BMCH2017-016278-495 CALL TAMPICO
4 aw
LA QUINTA, CALIFORNIA 92253 DESIGN & DEVELOPMENT DEPARTMENT
BUILDING PERMIT
Application Number: BMCH2O17-0162
Property Address: 56810 JACK NICKLAUS
APN: 762070045
Application Description: TAYLOR RESIDENCE / HVAC CHANGE OUT
Property Zoning: _
Application Valuation: $2,229.00
Applicant:
JOHN BORDEN HEATING AND AIR CONDITIONING
P 0 BOX 459
YUCAIPA, CA 92399
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: _ License No.: 719570
(Date: Contractor: `Yr
d
4_1V G-11
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.).
( ) 1, 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:
777-7125
FAX�7) 777-7011
I NSPECTIONSr4761;777-7153
,.A Dat �5t-/s1/2017
Owner:
DENNIS TAYLOR �� V
O
r
Contractor:
JOHN BORDEN HEATING AND AIR CONDITIONING
P 0 BOX 459
YUCAIPA, CA 92399
(951)797-5669
Llc. No.: 719570
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: INSURANCE COMPANY OF THE WEST . Policy Number: WSD5031288
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 LaborCode, I shall forthwith
comply with those provisions.
Date: �r�' 7 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 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 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: r % Signature (Applicant or Agent):
'
Date: 5/1/2017
Application Number: BMCH2O17-0162
Owner:
Property Address: 56810 JACK NICKLAUS
DENNIS TAYLOR
APN: 762070045
Property Zoning:
Application Valuation: $2,229.00
Applicant:
Contractor:
JOHN BORDEN HEATING AND AIR CONDITIONING
JOHN BORDEN HEATING AND AIR CONDITIONING
P 0 BOX 459 •
P 0 BOX 459
YUCAIPA, CA 92399
YUCAIPA, CA 92399
(951)797-5669
Llc. No.: 719570
---------------------------------------------------------------------------------------------
Detail: CONDENSER ONLY - 14 SEER/80AFUE SPLIT SYSTEM. CARBON MONOXIDE ALARM(S) TO BE INSTALLED PRIOR TO FINAL INSPECTION. 2016 `
CALIFORNIA BUILDING CODES.
l
FINANCIAL •R •
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 - CONDENSER ONLY
101-0000-42402 1
0
$38.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
HVAC CHANGEOUT - CONDENSER ONLY PC
101-0000-426000
$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
r
Bin.
City of La Quinta
Bullding 8r Safety Dildslon
P.O. Box 1504,-7B-495 Calle Tampico
La.Quinta, CA 92253 -:(760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
Project Address: S(Dg ( C -5 Rky
Owner's Name:. 1
A. P. Number.
Address:
Legal Description:
Contractor.�VS JTelephoner
City, ST, Zap.
Address: .O. S
Project Description: zll. nP_u�A S +o
City, ST, Zip: 7 a
y SCM Con&nseeI 41 q1Q
Telephone: OQ - 444 _31z(0 (1 uTXV
State Lir. #: C,a O — . S 0 City Lic. #;Y -4S
vid
Arch, Engr., Designer.
Address:
City., ST, Zip:
Telephone:
State Lia #:
Name of Contact Person: S CIYw, LU
Construction Type:.1AvAC Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
-Sq. Ft.: R.10 T#Stories: -owl I e # Units:
Telephone # of Contact Person: QO -Sip (pQ Fxf.
Estimated Value of ProjectoZ 02 Q q
APPLICANT: DO NOT WRITE BELOW THIS UNE
#
Submittal
Req'd
Reed
TRACKNG
PERMIT FEES
PIP Seta
Pian Check submitted
Item Amount
Structural Coles.
Reviewed, ready for corrections
Plan Check Deposit. .
Truss C21c•
Called Contact Person
Plan Check Balance.
Title 24 Cates.
Pians picked up
Construction
Flood plain plan
Plans resubmitted..
Mecharitcal
Grading plan
2" Review, ready for correctionslissue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
'"' Review; ready for correcdonsAssue
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 -1R -ALT -HVAC) (Page 1 of 3)
Project Name:DENNIS TAYLORFate Prepared: 2017-04-28
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
DENNIS TAYLOR
02
Date Prepared
2017-04-28
03
Project Location
56810 JACK NICKLAUS BLVD
04
Building Type
Single family
05
CA City
YUCAIPA ter ;;
: 06
Dwelling Unit Name
SYSTEM
SC System
SC System
CFA served
system a
Dwelling Unit Conditioned
Installing new SCS
07
Zip Code
92399 1 ��
08�
Area (ft2)
2101
by this SC',ducted
r
system
.Floor
entirely new
entirely new
-
Served
Number of Space
system?
