BMCH2017-037778-495 CALLE TAMPICO � D
QuiRrcv VOICE (760) 777-7125
4
LA QUINTA, CALIFORNIA 92253 FAX (760) 777-7011
DESIGN & DEVELOPMENT DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 8/29/2017
Application Number: 6MCH2O17-0377 Owner:
Property Address: 78267 HIGHWAY 111 MICHAEL HOOD
APN: 604050012 L/4,'L''�'8267 HIGHWAY 111
Application Description: HOOD RESIDENCE•/ HVAC CHANE U QUINTA; CA 92253.
Property Zoning:
Application Valuation: $5,809.00 AUG 2 9 2017
Applicant: CITY OF LA QUINTA 'Contractor:
IE INC DESIGN AND DEVELOPMENT DEPARTMEN ARRISON ENTEtPRISES INC DBA GENERAL AIR
31225 LA BAYA 1170 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 70001 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: A 2 A I t--1 Contractor: v!
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
(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 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.
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 insuranm carrier and policy number are:
Carrier: INSURANCE COMPANY OF THE WEST Policy Number: WSD5031658
_ I certify that in the performance of :he 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 3.700 of the Labor Code, I shall forthwith
comply with those provisions.
Date: ?f 7•1ZIt I, Applicant: ryZ t
WARNING: FAILURE TO SECURE WORKERS' COLAPENSATION 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 perform ad 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 applic: tion 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 representat ves of this city to enter upon the
above-mentioned property for inspection purposes.
Date: Signature (Applicant or Agent):--��----�
r
Date: 8/29/2017
Application Number: '
BMCH2O17-0377
Owner:
Property Address:
78267 HIGHWAY 111
MICHAEL HOOD
APN:
604050012
78267 HIGHWAY 111
Application Description:
HOOD RESIDENCE / HVAC CHANGE.OUT
LA QUINTA, CA X2253
Property Zoning:
Application Valuation:
$5,809.00
Applicant;
Contractor:
IE INC
HARRISON ENTE1PRISES INC DBA GENERALAIR
31225 LA BAYA
31170 RESERVE DRIVE
WESTLAKE VILLAGE, CA 91362
THOUSAND PALMS, CA 92276
(760)343-7488
------------------
--------------------------------------------
Llc. No.: 686310
-------------------------------
Detail: INSTALL MINI. SPLIT
SYSTEM - CARBON MONOXIDE ALARM(S) TO BE INSTALLED
PRIOR TO FINAL INSPECTION. PER 2016 CALIFORNIA BUILDING
CODES.
1
FINANCIAL .1,
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
AIR HANDLER
101-0000-42402
0
$38.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
AIR HANDLER PC
101-0000-42600
0
$12.67
DESCRIPTION
ACCOUNT
QTY
AMOUNT
CONDENSER/COMPRESSOR
101-0000-42402
0
$38.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
CONDENSER/COMPRESSOR PC
101-0000-42600
0
$25.33
Total Paid for MECHANICAL: $114.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PERMIT ISSUANCE
101-0000-42404
0
$96.27
Total Paid for PERMIT ISSLANCE: $96.27
DESCRIPTION
ACCOUNT
QTY
AMOUNT
TECHNOLOGY ENHANCEMENT FEE
502-0000-43611
0
$5.00
Total Paid for TECHNOLOGY ENHANCEMENT FEE: $5.00
Bin. #
r Qty of LA Quin to
Blriiding 8L Safety Di&ion
P.O. Box 1504,78-495 Caile Tampico
La.Quinta, CA 92253 - (760) 777-7012
Building Permit Application' and Tracking Sheet
Permit #
Project Address: 78267 Highway 111
Owner's Natne:.Michael Hood
A. P. Number.
Address: 78267 Highway 111
Legal Description:
City, ST, Zip: La Quinta, CA 92253
Contractor. General Air Conditioning
Telephone: 760-564-1154 ,. � �.
Address: 31170 Reserve' Drive
Project Description: Install 1.5 ton mini split heat pump &
City, ST, Zip: Thousand Palms, CA 92276
air handler
Telephone: 760-343-7488 ..... lC\'I'
ti
State Lic. # : 686310 City Lie. M.
Arch, Eng -r., Designer.
Address:
City., ST, Zip:
Telephone: `�',
P
State Lic. #:wrjp;
Name of Contact Person: Steven Schnierer
Construction Type: Oeupancy: .
