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