09
Climate Zone
10
10
Conditioning (SC) Systems in
1
SYSTEM
HOUSE
\`T
\t�
Yes
this Dwelling Unit:
Yes
B. Space Conditioning (SC) System Information >—n # T�.
01
02
03
04
it b 05 f
`- 06'4 '�
07
08
09
10
Is the SC
�aT
Installing a
btu r.cy :,�.. vt
o with inmar)
SC System
SC System
CFA served
system a
refrigerant
Installing new SCS
Installing
Installing
Installing
Identification or
Location or Area
by this SC',ducted
containing
system
more than 40
entirely new
entirely new
Name
Served
System (ft2)
system?
component?
components?
feet of ducts?
duct system?
SC system?
Alteration Type
SYSTEM
HOUSE
2101
Yes
Yes
Yes
No
No
No
Altered space.
-
conditioning system
C. Extension of Existing Duct System, Greater Than 40 Feet (Section 150.2(b)1Diib)
This section does not apply to this project.
Registration Number: 417-A020091597A-000-000-0000000-0000
CA Building Energy Efficiency Standards - 2016 Residential Compliance
Registration Date/Time: 2017-04-28 12:31:28
Report Version: 2016.1.005
~ Schema Version: rev 10/16
HERS Provider:>CHEERS
Report Generated: 2017,-04-28 412:31:29
w `
t
CERTIFICATE OF COMPLIANCE CFIR-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
Less than or
SYSTEM
furnace
heating
AFUE
0.81
AC
cooling
SEER
14
Setback
equal to 40
R-6
components
components
feet
Required Documentation:
CF2R-MCH-01-E - Space Conditioning Systems s r
- Duct insulation requirement for the new portions of supply -air and return -air ducts or plenums: R6,(CZ 1=10, 12�and 13) and R8 (CZ 11 and 14-16)
CF2R and CF3R-MCH-20-H -Duct Leakage Test required when heating or cooling components are 'installed inducted systems, or when more than 40 ft of duct length is replaced
-Leakage rate compliance: <= 15% or <= 10% leakage to outside, 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).
CF2R and CF3R-MCH-23 Airflow Rate >= 300 CFM per ton required when MCH -25 is required.
Exceptions: i
Duct as
systems registered with HERS provider previously sealed are exempt from MCH -20 Duct Leakage Testing requirements.
Heating -only systems and Air Handler Furnace changes do not require verification of Air Flow MCH -23, or Refrigerant Charge MCH -25.
-Existing duct systems constructed, insulated or sealed with asbestos are exempt from MCH -20 Duct Leakage Testing requirements.
fr Y iF_JI If_ 1 I f It ' IL„_
E. EntirelyNew or Complete Replacement Duct System, wifh orlw thout~Equipment`I Ch n eo t Sections 150.2 b 1Diia and 150.2 b 1E F
P P Yg ( () () )
'This section does notapply 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: 417-A020091597A-000-000-0000000-0000
CA Building Energy Efficiency Standards - 2016 Residential Compliance
Registration Date/Time: 2017-04-28 12:31:28 HERS Provider: CHEERS
Report Version: 2016.1.005 Report Generated: 2017-04-28 12:31:29
Schema Version: rev 10/16 ,
A,
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.J certify that this Certificate of Compliance documentation is accurate and complete.
Documentation Author Name:
Documentation Author Signature:
Connie Goe
COTU i&g0t,
Company:
Signature Date:
Russells Heating & Air Conditioning
2017-04-28
Address:
CEA/ HERS Certification Identification (if applicable):
33145 Yucaipa Boulevard
City/State/Zip:Phone:
Yucaipa CA 92399 ti ]�969797-5669
'
Responsible Persons Declaration statement
p
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. That the energy features and performance specifications, materials, components, and mariufactu ed 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 thislbuilding permit application.
5. 1 will ensure that a registered copy of this Certificate of Compliance shall5be 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 registered copy of this Certificate of Compliance is requiredto be�includecl wif the documentation the builder provides to the building owner at occupancy.
Responsible Designer Name:Responsible
Connie Goe ��Iir� tCh d rx`I
Designer, Signature:
ti-" iL i
,PiQcelV
Company:
Date Signed:
Russells Heating & Air Conditioning
2017-04-28
Address:
License:
33145 Yucaipa Boulevard
719570
City/State/Zip:
Phone:
Yucaipa CA 92399
909-797-5669
Digitally signed by CHEERS'^': 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: 417-A020091597A-000-000-0000000-0000 Registration Date/Time: 2017-04-28 12:31:28 HERS Provider: CHEERS
CA Building Energy Efficiency Standards - 2016 Residential Compliance Report Version: 2016.1.005 Report Generated: 2017-04-28 12:31:29
Schema Version: rev 10/16