BMCH2017-0483LICENSED CONTRACTOR'S DECLARATION
I he 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.: 1022645
Dat Z 1� Col nt�actor:
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 theJ
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, 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.).
( 11, 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
Lender's Address:
(760)863-0832
Llc. No.: 1022645
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
I have and will maintain a certifica:e of consent to self -insure for workers'
compensation, as provided for by Section 37CO of the Labor Code, for the performance
of the work for which this permit is issued.
5:257' 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: WESCO INSURANCE COMPANY Policy Number: WWC3295958
I certify that in the performance o: the work for which this permit is issued, I
shall not employ any person in any manner sc as to become subject to the workers'
compensation laws of California, and agree tfat, if I should become subject to the
workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith
comply with those provisions.
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 ($100,000). IN ADDITION TO THE COST OF
COMPENSATION, DAMAGES AS PROVIDED FCR IN SECTION 3706 OF THE LABOR CODE,
INTEREST, AND ATTORNEY'S FEES.
APPLICANT ACKNCWLEDGEMENT
IMPORTANT: Application is hereby made to tie 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 perforned 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 _he work being performed under or
following issuance of this permit.
2. Any permit issued as a result of this appfcation 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 cancellation.
(.certify that I have read this application and slate 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 represent3tives.of this.city to enter upon the
above-mentioned property for inspection pumoses.
Date -a Signature (A or Agent)
T
Q.�i
VOICE (760) 777-7125
78-495 CALLE TAMPICO
D
FAX (760) 777-7011DESIGN
LA QUINTA, CALIFORNIA 92253
& DEVELOPMENT DEPARTMENT
INSPECTIONS (760) 777-7153 .
BUILD NG PERMIT
Date: 11/21/2017
Permit Type/Subtype:
MECHANICAL/
O
Owner:
Application Number:
BMCH2O17-0
DOUG MASON
Property Address:
48627 CALLE
AN t rto'�1
48627 CALLE ESPERANZA
APN:
646121014!•
LA QUINTA, CA E2253
Application Description:
MASON RESIDE
/ Vol7p l" ANG P ES
Property Zoning:
Application Valuation:
�F�QpEQ�
$11,992.00o��AQM
.
GOMMUN
Applicant:
Contractor:
IE INC
PREFERRED AIR CONDITIONING HEATING & PLU
31225 LA BAYA
45-311 GOLF CENTER PKWY STE A
WESTLAKE VILLAGE, CA 91362
INDIO, CA 92201
LICENSED CONTRACTOR'S DECLARATION
I he 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.: 1022645
Dat Z 1� Col nt�actor:
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 theJ
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, 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.).
( 11, 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
Lender's Address:
(760)863-0832
Llc. No.: 1022645
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
I have and will maintain a certifica:e of consent to self -insure for workers'
compensation, as provided for by Section 37CO of the Labor Code, for the performance
of the work for which this permit is issued.
5:257' 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: WESCO INSURANCE COMPANY Policy Number: WWC3295958
I certify that in the performance o: the work for which this permit is issued, I
shall not employ any person in any manner sc as to become subject to the workers'
compensation laws of California, and agree tfat, if I should become subject to the
workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith
comply with those provisions.
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 ($100,000). IN ADDITION TO THE COST OF
COMPENSATION, DAMAGES AS PROVIDED FCR IN SECTION 3706 OF THE LABOR CODE,
INTEREST, AND ATTORNEY'S FEES.
APPLICANT ACKNCWLEDGEMENT
IMPORTANT: Application is hereby made to tie 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 perforned 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 _he work being performed under or
following issuance of this permit.
2. Any permit issued as a result of this appfcation 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 cancellation.
(.certify that I have read this application and slate 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 represent3tives.of this.city to enter upon the
above-mentioned property for inspection pumoses.
Date -a Signature (A or Agent)
Date: 11/21/2017
Application Number: BMCH2017-0483
Owner:
Property Address: 48627 CALLE ESPERANZA
DOUG MASON
APN: 646121014
48627 CALLE ESPERANZA
Application Description: MASON RESIDENCE/ HVAC CHANGE OUT
LA QUINTA, CA 52253
Property Zoning:
Application Valuation: $11,992.00
Applicant:
Contractor:
IE INC
PREFERRED AIR CONDITIONING HEATING & PLU •
31225 LA BAYA
45-311 GOLF CENTER PKWY STE A
WESTLAKE VILLAGE, CA 91362
INDIO, CA 92201
(760)863-0832
----------------------------------------------------------------------------------------------
Llc. No.: 1022645
Detail: HVAC CHANGE OUT - 16 SEER/80AFUE SPLIT SYSTEM: CARBON MONOXIDE ALARM(S) TO BE INSTALLED PRIOR TO FINAL INSPECTION. 2016
CALIFORNIA BUILDING CODES.
l
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
$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
CITY
AMOUNT
PERMIT ISSUANCE
101-0000-42404
0'
$98.83
Total Paid for PERMIT ISSUANCE: $98.83
DESCRIPTION
ACCOUNT
CITY
AMOUNT
RECORDS MANAGEMENT FEE
101-0000-42416
0
$10.00
Total Paid for RECORDS MANAGEMEIMT FEE: $10.00
DESCRIPTION
ACCOUNT
CITY
AMOUNT
TECHNOLOGY ENHANCEMENT FEE
502-0000-43611
0
$5.00
Total Paid for TECHNOLOGY ENHANCEMENT FEE: $5.00
-- ------ - � -- --- PERMIT # .
