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BMCH2017-0508I 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Permit Type/Subtype: Application Number: Property Address: APN:, Application.Description Property Zoning: Application Valuation: TAt4 aw DESIGN & DEVELOPMENT DEPARTMENT BUILDING PERMIT MECHANICAL/ BMCH2O17-0508 81345 KINGSTON HEATH. 767490015 KRUSZEWSKI / (4) HVAC CHANGEOUTS Applicant: IE INC _ 31225 LA BAYA WESTLAKE VILLAGE, CA 91362 - D Q � DEC 2 8 2017 CITYOFLAQUINTA COMMUNITY DEVELOPMENT DEPARTt,9ENT VOICE (760) 777-7125 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 12/28/2017 Owner: KEVIN KRUSZEWSKI 81345 KINGSTON HEALH . LA QUINTA, CA 92253 Contractor: PSYCHROM INC.DBA NIELSEN FIRE AND ICE HE 56310 PIMA TRAIL UNIT C YUCCA VALLEY, CA 92284 (760)366-9811 Llc. No.: 1032788 ----------------------------------------------- LICENSED CONTRACTOR'S DECLARATION ----------------------------------------------- WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter I hereby affirm under penaltyof perjury one of the following declarations: 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, I have and will maintain a certificate of consent to self -insure for workers' and my License is in full force and effect. compensation, as provided for by Section 3700 of the Labor Code, for the performance License Class: License No.: 1032788 of the work for which this permit is issued. I have and will maintain workers' compensation insurance, as required by �-2 lir 1-1 Conte tractor. 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: OWNER -BUILDER DECLARATION Ca EXEMPT EX,E�MPT Policy Number: _ I hereby affirm under penalty of perjury that I am exempt from the Contractor's State _ certify that in the performance of the work for which this permit is issued, I License Law for the following reason (Sec. 7031.5, Business and Professions Code: Any shall not employ any person in any manner so as to become subject to the workers' city or county that requires a permit to construct, alter, improve, demolish, or repair compensation laws of California, and agree that, if I should become subject to the any structure, prior to its issuance, also requires the applicant for the permit to file a workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith signed statement that he or she is licensed pursuant to the provisions of the comply with those provisions. 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 I_Q bei: A p cant:��— 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 WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, ($500).: AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO (_) I, as owner of the property, or my employees with wages as their sole ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION TO THE COST OF " compensation, will do the work, and the structure is not intended or offered for sale. COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, (Sec. 7044, Business and Professions Code: The Contractors' State License Law does not INTEREST, AND ATTORNEY'S FEES. apply to an owner of property who builds or improves thereon, and who does the work himselfor herself through his or her own employees, provided that the improvements APPLICANT ACKNOWLEDGEMENT are not intended or offered for sale. If, however, the building or improvement is sold IMPORTANT: Application is hereby made to the Building Official for a permit subject to within one year of completion, the owner -builder will have the burden of proving that the conditions and restrictions set forth on this application. he or she did not build or improve for the purpose of sale:). 1. Each person upon whose behalf this application is made, each person at whose (_) I, as owner of the property, am exclusively contracting with licensed contractors request and for whose benefit work is performed under or pursuant to any permit to construct the project. (Sec. 7044, Business and Professions Code: The Contractors' issued as a result of this application , the owner, and the applicant, each agrees to, and State License Law does not apply to an owner of property who builds or improves shall defend, indemnify and hold harmless the City of La Quinta, its officers, agents, and thereon, and who contracts for the projects with a contractor(s) licensed pursuant to employees for any act or omission related to the work being performed under or the Contractors' State License Law.). following issuance of this permit. (_) I am exempt under Sec. B.