANT: DO NOT WRITE BELOW THIS LINE
N
Submittal
Req>d
Recd
TRACMG
PERMI[T FEES
Plan Sets
Plan Check submitted
Item Amount
Structural Calm
Rev lewed 'ready for corrections
Plan Check Deposit. .
Truss Calcs.
Called Contact Person
Plan Check Balance.
Title 24 Calm,
Pians picked up
Construction
Flood plain plan
Plans resubmitted..
Mechanical
Grading plan
2'd Review, ready for corrections/'issue
Electrical
Subeontactor 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 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:
HANSEN I Date Prepared:
CF1R-ALT 02-E
(Page 1 of 3)
2018-03-19
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
HANSEN
02
Date Prepared
2018-03-19
03
Project Location
58103 CARMONA
04
Building Type
Single family
05
CA City
La Quinta
06
Dwelling Unit Name
HOME
07
Zip Code
92253 r`�
O8"I
Dwelling Unit Conditioned
3889
Installing new SC
Installing
Installing
Installing
Floor Area (ftZ)
Identification or
Location or Area
by this SC
ducted
containing
system
more than 40
entirely new
entirely new
-1r10
Name
Number of Space
System (ftZ)
09
Climate Zone
15
feet of ducts?
Conditioning (SC) Systems in
1
Alteration Type
'+�; •
`
this Dwelling Unit:
B. Space Conditioning (SC) System Information
fc i k;:ti
O1
02
03
04 `''
' 05 lk—
07
08
09
10
Is the SC
Installing a
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 (ftZ)
system?
component?
components?
feet of ducts?
duct system?
SC system?
Alteration Type
Altered space
HVAC1
3889
3889
Yes
Yes.
Yes
No
No
No
"
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.
k
Registration Number: 418-A020016524A-000-000-0000000-0000
CA Building Energy Efficiency Standards - 2016 Residential Compliance
Registration Date/Time: 2018-03-19 07:40:45
Report Version: 2016.1.006
Schema Version: rev 10%16
HERS Provider: CHEERS
Report Generated: 2018-03-19 07:40:46
CERTIFICATE OF COMPLIANCE CF1R-ALT-02-E
Alterations to Space Conditioning Systems (formerly CF -IR -ALT -HVAC) (Page 2of 3)
D. Altered Space Conditioning System (Sections 150.2(b)lE 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
Centrals lit
p
All new
Central split
All new
This field or
This field or
HVAC1
HP
heating
HSPF
g
HP
cooling
SEER
14
Setback
section is not
section is not
components
components
applicable
applicable
Required Documentation: �, • �t
-
CF2R-MCH-01-E - Space Conditioning Systems s t �•
- Duct insulation requirement for the new portions of supply -air and return -air ducts or plenums.'R6 (CZ 1% 12 a4'13) 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: <= 153'0 or <= 10% leakage to outside, or seal all accessible leaks. �.�.v
,-r
CF2R and CF3R-MCH-25-H Refrigerant Chaige 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 are exempt from MCH -20 Duct Leakage Testing 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.
r_ -Y x .71— Tt
E. Entirely New or Complete Replacement Duct System, with or without Equipment Changeout (Sections 150.2(b)1Diia and 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)1C)
This section does not apply to this project.
t,
Registration Number: 418-A020016524A-000-000-0000000-0000 Registration Date/Time: 2018-03-19 07:40:45 HERS. Provider: CHEERS
CA Building Energy Efficiency Standards - 2.016 Residential Compliance Report Version: 2016.1.006. Report Generated: 2018-03-19 07:40:46
Schema Version: rev 10/16
CERTIFICATE OF COMPLIANCE CF111-ALT-024
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:
Christina Calhoun
C WLWL�na.Caihouw
Company:
Signature Date:
Rightime Home Services
2018-03-19
Address:
CEA/ HERS Certification Identification (if applicable):
965 Ridge lake Blvd, Suite 201
City/State/Zip:
Phone:
Memphis TN 38120 ' '
95.1-276-9744
Responsible Person's Declaration statement,.•e
certify the following under penalty of perjury, under the laws of the State of California-.-
alifornia:1.
1.The information provided on this Certificate of Compliance is true and correct. ' 1
2. 1 am eligible under Division 3 of the Business and Professions Code to accept responsibility16 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 -approval with this building permit application.
S. I will ensure that a registered copy of this Certificate of Compliance shall be made available with the building 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 is'requireiJ'to be included witfi'the documentation the builder provides to the building owner at occupancy.
Responsible Designer Name:
Responsible Designer'Signature:
Christina Calhoun
chi tula.cai3wuw
Company:
Date Signed:
Rightime Home Services
2018-031-19
Address:
License:
965 Ridge lake Blvd, Suite 201
765074
City/State/Zip:
Phone:
h/lemphi.s TAI 38120
951.276.9744
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: 418-A020016524A-000-000-0000000-0000 . Registration Date/Time: 2018-03-19 07:40:45 HERS Provider: CHEERS
CA Building Energy Efficiency Standards - 2016 Residential Compliance Report Version: 2016.1.006 Report Generated: 2018-03-19 07:40:46
Schema Version: rev 10/16
V
e' -