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BMCH2017-019778-495-CALLE TAM P I CO LA QUINTA, CALIFORNIA 92253 DESIGN & DEVELOPMENT DEPARTMENT BUILDING PERMIT Application Number: BMCH2O17-0197 Property Address: 51420 CALLE JACUMBA APN: 770166024 Application Description: JACKSON RESIDENCE / HVAC CHAN Property Zoning: Application Valuation: $6,600.00 Applicant: BERNIE'S AIR CONDITIONING 69249 BARISTO RD CATHEDRAL CITY, CA 92234 n; 2, 4 CITY OFLAQUINTA `I COMPAU IITYDEVELOPMENTDEPART&IENT 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 License No.: 979505 ,^ Date: Contractor:,�� r 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 eicempt under Seca . 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 Nam Lender's Address: VOICE (760) 777-7125 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 5/24/2017 Owner: RICK JACKSON 51420 CALLE JACUMBA LA QUINTA, CA 92253 Contractor: BERNIE'S AIR CONDITIONING 69249 BARISTO RD A CATHEDRAL CITY, CA 92234 (760)905-1011 Llc. No.: 979505 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: EXEMPT Policy Number: 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 Sectiori 3700 of the Labor Code, I shall forthwith comply with those tovisions. Date: 2 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: ZL Signature (Applicant or Agent): Date: 5/24/2017 Application Number: BMtCH2O17-0197. Owner: Property Address: 51420 CALLE JACUMBA RICK JACKSON APN: 770166024 51420 CALLE JACUMBA Application Description: JACKSON RESIDENCE / HVAC CHANGE OUT LA QUINTA, CA 92253 Property Zoning: Application Valuation: $6,600.00 Applicant: Contractor: BERNIE'S AIR CONDITIONING BERNIE'S AIR CONDITIONING 69249 BARISTO RD 69249 BARISTO RD CATHEDRAL CITY, CA 92234 CATHEDRAL CITY, CA 92234 (760)905-1011 -------'----------------------- Llc. No.: 979505 =------------------------- ------------------------------------- Detail: HVAC CHANGE OUT - 14 SEER780AFUE PACKAGED SYSTEM. CARBON MONOXIDE ALARM(S) TO BE INSTALLED PRIOR TO FINAL INSPECTION. 2016 CALIFORNIA BUILDING CODES. Total Paid for TECHNOLOGY ENHANCEMENT FEE: $5.00 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 QTY AMOUNT HVAC CHANGEOUT - PACKAGED UNIT 10170000-42402 0 $38.00 DESCRIPTION ACCOUNT QTY AMOUNT HVAC CHANGEOUT - PACKAGED UNIT PC 101-0000-42600 0 $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 CERTIFICATE OF COMPLIANCE CFiR-ALT 02-E Alterations to Space Conditioning Systems (formerly CF-iR-ALT HVAC) (Pagel of 3) Project Name: Ric Jackson I Date Prepared: 2017-05-24 I 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 Ric Jackson 02 Date Prepared 2017-05-24 03 Project Location 51420 Calle Jaumba 04 Building Type Single family 05 CA City La Quinta 06 Dwelling Unit Name Ric Jackson SC System SC System Dwelling Unit Conditioned system a 07 Zip Code 92253 08 Floor Area (ftz) 1200 Identification or Location or Area by this SC ducted Number of Space system 09 Climate Zone 15 10 Conditioning (SC) Systems in 1 System (ft) system? component? components? this Dwelling Unit: duct system? B. Space Conditioning (SC) System Information + _� 01 02 03 04 05 06 Y 07J JI U8 09 10 Is the SCI— Installi g a ° g 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 WHOLE HOUSE 1200 Yes Yes Yes No No No Altered space conditioning system C. Extension of Existing Duct System, Greater Than 40 Feet (Section1S0.2(b)1Diib) This section does not apply to this project. Registration Number: 217-A020173050A-000-000-0000000-0000 Registration Date/Time: 2017-05-24 08:33:21 HERS Provider: CalCERTS CA Building Energy Efficiency Standards - 2016 Residential Compliance Report Version: 2016.1.005 Report Generated: 2017-05-24 08:33:22 Schema Version: rev 10/16 CERTIFICATE OF COMPLIANCE CF111-ALT-024 Alterations to Space Conditioning Systems (formerly CF -1R -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 All new Central All new Less than or System 1 packaged HP heating AFUE 81 packaged AC cooling SEER 14 Setback equal to 40 R-8 components components feet Reauired Documentation: CF2R-MCH-01-E - Space Conditioning Systems - 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 in ducted systems, or when more than 40 ft of duct length is replaced -Leakage rate compliance: <=154 or <=104 leakage to outside, or seal all accessible leaks. CF2R and CF311-MCH-25-H Refrigerant Charge verification required when refrigerant containing components are installed or altered (applicable in CZ 2, 8-15). CF2R and CF311-MCH-23 Airflow Rate >= 300 CFM per ton required when MCH -25 is required. Exce tions: Duct systems registered with HERS provider as 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, orRifiigerant Charge MCH -25. Existing duct systems constructed, insulated or sealed with asbestos are exemptfrom MCH 20 Duct Leakage Testing requirements'. �".,. 