BMCH2017-0001LICENSED 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.: 920,062
I
-'Date: I _ / —7 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
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 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)770-4357
Llc. No.: 920062
WORKER'S COMPE JSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
I have and will maintain a cert Ificate of consent to self -insure for workers'
compensation, as provided for by Section 3700 of the Labor Code, for the performance
of thk for which this permit is issuec.
wor
�I have and will maintain workers' compensation insurance, as required by
Section 3;00 of the Labor Code, for the p 2rformance of the work for which this permit
is issued. My workers' compensation insurance carrier and policy number are:
Carrier: NORGUARD INSURANCE COMPAr1Y Policy Number: TIWC721117
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 Sect 7 the Labor Code, I shall forthwith
comply with those provisions.
Date: 1 r _ l / Applicant:
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL,
AND SHALL SUBJECT AN EMPLOYER TO CRMINAL PENALTIES AND CIVIL FINES UP TO
ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION TO THE COST OF
COMPENSATION, DAMAGES AS PROVIDE[ FOR IN SECTION 3706 OF THE LABOR CODE,
INTEREST, AND ATTORNEY'S FEES.
APPLICANT ACENOWLEDGEMENT
IMPORTANT: Application is hereby made -o the Building Official for a permit subject to
the conditions and restrictions set forth ov this application.
1. Each person upon whose behalf this a.pplication is made, each person at whose
request and for whose benefit work is per:"ormed 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 aryl state that the above information is correct.
I agree to comply with all city and county �xdinances and stat a relatingito building
construction, and hereby authorize representatives of thisaWone
above-mentioned property for inspection purposes. •
Date: Signature (Applicant or Agent):
C `
VOICE (760) 777-7125
78-49S CALLE TAM PICO c
0 D
FAX (760) 777-7011
LA QWNTA, CALIFORNIA 92253
DESIGN & DEVELOPMENT DEPARTMENT
INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 1/3/2017
Application Number: BMCH2O17-0001
Owner: C�
Property Address: 54205 AVENIDA JUAREZ
DEBRA PEARL
APN: 774193023
Q w
Application Description: PEARL / CHANGE OUT (1)14SEER/8HSPF
SPLIT SYSTEM
92253 o
Property Zoning:
M o LU
Application Valuation: $6,926.00
g
}o
-Jt
Applicant:
Contractor: v L
TIMO'S AIR CONDITIONING & HEATING INC
TIMO'S AIR CONDI IONI G & HEA N C
72232 CORPORATE WAY
72232 CORP DRAT
THOUSAND PALMS, CA 92276
THOUSAND PALMS,
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.: 920,062
I
-'Date: I _ / —7 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
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 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)770-4357
Llc. No.: 920062
WORKER'S COMPE JSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
I have and will maintain a cert Ificate of consent to self -insure for workers'
compensation, as provided for by Section 3700 of the Labor Code, for the performance
of thk for which this permit is issuec.
wor
�I have and will maintain workers' compensation insurance, as required by
Section 3;00 of the Labor Code, for the p 2rformance of the work for which this permit
is issued. My workers' compensation insurance carrier and policy number are:
Carrier: NORGUARD INSURANCE COMPAr1Y Policy Number: TIWC721117
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 Sect 7 the Labor Code, I shall forthwith
comply with those provisions.
Date: 1 r _ l / Applicant:
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL,
AND SHALL SUBJECT AN EMPLOYER TO CRMINAL PENALTIES AND CIVIL FINES UP TO
ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION TO THE COST OF
COMPENSATION, DAMAGES AS PROVIDE[ FOR IN SECTION 3706 OF THE LABOR CODE,
INTEREST, AND ATTORNEY'S FEES.
APPLICANT ACENOWLEDGEMENT
IMPORTANT: Application is hereby made -o the Building Official for a permit subject to
the conditions and restrictions set forth ov this application.
1. Each person upon whose behalf this a.pplication is made, each person at whose
request and for whose benefit work is per:"ormed 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 aryl state that the above information is correct.
I agree to comply with all city and county �xdinances and stat a relatingito building
construction, and hereby authorize representatives of thisaWone
above-mentioned property for inspection purposes. •
Date: Signature (Applicant or Agent):
Date: 1/3/2017
Application Number: PMCH2017-0001 Owner:
Property Address: 54205 AVENIDA JUAREZ DEBRA PEAP.L
APN: 774193023
Application Description: PEARL / CHANGE OUT (1)14SEER/8HSPF SPLIT SYSTEM 92253
Property Zoning:
Application Valuation: $6,926.00
Applicant: Contractor:
TIMO'S AIR CONDITIONING & HEATING INC TIMO'S AIR CONDITIONING & HEATING INC
72232 CORPORATE WAY 72232 CORPORATE WAY
THOUSAND PALMS, CA 92216 THOUSAND ?ALMS, CA 92276
(760)770-4357
Llc. No.: 920062
---------------------------------------------------------------------------------------------
Detail: CHANGE OUT (1)14SEER/8HSPF SPLIT SYSTEM [2013 ENERGY] CARBON MONOXIDE ALARM(S) TO BE INSTALLED PRIOR TO FINAL INSPECTION. 2013
CALIFORNIA BUILDING CODES.
