BMCH2017-003578-495 CALLE.TAMPICO C� 0 D ItiN1AC(/
LA QUINTA, CALIFORNIA 92253 DESIGN & DEVELOPMENT DEPARTMENT
BUILDING PERMIT
Application Number: BMCH2O17-0035
Property Address: 52810 AVENIDA DIAZ
APN: 773312005
Application Description: MEYERS / CHANGE OUT(1)HVAC
Property Zoning:
Application Valuation: $20,000.00
Applicant:
J ANTHONY PLUMBING HEATING & AIR CONDITI
72216 NORTH SHORE ST #101
THOUSAND PALMS, CA 92276
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.: 777
Date: Contractor:
4.
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).:
(_J 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. 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. Q.
Lender's Name:
Lender's Address:
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Owner:
DEBBIE MYERS
52810 AVENIDA D�AZ
LA QUINTA, CA 92253
Contractor:
1 ANTHONY PLUMBING
72216 NORTH SHORE S
THOUSAND PALM 3, CA
(760)328-8096
Llc. No.: 777794
Date:' 2/22/2017
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of -he following declarations:
I have and will maintain a certificate of consent to self -insure for workers'
compensati n, as provided for by Section 3700 of the Labor Code, for the performance
of thew 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: MIDWEST EMPLOYERS CASUALTY COM?ANY Policy Number:
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 subject to the workers'
compensation laws of California, and agree that ij I should become subject to the
workers' compensation provisions of Section 37D of the Labor Code, I shall forthwith
comply with those provisions.
Date: 1A�A 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 ($100,0001. IN ADDITION TO THE COST OF
COMPENSATION, DAMAGES AS PROVIDED FOR N 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 applicacion becomes null and void if work is
not commenced within 180 days from date of issuance of such permit, or cessation of
work for 180 days will subject permit to canceliction.
I certify that I have read this application and sta*•e that the above information is correct.
I agree to comply with all city and county ordin::nces and sta laws relating to building
construction, and hereby authorize representatives of thi ci to enter upon the
above -mention d property for inspection purpm:ses.
Date: 2� l� Signature (Applicant ca Agent):
s
z
CV C3 UJ
HE
& AMIlCORIFi;
92
.�TING
7LJA
1
s1
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of -he following declarations:
I have and will maintain a certificate of consent to self -insure for workers'
compensati n, as provided for by Section 3700 of the Labor Code, for the performance
of thew 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: MIDWEST EMPLOYERS CASUALTY COM?ANY Policy Number:
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 subject to the workers'
compensation laws of California, and agree that ij I should become subject to the
workers' compensation provisions of Section 37D of the Labor Code, I shall forthwith
comply with those provisions.
Date: 1A�A 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 ($100,0001. IN ADDITION TO THE COST OF
COMPENSATION, DAMAGES AS PROVIDED FOR N 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 applicacion becomes null and void if work is
not commenced within 180 days from date of issuance of such permit, or cessation of
work for 180 days will subject permit to canceliction.
I certify that I have read this application and sta*•e that the above information is correct.
I agree to comply with all city and county ordin::nces and sta laws relating to building
construction, and hereby authorize representatives of thi ci to enter upon the
above -mention d property for inspection purpm:ses.
Date: 2� l� Signature (Applicant ca Agent):
Date: 2/22/2017
Application Number: BMCH2017-0035
Owner:
Prdperty Address: 52810 AVEN IDA DIAZ
DEBBIE MYERS
APN: 773312005
52810 AVENIDA D.AZ
Application Description: MEYERS / CHANGE OUT (1) HVAC
LA QUINTA, CA 92?53
Property Zoning:
Application Valuation: $20,000.00
Applicant:
Contractor:
1 ANTHONY PLUMBING HEATING & AIR CONDITI
1 ANTHONY PLUM 31NG HEATING & AIR CONDITI
72216 NORTH SHORE ST #101
72216 NORTH SHCRE ST #101
THOUSAND PALMS, CA 92276
THOUSAND PALMS, CA 92276
(760)328-8096
Llc. No.: 777794
Detail: HVAC CHANGE OUT - 16SEER/81AFUE SPLIT SYSTEM [2016 ENERGY] CARBON.MONOXIDE ALARM(S) TO BE INSTALLED PRIOR TO FINAL INSPECTION.
' 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
aTY
AMOUNT
HVAC CHANGEOUT - SPLIT -SYSTEM
101-0000-42402
0
$76.00
DESCRIPTION
ACCOUNT
OTY
AMOUNT
HVAC CHANGEOUT - SPLIT -SYSTEM PC
101-0000-42600
0
$38.00
Total Paid for CHANGEOUT: $114.00
DESCRIPTION
ACCOUNT
ZtTY
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 ENHANCEMEN— FEE: $5.00
CERTIFICATE OF COMPLIANCE
Alterations to Space Conditioning Systems (formerly CF -1R -ALT -HVAC)
Project Name:
CF1R-ALT 02-E
(Page 1 of 3)
AVENIDA DIAZ I Date Prepared: 2017-02-22
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
AVENIDA DIAZ
02
Date Prepared
2017-02-22
03
Project Location
52810 AVENIDA DIAZ
04
Building Type
Single family
05
CA City
La Quinta
06
Dwelling Unit Name
AVENIDA DIAZ
Dwelling Unit Conditioned
07
Zip Code
92253 : i
08
2
Floor Area (ft )
2000
SC System
?,
CFA served
system a
refrigerant
Installing new SC
Installing
t
Installing
Number of Space
Identification or
09
Climate Zone `'"
15 "' r
10
Conditioning (SC) Systems in
1
entirely new
entirely new
Name
Phis Dwelling Unit:
System (ft2)
B. Space Conditioning (SC) System Information
01
02
03y
04
05
06
07
OS
09
10
4AN01
4.,
ifsthe SCSI
1 tallf ga x
_
-
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 duds?
