BMCH2017-0202a^" `^ VOICE (760) 777-7125
78-495 CALLE TAMPICO T�/ Q�i D � FAX 760 777-7011
LA QUINTA, CALIFORNIA 92253 0 ( )
DESIGN & DEVELOPMENT DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 5/30/2017
0
Application Number: BMCH2017 0202 B1100
ner.
Property Address: 57570 INTERLACHEN PP
�`—' QUELINE KEEHN
APN: -� 762180022
Application Description: KEEHN RESIDENCE/ HVAC CHANG MAY 3 0 2017RMAN
Property Zoning:
Application Valuation: $7,072.00
CITY OF LA QUINTA
Applicant: DESIGN AND DEVELOPMENT DEPARTMEPontractor:.
1 ANTHONY PLUMBING HEATING & AIR CONDITI J ANTHONY PLUMBING HEATING & AIR CONDITI
72216 NORTH SHORE ST #101 72216 NORTH SHORE ST #101
THOUSAND PALMS, CA 92276 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: Q0, C36 License No.: 777794
Date: i 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 !i
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)328-8096
Uc. No.: 777794
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.
_ 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: MIDWEST EMPLOYERS CASUALTY COMPANY Policy Number:
BNUWC0135300
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 t become subject to the workers'
compensation laws of California, and agree that, ' I should become subject to the
workers' compensation provisions of Section 7 of the Labor Code, I shall forthwith
comply ' hhtthose provisions.
Date:
L 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 personupon. 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 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 abo a information is correct.
I agree to comply with all city and county ordinances a d sta laws relating to building
construction an' hereby authorize representatives o 's c' ter upon the
above n / pygperty for inspection purposes.
Date: •'// Signature (Applicant or Ag t)•
,_ i
Date: 5/30/2017
Application Number: BMCH2017-0202
Owner:
Property Address: 57570 INTERLACHEN
JACQUELINE KEEHN
APN: 762180022
Application Description: KEEHN RESIDENCE / HVAC CHANGE OUT
Property Zoning:
' Application Valuation: $7,072.00
Applicant:
Contractor:
1 ANTHONY PLUMBING HEATING & AIR CONDITI
J ANTHONY PLUMBING HEATING & AIR CONDITI
• 72216 NORTH SHORE ST #101
72216 NORTH SHORE ST #101
THOUSAND PALMS, CA 92276
THOUSAND PALMS, CA 92276
(760)328-8096 "
------------------------------------------------------------------------------=--------------
Llc. No.: 777794
Detail: HVAC CHANGE OUT - 14 SEER/80 AFUE SPLIT SYSTEM. CARBON MONOXIDE ALARM(S) TO BE INSTALLED PRIOR TO FINAL INSPECTION. PER 2016
CALIFORNIA BUILDING CODES.
12
FINANCIAL INFORMATION
DESCRIPTION ACCOUNT QTY 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 CHANGEOUT: $114.00
DESCRIPTION
ACCOUNT
CITY
AMOUNT
PERMIT ISSUANCE
101-0000-42404
0
$96.27
Total Paid for PERMIT ISSUANCE: $96.27
DESCRIPTION
ACCOUNT
CITY
AMOUNT
TECHNOLOGY ENHANCEMENT FEE
'502-0000-43611
0
$5.00.
Total Paid for TECHNOLOGY ENHANCEMENT FEE: $S.00
Qin ## .
Qty. of La Quinta
Building & Safety Division
Permit #{ 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-701,2
Building Permit Application and Tracking Sheet
Project Address: 's / s%p -y� t-,�� Owner's Name: A-cw (e— i-6eelw
A. P. Number:
Address:
Legal Description:
City, ST, Zip:
Contractor:.'
A114fli8MYSERVIeES
Telephone:
P (�
.i
Address: _ '; WR T H SHORE ST STE 101
City, ST, zip: I OJS D PAL ,
..................
Project Description: STa fi " 5
Telephone:
o .
State Lie. # : �17 6" G
City Lie. #.-r"5 04S
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone.*
h one:
Construction s on T e: ecu Pane
Occupancy:
Y Y:
State Lie. #: •
Project type �circle one): New Add'n Alter RePair • Demo
o
Name of Contact Person: b�l�N��tJ"
Sq. Ft.:
# Stories: _
# Units:
Telephone # of Contact Person:3
i Z/Z,
Estimated Value of Project: 707-2,-
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 Cafes.,
Called Contact person
Plan Check Balance
Title 24 Calcs.
Plans picked up
Construction '
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2" Review, ready for corrections/issue
Electrical .
Subcontactor List
Called Contact-Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN IiOUSE:-
Jrd 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 Permit Fees
CERTIFICATE OF COMPLIANCE
CF1R-ALT 02-E
Alterations to Space Conditioning Systems (formerly CF -IR -ALT HVAC) (Pagel of 3) 1
Project Name:
KEEHN I Date Prepared:
2017-05-30
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
CF1R-ALT-02 document for each dwelling unit.
