BMCH2017-0059LICENSED 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, C36 License No.: 977333
Date:3 I7 )--) Contractor:aSL
t
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).:
(1 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.).
(� 1, 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 Na
Lender's Address:
f
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury oneof the following declarations:
I have and will maintain a certificate of consent to self -insure for workers'
compensation, as provided for by Section 3770 of the Labor Code, for the performance
Df 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: REPUBLIC UNDERWRITERS INSURANCE COMPANY Policy Number: ATW
+010094
_ I certify that in the performance d the work for which this permit is issued, I
shall not employ any person in any manner !o as to become subject to 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.
It
Date: -3) 1-7 I% Applicant:
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,,D00). IN ADDITION TO THE COST OF
COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,
INTEREST, AND ATTORNEY'S FEES.
APPLICANT ACKYOWLEDGEMENT
IMPORTANT: Application is hereby made tothe 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, and the applicant, each agrees to, and shall
defend, indemnify and hold harmless the Ciry 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 ofthis aprlication becomes null and void if work is not
commenced within 180 days from date of isuance of such permit, or cessation of work
For 180 days will subject permit to cancellaton.
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 relating to building.
construction, and hereby authorize representatives of this city to enter upon the above-
mentioned property for inspection purpose:..
Date: Signature (Applicant or Agent):—��
f
D 4v
VOICE (760) 777-7125
78-495 CALLE TAMPICO
FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253
DESIGN & DEVELOPMENT DEPARTMENT
INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 3/17/2017
Application Number: BMCH2O17-0059
Owner:
Property Address: 78311 W DEACON DR
STEPHEN MCLI_N w
APN: 770210030
a
Property Zoning:
$7,500.00
¢ W
a
® z
Application Valuation:
c
N W
Applicant:
Contractor: p
IE INC
A#1 SERVICES HEATING & I� NDITIOONING O
31225 LA BAYA
78206 VARNEF RD #D-189 vv Q o
WESTLAKE VILLAGE, CA 91362
PALM DESERT,.CA 92211 v
(760)565-2691 z
t7
LIc. No.: 977333 w
----------------- --------------------------------------------------------------------------
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, C36 License No.: 977333
Date:3 I7 )--) Contractor:aSL
t
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).:
(1 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.).
(� 1, 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 Na
Lender's Address:
f
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury oneof the following declarations:
I have and will maintain a certificate of consent to self -insure for workers'
compensation, as provided for by Section 3770 of the Labor Code, for the performance
Df 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: REPUBLIC UNDERWRITERS INSURANCE COMPANY Policy Number: ATW
+010094
_ I certify that in the performance d the work for which this permit is issued, I
shall not employ any person in any manner !o as to become subject to 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.
It
Date: -3) 1-7 I% Applicant:
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,,D00). IN ADDITION TO THE COST OF
COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,
INTEREST, AND ATTORNEY'S FEES.
APPLICANT ACKYOWLEDGEMENT
IMPORTANT: Application is hereby made tothe 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, and the applicant, each agrees to, and shall
defend, indemnify and hold harmless the Ciry 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 ofthis aprlication becomes null and void if work is not
commenced within 180 days from date of isuance of such permit, or cessation of work
For 180 days will subject permit to cancellaton.
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 relating to building.
construction, and hereby authorize representatives of this city to enter upon the above-
mentioned property for inspection purpose:..
Date: Signature (Applicant or Agent):—��
I
Date: 3/17/2017
Application Number:. BMCH2O17-0059
Owner:
Property Address: 78311 W DEACON DR
STEPHEN MCLIN
APN: 770210030
Property Zoning:
Application Valuation: $7,500.00
Applicant:
Contractor:
IE INC
A#1 SERVICES HEATING & AIR CONDITIONING
31225 LA BAYA
78206 VARNER RD #D-189
WESTLAKE VILLAGE, CA 91362
PALM DESERT, CA 92211
(760)565-2691
LIc. No.: 9773313
J
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Detail: HVAC CHANGE OUT - 21SEER/80AFUE SPLIT SYSTEM. CARBON MONOXIDE ALARM(S) TO BE INSTALLED PRIOR TO FINAL INSPECTION. 2016
CALIFORNIA BUILDING CODES.
I
Total Paid for TECHNOLOGY ENHANCEMENT FEE: $5.00
FINANCIAL INFORMATION
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
QTY
AMOUNT
TECHNOLOGY ENHANCEMENT FEE
502-0000-43611
0
$5.00
Total Paid for TECHNOLOGY ENHANCEMENT FEE: $5.00
#
Qty of LQ Quinta
Building u Safety Division
P.O. Box 1504,78-495 Caife Tampico
La.Quinta, CA 92253 -:(760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
Project Address: 78311 Deacon Drive West
Owner's Name:. Steve and Cathy McLih
A. P. Number.
Address: 78311 Deacon Drive West
Legal Description:
City, ST, Zip: La Quinta, CA 92253
Contractor. A#1 Services Heating & Air Conditioning
Telephone:
Address: 78206 Varner Road #D-189
ProjeaDescription: Replace 4 ton A/C, coil, & 90,000 BTU .
City, ST, Zip: Palm Desert, CA 92211
furnace
Telephone: 760-342-3610
mi.1011M
State Lic. # : 977333
City
Arch., Engr., Designer.