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 - SPLIT -SYSTEM
101-0000-42402
0
$76.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
HVAC CHANGEOUT - SPLIT -SYSTEM PC
101-0000-42600
0
$38.00
Total Paid for CHANGEOUT: $114.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PERMIT ISSUANCE
101-0000-42404
0
$96.27
Total Paid for PERMIT ISSUANCE: $96.27
i
CERTIFICATE OF COMPLIANCE CF1R-ALT-02-E
Alterations to Space Conditioning Systems (forrnedy CF -IR -ALT -HVAC) (Page 1 of 3)
Project Name: Debra P.-IT
earl Date Prepared: 2017-01-03
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
CF111-ALT-02 document for each dwelling unit.
01
Project Name
Debra Pearl
02
Date Prepared
2017-)1-03
03
Project Location
54205 Avenida Juarez
04
Building Type
Singlefamily
05
CA City
La Quinta
06
Dwelling Unit Name
Debra Pearl
�' :` ?
14.. V I
t -A# C
rX
Dwelling Unit Conditioned
SC System
07
Zip Code
92253
r;
08
Floor Area (ftz)
1370
Installing
Installing
Identification or
Number of Space
by this SC
09
Climate Zone
15
10
Conditioning (SC) Systems in
1
Name
Served
System (ftz)
this Dwelling Unit:
component?
B. Space Conditioning (SC) System InformationA 1\ k� 4, *, 11 { I
11 �
(c
01
02
X03 _
S k 04
'b!r `
"s 'x""06"
'07' 1/
" 08
'--1 1d9
10
FIs the SC='
I Lalling a •
�' :` ?
14.. V I
t -A# C
rX
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 (ftz)
system?
component?
components?
feet of ducts?
duct system?
SC system?
Alteration Type
System 1
Location 1
1370
Yes
Yes
Yes
No
No
No
Altered space
conditioning system
C. Extension of Existing Duct System, Greater Than 40 Feet (Section150.2(b)SDiib)
This section does not apply to this project.
Registration Number: 217-A020000347A-000-000-0000000-0000 Registration Date/rime: 2017-01-03 08:23:02 HERS Provider: CaICERTS
CA Building Energy Efficiency Standards - 2016 Residential Compliance Report Version: 2016.1.005 Report Generated: 2017-01-03 08:23:15
Schema Version: rev 10/16
Ell
CERTIFICATE OF COMPLIANCE
CF1R-ALT-02-E
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)
O1
02
03
04
05
06
07
08
09
10
it
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 split
All new
Central split
All new
This field or
This field or
System 1
HP
heating
HSPF
g
HP
cooling
SEER
.4
Setback
section is not
section is not
components
components
applicable
applicable
Required Documentation:
CF2R-MCH-01-E - Space Conditioning Systems
- Duct insulation requirement for the new portions of supplya it and retum-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: <= 15% or <= 10% leakage to outiide;'or seal all accessible leaks.
CF2R and MR -MCH -25-H Refrigerant Charge verification required when refrigerant containing components are installed or altered (applicable in CZ 2,84%.
CF211 and CF311-NCH-23 Airflow Rate >i:,300 CFM per ton. required when MCH -25 is required.
Exceptions:'`
- Duct systems registered with HERS provider as previously sealed are exe47, m MCH -20 Duct Leakage Testing requirements
- Heating -only systems and Air Handler Furnace changes do not requirevenfiwti n'o'f Air Flow MCH 123,fRefrigerenYl7,arge MCH=25`.'
-Existing duct systems constructed, insulated or sealed with asbestos are exemptifrom MCH 02 Duct,Lealoge Testing requiiemen`ti.
fW VL 8( A #f y's 0 U y6 0 A _. it It W11 it
i
-%"" `. _ --- " +..r __
E. Entirely New or Complete Replacement Duct,System, with or without Equipment Changeout (Sections-150Z;b)1Diia.and 150.2(b)3E, F)
X% d IE y iF-
Y This section does not apply to this project.
'
F. Entirely New or Complete Replacement Space Conditioning System (Section 150.2(b)iC)
This section does not apply to this project.
