BMCH2017-0066LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9
(commencing with Section 70001 of Division 3 of the Business and Professions Code, and
my License is in full force and effect.
Liceen/se,Class: C20 �7 License No.: 920062s Q_Z_
Dat' a Contractors
OWNER -BUILD DE ATIO
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.).
(_) 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. C.).
Lender's Na
Lender's Add
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one •f the following declarations:
I have and will maintain a certificate of consent to self -insure for workers'
compensation, as provided for by Section 37W of the Labor Code, for the performance
of 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: NORGUARD INSURANCE COMPANY Policy Number: TIWC721117
—I certify that in the performance of -the work for which this permit is issued, 1
shall not employ any person in any manner se 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.
Da� y —:11-17 Applicant:
WARNING: FAILURE TO SECURE WORKERS' COMPE SA 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 to be 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 appltation becomes null and void if work is not
commenced within 180 days from date of isseance 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 ordFlances and state laws relating to building
construction, and hereby authorize representatives of this city to enter,u onthheabove-
mentioned
ntioproperty for inspection purposes.
Date: - `Signature(Applicantor :�,�
Tdy/aw
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
.
v `
rn
M / 017
Application Number: BMCH2O17-0066
Owner: z
Property Address: 55405 FIRESTONE
BOB CARPENTER z
APN: 775051011
55405 FIRESTOVE v n ir.
:�
Application Description: CARPENTER / CAHNGE
OUT 14SEER/81AFUE SPLIT
LA QUINTA, CA92253 � )
Property Zoning:
� On
Application Valuation: $8,948.00
H.a
D
M ry
C= c
Applicant:
Contractor: p n ti
TIMO'SAIR CONDITIONING & HEATING INC
TIMO'S AIR C014DITIOWIG & HEATING INC
72232 CORPORATE WAY
72232 CORPORATE WAV
THOUSAND PALMS, CA 92276
THOUSAND PA•_MS, CAM227
z
(760)770-4357
Llc. No.: 92006'°
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9
(commencing with Section 70001 of Division 3 of the Business and Professions Code, and
my License is in full force and effect.
Liceen/se,Class: C20 �7 License No.: 920062s Q_Z_
Dat' a Contractors
OWNER -BUILD DE ATIO
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.).
(_) 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. C.).
Lender's Na
Lender's Add
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one •f the following declarations:
I have and will maintain a certificate of consent to self -insure for workers'
compensation, as provided for by Section 37W of the Labor Code, for the performance
of 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: NORGUARD INSURANCE COMPANY Policy Number: TIWC721117
—I certify that in the performance of -the work for which this permit is issued, 1
shall not employ any person in any manner se 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.
Da� y —:11-17 Applicant:
WARNING: FAILURE TO SECURE WORKERS' COMPE SA 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 to be 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 appltation becomes null and void if work is not
commenced within 180 days from date of isseance 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 ordFlances and state laws relating to building
construction, and hereby authorize representatives of this city to enter,u onthheabove-
mentioned
ntioproperty for inspection purposes.
Date: - `Signature(Applicantor :�,�
Applicant:
TIMO'SAIR CONDITIONING & HEATING'INC
72232 CORPORATE WAY
THOUSAND PALMS, CA 92276
Date: 3/21/2017
Owner:
BOB CARPENTER
55405 FIRESTCNE
LA QUINTA, CA 92253
Contractor:
TIMO'S AIR CONDITIONING & HEATING INC
72232 CORPORATE WAY
THOUSAND PALMS, CA 92276
(760)770-4357
Llc. No.: 920062
--------------------------------------------------------------------------------------------
Detail: HVAC CHANGE OUT - 14SEER/81AFUE SPLIT SYSTEM. CARBON MONOXIDE ALARM(S) TO BE INSTALLED PRIOR TO FINAL INSPECTION. 2016
CALIFORNIA BUILDING CODES.
Application Number:
BIV162017-0066
Property Address:
55405 FIRESTONE
APN:
775051011
Application Description:
CARPENTER / CAHNGE OUT 14SEER/81AFUE SPLIT
Property Zoning:
Application Valuation:
$8,948.00
Applicant:
TIMO'SAIR CONDITIONING & HEATING'INC
72232 CORPORATE WAY
THOUSAND PALMS, CA 92276
Date: 3/21/2017
Owner:
BOB CARPENTER
55405 FIRESTCNE
LA QUINTA, CA 92253
Contractor:
TIMO'S AIR CONDITIONING & HEATING INC
72232 CORPORATE WAY
THOUSAND PALMS, CA 92276
(760)770-4357
Llc. No.: 920062
--------------------------------------------------------------------------------------------
Detail: HVAC CHANGE OUT - 14SEER/81AFUE SPLIT SYSTEM. CARBON MONOXIDE ALARM(S) TO BE INSTALLED PRIOR TO FINAL INSPECTION. 2016
CALIFORNIA BUILDING CODES.
