BMCH2018-005078-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Permit Type/Subtype:
Application Number:
Property Address:
APN:
Application Description:
Property Zoning:
Application Valuation:
Applicant:
ADAM SIMMONS
P O BOX 314
LA QUINTA, CA 92247
MECHANICAL/
BMCH2O18-0050
DESIGN & DEVELOPMENT DEPARTMENT
BUILDING PERMIT
48380 CASITAS DR . .
602112025
BLOMESTEIN / (2) HVAC CHANGEOUTS 14SEER/81 AFUE SPLIT
SYSTEM
$20,000.00
U MAR 01 2018 Ld
CITY OF LA QUINTA
COMMUNITY DEVELOPMENT DEPARTMENT
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 License No.: 780534
Date: Q Contractor: 6`��+
VOICE (760) 777-7125
'FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 3/1/2018
Owner:
RODGER LOMESTEIN
48380 CASITA DR
LA QUINTA, CA 92253
Contractor:
ADAM SIMMOVS
P0BOX 314
LA QUINTA, CA 92247
(760)564-7525
Llc. No.: 780534
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one if the following declarations:
I have and will maintain a certificae of consent to self -insure for workers'
compensation, as provided for by Section 3700 of the Labor Code, for the performance
of tl a &ork for which this permit is issued.
1 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:
OWNER -BUILDER DECLARATION
Carrier: STATE COMPENSATION INSURANCE FUND Policy Number: 9054788
I hereby affirm under penalty of perjury that 1 am exempt from the Contractor's State
_ I certify that in the performance o1 the work for which this permit is issued, I
License Law for the following reason (Sec. 7031.5, Business and Professions Code: Any
shall not employ any person in any manner s■ as to become subject to the workers'
city or county that requires a permit to construct, alter, improve, demolish, or repair any
compensation laws of California, and agree that, if I should become subject to the
structure, prior to its issuance, also requires the applicant for the permit to file a signed
workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith
statement that he or she is licensed pursuant to the provisions of the Contractor's State
comply with those provisions.
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business
/ Z
and Professions Code) or that he or she is exempt therefrom and the basis for the
Date: $ Applicant: _ G r� > GC
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).:
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL,
(� I, as owner of the property, or my employees with wages as their sole
AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO
compensation, will do the work, and the structure is not intended or offered for sale.
ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION TO THE COST OF
(Sec. 7044, Business and Professions Code: The Contractors' State License Law does not
COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,
apply to an owner of property who builds or improves thereon, and who does the work
INTEREST, AND ATTORNEY'S FEES.
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
APPLICANT ACKNOWLEDGEMENT
within one year of completion, the owner -builder will have the burden of proving that he
IMPORTANT: Application is hereby made to the Building Official for a permit subject to
or she did not build or improve for the purpose of sale.).
the conditions and restrictions set forth on th*s application.
( )1, as owner of the property, am exclusively contracting with licensed contractors to
1. Each person upon whose behalf this appl cation is made, each person at whose
construct the project. (Sec. 7044, Business and Professions Code: The Contractors' State
request and for whose benefit work is perforned under or pursuant to any permit issued
License Law does not apply to an owner of property who builds or improves thereon,
as a result of this application , the owner, andthe applicant, each agrees to, and shall
and who contracts for the projects with a contractor(s) licensed pursuant to the
defend, indemnify and hold harmless the City of La Quinta, its officers, agents, and
Contractors' State License Law.).
employees for any act or omission related to Ilhe work being performed under or
l—) I am exempt under Sec. B.&P.C. for this reason
following issuance of this permit.
2. Any permit issued as a result of this application be null and void if work is not
commenced within 180 days from date of issuance of such permit, or cessation of work
Date: Owner:
for 180 days will subject permit to cancellation.
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:
I certify that I have read this application and sate that the above information is correct.
I agree to comply with all city and county ordi lances and state laws relating to building
construction, and hereby authorize representatives of this city to enter upon the above-
mentioned property for inspection purposes.
Dater Signature (ApplicantxAgent):
Dater 3%1/2018 .
Application Number:
BMCH2O18-0050.