01
Project Name
KEEHN
02
Date Prepared
2017-05-30
03
Project Location
57570 INTERLACHEN
04
Building Type
Single family
05
CA City
La Quinta
06
Dwelling Unit Name
KEEHN
Dwelling Unit Conditioned
Installingi�a A
07
Zip Code
92253
OS
Floor Area (ft2)
1600
SC System
CFA served
system a
refrigerant
Number of Space
Installing
09
Climate Zone ,�;
15�� <_ -
10
Conditioning (SC) Systems in
1
ducted
containing
system
more than 40
this Dwelling Unit:
entirely new
-A 'r _.°. a C A rte- it r• r I e -
B. Space Conditioning (SC) System InformationWTI
01
02
03
04
P S'.
05
tE:.°``('F.'kG
06
`6` `^'.
07
ahM b8 . '.
OS
'yssp.aYi "fit
09
10
.�
Is,the SC
Installingi�a A
.
Y*1.
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
1600
Yes
Yes
Yes
No
No
No
Altered space
conditioning system
C. Extension of Existing Duct System, Greater Than 40 Feet (Section 150.2(b)iDiib)
This section does not apply to this project.
Registration Number: 217-A020179041A-000-000-0000000-0000
Registration Date/Time: 2017-05-30 09:49:25
HERS Provider: CalCERTS
CA Building Energy Efficiency Standards - 2016 Residential Compliance Report Version: 2016.1.005 Report Generated: 2017-05-30 09:49:37
Schema Version: rev 10/16
CERTIFICATE OF COMPLIANCE CF111-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)lE 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
Outdoor
This field or
This field or
System 1
Central gas
Gas furnace
AFUE
81
Central split
condensing
SEER
14
Setback
section is not
section is not
furnace
AHU
AC
unit
applicable
applicable
Reauired Documentation:
CF2R-MCH-01-E - Space Conditioning Systems 3
- Dud insulation requirement for the new portions of supply -air and return -air duds or plenums: R6 (CZ 1-10, 12 and 13) and R8 (CZ 11 and 14-16)
CF211 and CF3R-MCH-20-H - Dud Leakage Test required wtien<fieating or cooling components are installed in ducted systems, or when more than 40 ft of dud length is replaced
-Leakage rate compliance: <= 15% or <= 10% leakage to dutside ;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).
CF211 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 exempt from,MCH-20 Dud Leakage Testing requirements
.-p a✓ fi k s y,
Heating -only systems and Air Handler Furnace changes do not require venficattion of Air Flow 23,0 'Refrigerant Charge MCH=25 .
�MCH
Existing duct systems constructed, insulated or sealed with asbestos=are exemptfrom MCH20 puCt Leakage Testing requiiremens".
:-
_
E. Entirely New or Complete Replacement Du&System, with or witthou. Equpi_p_rr
lent Changeout (Sections �150.2(b.)1Dua and 150.2(b)1E, F)
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-A020179041A-000-000-0000000-0000 Registration Date/Time: 2017-05-30 09:49:25 HERS Provider: CalCERTS
CA Building Energy Efficiency Standards - 2016 Residential Compliance Report Version: 2016.1.005 Report Generated: 2017-05-30 09:49:37
Schema Version: rev 10/16
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.
Documentation Author Name:
Documentation Author Signature:
Robinson, Kevin
Company:
Signature Date:
J ANTHONY PLUMBING HEATING & AIR CONDITIONING
2017-05-30 09:49:25
Address:
CEA/ HERS Certification Identification (if applicable):
72216 NORTH SHORE ST #101
City/State/Zip:
Phone:
THOUSAND PALMS CA 92276 A
760-343-2121
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 Certificatero�Compliance..is.true and correct.
2. 1 am eligible under Division 3 ofhe 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 de gn 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 R�56 Ens �" �
4. The building design features or system design features identified on this Certificate of Compliance are consistent wFth the informationrprovided o thersapplicable compliance documents, worksheets,
calculations, plans and specifications ssu' bmittedao'the enforcement agency fot'approva�kwitthis buildLng perT�tli application, , f
si. a" x.^,+
5. I will ensure that a registered copy of this'Certificate'of Compliance sfiatlbettade available with'the;bwtdirng+permit(s);issued fonthe.building, andmade available totFle;enforcement agency for all applicable
inspections. I understand that a registered copy of thisrtificate of Compliance is required to be includedsnrith thec(aocumentation�thebuilder provides to the bldng owner at occupancy.
Responsible Designer Name: " V
Responsible Desigler Signature. t,
KP-�/l.�f/i�Ri�G!G4Bll/
Robinson, Kevin
Company:
Date Signed:
J ANTHONY PLUMBING HEATING & AIR CONDITIONING
2017-05-30 09:49:25
Address:
License:
72216 NORTH SHORE ST #101
777794
City/State/Zip:
Phone:
THOUSAND PALMS CA 92276
760-343-2121
Easy to Verify Maw
at CaICERTS.com
Digitally signed by CaICERTS. This digital signature is provided in order to secure the content of this registered document, and in noway implies Registration Provider
responsibility for the accuracy of the information.
a
Registration Number: 217-A020179043A-000-000-0000000-0000
Registration Date/Time:
2017-05-30 09:49:25
HERS Provider: CaICERTS
CA Scudding Energy Efficiency Standards - 2016 Residential Compliance Report Version: 2016.1.005 Report Generated: 2017-05-30 09:49:37
Schema Version: rev 10/16