_� � • �: 1.
xf PLAN LOCATION •
-------------------
Project Address: y Z� `� sPe�orz� Project Description: Pool, Remodel_ Add'l, Elect, Plumb, Mech
APN 4:
� 1ar e. sics'% A 0=c' div
Conditioned Space SF
City, St; Zip CA 92zo t
Applicant Name:Y.hr��ece
Telephone:-2g
Address: 3\Zz5 Cry l�Rya�r.Z\3
Email:
City, ST, Zip: Lie_sk\,4ee_VZ1 Q,5e.� CA _ CO3[c?__
State Lic: • JoZ2.1c�}S City Bus Lic:
Telephone:
tate Lic: City Bus Lic:
Email:
Valuation of Project $ 11.1 q9 Z. C�
Contractor Name: �re�erred L
New SFD Construction:
Address:
Conditioned Space SF
City, St; Zip CA 92zo t
Garage SF
Telephone:-2g
Patio/Porch SF
Email:
Fire Sprinklers SF
State Lic: • JoZ2.1c�}S City Bus Lic:
Arch/Eng Name:
Construction Type: Occupancy:
4ddress:
Grading:
-ity, St, Zip
Construction Type: Occupancy:
Telephone:
Bedrooms:Sto;
ies:
#E Units:
_ nail:.
tate Lic: City Bus Lic:
'roperty Owner's Name:� '3Q5O ^
New Commercial /Tenant Improvements:
iddress: GAZtoZ-? C�m11E
Total Building SF
:ity, ST, Zip C� g��53
Construction Type: Occupancy:
eleplione: yZ5 _ 394--1e4
mail: _
78495 CALLE TAMPICO
LA QUINTA, CA 92253
760-777-7000
CERTIFICATE OF COMPLIANCE
CFiR-ALT 02-E
Alterations to Space Conditioning Systems (formerly CF -IR -ALT -HVAC) (Pagel of 3) 1
Project Name: DOUG MASON I Date Prepared: 2017-11-21 I
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
LF1R-AL'I=U1 document for each dwelling unit.
01
Project Name
DOUG MASON
02
Date Prepared
2017-11-21
03
Project Location
48627 CALLE ESPERANZA
04
Building Type
Single family
05
CA City.
La Quinta
.06
Dwelling Unit Name
HOUSE
SC System .
SC System
CFA served
system a
refrigerant
Installing new SC
07
Zip Code
er
92253 �`�
`08
Dwelling Unit Conditioned
1980
by this SC
ducted
containing
system
Floor Area (ftZ)
entirely new
entirely new
Name
1
Number of Space
system?
09
Climate Zone
15
duct system?
Conditioning (SC) Systems in
1
SYSTEM #1
WHOLE HOUSE
1980
X10
,., f
this Dwelling Unit:
Yes
B. Space Conditioning (SC) System Information
It =�"' ik-
01
02
03
04 `
- 0 (( 05
% 06%
07
08
09
10
Is the SC
+.aril t
Installing a,ri��ar€
aV;:i i 4� ,9-ry
-A -,Vsf
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
SYSTEM #1
WHOLE HOUSE
1980
Yes
Yes
Yes
No
No
No
Altered spaceconditioning
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-A020129756A-000-000-0000000-0000
Registration Date/Time: 2017-11-21 13:00:13
HERS Provider: CHEERS
CA Building Energy Efficiency Standards - 2016 Residential Compliance Report Version: 2016.1.006 Report Generated: 2017-11-21 13:00:14
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)lE and F)
01
02
03
04
.05
06
07
08
09
10
it
12
Heating
Cooling
System
Heating
Altered
Heating
Mininwill
Altered
Cuuling
fvlinlmum
Hequlrea
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
16
Setback _
section is not
section is not
components
components
applicable
applicable
Required Documentation:`
CF2R-MCH-01-E - Space Conditioning Systems�'� ~;
ms.
Duct insulation requirement for the new portions of supply -air and return -air ducts or plenu.R6,(CZ 1,10; 32.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 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. -�
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 T
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.
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 sectio does nlot a ply t6 th s pro ect.
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-A020129756A-000-000-0000000-0000
CA Building Energy Efficiency Standards - 2016 Residential Compliance
Registration Date/Time: 2017-11-21 13:00:13
Report Version: 2016.1.006
Schema Version: rev 10/16
HERS Provider: CHEERS
Report Generated: 2017-11-21 13:00:14
ZI
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.
Documentdtign Author Name
nori,imgnt?tinn Allthnr,.Signgtt, re:
Octovio Garza
OctvvZo C1C1C pW
Company:
Signature Date:
Preferred Air Conditioning Heating & Plumbing
2017-11-21
Address:
CEA/ HERS Certification Idehtification.(if applicable):
40719 Fortunato Court
City/State/Zip:-Phone:
y �.
Indio CA 92203 i
760t863-0832
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 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.
5. I will ensure that a registered copy of this Certificate of Compliance shall be made avallable with the bullding:permit(s) issued for the -building, and made available to the enforcement agency for all applicable
1-61
ins ections. I understand that a registered co of this Certificate of om liance i1,4
re uired tto be included wlth the documentation the builder provides to the building owner at occupancy.
P g PY P q P g P cY•
Responsible Designer Name:
UnMt"h i 't i r
11esponrsible.Designer Signature:
` pctrrvfv LY
Octovio Garza
Gar3cv
Company:
Date Signed:
Preferred Air Conditioning Heating & Plumbing
2017-11-21
Address:
License:
40719 Fortunato Court
1022645
City/State/Zip:
Phone:
Indio CA 92203
760-863-0832
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-A020129756A-000-000-0000000-0000
CA Building Energy Efficiency Standards - 2016 Residential Compliance
Registration Date/Time: 2017-11-21 13:00:13
Report Version: 2016.1.006
Schema Version: rev 10/16
HERS Provider: CHEERS
Report Generated: 2017-11-21 13:00:14