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 CHAN3EOUT: $114.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PERMIT ISSUANCE
101-0000-42404
0
$96.27
Total Paid for PERMIT ISSJANCE: $96.27
DESCRIPTION
ACCOUNT
CITY
AMOUNT
TECHNOLOGY ENHANCEMENT FEE
.502-0000-43611
0
$5.00
Total Paid for TECHNOLOGY ENHANCEMENT FEE: $5.00
CERTIFICATE OF COMPLIANCE CF1R-ALT-02-E
Alterations to Space Conditioning Systems (formerly CF -IR -ALT -HVAC) (Page 1 of 3)
Project Name: Bob Carpenter Date Prepared: 2017-03-21
A. General Information
CF111-ALT-02 is applicable to multiple space conditioning systems contained within a single dwelling unit. When multiple dwelling units m 1st be documented, use one
CF1R-ALT-02 document for each dwelling unit.
01
Project Name
Bob Carpenter
02
Date Prepared
2017-03-21
03
Project Location
55405 Firestone
04
Building Type
Single family
05
CA City
La Quinta
06
Dwelling Unit Name
Bob Carpegter
SC System
Dwelling Unit Conditioned
CFA served
07
Zip Code
92253
08
Floor Area (ft2)
2500
Identification or
Location or Area
by this SC
Number of Space
containing
09
Climate Zone
15
10
Conditioning (SC) Systems in
1
Served
System (ft)
system?
component?
this Dwelling Unit:
feet of ducts?
B. Space Conditioning (SC) System Informat on
�e
k� , R NI
F
01
02
03
04 `�
`OSS
"'x'06"
07— ;(�
«V
" 08
~ `69
10
FIs the SCr!
Installin—&a
ll`"" M
41-4 t
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?
duct system?
SC system?
Alteration Type
System 1
Location 1
1250
Yes
Yes
Yes
Yes
No
No
Altered space
conditioning system
Extension of Existing Duct System, Greater Than 40 Feet (Section150.2(b)1D1ib)
This section does not apply to this project.
Registration Number: 217-A020088853A-000-000-0000000-0000 Registration Oate/ Time: 2017-03-21 12:20:10 HERS Provider: CalCERTS
CA Building Energy Efficiency Standards - 2016 Residential Compliance Report Version: 2016.1.005 Report Generated: 2017-03-21 12:20:27
Schema Version: rev 10/16
CERTIFICATE OF COMPLIANCE
CFSR-ALT-02-E
Alterations to Space Conditioning Systems (formerly CF-IR-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
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
Greater than
System 1
furnace
heating
AFUE
81
AC
cooling
SEER
14
Setback
40 feet
R.8
components
components
Required Documentation:
CF211-MCH-01-E - Space Conditioning Systems
- Duct insulation requirement for the new portions of supply-air and retum-air ducts or plenums: R6 (CZ 1-10, 12 and 13) and R8 (CZ 11 and 14-16)
CF2R and MR-MCH-20-H - Duct Leakage Test required when heating or cooling components are installed in ducted systems, or when more than 40 it of duct length is replaced
-Leakage rate compliance: <= 15% or <= 10% leakage to outside, or seal all accessible leaks.