Owner:
Property Address:
48380 CASITAS DR
RODGER LOMESTEIN
APN:
602112025
48380 CASITA DR
Application Description:
BLOMESTEIN / (2) HVAC CHANGEOUTS 14SEER/81 AFUE SPLIT SYSTEM
LA QUINTA, CA 92253
Property Zoning:
Application Valuation:
$20,000.00
Applicant:
Contractor:
ADAM SIMMONS
ADAM SIMMONS
P0BOX 314
P0BOX 314
LA QUINTA, CA 92247
LA QUINTA, CF. 92247
(760)564-7525
Llc. No.: 780534
--------------------------------------------------------------------------------------------
Detail: (2) HVAC CHANGE OUTS-Y4SEER/81AFUE SPLIT SYSTEM. CARBON MONOXIDE ALARM(S) TO BE INSTALLED PRIOR TO FINAL INSPIECTION. 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 - SPLIT -SYSTEM'
101-0000-42402
0
$78.02
DESCRIPTION
ACCOUNT
QTY
AMOUNT
HVAC CHANGEOUT- SPLIT -SYSTEM PC
101-0000-42600
0
$156.04
Total Paid for CHANGEOUT: $234.06
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: $S.00
$348.89
Bin #
City of La Quinta
Building &r Safety Division
P.O. Box 1504, 78-495 Calle Tampico.
La Quinta, CA 92253 - (760) 777-7012
&vs -o Building Permit Application and Tracking Sheet
Permit #
GkAci4a41 _
Project Address: 97"3F,() Orl d -e—
Owner's Name - Td, 0 ,&Y- , -n
A. P. Number:
Address: 4 8 3 0 CAS t � P
Legal Description:
City, ST,.Zip: 1,.0- ®U in 1 yi t_ 019 573
Contractor: C S'
Telephon W- t3
Address: Sy y 0 Ave'Irk
a �"r n
Project Description:
City, ST, Zip: (-a Q(J Q
Telephon446) S/o
State Lic. # : -7
City Lic. #..
Arch., Engr., Designer.
Address:
City., ST, Zip:
Telephone:
3g:"•:V,
::.;r ;:::v«<-;: < .z:>:<>?::><`::>.<.>:
':.<:<•<•.>•-�•o:•<•>x•::>-:;>.;:.:r::>::-::.<
Construction Type: Occupancy
State Lic. #:
,
Project type (circle one): New Add'n Alter Repair Demo
Name of Contact Person:
Sq. Ft.:
# Stories:
#Units:
Telephone #,of Contact Person:
-Estimated Value of Project ' 0 O Q.
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACKING
PERMIT FEES.
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance
Title 24 Calcs.
PIans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2" Review, ready for corrections/issue
Electrical
Subcontactor List
Called ContactPcrson
Plumbing
Grant Decd
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN IiOUSE:-
'"' Review, ready for correctionsrissue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Feu
CERTIFICATE OF COMPLIANCE CF1R-ALT 02-E
Alterations to Space Conditioning Systems (formerly CF -1R -ALT -HVAC) (Page 1 of 3)
Project Name: 48380 CASTITA DRIVE I Date Prepared: 2018-02-20 I
A. General Information
CFIR-ALT-02 is applicable to multiple space conditioning systems contained within a single dwelling unit. When multiple dwelling units must be documented, use one
CF111-ALT-02 document for each dwelling unit.
01
Project Name
48380 CASTITA DRIVE
02
Date Prepared
2018-02-20
03
Project Location
48380 CASTIA DRIVE
04
Building Type
Single family
05
CA City
La Quinta
06
Dwelling Unit Name
48380 CASTITA DRIVE
"SC System
Dwelling Unit Conditioned
CFA served
07
Zip Code
92253
08
Floor Area (ft)2151
Installing
Identification or
Location or Area
by this SC
Number of Space
containing
09
Climate Zone
15
10
Conditioning (SC) Systems in
2
Served
System (ft)
system?
component?
this Dwelling Unit:
feet of ducts?
I i- -- 1 i f I' -- i�- 1 N--'-) : 1 r 7 t
B. Space Conditioning SCS stem Information
01
02
03 \
`' 04 -
'-05'
_� -06-
07` U
08 -'
=09
10
FIs the SCS`'
Iiistalli gla
>
"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 (ft)
system?
component?
components?
feet of ducts?
dud system?
SC system?
Alteration Type
System 1
WHOLE HOUSE
1200
Yes
Yes
Yes
No
No
No
Altered space
conditioning system
System 2
WHOLE HOUSE
1200
Yes
Yes
Yes
No
No
No
Altered space
conditioning system
C. Extension of Existing Duct System, Greater Than 40 Feet (Section150.2(b)iDiib)
This section does not apply to this project.