Registration Number: 217-A020000347A-000-000-0000000-0000
Registration Date/Time: 2017-01-03 08:23:02
HERS Provider: CaICERTS
CA Building Energy Efficiency Standards - 2016 Residential Compliance Report Version: 2016.1.005 Report Generated: 2017-01-03 08:23:15
Schema Version: rev 10/16
ro
CERTIFICATE OF COMPLIANCE CFSR-ALT-02-E
Alterations to Space Conditioning Systems (formerly CF -SR -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:
Timo , Joseph
11�M6
Company:
Signature Date:
TIMO'S AIR CONDITIONING & HEATING INC
2017-01-03 08:23:02
Address:.
CEA/ HERS Certification Identification (if applicable):
72232 Corporate Way
City/State/Zip:
Phone:
THOUSAND PALMS CA 92276
760-770-4357
Responsible Person's Declaration statement
I certify the following under penalty of perjury, under the la`w`s;of the State of California:
1. The information provided on.th(s.Certificata of Compliance_is,true and correct.' t
2. 1 am eligible under Division 3 of, the Business and Professions Code to accept responiibility for the building design or system design identified on this Certificate of Compliance(responsible designer).
3. That the energy features and Performance specifiications, 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 Califoriia.Code ofy egulahon - er� }
e -�
4. The building design features or system design features identified ondhis Certiricate of Compliance are consistent w th the infortnation,p`*rovided on wtheoapplicable compliance documents, worksheets,
'. ° 1
r,—ppr R f i. C i C- P
calculations, plans and specifications submittgE to the nforcement agency for aDProval with this bwldmg Dermn ii-
+ '
A i shall, f 5 /vaila 4� 9'r R ?i"9
S. I will ensure that a registered copy of thisCertificate'ofyCompliance shall be made,avadable with the bwlding permrt(s) issued for the building, and,. ade a Iable,to the"enforcement agency for all applicable
inspections. I understand that a registered copy of ti iiCeirtlficate of Compliance�requ� toincluded with the�dgcumentationAhe builderp_owddde/ss tt�the building owner at occupancy.
Responsible Designer Name: � 'i i .:'
—e .Lw A
Responsible Designer sl'gnature: V I (�
Timo , Joseph
r
Company:
Date signed:
TIMO'S AIR CONDITIONING & HEATING INC
2017-01-03 08:23:02
Address: .. -
License:
72232 Corporate Way
920062
City/State/Zip:
Phone:
THOUSAND PALMS CA 92276
760 770-4357
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 .7r the accuracy of the information.
Registration Number: 217-A020000347A-000-000-0000000-0000 Registration Date/ Time: 2017-01-0308:23:02 HERS Provider: CaICERTS
CA Building Energy Efficiency Standards - 2016 Residential Compliance Report Version: 2016.1.005 Report Generated: 2017-01-03 08:23:15.
Schema Version: rev 10/16
R
Bin # City Of u • QUihta
Building 1r Safety Division
P.O, Box 1504, 78-495 Calle Tampico .
Permit # La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Project AddTOSS. ad �/ � � )eP±A�d
wner's Name: ��t4 iL�—
A. P. Number. dress:
Legal Description: City, ST, Zip:
Contractor. �d�CJ.�d' c�a% 4-. Telephone: ' ( �
Address:
��}"'� 0`n s Pro" Description*
City, ST, Zip: CP
Telephone:X46— •-7 3.
State Lic. # ; Q D City Lic. #;
Arch., Engr., Designer:
Address:
city., ST. Zip:
Telephone:
State Lic, 4:
Name of Contact Pcsson:..�"
Telephone # of contact Person, a
3`ao/ -7
qua)
Construction Type; Occupancy'
Project type (circle one): i New Add'n Alter Repair Demo
Sq. FL # Stories: #Units
F,stitaated Value of Proj
pT WRITE Rpt -m THIS UNI;
At FUUAty
t ud N..
TR�eL'FC»�G
Plan Check submitted
#,...
Submittal
Plan Sets
Req'd
Recd
Structural Cala.
Reviewed, ready for corrections
-,-�
Truss Cala.
Called Contact Person
Title 24 Cales.
Purrs picked vp
Flood plat. plan
Plans resubmitted
Grading plan
20' Review, ready for correctionslissue
Subcontactor List
Called Contact Person
GrantDccd
Plans picked up
li.O.A• Approval
Plans, resubmitted
INHOUSE -
3" Rtvlew, ready for cgrrectionsrissue
-
Planning Approval
Pub. Wks. Appr
Called Contact Person
Date of permit issue
Schodl FCC;
Item Amount
Plan Check Deposit
Plan Check Balance •
Construction
Mechanical
• Electrical
Plumbing
S,Mx
Grading
Developer Impact Fee
• A.LP,P.
Tota: Permit Fees