BMCH2017-0134LICENSED 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.: 686310
c Date:,4 1411 -1 -Contractor:
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).:
( ) 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 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 Address:
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 3700 of the Labor Code, for the performance
of the work for which this permit is issued..
X51 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: INSURANCE COMPANY OF THE WEST Polity Number: WSD5031658
_ 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, if I should become subject to the
workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith
comply with those provisions.
� r
Date: 41 I4 1 1-1 -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 ($100,000). IN ADDITION TO THE COST OF
COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,
INTEREST, AND ATTORNEY'S FEES.
APPLICANT ACKNOWLEDGEMENT
IMPORTANT: Application is hereby made tc 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 Cicy 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 application • 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.
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 building
construction, and hereby authorize representatives of this city to enter upon the above-
mentioned property for inspection purposes.
Date: 4 1ti 11 -Signature (Applicant or Agent): S �
VOICE (760) 777-7125
78-495 CALLE TAMPICO
D
PAX (760) 777-7011DESIGN
LA QUINTA, CALIFORNIA 92253
& DEVELOPMENT DEPARTMENT
INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 4/14/2017
Application Number: BMCH2O17-0134
Owner:
Z
Property Address: 77090 AVENIDA FERNANDO
LORRAINE FAIR
® M
APN: 658240004
77090 AVENIDA FERNAN
tIE
Application Description: FAIR / HVAC CHANGE OUT 80AFUE/14 SEER PACKAGED
LA QUINTA, CA 92253
w
Property Zoning:
® r� ta— o
Application Valuation: $10,475.00
N � z
LU
Applicant:
IE INC
'
Contractor:
HARRISON ENTERPRISESA
GEff RAL f w
4Q
31225 LA BAYA
31170 RESERVE DRIVE
cp
WESTLAKE VILLAGE, CA 91362
THOUSAND PALMS, CA 92276
z
(760)343-7488
® cn
Llc. No.: 686310
cn
�
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.: 686310
c Date:,4 1411 -1 -Contractor:
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).:
( ) 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 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 Address:
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 3700 of the Labor Code, for the performance
of the work for which this permit is issued..
X51 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: INSURANCE COMPANY OF THE WEST Polity Number: WSD5031658
_ 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, if I should become subject to the
workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith
comply with those provisions.
� r
Date: 41 I4 1 1-1 -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 ($100,000). IN ADDITION TO THE COST OF
COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,
INTEREST, AND ATTORNEY'S FEES.
APPLICANT ACKNOWLEDGEMENT
IMPORTANT: Application is hereby made tc 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 Cicy 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 application • 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.
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 building
construction, and hereby authorize representatives of this city to enter upon the above-
mentioned property for inspection purposes.
Date: 4 1ti 11 -Signature (Applicant or Agent): S �
I
Date:4/14/2017
Application Number: BMCH2017-0134. Owner:
Property Address: 77090 AVENIDA FERNANDO LORRAINE FAIR
APN: 658240004 77090 AVENICA FERNANDO
Application Description: FAIR / HVAC CHANGE OUT 80AFUE/14 SEER PACKAGED LA QUINTA, CA 92253
Property Zoning:
Application Valuation: $10,475.00
Applicant: Contractor:
IE INC HARRISON ENTERPRISES INC DBA GENERALAIR
31225 LA BAYA 31170 RESERVE DRIVE
WESTLAKE VILLAGE, CA 91362 THOUSAND PALMS, CA 92276
(760)343-748E
Llc. No.: 686310
--------------------------------------------------------------------------------------------
Detail: HVAC CHANGE OUT - 14SEER/80AFUE PACKAGED UNIT. CARBON MONOXIDE ALARM(S) TO BE INSTALLED PRIOR TO FINAL INSPECTION. 2016
CALIFORNIA BUILDING CODES.
FINANCIAL •• •
-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- PACKAGED UNIT
101-0000-42402
0
$38.00
DESCRIPTION
ACCOUNT
QTY
, AMOUNT
HVAC CHANGEOUT - PACKAGED UNIT PC
101-0000-42600
0
$25.33
Total Paid for CHANGEOUT: $63.33
DESCRIPTION
ACCOUNT
QTY
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: $5.00
e
Bin #
Permit ;;
�11,WN0--el17 - a 3L
Project Address: i 09 D
City of La QUill to
Building 8t Safety Division
78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-70 12
Building Permit Application and Tracking Sheet
Owner's Name: J)Dh .Lore 0.iv�e lF a:
A. P. Number:
Address: '%7pga QveYRJc=ie
Legal Description:
City, ST, Zip: L., Q�nwA a to C X253
Contractor: Geon.$
I Air
TeleP n - 1�
ho e. foo• �
7
.............
Address: 311-10
Project Description: 4�e p�ac� StO�n7kiz��
City, ST, Zip:
a�mS CAq2-L7b'
Telephone: 7 j
P -)GO-Y43-7489
48
State Lic. # : Unto 310
City Lie.
Arch.,'Engr., Designer:
Address:
City, ST, Zip:
Telephone:
an
COccupancy:
cY:onstructi n Type:
State L ic. #-
r
ecttYPPe circle one : New Add'n Alter Repaira" Demo
r J
Name of Contact Person:
Sq. Ft.:
# Stories:
# Units:
Telephone # of Contact Person:
Estimated Value of Project: lil O , -O S. n-c>
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req.'d
Rcc'd
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 Bala%ce.
Title 24 Calcs.