Registration Number: 218-A020050879B-000-000-0000000-0000 Registration bate/Time: 2018-02-20 07:03:13 HERS Provider: CaICERTS
CA Building Energy Efficiency Standards - 2016 Residential Compliance Report Version: 2016.1.006 Report Generated: 2018-02-20 07:03:51
Schema Version: rev 10/16
CERTIFICATE OF COMPLIANCE CUR -ALT 02-E
Alterations to Space Conditioning Systems (formerly CF -1R -ALT -HVAC) (Page 2 of 3)
i
'D. Altered Space Conditioning System (Sections 150.2(b)IE and F)
01
02
03
04
05
06
07
08
09
30
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
Central split
All new
Less than or
System 1
furnace
heating
AFUE
81
AC
cooling
SEER
14
Setback
equal to 40
R-8
components
components
feet
Central gas
All new
Central split
All new
Less than or
System 2
furnace
heating
AFUE
81
AC
cooling
SEER
14
Setback
equal to 40
R-8
components
components
feet
Required Documentation:
CF2R-MCH-01-E - Space Conditioning Systems
- Dud 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 CF3R-MCH-20-H - Dud Leakage Test required when heating or cooling components are installed in ducted systems, or when more than 40 ft of dud length is replaced
-Leakage rate compliance: <= 15% or <=10% leakage to outside, or seal all accessible leaks.
CF211 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 are exempt from MCH -20 Duct Leakage Testing,requirements. i1
� LJ �,11
Heating -only systems and*Air Handler Furnace changes do not require verification of Air Flow MCH -23, or Refrigerant Charge MCH -25.
Existing dud systems constructed, insulated or sealed with asbestos`are exempt fr0m.IV1CH ZO Duct Leakage Testing requirements ! {{
E. Entirely New or Complete Replacement Duct System, with or without Equipment Changeout (Sections 150.2(b)iDiia and 150.2(b)lE, 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.
Registration Number: 218-A020050879B-000-000-0000000-0000
Registration Date/Time:
2018-02-20 07:03:13
,HERS Provider: CaICERTS
CA Building Energy Efficiency Standards - 2016 Residential Compliance Report Version: 2016.1.006 Report Generated: 2018-02-20 07:03:51
Schema Version: rev 10/16
CERTIFICATE OF INSTALLATION CF2R-MCH-01-E
Space Conditioning Systems, Ducts, and Fans (Page 8 of 8) .
Documentation Author's Declaration Statement
1. 1 certify that this Certificate of Installation documentation is accurate and complete.
Documentation Author Name:
Documentation Author Signature: �,��
Tom Bachus
Company:
Signature Date:
MLC Building Performance
2018-02-20 07:24:13
Address:
CEA/ HERS Certification Identification (if applicable):
77825 Delaware Place
City/State/Zip:
Phone:
Palm Desert CA 92211
760-836-0066
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 Installation Is true and correct.
2. 1 am either: a) a responsible person eligible under Division 3 of the Business and Professions Code in the applicable classification to accept responsibility for the system design, construction, or installation of
features, materials, components, or manufactured devices for the scope of work identified on this Certificate of Installation, and attest to the declarations in this statement, or b)1 am an authorized
representative of the responsible person and attest to the declarations in this statement on the responsible person's behalf. -1
3. The constructed or Installed features, materials, components or manufactured devices (the 1nstallatiori) identified on this Certificate.o` Installation conforms to all.appllcable codes and regulations and the
installation conforms to the requirements given on the Certificate of Compliance,'plans` and specifications approved by the enforcement agency?)
., '. - j
S % % r 1 5 � 4 l 1 i
4. 1 will ensure that a registered copy of this Certificate oflnstallation shall be posted or made available with the building permit(Cs)_,issued for the building, and made available to the enforcement agency for all
applicable inspections. I understand that a registered ropy of this Certiific�ajte of Installation is required to be included documentatlon thfj bbuuiilder provides to the building owner at occupancy.
}with-ih`el
HERS' R S P - r% % i.«/ � � 0.t./
Responsible Builder/Installer Name:
Responsible Builder/Installer Signature:
Donna Simmons
Company Name: (Installing Subcontractor or General Contractor or Builder/Owner)
Position With Company (Title):
ADAM SIMMONS •
OWNER
Address:
CSLB License:
54440 AVENIDA CARRANZA
780534
CIN/State/Zig;
Phone:
Date Signed;
LA QUINTA CA 92253
760-564-7525
12018-02-20 07:47:50
Digitally signed by CaICERTS. This digital signature is provided in order to secure the content of this registered document and in noway implies Registration Provider responsibility for the accuracy of the information.
Registration Number: 218-AO20050879B-000-001-MO1001A-0000 Registration Date/Time: 2018-02-20 07:47:50 HERS Provider: CaICERTS
CA Building Energy Efficiency Standards - 2016 Residential Compliance Report Version: 2016.1.006 Report Generated: 2018-02-20 07:17:17
Schema Version: rev 4/7/2017