&P.C. for this reason 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. Date: Owner: I certify that I have read this application and state that the above information is correct. CONSTRUCTION LENDING AGENCY • I agree to comply with all city and county ordinances and state laws relating to building I hereby affirm under penalty of perjury that there is a construction lending agency for construction, and hereby authorize representatives of this city to enter upon the the performance of the work for which this permit is issued (Sec. 3097, Civ. C.). above-mentioned property for inspection purposes. Lender's Name: D e': IZ �' t1 Sig n1ature.(Applicant_orAgti-3wG�� Lender's Add Date: 12/28/2017 Application Number: BMCH2O17=0508 Owner: Prop Ttoddress ..,•.'„,"81345 KINGSTON'HEATH KEVIN KRUSZEWSXl APN: 767490015 81345 KINGSTON HEALH Application Description:. KRUSZEWSKI / (4) HVAC CHANGEOUTS LA QUINTA, CA 922253 Property Zoning:: Application Valuation: Applicant: Contractor. IE INC PSYCHROM INC DBA NIELSEN FIRE AND ICE HE 31225 LA BAYA 56310 PIMA TRAIL UNIT C - WESTLAKE VILLAGE, CA 91362 YUCCA VALLEY, CA 92284 (760)366-9811 ---------------------------- Llc. No.: 1032788• - Detail: (4) HVAC CHANGE OUTS - (1) 2.5 TON 14SEER/80AFUE, (2-4) 3, 3.5, AND 5 TON 16SEER/80AFUE SPLIT SYSTEMS. CARBON MONOXIDE ALARM(S) TO BE INSTALLED PRIOR TO FINAL INSPECTION. 2016 CALIFORNIA BUILDING CODES. FINANCIAL INFORMATION DESCRIPTION ACCOUNT QTY AMOUNT HVAC CHANGEOUT - SPLIT -SYSTEM 101-0000-42402 0 $156.04 DESCRIPTION ACCOUNT QTY AMOUNT HVAC CHANGEOUT - SPLIT -SYSTEM PC 101-0000-42600 0.$312.08 Total Paid for CHANGEOUT: $468.12 DESCRIPTION ACCOUNT -QTY AMOUNT PERMI.TISSUANCE 101-0000-42404 0 $98.83 Total Paid for PERMIT ISSUANCE: $98.83. DESCRIPTION ACCOUNT QTY AMOUNT RECORDS MANAGEMENT FEE - 101-0000-42416 0 $10.00 • . Total Paid for RECORDS MANAGEMEN- FEE: $10.00 DESCRIPTION ACCOUNT D.TY AMOUNT TECHNOLOGY ENHANCEMENT FEE 502-0000-43611 0 $5.00 Total Paid for TECHNOLOGY ENHANCEMEN- FEE: $5.00 Bin. # C►�}/ Of LaQ[►►►1� Btlilding 8r Safety Div[sPon ' P.O. Box 1504,78-495 Calle Tampico La.Qtdnta, CA 92253 -.:(760) 777-7012 Building Permit Application and Tracking Sheet Permit # ProjectAdder: 81345 Kingston Heath Owner's Name:. Kevin Kruszewski A- P. Number. Address: 81345 Kingston Heath Legal Description: City, ST, Zip: La Quinta, CA 92253 Contractor. Nielsen Fire and Ice Heating and Air Telephone: 248-561-9294 Address: 56310 Pima Trail Unit C Proje4Description: . City, ST, Zip: Yucca Valley, CA 92284 Replace 5 ton / 80,000 BTU complete HVAC system Telephone: 760-366-9811 M,• Replace 3.5 ton / 60,000 BTU complete HVAC system. Replace 3 ton 160,000 BTU complete HVAC system State Lic. # : 1032788 City Lie. #: Arch, Engr:, Designer. Replace 2.5 ton A/C Address:. City., ST, Zap: Telephone: P Y�' State Lic #: ,; �,�j Name ofContact Person: Steven Schnierer Construction Type:. Occupancy: Project type (circle one): New Add'n Alter Repair Demo Sq. Ft:# Stories: #Units ' Telephone # of Contact Person: 818-735-7876 Estimated Value of Project: $30,000.00 . APPLICANT:- DO NOT WRITE BELOW THIS UNE # Submittal Req'd Reed TRAC ING PERMIT FEES Plan Sets Pian Check submitted Item Amount Structure! Calan. Reviewed, ready for corrections '. Plan Check Deposit. . Truss Calcs• Called Contact Person Plan Check Balance Title 24 Calls. Plans picked up Construction Flood pWa plan Plans resubmitted Mechaiilcal Grading plan 214 Review, ready for corrections/issue Electrical Subcontactor List Called Contact Person Plumbing Grant Deed Plans picked up SALL H.O.A. Approval Plans resubmitted Grading IN HOUSE:- '^' Review; ready for corrections/issue Developer Impact Fee Planning Approval Called Contact Person A.LP.P. Pub. Wks. Appr Date of permit Issue School Fees Total Permit Fees CERTIFICATE OF COMPLIANCE - CF111-ALT 024 Alterations to Space Conditioning Systems (formerly CF -1R -ALT -HVAC) r (Page 1 of 4) 'Project Name: Kevin Kruszewski . Date Prepared.: 2017-12-2$ A. General -Information CF111-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 Kevin Kruszewski 02 Date Prepared 2017-12-28 03 Project Location 81345 Kingston Heath 04 Building Type Single family '05 CA City La Quinta 06 Dwelling Unit Name Kevin Kruszewski ''. rs the SCS' Dwelling Unit Conditioned 07 Zip Code 92253 08 Floor Area (ft) 4500 CFA served system a refrigerant Installing new SC Number of Space Installing 09 Climate Zone 15 - , __ 10 Conditioning (SC) Systems.im 4 containing system more than 40 entirely new this Dwelling Unit: B. Space Conditioning (SC) System Information 14 01 02 03 04 .�_. 