BMCH2017-0010VOICE (760) 777-7125
78-495 CALLE TAMPICO D
LA gUINTA, CALIFORNIA 92253 FAX (760) 777-7011
DESIGN & DEVELOPMENT DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 1/24/2017
Application Number: BMCH2O17-0010® Owner:
Property Address: 78267 HIGHWAY 111D ® MICHAEL HOOD -
APN: 604050012 78267 HIGHWAY 111
Application Description: HVAC CHANGE OUT JAN 2 3 LA QUINTA, CA 92253
Property Zoning: 2017
Application Valuation: $5,179.00
CITY OF LA QUINTA
Applicant: DESIGN AND DEVELOPMENT DEPARTMENT
IE INC HARRISON ENTElPRISES INC DBA GENERAL AIR
31225 LA BAYA 31170 RESERVE DRIVE
WESTLAKE VILLAGE, CA 91362 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.: 686310
Date: i L 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.).
(_) 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 Name:
Lender's Address:
(760)343=7488
Llc. No.: 686310
WORKER'S COMPENSAMON DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
I have and will maintain a certificatz of consent to self -insure for workers'
compensation, as provided for by Section 3700 of the Labor Code, for the performance
oftwork 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 insuranr? carrier and policy number are:
Carrier: INSURANCE COMPANY OF THE WEST Policy Number: WS05031658
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 3900 of the Labor Code, I shall forthwith
comply with those provisions.
112-411-1
Date: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 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 owne-, 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 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 cancellbtion.
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 ordir-,ances 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: 1 1 17 Signature (Applicant or Agent):
Application Number:
BMCH2O17-0010
Property Address:
78267 HIGHWAY 111
APN:
604050012
Application Description:
HVAC CHANGE OUT
Property Zoning:
Application Valuation:
$5,179.00
Applicant:
IE INC
31225 LA BAYA
WESTLAKE VILLAGE, CA 91362
Date: 1/24/2017
Owner:
MICHAEL HOOD
78267 HIGHWAY 111
LA QUINTA, CA 52253
Contractor:
HARRISON ENTEIPRISES INC DBA GENERAL AIR
31170 RESERVE DRIVE
THOUSAND PALMS, CA 92276
•(760)343-7488
Llc. No.: 686310
--------------------------,-------------------------------------------------------------------
Detail: REPLACE 1 TON DUCTLESS MINI SPLIT SYSTEM - COOL ONLY [2016 ENERGY] CARBON MONOXIDE ALARM(S) TO K INSTALLED PRIOR TO FINAL
INSPECTION. PER 2016 CALIFORNIA BUILDING CODES
1
FI NANCIALIN FORMATION
DESCRIPTION ACCOUNT QTY AMOUNT
BSAS SB1473 FEE 101-0000-20306 0 $1.00
Total Paid for BUILDING STANDARDS ADMINISTRATIOV BSA: $1.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
HVAC CHANGEOUT - SPLIT -SYSTEM
101-0000-42402
0
$76.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
HVAC CHANGEOUT - SPLIT -SYSTEM PC
101-0000-42600
0
$38.00
Total Paid for CHANGEOUT: $114.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PERMIT ISSUANCE
101-0000-42404
0
$96.27
Total Paid for PERMIT ISSUANCE: $96.27
Bin.#
Cray Of La Quin' t' i
Building a Safety Division
_ WTO P.O. Box 1504,78-495 Calle Tampico
La.Quinta, CA 92253 -:(760) 777-7012
Building Permit Applicaponand Tracking Sheet
Permit #
Project Address: 78267 Highway 111
Owner's Name:. Michael Hood
X P. Number.
Address: 78267 Highway 111
Legal Description:
City, ST, Zip: La Quinta, CA 9225":
Contractor: General Air Conditioning`�f`g°5
^'
Telephone: 760-564-1154 ,.
Address: 31170 Reserve Drive
Project Description: Replace 1 ton ductless mini split system
City, ST, Zip: Thousand Palms, CA 92276
cool only
Telephone: 760-343-7488
State Lic. # : 686310
City Lie'. #,
Arch, Eagr., Designer
Address:
City., ST. Zip:
Telephone:
State Lia #:,�/
Name of ConW Person: Steven Schnierer
Construction Type:. Ocupancy:
Project type (circle one): New Add'n. Alter Repair Demo
Sq. Ft.:
# Stories: # Units:
Telephone # of Contact Person: 8.18-735-7876
Estimated Value of Project: $5,179.00
APPLICANT: DO NOT WRITE BELOW THIS UNE
#
Submittal
Req'd
Recd
TRACIQAII IG
PERMIT FEES
Plan Sets
Plan Check submitted
Item Amount
Structural Calm
Reviewed, ready for corrections
Plan Check Deposit. .
