BMCH2017-006178-495 CALLE TAMPICO Ct 0 D "i �NMUCl/
LA QUINTA, CALIFORNIA 92253 DESIGN & DEVELOPMENT DEPARTMENT
BUILDING PERMIT
Application Number:
BMCH2O17-0061
Property Address:
.44265 LAS VISTAS DR
APN:
604175013
Application Description:
RODRIGUEZ / HVAC CHANGE OUT
Property Zoning:
at
Application Valuation:
$4,800.00
Applicant:
1 ANTHONY PLUMBING HEATING & AIR CONDITI
72216 NORTH SHORE ST #101
THOUSAND PALMS, CA 92276
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.: 77 7 4
Date: 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.).
( ) 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 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 Address:
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
WORKER'S COMPENSFTION DECLARATION
I hereby affirm under penalty of perjury one d the following declarations:
. _ I have and will maintain a certificam of consent to self -insure for workers"
compensation, provided for by Section 3700 of the Labor Code, for the performance
of the won r 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: MIDWEST EMPLOYERS CASUALTY COMPANY 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 sows to become subject to the workers'
compensation laws of California, and agree that, if I should become subject to the
workers' compensation provisions of Sectio =700 of the Labor Code, I shallforthwith
comply with those provisions.
Date: Applica
WARNING: FAILURE TO SECURE WORKERS' CaMPENSATION COVERAGE IS UNLAWFUL,
AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO
ONE HUNDRED THOUSAND DOLLARS ($100,0[0). IN ADDITION TO THE COST OF
COMPENSATION, DAMAGES AS PROVIDED FOC IN SECTION 3706 OF THE LABOR CODE,
INTEREST, AND ATTORNEY'S FEES.
APPLICANT ACKNCWLEDGEMENT
IMPORTANT: Application is hereby made to the Building Official for a permit subject to
the conditions and restrictions set forth on thi: 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 :he 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 appliotion 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 ab ve information is correct.
I agree to comply with all city and county ordinances and st a laws relating to building
construction, and hereby authorize representa-ives o thi city to enter upon the above-
mentioned property for inspection purposes.
Datelt?12�1 Signature (Applicant cr Agit)
Date: 3/20/2017
Owner:
w
SHERI RODRIGUEZ
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44265 LAS VISTAS
at
LA QUINTA, CA.92253
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N Q LLJ
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Contractor:
Contractor:
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J ANTHONY PLUMBING HEAT
AIR C-MDITl� o
72216 NORTH SHORE ST
#101 M C5 o
THOUSAND PALMS, CA 92276
Z
CD
(760)328-8096
W
Llc. No.: 77779,c
o
WORKER'S COMPENSFTION DECLARATION
I hereby affirm under penalty of perjury one d the following declarations:
. _ I have and will maintain a certificam of consent to self -insure for workers"
compensation, provided for by Section 3700 of the Labor Code, for the performance
of the won r 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: MIDWEST EMPLOYERS CASUALTY COMPANY 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 sows to become subject to the workers'
compensation laws of California, and agree that, if I should become subject to the
workers' compensation provisions of Sectio =700 of the Labor Code, I shallforthwith
comply with those provisions.
Date: Applica
WARNING: FAILURE TO SECURE WORKERS' CaMPENSATION COVERAGE IS UNLAWFUL,
AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO
ONE HUNDRED THOUSAND DOLLARS ($100,0[0). IN ADDITION TO THE COST OF
COMPENSATION, DAMAGES AS PROVIDED FOC IN SECTION 3706 OF THE LABOR CODE,
INTEREST, AND ATTORNEY'S FEES.
APPLICANT ACKNCWLEDGEMENT
IMPORTANT: Application is hereby made to the Building Official for a permit subject to
the conditions and restrictions set forth on thi: 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 :he 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 appliotion 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 ab ve information is correct.
I agree to comply with all city and county ordinances and st a laws relating to building
construction, and hereby authorize representa-ives o thi city to enter upon the above-
mentioned property for inspection purposes.
