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BMCH2017-031778-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 T-iht w . YES16V &DEVELOPMENT DEPARTMENT B PEIIT . P) LLpp,��11 VOICE (760) 777-7125 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 7/25/2017 Application Number: Property Address: BMCH2O17-0317 ST 11I C 7 JUL 2 �% 2U11 Owner: USA 761 76075 2040010ERSON � US DEPT OF THE INTERIOR Application Description: GARDNER /CHANGE OUT (1) HEAT PUMP F LA QUANTA g� L WASHINGTON, DC 0 Property zoning: DESIGNAND Application Valuation: $3,200.00DEPA." DEVELOPMENT *fIiEIVT Applicant: Contractor: IE INC A#1 SERVICES HEATING & AIR CONDITIONING 31225 LA BAYA 78206 VARNER RD #D-189 WESTLAKE VILLAGE, CA 91362 PALM DESERT, CA 92211 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.: 977333 D.1017�� Contra ctor-�Ot 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).: (_J 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 did not build or improve for the purpose of sale.). (_J 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 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 Na Lender's Address: (760)565-2691 Llc. No.: 977333 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 Secti�700 of the Labor Code, for the performance of the work for which this.permit is issued. My workers' compensation insurance carrier and polity number are: Carrier: FALLS LAKE FIRE AND CASUALTY COMPANY Policy Number: FLA006188 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 Labor Code, I shall forthwith comply with those -provisions. Applicant-11C—_-NAAA)Z-- �2 f 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: '� 25 1i Signature (Applicant or Agent}. �`� Date: 7/25/2017 Application Number: BMCH2017-0317 Owner: Property Address: 58075 JEFFERSON ST USA 761 APN: 762040010 US DEPT OF THE INTERIOR Application Description: GARDNER / CHANGE OUT (1) HEAT PUMP WASHINGTON, DC 0 Property Zoning: Application Valuation: $3,200.00 . Applicant: Contractor: IE INC A#1 SERVICES HEATING & AIR CONDITIONING 31225 LA BAYA 78206 VARNER RD #D-189. WESTLAKE VILLAGE, CA 91362 PALM DESERT, CA 92211 (760)565-2691 --------------- ---------------------=------------ Llc. No.:.977333 - ------------------------------------------- Oetail: CHANGE OUT (1) HEAT PUMP: CARBON MONOXIDE ALARM(S) TO -BE INSTALLED PRIOR TO FINAL INSPECTION. 2016 CALIFORNIA BUILDING CODES. N 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 - OTHER EQUIPMENT 101-0000-42402 0 $38.00 DESCRIPTION ACCOUNT QTY AMOUNT HVAC CHANGEOUT - OTHER EQUIPMENT PC 101-0000742600 0', $38.00 Total Paid fo'r CHANGEOUT: $76.00 DESCRIPTION ACCOUNT QTY AMOUNT PERMIT ISSUANCE 101-0000-42404 0 $96.27 Total Paid f6r PERMIT ISSUANCE: $96.27 i DESCRIPTION ACCOUNT QTY AMOUNT TECHNOLOGY ENHANCEMENT FEE 502-0000-43611 0 $5.00 Total Paid for TECHNOLOGY ENHANCEMENT FEE: $5.00 0 e;rt.# Cit}r. Of La Quif1ta Buikr1ng 8i' Safety Division. P.O. Box 1504,78-495 Calle Tampico n U.Quinta, CA 92253 -:(760) 777-7012 l Building Permit Application and Tracking Sheet Perinit # Im-7' Project Address: 58-075 Jefferson Owner's Name:.Nori Gardner . A. P. Number. Address: 58-075 Jefferson Legal Description: Contractor. A#1 Services Heating & A/C City, ST, Zip: La Quinta, CA' 92253 Telephone: 760-578-4636 +',.,��sx.,x� Address: 78206 Varner Road #D-189 Project Description: Replace 4 ton heat pump for club City, ST, Zip: Palm Desert, CA 92211 house at Lake Cahuilla Telephone: 760-342-3610 City Lie'. #; State Lic. # : 977333 Arch., Engn, Designer. Address: City., ST, Zip: Telephone: v Y. `� - State Lic. #: ;. � of t' .wic . ,H Construction Type:. Occupancy: Project type (circle one): New Add'n Alter Repair Demo Sq. Ft : #Stories: —IOU Name of Contact Person: Steven Schnierer Telephone # of Contact Person: 818-73577876 Estimated Value of Project: $3,200.00 . APPLICANT: DO NOT WRITE BELOW THIS UNE # Submittal Req'd Recd TRACENG PERMIT FEES- EESPlan PlanSets Plan Check submitted Item Amount Structural Cales. Reviewed, ready for corrections Plan Check Deposit. . Truss C21cs. Called Contact Person Plait Check Balance Title 24 Calci. Plans picked up Construction Flood plain plan Plans resubmitted.. Mechanical Grading plan 2'' Review, ready for correct'iouslissue 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 correctionsliissue Developer Impact Fee Planning Approval. Called Contact Person A.I.P.P. Pub. Wks. Appr Date of permit issue School Fees Total Permit Fees 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 1 of 3 Project Name: Date Prepared: 5S -ors �' -7zs % 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 (� NRCC-MCH-01-E (Part 1 of 3) Certificate of Compliance, Declaration: Required on plans for all submittals. (� 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. Q 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. Q (3 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. Q (i 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. Q Q NRCC-MCH-03-E Mechanical Ventilation and Reheat is required for all submittals with multiple zone heating and cooling systems. Itis optional on plans. Q G NRCC-MCH-07-E (Part 1 of 2) Power Consumption of Fans. Required on plans where applicable 0 Q 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 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 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 (DGV) VAV Leakage Test Temp.. Reset Flow Control Shed Control El E3 El CA Building Energy Efficiency Standards - 2016 Nonresidentiat Compliance January 2016 STATE OF CALIFORNIA MECHANICAL SYSTEM'S CEC-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: • Data Prepared: S 9 - 0-7S e �erso, �s Y7 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-01-E compliance document is not considered a completed document and is not to be accepted by the building department unless the carred 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 Reset Controls - Controls ECMS L-) Ax: `--1 e' --V �vv�n 11 0 0 ❑ © 0 ❑ 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 may' CERTIFICATE OF COMPLIANCE" NRCC-MCH-01-E Mechanical Systems Page 3 of 3 Project Name: — C >-7-S - Date Prepared: 7 ZS 1 1-7 I DOCUMENTATION AUTHOR'S DECLARATION STATEMENT 1. 1 certify that this Certificate of Compliance documentation is accurate and complete. Do cu ntation Author Na �1rst1' Documentation Author Signature: �vev� e C mpan : . - Sign ture ate: 7 zst'-') Address: CEA/ HERS Certification Identification (If applicable): City/State/Zip: CIa 9 2211 Phone: 760- 34 Z-3 (o i0 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 identifled 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: - clty/State/Zip: Phone: CA Building. Energy Efficiency Standards - 2016 Nonresidential Compliance January 2016