Truss Cates.
Called Contact Person
Plan Check Balance.
Title 24 Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted..
Mechanical
Grading plan
V Review, ready for corrections/issue
Electrical
Subcoetactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN ROUSE:-
''" Review ready for correetions<Ssae
Developer Impact Fee
Planning Approval
Called Contact Person
A.LP.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees
STATE OF CALIFORNIA
MECHANICAL SYSTEMS
Al"
CEC-NRCC-MCH-01-E Revised 01116 CALIFORNIA ENERGY COMMISSION
CERTIFICATE OF COMPLIANCE NRCC-MCH-01-E
Mechanical Systems Page 1 of 4
Project Name: ./ r Z(0-7 ` \ w a "t Date Prepared:
A. MECHANICAL COMPLIANCE DOCUMENTS & WORKSHEETS (check box if worksheet is Included)
For detailed instructions on the use of this and all Energy Efficiency Standards compliance forms, refer to the 2016 Nonresidential Manual
Note: The Enforcement Agency may require all forms to be incorporated onto the building plans.
YFS Nn Comp, Luer/Worksheet It Titic - �—
(�j NRCC-MCH-01-E (Part 1 of 3)
Certificate of Compliance, Declaration. Required on.plans for all submittals.
0 NRCC-MCH-01-E (Part 2 of 3)
Certificate of Compliance, Required Acceptance Tests (MCH -02-A to 11-A). Required on plans for all submittals.
�j NRCC-MCH-01-E (Part 3 of 3)
Certificate of Compliance, Required Acceptance Tests{MCH-12-A to 18-A). Required on plans where applicable.
(7i OK NRCC-MCH-02-E (Part 1 of 2)
Mechanical Dry Equipment Summary is required for all submittals with Central Air Systems. It is optional on plans.
(} NRCC-MCH-02-E (Part 2 of 2)
Mechanical Wet Equipment Summary is required for all submittals with.chilled water, hot water or condenser water
systems. It is optional on plans.
QNRCC-MCH 03 E
Mechanical Ventilation and Reheat is required for all•submittals with multiple zone he and cooling systems. -It is
optional on plans.
0 NRCC-MCH-07-E (Part 1 of 2)P
ower Consumption of Fans. Required on plans where applicable
(} NRCC-MCH-07-E (Part 2 of 2) .
Power Consumption of Fans, Declaration. Required on plans where applicable
Building Energy Efficiency Standards - 2016 Nonresidential Compliance January 2.016
STATE OF CALIFORNIA
MECHANICAL. SYSTEMS
%--
CEC-NRCC-MCH-01-E Revised 01116 CALIFORNIA ENERGY COMMISSION a�
CERTIFICATE OF COMPLIANCE NRCC-MCH-01-E
Mechanical Systems Page 2 of 4
Pfeied Nam.: 74,7 I i, - Date Prepared: t ,�
WR
B. MECHANICAL HVAC ACCEPTANCE FORMS (check box for required compliance documents)
Test Performed By:
Designer:
This compliance document is to be used by the designer and attached to the plans. Listed below are all the acceptance tests for HVAC systems. The. designer is required to check the applicable boxes
for all acceptance tests that apply and list all equipment that requires an acceptance test. All equipment of the same type that requires a test, list the equipment description and the number of
systems.
Installing Contractor: -
The contractor who installed the equipment is responsible to either conduct the acceptance test themselves or have a qualified entity run the test for them. If more than one person has responsibility
for the acceptance testing, each person shall sign and submit the Certificate of Acceptance applicable to the portion of the construction or installation for which they are responsible.
Enforcement Agency:
Plancheck - The NRCC-MCH-01-E compliance document is not considered a completed document and Is not to be accepted by the building department unless the correct boxes are checked.
Inspector- Before occupancy permit is granted all newly installed process systems must be tested to ensure proper operations.