Datelt?12�1 Signature (Applicant cr Agit)
Application Number:
BMCH2017-0061
Property Address:
44265 LAS VISTAS DR
APN:
604175013
Application Description:
RODRIGUEZ / HVAC CHANGE OUT
Property Zoning:
Application Valuation:
$4,800.00
Applicant:
J ANTHONY PLUMBING HEATING & AIR CONDITI
72216 NORTH SHORE ST #101
THOUSAND PALMS, CA 92276
Date: 3/20/2017
Owner:
SHERI RODRIGUEZ
44265 LAS VISTAS
LA QUINTA, CA 92253
Contractor:
J ANTHONY PLUMBING HEATING & AIR CONDITI
72216 NORTH SHORE ST #101
THOUSAND PALMS, CA 92276
(760)328-8096
LIc. No.: 777794
--------------------------------------------------------------------------------------------
Detail: HVAC CHANGE OUT - 14SEER/81AFUE SPLIT SYSTEM (CONDENSER AND COIL REPLACEMENT ONLY). CARBON MONOXIDE ALARM(S) TO BE
INSTALLED PRIOR TO FINAL INSPECTION. 2016 CALIFORNIA BUILDING CODES.
FINANCIAL INFORMATION
DESCRIPTION ACCOUNT
QTY AMOUNT
BSAS SB1473 FEE 101-0000-203060
$1.00
Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $1.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
HVAC CHANGEOUT - CONDENSER ONLY
101-0000-42402
0
$38.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
HVAC CHANGEOUT - CONDENSER ONLY PC
101-0000-42600
0
$25.33
DESCRIPTION
ACCOUNT
QTY
AMOUNT
HVAC CHANGEOUT - REPAIR/ALTERATION
101-0000-42402
0
$12.67
DESCRIPTION
ACCOUNT
QTY
AMOUNT
HVAC CHANGEOUT - REPAIR/ALTERATION PC
101-0000-42600
0
$5.07
Total Paid for CHANGEOUT: $81.07
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
.1UTALb: altS3.34
Bin #
qty cif ; aucnia
Building,& Safety Division
Permit # 78-495.Calle Tampico.
La Quinta, CA 92253 - (760) 777-701,2
Building Permit Application and Tracking Sheet
Project Address:} Owner's Name:
A: P. Number:
Address:
Legal Description:
City, ST, Zip:
Contractor:
Telephone:
Address:
-1 ANTHONY SERVIGES
Project Description: ' —?aN
City_ ST, Zip: 72216 NORTH SHORE ST STE 101%
ehnep '
o .
el 7v
T"�7
State Lic. # : I'll 7City
Lie.:4>:s::>:
Arch.; Erign, Designer:
Address:
City, ST, Zip:
Telephone:
e.
Construction on cY:
Type: Occupancy:
State Lic. 4. •
�Pa (circle one. New Add'n AlterRepair r Demo
Name of Contact Person:Sq.
Ft.:
#Stories:
# Units:
Telephone # of Contact Person:
Estimated Value of Project:p�
APPLICANT: DO NOT WRITE BELOW THIS LINE
9
Submittal
Req'd
Rec'd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Cafes.
Reviewed, ready for corrections
Plan Check Deposit
Truss Cates.
Called Contact Person
Plan Check Balance
Title 24 Cates.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan'
2" Review, ready for corrections/issue
Electrical .
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
II.O.A. Approval
Plans resubmitted
Grading
INHOUSE:-
Review, ready for corrcctions/issuc
Developer Impa=t Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Dale of permit issue
School Fees,
Total Pcrmit Fps
CERTIFICATE OF COMPLIANCE CFiR-ALT 02-E I
Alterations to Space Conditioning Systems (formerly CF-1R-ALT-1HVAC) (Page 1 of 3)
Project Name: RODRIGUEZ Date Prepared: 2017-03-20
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
CF111-ALT-02 document for each dwelling unit.
01
Project Name
RODRIGUEZ
02
Date Prepared
2017-03-20
03
Project Location
44265
04
Building Type
Single family
05
CA City
La Quinta
06
Dwelling Unit Name
RODRIGUEZ
¢
Dwelling Unit Conditioned
in- I I i'n'g" A. a
07
Zip Code
92253
08
Z
Floor Area (ft)
2000
SC System
CFA served
system a
refrigerant
Installing new SC
Installing
Installing
Installing
Identification or
Number of Space
by this SC
09
Climate Zone
4
15'
10
Conditioning (SC) Systems in
1
Name
Served
System (ft)
this Dwelling Unit:
component?
B. Space Conditioning (SC) System Inforrriaton
01
02
r ' % 03 N
� 04
' `
.�:.H
0�7
-
09
10
.
,
4
_OS
els the SCS
in- I I i'n'g" A. a
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?
I SC system?