Project type (circle one): New Add'n Alter Repair Demo
Sq. Ft: # Stories: #Units:
Telephone # of Contact Person: 818-735-7876
Estimated Value of Project $5,809.00
APPLICANT: DO NOT WRITE BELOW THIS LIME
#
Submittal
Req'd
Reeld
TRACMG
PERMIT FEES
Plan Sets
Plan Check submitted
Item Amount,
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit. .
Truss Cates.
Called Contact Person
Plan Check Balance
Tide 24 Calci.
Plans picked up
Constrnedoc
Flood plain plan
Plans resubmitted.'.
Meeharilcal
Grading plan
V Review, ready for corrections/issue
Electrical
Subcoutactor List
Called ContactPerson
Plumbing
Grant Deed
Plans picked up
S.M L
H.OA. Approval
Plans resubmitted
Grading
IN HOUSE:-
'^' Review, ready for corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit Issue
School Fees
Total Perm -t Fees
STATE OF CALIFORNIA
MECHANICAL SYSTEMS
CEC-NRCC-MCH-01-E (Revised 01116) CALIFORNIA ENERGY COMMISSION
CERTIFICATE OF COMPLIANCE NRCC-MCH-01-E
Mechanical Systems Page 1 of 3
Project Name: 78267 Highway 111 Date Prepared: August 29, 2017
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.
YES
NO
Comp. Doc./Worksheet #
Title
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
NRCC-MCH-01-E (Part 1 of 3)
Certificate of Compliance, Declaration. Required on plans for all submittals.
(j
(;
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.
MCH -03-A
MCH -04-A
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.
(
(�7
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.
C
(�
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.
NRCC-MCH-03-E
Mechanical Ventilation and Reheat is required for all submittals with multiple zone heating and cooling systems. It is
optional on plans.
NRCC-MCH-07-E (Part 1 of 2)
Power 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
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 acceptarIce 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
Demand
Hydronic
Air.
Controlled
Supply
System
Automatic
Equipment Requiring Testing or
# of
Single Zone
Distribution
Economizer
Ventilation
Supply Fan
Valve
Water
Variable
Demand
Verification
Units
Outdoor Air
Unitary
Ducts
Controls
(DCV)
VAV
Leakage Test
Temp. Reset
Flow Control
Shed Control
1.5 ton mini split heat pump
1
El
E
El
❑
❑
0
0
[]
Add Rovu "
�Rem veo,Last
if E� .
CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance January 2016
STATE OF CALIFORNIA
MECHANICAL SYSTEMS
:EC-NRCC-MCH-01-E (Revised 01/16) CALIFORNIA ENERGY COMMISSION
CERTIFICATE OF COMPLIANCE NRCC-MCH-01-E
Mechanical Systems Page 2 of 3
Project Name: 78267 Highway 111 — oate Prepared: August 29, 2017
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 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-017E 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
Automatic Fault
Fault Detection
Detection &
Distributed
Thermal Energy
Supply Air
Condenser
Equipment Requiring Testing or
& Diagnostics
Diagnostics for
Energy Storage
Storage (TES)
Temperature
Water Reset
Verification
# of Units
for DX Units
Air & Zone
DX AC Systems
Systems
I Reset Controls
Controls
ECMS
1.5 ton mini split heat pump
1
❑
❑
❑
❑
❑
❑
❑
Add Row
Remove Last
CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance January. 2016
STATE OF CALIFORNIA
MECHANICAL SYSTEMS
D
CEC-NRCC-MCH-01-E Revised 01/16 CALIFORNIA ENERGY COMMISSION
CERTIFICATE OF COMPLIANCE NRCC-MCH-01-E
Mechanical Systems Page 3 of 3
Project Name: 78267 Highway 111 Date Prepared: August 29, 2017
DOCUMENTATION AUTHOR'S DECLARATION STATEMENT
1. 1 certify that this Certificate of Compliance documentation is accurate and complete.
Documentation Author Name: Schnierer
Steven
Documentation Author Signature: + Digitally signed by Steven Schnierer
Steven Schnierer -Date:
2017.08.29 06:10:22 -07'00'
Company:
. General Air Conditioning �
Signature Date.August
August 29,.2017
Address:31170 Reserve Drive
CEA/ HERS Certification Identification (if applicable):
City/state/zip7housand Palms, CA 92276
Thousand
Phone
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. 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.
Responsible Designer Name:
Responsible Designer Signature:
Company:
Date Signed:
Address:
License:
City/State/Zip:
Phone:
CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance January 2016