1 '4 10 E. Entirely New or Complete Replacement Duct System, with or without Equipment Changeout (Sections,150.2(b)iDiia:and 250.2(b)1E, F) �. 0-0 1� ice ,. P i-4 W 'i P. - 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-A020173050A-000-000-0000000-0000 Registration Date/Time: 2017-05-24 08:33:21 HERS Provider: CalCERTS CA Building Energy Efficiency Standards - 2016 Residential Compliance Report Version: 2016.1.005 Report Generated: 2017-05-24 08:33:22 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: Bachus, Tom Company: Signature Date: MLC Building Performance 2017-05-24 08:33:21 Address: CEA/ HERS Certification Identification (if applicable): 77825 Delaware Place City/State/Zip: Phone: Palm Desert CA 92211 1760-836-0066 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. That 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 ofjRegulations. j I / � 1 � j`-1 "j � � �— L 4. The building design features or system design features identified on this Certlficate of Compliance are consistent with -the information,provided on rither;applicable compliance documents, worksheets, calculations, plans and specifications submitted to the enforcement agency for approval with this building perki application. t,. ")�, IIJI ii(� " . �� t�, 7 x 5. I well ensure that a registered copy of this Certificate ofCompliance shall be made,available with the bulldirig pe�mit(s),issuel for=the building, and made available o the, enforcement agency for all applicable inspections. I understand that a registered copy of this,Certificate of Compliance is required to be included with the documenta_tion}the.builder provides to the building owner at occupancy. - Responsible Designer Name: ..;i Responsible Designer Signature: Bachus, Tom Company: Date Signed: MLC Building Performance 2017-05-24 08:33:21 Address: License: 77825 Delaware Place City/State/Zip: Phone: Palm Desert CA 92211 760-836-0066 Easy to Verify a 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. Registration Number: 217-A020173050A-000-000-0000000-0000 Registration Date/Time: 2017-05-24 08:33:21 HERS Provider: CalCERTS CA Building Energy Efficiency Standards - 2016 Residential Compliance Report Version: 2016.1.005 Report Generated: 2017-05-24 08:33:22 Schema Version: rev 10/16 BfR # City. of La Quints Bullding ar Safety Division P.O. Box 1504,78-495 Calle Tampico La.Quinta, G4 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Pelt # Project Address: Z ��$ u /61 Owner's Name:. A. P. Number. Adder: . Legal Description: Contractor n ie—' I e.,nn City, ST, Zip: Telephone: Project Description: Address: r i S O l �' • City, $T, Zip: : I 611n Telephone: 1)/ State Lic # : b City Lic f Arch., Engr., Designer. Address: City, ST. Zip. Telephone: Construction Type: • Occupan`y: Project type (circle one): New Add'n Alter Repair Demo Sq. Ft,: # Stories: # Univ: Estimated Value of Project �� State Lic. #: Name of Contact Person: Telephone # of Contact Person: . . 4QZ APPLICANT: DO NOT WRITE BELOW THIS UNE # Submittal Req'd Reed TRACIMG PERMIT FEES Plan seta Plan Check submitted Item Amount Structural Coles. Revlewed, ready for convedons Plan Cheek Deposit. . Truss Cala. Called Contact Persoa Pian Check Balance Title 24 Cales. Plans picked up Construction Flood plain plan Plans resubmitted. • Meclul ilcsi Grading plan Z'! Review, ready for iwrrectionViissue Electrical Subcontactor List Called Contact Person Plumbing Grant Deed ?tans picked up S.M.I. H.O.A. Approval Plum resubmitted Grading IN HOUSE} ''d Review; ready for eorrectiomlissae Dcvdoper Impact Fee Planning Approval Called Contact Person A.I.P.P. Pub. Wks. Appr Date of permit Issue School Fees Total Permit Fees r