Address:
City, ST. Zip:
Telephone:
State Lic. #: w%Y
Construction Type:. Occupancy:
Proj� � (eimle one): New Add'n Alter Repair Demo
Name of Contact Person: Steven SchniererSq.
Ft.: # Stories:
# Utdts
Telephone # of Contact Person: 818-735-7876
Estimated Value of Project: $7,500.00 .
APPLICANT: DO NOT WRITE BELOW THIS UNE
N
Submittal
Req'd
Recd
TRACIMG
TERMIT FEES
Plan Sets
Pian Check submitted
Item Amount
Strgcturai Cates.
Reviewed, ready for corrections
Plan Check Deposit. .
Truss Cates.
Called Contact Person
Plan Check Mance
Title 24 Calcs..
Plans picked up
Construction
Flood Plain plan
Plans resubmitted
Mechanical
Goading plan
Z`! Review, ready for correctionsrissue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
'"' Review; ready for correetionsrasue
Developer Impact Fee
Planning Approval
Caned Contact Person
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permi: Fees
CERTIFICATE OF COMPLIANCE
Alterations to Space Conditioning Systems (formerly CF -1R -ALT -HVAC)
Project Name:
STEVE & CATHY MCLIN I Date Prepared:
CF1R-ALT-02-E
(Page 1 of 3)
2017-03-16
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
STEVE & CATHY MCLIN
02
Date Prepared
2017-03-16
03
Project Location
78311 DEACON DRIVE WEST
04
Building Type
Single family
05
CA City
LA QUINTA06
Dwelling Unit Name
WHOLE HOUSE
07
Zip Code
92253
08
Dwelling Unit Conditioned
5267
r� J.
Installing new, C
Installing
Installing
Installing
Floor Area (ft)
Identification or
Location or Area
by this SC
ducted
containing
system
more than 40
entirely new
entirely new
Name
Number of Space
System (ft2)
09
Climate Zone
15
10
Conditioning (SC) Systems in
1
Alteration Type
SYSTEM 1
WHOLE HOUSE
5267
this Dwelling Unit:
Yes
B. Space Conditioning (SC) System Information
01
02-03
04 �
OS
i 06 '
07
08
09
10
Is the SC
Installing,a, .;
, With'. hien €f
SC System
SC System
CFA served
"-`nom
system a
-Ell::"r�R=, M; r`vi
refrigerant
r� J.
Installing new, C
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
WHOLE HOUSE
5267
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-A020060514A-000-000-0000000-0000
Registration Date/Time: 2017-03-16 14:24:07
HERS Provider: CHEERS
CA Building Energy Efficiency Standards - 2016 Residential Compliance Report Version: 2016. 1.005 Report Generated: 2017-03-16 14:24:10
. Schema Version: rev 10/16
CERTIFICATE OF COMPLIANCE CFiR-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)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
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
This field or
This field or
SYSTEM 1
furnace
heating
AFUE
80
AC
cooling
SEER
21
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 � (CZ 1_10,12 and 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 Inducted 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. 1:
Wit,
CF2R 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
Ekceotions:
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.
E. Entirely New or Complete Replacement Duct System, with or without Equipment Chn eo (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.
Registration Number: 417-A020060514A-000-000-0000000-0000 Registration Date/Time: 2017-03-16 14:24:07 HERS Provider: CHEERS
CA Building Energy Efficiency Standards - 2016 Residential Compliance Report Version: 2016.1.005 Report Generated: 2017-03-16 14:24:10 .
Schema Version: rev 10/16
CERTIFICATE OF COMPLIANCE CF1R-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:
Cara Goldberg
Ccw a1( o& d -e rg
Company:
Signature Date:
A#1 Services Heating & Air Conditioning
2017-03-16
Address:
CEA/ HERS Certification Identification (if applicable):
78026 Varner Road #D-189
City/State/Zip:
Phone:
Palm Dessert CA 92211
(760) 342-3610
Responsible Person's Declaration statement`
,..v.
I certify the following under penalty of perjury, under the laws of the State of California: i ��' _
7?;
1. The information provided on this Certificate of Compliance is true and correct. _....J47
2. 1 am eligible under Division 3 of the Business and Professions Code to accept responsibilit ,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 manufActu ed'devices for the building design or system design identified on this Certificate of Compliance conform to the
requirements of Title 24, Part land 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•approvalwith this building permit application.
5. I will ensure that a registered copy of this Certificate of Compliancesha0* 11 be ma�de�vailab a with the -buildingpermit(s) i ued 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 required -to be Ihclbcled iNItiNhe documentation the builder provides to the building owner at occupancy.
Responsible Designer Name:
Unmatched �i'C"ai%a:*G``ietr�
Responsible Designer Signature:
Cara Goldberg
Company:
Date Signed:
A#1 Services Heating & Air Conditioning
2017-03-16
Address:
License:
78026 Varner Road #D-189
977333
Qty/State/zip;
Phone:
Palm Dessert CA 92211
(760) 342-3610
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-A020060514A-000-000-0000000-0000 Registration Date/Time: 2017-03-16 14:24:07 HERS Provider: CHEERS
CA Building Energy'Efficiency Standards - 2016 Residential Compliance Report Version: 2016.1.005 Report Generated: 2017-03-16 14:24:10
Schema Version: rev 10/16