Plans picked up
Construction '
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2" Review, ready for correctionslissue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.T.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
'rd Review, ready for corrections/issuc
Developer ImpaC Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees,
I
Total Permit Fees
STATE OF�CALIFORNIA
ALTERATIONS - HVAC
I�S
CEC-CFIR-ALT-04-E Revised 01/16 CALIFORNIA ENERGY COMMISSION
CERTIFICATE OF COMPLIANCE CF1R-ALT-04-E
Alterations - HVAC CZ 2, and 8-15 (Page 1 of 1)
Site Address:
Enforcement Agency:
Da -:e Prepared:
Permit#:
-77()90 tie�t� c. erna�ncio
C" De 1-0,0.Y'Na
4 1 Ili 1 1'7
Equipment Type
Equipment Efficiency
New Ducting or Lineset:
Required R -value
Conditioned Z
Floor Area (ft)
Thermostat
V Packaged
❑ Evaporator Coil
/• AFUE
COP
❑ R-6 (CZ 1-10, 12&13) Ducts
Served by system
X Setback
System
❑
❑ Condensing Unit
V4
❑ R-8' (CZ 11, 14-16) Ducts
a—&700 ft
(If not already
Split System
❑ Compressor
SEER
HSPF
❑ a R-2.8 Lineset°
present, must
❑ Mini Split
❑ Lineset
be installed)
❑ Furnace
❑ TXV
EER
HERS VERIFICATION SUMMARY Installer determines work to be completed and matches to one of the options below. At permit application this
form is allowed to be filled out by hand. For final inspection all forms are to be registered (no hand filled forms allowed) and a copy left on site.
V 1. HVAC Changeout/Repair Required Compliance Documents to be left on site for Final:
All Equipment, CF1R-ALT-02-E
Condenser Unit, Evaporator Coil, CF2R-MCH-01-E, MCH -20-H, MCH -(23 or 24)2-H, MCH -25-H2
Compressor, TXV, Lineset, CF3R-MCH-20-H, MCH -(23 or 24)-H2, MCH -25-H'
Air Handler/Furnace' (Can include new ducting)
Installer Requirement: Duct leakage (< 15%, or 5510% to outside, or seal all accessible leaks), Air Flow z 300 CFM/toi, Refrigerant Charge.
Exempted from duct leakage testing if:
❑ 1. Duct system registered with HERS provider as previously sealed, or ❑ 2. There is less than 40 linear feet of duct in unconditioned space, or
❑ 3. Existing duct systems are constructed, insulated or sealed with asbestos (list manufacture date of building ....... I
❑ 2. New HVAC System
Required Compliance Documents to be left on site for Final:
All new equipment and All New Ducts-'
CF1R-ALT-02-E
including Mini Split
CF2R-MCH-01-E, MCH -20-H, MCH -22-H, MCH -(23 or 24)-H2, MCH -25-H2
CF3R-MCH-20-H, MCH -22-H, MCH -(23 or 24)-H2, MCH -25-H2
Mini Splits require CF1R-ALT-02-E, CF2R-MCH-01-E, and (CF2R-CF3R) MCH -25-H
Installer Requirement: Duct leakage < 5%, Fan Efficacy (0.58W/CFM), Air Flow >_ 350 CFM/ton (or alternative), Refrigerant Charge
1-13. All New Ducts with Replacement
Required Compliance Documents to be left on site for Final:
All New Ducts' and one or more of the following
CF1R-ALT-02-E
replaced: Condenser Unit, Evaporator Coil,
CF2R-MCH-01-E, MCH -20-H, MCH -(23 or 24)-H, MCH -25-H
Compressor, TXV, Lineset, Furnace2
CF3R-MCH-20-H, MCH -(23 or 24)-H, MCH -25-H
Installer Requirement: Duct leakage < 5%, Air Flow >_ 350 CFM/ton (or alternative), Refrigerant Charge
Exempted from duct leakage testing if: ❑ 1. Existing duct systems are constructed, insulated or sealed with asbestcs
❑ 4. New Ducting over 40 feet Required Compliance Documents to be left on site for Final:
New ducting but less than All New Ducts-' I CF1R-ALT-02-E, CF2R-MCH-20-H, CF311-MCH-20-1-1
Installer Required to: Duct leakage (< 15% or, 510% to outside or, or seal all accessible leaks)
❑ EXCEPTION: Existing duct systems constructed, insulated or sealed with asbestos.
'All new ducting requires R-8 insulation when more than 40 ft installed in CZs 11 & 14-16 and R-6 in CZs 1-10, 12 &13, and R-6 insulation when less
than 40 ft installed. This includes in walls, between floors etc.
2 Heating only systems and Air Handler/Furnace changes do not require Air Flow MCH -(23 or 24), or Refrigerant Charge verification MCH -25
-' All New Ducts is when at least 75%of the duct system is new duct material, and up to 25%may consist of reused parts from the dwelling unit's
existing duct system (e.g., registers, grilles, boots, air handler, coil, plenums, duct material)
" R-2.8 (1" thick insulation) for linesets 1" and less.
Contractor (Documentation Author's /Responsible Designer'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 California Business and Professions Code to accept responsibility for the information on this document.
3. That the energy features and performance specifications for the design identified on this Certificate of Compliance conform to the
requirements of Title 24, Parts 1 and 6 of the California Code of Regulations (CCR).
4. That the energy features and performance specifications, materials, components, and manufactured devices fcr the building design or
system design identified on this Certificate of Compliance conform to the requirements of Title 24, Part 1 and Fart 6 of the CCR.
5. 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 submited to the enforcement
agency for approval with this building permit application.
Re onsible Desi r Name:
R`PC��n—sible Desi r Signature:
Dat
Sig ed:
U nse:
�i ertf
,,_
Iy
(0310
Company:
a A� r l�Ot�di
Address,[—Cu/State/Zip:
31170 KeServe
' /State/Zip:
11,o.z�..d al 97-7-7
Phone:
7top 3�I9-7'>f88
For assistance or'questions regarding the Energy Standards, contact the Energy Hotline at: 1-8CO-772-3300