MR and MR-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 exemptfrom MCH 20 Duct Leakage Testing requirements
- Heating-only systems and Air Handler Furnace changes do not require venficatio^'of Air Flow MCH-l23, or"Refrigeraiit'6arge
�
, ., r{ F � a a r ,
-Existing duct systems constructed, insulated or sealed with asbestos are exemptifrom MCH40 Duct Leakage Tes6ngrequiremerg
!( !1 tY
E. Entirely New or Complete Replacement Duct System, with or without.Equipment Changeout (Sections 150.2(b)1Diia:anc-150.2(b)3E, F)
!► Nf 1iw ii -t) _` iW N-�C 4 r #� % tl k iM» MItiC
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-AO20088853A-000-0OD-0000000-0000 Registration Date/Time: 2017-0321 12:20:10 HERS Provider: CalCERTS
CA Building Energy Efficiency Standards - 2016 Residential Compliance Report Version: 2016.1.00S lReport Generated: 2017-03-21 12:20:27
Schema Version: rev 10/16
CERTIFICATE OF COMPLIANCE CF1R-ALT-02-E
Alterations to Space Conditioning Systems (formerly CF -SR -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:
fflno
Timo , Joseph
Company:
Signature Date:
TIMO'S AIR CONDITIONING & HEATING INC
2017-03-21 12:20:09
Address: -
CEA/ HERS Certification Identification (ifapplicable):
72232 Corporate Way
City/State/Zip:
Phone:
THOUSAND PALMS CA 92276
760-770-4357
Responsible Person's Declaration statement`
1 certify the following under penalty of perjury, under thelaws of the State of California:
1. The information provided on this Certificate of Compliance is true and correct.
2. I am eligible under Division 3 of the Businessand 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 fotr thebuildingdesign or system design identified nn this Certificate of Compliance conform to the
requirements of Title 24, Part 1 and Part 6 of the California Code ofR egulat 'ions
K n h1 I
4. The building design features or stem design features identified on this Certificate ofCompliancen r t car
ng rg ry g are cor s sten tib the mformation.p. rovided on otheoapplica5lecompliance documents, worksheets,
calculations, plans and specifications submitted to the enforcement agency for approval with this building permit appircation.
ate t *{ i,�} !{ it d{ 4f
S. I will ensure that a registered copy of this Certificate of Compliance sfiall be' made available with the building permit(s),issued for the buildGg, and made avail' 66,10 the enforcement agency for all applicable
Inspections. I understand that a registered copy of this artifrcate of Compliance,i srequired to be included with thud«urrentation the builder provides toFthe bvi�ding owner at occupancy.
Responsible Designer Name: i ate- .J
Respons'ibfe De signer Signature: V ✓I y,��p%h�Dj�,w��
C%�
Timo , Joseph
Company:
Date Signed:
TIMO'S AIR CONDITIONING & HEATING INC
2017-03-21 12:20:10
Address:
License:
72232 Corporate Way
920062
City/State/Zip:
Phone:
THOUSAND PALMS CA 92276
760-770-4357
Digitally signed by CaICERTS. 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: 217-A020088853A-000-000-0000000-0000 Registration Date/Time: 2017-03-21 12:20:10 HERS Provider: CaICERTS
CA Building Energy Efficiency Standards - 2016 Residential Compliance Report Version: 2016.1.005 Report Generated: 2017-03-21 12:20:27
Schema Version: rev 10/16
Bin #
Submittal
City Of La ' Quillta
Building &r Safety Division
P.O. Box 1504, 78-495 Calle Tampico .
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking"SheeI
Permit
Project Address: Jam- �c �I/eLoS %��.CJ
Owner's Name:��
A. P. Number.
Plan Sets
Address: Get
Legal Description:
Plan Chock submitted
City, ST, ZiWZ><A- &Gt
Contractor.a�lci tam e�1+�.
Address:-
" �zr s: ;ice
Telephone: (%3 3I - 3 3 a � 3� •
Proj Description:
City, ST, Zip:
Telephoner
Reviewed, ready for corrections
Plan Cluck Deposit
State Lic. # :
Qty Lie. #t
Arch., Engr., Designer-
esip�rw
Called Contact Person
L
Address:
Address:
City., ST, Zip:
Telephone:„,
Ate,°
µ:. ,t! "'<•µ-.,��u
Construction Type: Occupancy:
State Lic. #:
Flood plain plan
Project type (circle one): New Add'n Alta• Repair Demo
��-
Name of Contact Person: v 19—
�
�L c`�
Sq. Ft.:#Stories:
Mechanical
# Units.
Telephone #,of Contact Person:
Q • —��
Estimated Value of Project
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Rcq'd
Rced
TRACING
PETJMTFM
Plan Sets
Plan Chock submitted
Item
Amount
Structural Cala.
Reviewed, ready for corrections
Plan Cluck Deposit
----------------
Truss Cates.
Called Contact Person
Plan Check Balance.
Title 24 Cates.
Placa picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2'' Review, ready for corrcctionslissue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M L
MOA. A. Approval
Plans resubmitted
Grading
IN HOUSE:-
'n° Review, ready for corrections/issue
Developer Impact Tee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
Se11061 Fees
Total Permit Pees