Alteration Type
System 1
Location 1
2000
Yes
Yes
Yes
No
No
No
Altered space
conditioning system
C. Extension of Existing Dud System, Greater Than 40 Feet (Section 150.2(b)1Diib)
IThis section does not apply to this project.
Registration Number: 217-A020086795A-000-000-0000000-0000 Registration Date/Time: 2017-03-20 08:37:37 HERS Provider: CalCERTS
CA Building Energy Efficiency Standards - 2.016 Residential Compliance Report Version: 2016.1.005 Report Generated: 2017-03-20 08:38:03
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 3)
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
Outdoor
This field or
This field or
System 1
Central gas
Gas furnace
AFUE
81
Central split
condensing
SEER
14
Setback
section is not
section is not
furnace
AHU
AC
unit
applicable
applicable
Required Documentation:
CF2R-MCH-01-E - Space Conditioning Systems
- Duct insulation requirement for the new portions of supply -air and return -air duds or plenums: R6 (CZ 1-10, 12 and 13) and R8 (CZ 11 and 14-16)
CF2R and CF3R-MCH-20-H - Dud Leakage Test required when heating or cooling components are installed in ducted systems, or when more than 40 ft of dud 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 ven ication'required when refrigerant containing components are installed or altered (applicable in CZ 2, 8-15).
CF2R and CF311-MCH-23 Airflow Rate »300 CFM person 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 verifications of A r Flow MCH -23 o geran Chargee M_CH=25 ''
';44
'from
-Existing duct systems constructed, insulated or sealed with asbestos re exemp` MCDuL age Testing regwrementsW
in
d t ...y.. -•-' -,WIftW 1W, W In ,ac+ W 'ate :ars s,. .,yae .v:.a; PW '.n. ;—
-,"Pw .tar
E. Entirely New or Complete Replacement DuftSygem, with or without,Equipment Changeout,(Sections,150Z(b)1Diia•and 150.2(b)IE, F)
lid :ate 4 ;1 5
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-A020086795A-000-000-0000000-0000
Registration Date/Time:
2017-03-20 08:37:37
HERS Provider: CalCERTS
CA Building Energy Efficiency Standards - 2016 Residential Compliance Report Version: 2016.1.005 Report Generated: 2017-03-20 08:38:03
Schema Version: rev 10/16
CERTIFICATE OF COMPLIANCE CFIR-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:
Robinson, Kevin
Company:
Signature Date:
J ANTHONY PLUMBING HEATING & AIR CONDITIONING
2017-03-20 08:37:37
Address:
CEA/ HERS Certification Identification (if applicable):
72216 NORTH SHORE ST #101
City/State/Zip:
Phone:
THOUSAND PALMS CA 92276 b
760-343-2121
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 oflcompliance.is true and; correct.
2. lam 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, matenals components, and manufactured devices for the_buildmg design.or.system design identified on this Certificate of Compliance conform to the
requirements of Title 24, Part1 and Part6 of the Cahfornia,Code of Regulations., ' h'
a+
4. The building design features or system design features identified on tthis Certificate of Corripllance are tonststeM wit the informatiDn provided on Ail. ica6lep ompiiance documents, worksheets,
n
calculations, plans and specifications su,brnitted to the enforcement agency for p rovat,w)th this building permt apphcatiori `
b $ 3t.tk 6r"
:val)able
issued I will ensure that a registered copy of this Certificate of Compliance shall tie�rnade available with the; buildlttg:permit(s);Issued forrthe b ilding, and made to tk a enforcement agency for all applicable
inspections. I understand that a regirstered copy of this -Certificate of Complliance is required toabe included,w,it�h the docur nWion.,{the b6illder provides to the bu ld ng owner at occupancy.
Responsible Designer Name: 4F1 ;t�*.- tA 4
Responsible Designer Signature. V -
Robinson, Kevin
,(�°k�`
Company:
Date Signed:
J ANTHONY PLUMBING HEATING & AIR CONDITIONING
2017-03-20 08:37:37
Address:
License:
72216 NORTH SHORE ST #101
777794
City/State/Zip:
Phone:
THOUSAND PALMS CA 92276
760-343-2121
Digitally signed by CalCERTS. 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-A020086795A-000-000-0000000-0000
Registration Date/Time
2017-03-20 08:37:37
HERS Provider: CaICERTS
CA Building Energy Efficiency Standards - 2016 Residential Compliance Report Version: 2016.1.005 Report Generated: 2017-03-20 08:38:03
Schema Version: rev 10/16