05 07 ., , 08 09 10 A € ''. rs the SCS' Installin 'a V 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 1125 Yes Yes Yes No No No Altered spaceconditioning system System 2 Location 2 1125 Yes Yes Yes No No No Altered space conditioning system System 3 Location 3 1125 Yes. Yes Yes No No No Altered space conditioning system System 4 Location 4 1125 Yes Yes Yes No No No Altered space • conditioning system Registration Number: 217-A026578894A-000-000-0000000-0000 Registration Date/Time: .2017-12-28 09:59:55 HERS Provider: CaICERTS CA Building Energy Efficiency Standards -'2016 Residential Compliance Report Version: 2016.1.006 Report Generated: 2017-12-28 12:59:57 Schema Version: rev 10/16 CERTIFICATE OF COMPLIANCE CF1R-ALT 02-E Alterations to Space Conditioning Systems (formerly CF -1R -ALT -HVAC) (Page 2 of 4) C. Extension of Existing Duct System, Greater Than 40 Feet (Section150.2(b)1Diib) This section does not apply to this project. 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 . Central gas All newAll 'S Central split new SEER Setback This field or is This field or System 1 furnace .heating i :AFUE 80 AC cooling 16 section not section is not components '' components applicable applicable Central gas * All new _ _ Central split All new This field or This field or System 2 furnace heating AFUE gp';." cooling SEER 16 Setback section is not section is not components y, -C V components . k applicable applicable System 3 Central gas All new heating AFUE .. 80 * ) ( C ntral split tAll•neA ' i cooling `'�.,, SEER 16 Setback This field or section is not This field or section is not furnace components P conents p applicable PP applicable . PP Central gas All new s o � �Central`split All new w. ��IHThis field or This field or. System 4 furnace heating AFUE 80 AC cooling SEER 14 Setback section is not section is not components components applicable applicable Required Documentation: CF211-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: <=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: 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; or Refrigerant Charge MCH -25. :Existing duct systems constructed, insulated or sealed with asbestos are exempt from MCH -20 Duct Leakage Testing requirements. Registration Number: 217-A026578894A-000-000-0000000-0000 Registration Date/Time: 2017-12-28 09:59:55 HERS Provider: CaICERTS CA Building Energy Efficiency Standards - 2016 Residential Compliance Report Version: 2016.1.006 Report Generated: 2017-12-28 12:59:57 Schema Version: rev 10/16 CERTIFICATE OF COMPLIANCE CF1R-ALT 02-E Alterations to Space Conditioning Systems (formerly CF -1R -ALT -HVAC) (Page 3 of 4) E. Entirely New or Complete Replacement Duct System, with or without Equipment Changeout (Sections 150.2(b)1Diia 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-A026578894A-000-000-0000000-0000 CA Building Energy Efficiency Standards - 2016 Residential Compliance nc!:, ' KR Registration Date/Time: 2017-12-28 09:59:55 Report Version: 2016.1.006 Schema Version: rev 10/16 HERS Provider: CaICERTS Report Generated: 2017-12-28 12:59:57 4 CERTIFICATE OF COMPLIANCE UlR-ALT 024 Alterations to Space Conditioning Systems (formerly CF -IR -ALT -HVAC) (Page 4 of $). Documentation Author's Declaration Statement 1. 1 certify that this Certificate of Compliance documentation is accurate and complete. Documentation Author Name: DocLimentetion Authnr Signature: � Jan Jacoby, Ian �acobJr. Company: Signature Date: i PERMIT E RATERS 2017-12-28 09:59:55 Address: CEA/ HERS Certification Identification (if applicable): 31225 La Baya Drive #213 City/State/Zip: Phone: West Lake Village CA 91362 ;'; 818-735-7876 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 . , bns requirements of Title 24, Part 1 and Parf.6 of the California Code of�Re�ulat� 4. The building design features or system design features identified on this Certificate a bf Compliance are consistent-lwith, he information,.provided on otherapplicable compliance documents, worksheets, calculations, plans and specifications submitted. t000tthe enforcement agency for approvaiWtK this building permit application. �� .n e, 5. I will ensure that a registered copy of this Certificate of,Campliance shall be mademailable with the buildingipet mtt(s) issued for the 11181 g, and, made ava,llable,toYtieenforcement agency for all applicable inspections. I understand that a registered copy of thls•Cettlticate of Compllance)s required to be..lncluded with th! cumentation the bUIder provides to the building owner at occupancy. .: �• v „ Responsible Designer -Name: i Responsible De°sig er Signature: V 9 ... Jacoby, Ian can Lacory Company: Date Signed: i PERMIT E RATERS 2017-12-28 09:59:55 Address: License: 31225 La Baya Drive #213 HOMEOWNER City/State/Zip: Phone: West Lake Village CA 91362 818-735-7876 Easy to Verify �+ at CaICERTS.com Digitally signed by Ca10ERTS. 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-A026578894A-000-000-0000000-0000 . Registration Date/Time: 2017-12-28 09:59:55 HERS Provider: CaICERTS CA Building Energy Efficiency Standards - 2016 Residential Compliance Report Version: 2016.1.006 Report Generated: 2017-12-28 12:59:57 Schema Version: rev 10/16