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)INb)
This section does not apply to this project.
Registration Number: 217-A020057882A-000-000-0000000-0000
Registration Date/Time: 2017-02-22 09:23:52
HERS Provider: CaICERTS
CA Building Energy Efficiency Standards - 2016 Residential Compliance Report Version: 2016.1.005 Report Generated: 2017-02-22 09:24:30
Schema Version: rev 10/16
CERTIFICATE OF COMPLIANCE CF111-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
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
Outdoor
This field or
This field or
System 1
Central gas
Gas furnace
AFUE
81
Central split
condensing
SEER
16
Setback
section is not
section is not
furnace
AHU
AC
unit
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 (CZ 1-10, 12 and 13) and R8 (CZ 11 and 14-16)
CF2R and CF3R-MCH-20-H - Duct Leakage Test required wh'enleating 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 outs'ide�or seal all accessible leaks.
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.
Exceptions:
aspreviously
- Duct systems registered with HERS provider sealed are exempt froi�-GCH. -20 Duct Leakage Testing-requiremenntts,� : -
- Heating -only systems and Air Handler Furnace changes do not require Senfiwtion'of Air Flow MCH -23 or Refrigerant Charge MGH -25
3 e ,eat,. N 6 �' k! f+ o v a
Existing duct systems constructed, insulated or sealed with as6estos,are exemptifrom MCH=20,0$uc-1eakage Testing requirremeoits..
1 1,11 %V .:. F' IN IV Ate.. _. t p R T §k 4'4 >_. J A "*» A t 1`4 li t AN,, ....
vzk *W
E. Entirely New or Complete Replacement Duct Sy3tem, with or withoult Equipment Changeout (Sections 150 2(b)iDiWand 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: 217-A020057882A-000-000-0000000-0000
Registration Date/Time:
2017-02-22 09:23:52
HERS Provider: CaICERTS
CA Building Energy Efficiency Standards - 2016 Residential Compliance Report Version: 2016.1.005 Report Generated: 2017-02-22 09:24:30
Schema Version: rev 10/16
CERTIFICATE OF COMPLIANCE CF111-AL7-02-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: //
Robinson, Kevin
IC��!/l�tli%��U/
E
Company:
Signature Date:
J ANTHONY PLUMBING HEATING & AIR CONDITIONING
2017-02-22 09:23:52
Address:
CEA/ HERS Certification Identification (if applicable):
72216 NORTH SHORE ST #101
City/State/Zip:
Phone:
THOUSAND PALMS CA 92276
1760-343-2121
Responsible Person's Declaration statement
I certify the following under penalty of perjury, under the" lawsof;the State of California:
w;o
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, mate it als 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 6bf the California Code of Reg f4--76as, rprovided
desgn res iaformon Other app Icabte ompliance documents, worksheets,
4. The building design features or system feat identified onthis Certifcateof t pliance are consistent wit:.the
a R ? i yg,. ice. 6n
calculations, plans and specifications submitted,to`the enforcemen :agency for approvat;with this budding permit application.:
5. I will ensure that a registered copy of"this Certificate off Compliance shaH�be made available wither,the;building P"it(s) issued forfthe bullfrog and trade available to iheenforcement agency for all applicable
bi riding
inspections. I understand that a registered copy of this= Certificate of Com plbance is regyired to�b101 ncluded with the documen tion%the eUilder provides to the owner at occupancy.
Responsible Designer Name: '
Responsible Des goer S gnature:,.(J
Robinson, Kevin
Company:
Date Signed:
J ANTHONY PLUMBING HEATING & AIR CONDITIONING
2017-02-22 09:23:52
Address:
License:
72216 NORTH SHORE ST #101
777794
City/State/Zip:
Phone:
THOUSAND PALMS CA 92276
760-343-2121
Digitally signed by Ca10ERTS. 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: 217-AO20057882A-000-000-0000000-0000
Registration Date/Time:
2017-02-22 09:23:52
HERS Provider: CaICERTS
CA Building Energy Efficiency Standards - 2016 Residential Compliance Report Version: 2016.1.005 Report Generated: 2017-02-22 09:24:30
Schema Version: rev 10/16
Bin ##
Permit #;
Project Address: p
Qty of La Quint'a
Building & Safety Division
78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-701,2
Building Permit Application and Tracking Sheet
A Ue� ) �Z Owner`s Name:
A. P. Numben.
Address:
Legal Description:
City, ST, Zip:
Contractor:
Telephone: 7 60 0 l
Address: J ANTHONY SERVICESM16 NGPA SHORE ST AT; i�j
City, ST, Zip: THOUSAND PALMS, CA 92276
Project Description:
e
Tleh on e:
P
t c Hot a L
State Lic. #: 17
City Lic.:# CU
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone:
.
Construction n TY aneY
Pe: Occupancy:
•
State Lic. ,.
Pr0J PtYa circle one): New Add n
Alter Repair. r• Demo
Name of Contact Person: --F,24 tkN 0,
Sq: Ft.:
# Sto les:
Telephone # of Contact Person:
�� J ��
Estimated Value of Project: Q� a
APPLICANT: DO NOT WRITE BELOW THIS LINE
tt
Submittal
Req'd
Rcc'd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Cafes.
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
Mechanical
Grading plan
2*' Review, ready for corrections/issue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.T.
II.O.A. Approval
Plans resubmitted.
Grading
IN ROUSE:-
3". Review, ready for corrections/issue
Developer Impac: Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees,
Total Permit Fees