Test Description
MCH -02-A
MCH -03-A
MCH -04-A
MCH -05-A
MCH -06-A
MCH -07-A
MCH -08-A
MCH -09-A
MCH -10-A
MCH -11-A
Air '
Demand
Supply
Hydronic
Automatic
Equipment Requiring Testing
# of Units
Outdoor Air
Single Zone
Distribution
Economizer
Controlled
Supply Fan
Valve
Water
System
Demand
or Verification
Unitary
Ducts
Controls
Ventilation
VAV
leakage Test
Variable
(DCV)
Reset
Temp.Flow
Control
Shed Control
El
El
CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance
January 2016
STATE OF CALIFORNIA
MECHANICAL SYSTEMS -
CEC-NRCC-MCH-01-E Revised 01/16 CALIFORNIA ENERGY COMMISSION
CERTIFICATE OF COMPLIANCE NRCC-MCH-01-E
Mechanical Systems - Page 3 of 4
Project Name: Date Prepared:
g Z% 1 .tst• l7
C. MECHANICAL HVAC ACCEPTANCE FORMS (check box for required compliance documents) -
Test Performed By: '
Designer:
This compliance document is to be used by the designer and attached to the plans. Listed below are all the acceptance tests for HVAC systems. The desigrier is required to check the applicable boxes
for all acceptance tests that apply and list all equipment that requires an acceptance.test. All equipment of the same type that requires, a test, list the equipment description and the number of
systems. "
Installing Contractor:
The contractor who installed the equipment is responsible to either conduct the acceptance test themselves or have a qualified entity run the test for them. If more than one person has responsibility
for the acceptance testing, each person shall sign and submit the Certificate of Acceptance applicable to the portion of the construction or installation for which they are responsible.
Enforcement Agency:
Plancheck - The NRCC-MCH-01-E compliance document is not considered a completed document and is not to be accepted by the building department unless the correct boxes are checked.
Inspector - Before occupancy permit is granted all newly Installed process systems must be tested to ensure proper operations.
Test Description -
MCH -12-A•
MCH -13-A
MCH -14-A
MCH -15-A
MCH -16-A
MCH -17-A
MCH -18-A
Fault Detection
Automatic Fault
Distributed
Thermal Energy
Supply Air
Condenser
Equipment Requiring Testing or
# of Units
& Diagnostics
Detection &
Energy Storage
Storage (TES)
Temperature
Water Reset
ECMS
Verification
for DX Units
Diagnostics for
DX AC Systems
Systems
Reset Controls
Controls
r
Air & Zone
,
17a�keY, �iw�i Sp1:�
❑
❑
❑
❑
❑
❑ •
❑
STATE OF CALIFORNIA
MECHANICAL SYSTEMS
CEC-NRCC-MCH-01-E Revised 01/16 CALIFORNIA ENERGY COMMISSION
CERTIFICATE OF COMPLIANCE NRCC-MCH-01-E
Mechanical Systems Page 4 of 4
PmJect Name: 1 $ZDate Prepared: ,•,
DOCUMENTATION AUTHOR'S DECLARATION STATEMENT
1. 1 certify.that this Certificate of Compliance documentation is accurate and complete.
Docu nation Author Na ;
� uth
Doc mentation Author ignature:
r
61Sa Idra 901151
A.ddress:.
3lZZS Lo.
CEA HERS Certification Identification if applicable):
CIw�v/S�ate/Zlp: -
IaJe CA i:m.
Phone:
X18 -735-7Z-%.
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 desl'gn or system design identified on this Certificate of Compliance (responsible
designer).
3. 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. . 1 will ensure that a completed signed copy of this Certificate of Compliance shall be made available with the building permit(s) issued for the building, and .made available to the enforcement
agency for all applicable inspections. I understand that a completed signed copy of this Certificate of Compliance is required to be included with the documentation the builder provides to the
building owner at occupancy.
Res Bible Designer Name:
G
Res INDe igner Signature: ,
CoLnpany:
E
Date Jignedi
t Z4
e-rrr, 1� a, ex
1
.Address:
IZzS L « � a 1l . Sv: re. 213
ucen e:
CityLState/ZIRq:
4l m;c,Ie Vi 11 toe CA q 13 6Z
Phone: '
I S18'7SS -7t%-
CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance January 2016
4