BMCH2017-00154 4va>�rw VOICE (760) 777-7125
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253 FAX (760) 777-7011
DESIGN & DEVELOPMENT DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 1/24/2017
Application Number: BMCH2O17-0015 Owner:
Property Address: 77561 LOS ARBOLES MILJENKO GRGICH
APN: 658260042 77561 LOS ARBOLES
Application Description: GRGICH RESIDENCE / HVAC LA QUINTA, CA 92253
Property Zoning:
Application Valuation: $15,237.00
Applicant: Contractor:
IE INC JAN 2 3 2017 HARRISON ENTER? -RISES INC DBA GENERAL AIR
D
31225 LA BAYA 31170 RESERVE DRIVE
WESTLAKE VILLAGE, CA 91362 CITY OF LA QUINTA THOUSAND PALN6, CA 92276
DESIGN AND D�lELOPMENT DEPARTMENT (760)343-7488 .
Llc. No.: 686310
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter
9 (commencing with Section 70001 of Division 3 of the Business and Professions Code,
and my License is in full force and effect.
License Class: C20, C36 License No.: 686310
/ Date: 1 24, AD Contractoh
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
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
Carrier: INSURANCE COMPANY OF THE WEST Policy Number: WSD5031658
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
I certify that in the performance of the work for which this permit is issued, I
city or county that requires a permit to construct, alter, improve, demolish, or repair
shall not employ any person in any manner so a6 to become subject to the workers'
any structure, prior to its issuance, also requires the applicant for the permit to file a
compensation laws of California, and agree that'. if I should become subject to the
signed statement that he or she is licensed pursuant to the provisions of the,
workers' compensation provisions of Section 3730 of the Labor Code, I shall forthwith
Contractor's State License Law (Chapter 9 (commencing with Section 7000) of Division
comply with those provisions.
3 of the Business and Professions Code) or that he or she is exempt therefrom and the
'
�dZ
basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a
Date: 112—,41)-1 Applicant:
permit subjects the applicant to a civil penalty of not more than five hundred dollars
($500).:
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL,
(__j I, as owner of the property, or my employees with wages as their sole
AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO
compensation; will do the work,•and the structure is not intended or offered for sale.
ONE HUNDRED THOUSAND DOLLARS ($100,000. IN ADDITION TO THE COST OF
(Sec. 7044, Business and Professions Code: The Contractors' State License Law does not
COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,
apply to an owner of property who builds or improves thereon, and who does the work
INTEREST, AND ATTORNEY'S FEES.
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
APPLICANT ACKNOVIQEDGEMENT
within one year of completion, the owner -builder will have the burden of proving that
IMPORTANT: Application is hereby made to the Building Official for a permit subject to
he or she did not build or improve for the purpose of sale.).
the conditions and restrictions set forth on this a pplication.
(__j I, as owner of the property, am exclusively contracting with licensed contractors
1. Each person upon whose behalf this application is made, each person at whose
to construct the project. (Sec. 7044, Business and Professions Code: The Contractors'
request and for whose benefitwork is performeI under or pursuant to any permit
State License Law does not apply to an owner of property who builds or improves
issued as a result of this application', the owner,:and the. applicant, each agrees to, and
thereon, and who contracts for the projects with a contractor(s) licensed pursuant to
shall defend, indemnify and hold harmless the Cty of La Quinta, its officers, agents, and
the Contractors' State License Law.).
employees for any act or omission related to the work being performed under or
( ) I am exempt under Sec. B.&P.C. for this reason
following issuance of this permit.
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:
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 is: uance of such permit, or cessation of
work for 180 days will subject permit to cancellation.
I certify that I have read this application and staff 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: Signature (Applicant oi Agent): y
Date: 1/24/2017
Application Number: BMCH2017-0015 Owner:
Property Address: 77561 LOS ARBOLES MIUENKO GRGICE
APN: ` 658260042 77561 LOS ARBOL=S
Application Description: GRGICH RESIDENCE/ HVAC LA QUINTA, CA 92253
Property Zoning:
Application Valuation: $15,237:00
Applicant: Contractor:
IE INC HARRISON ENTERPRISES INC DBA GENERAL AIR
31225 LA BAYA 31170 RESERVE DPIVE
WESTLAKE VILLAGE, CA 91362 • THOUSAND PALMS, CA 92276
(760)343-7488 .
Llc. No.: 686310
--------------------------------------=------------------------------------------------------
Detail: HVAC CHANGE OUT- 18 SEER/80AFUE SPLIT SYSTEM [2016 ENERGY] CARBON MONOXIDE ALARM(S) TO BE INSTALLED PRIOR TO FINAL INSPECTION.
2016 CALIFORNIA BUILDING CODES:
FINANCIAL •• •
DESCRIPTION ACCOUNT QTY AMOUNT
BSAS SB1473 FEE
101-0000-20306 0 $1.00
Total Paid for BUILDING STANDARDS ADMINISTRATION'S 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 CHANG[OUT: $114.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PERMIT ISSUANCE
101-0000-42404
0
$96.27
Total Paid for PERMIT ISSUANCE: $96.27
STATE OF CALIFORNIA
ALTERATIONS- HVAC
CEC-CFIR-ALT-04-E Revised 01/16 CALIFORNIA ENERGY COMMISSION '"No'
CERTIFICATE OF COMPLIANCE CF1R-ALT-04-E
Alterations - HVAC CZ 2, and 8-15 (Page 1 of 1)
Site Address:
Enforcement Agency:
Date. Prepared:
Permit#:
Lc, r e_s�t'
Gid-.oR Loi Q'vink-a.
1 Z<t 1 t -
Equipment Type
Equipment Efficiency
New Ducting or Lineset:
Required R -value
Conditioned 2
Floor Area (ft)
Thermostat
❑ Packaged
XEvaporator Coil
I�LAFUE
COP
❑ R-6 (CZ 1-10, 12&13) Ducts
Served by system
Setback
SystemCondensing
Unit
$
❑ R-8' (CZ 11, 14-16) Ducts
) G,ZZ ft 2
(If not already
XSplit System
❑ Compressor
SEER
HSPF
❑ > R-2.8 Lineset"
present, must
❑ Mini Split
❑ Lineset
be installed)
Furnace
❑ TXV
EER
HERS VERIFICATION SUMMARY Installer determines work to be completed and matches to one of the options below. At permit application this
form is allowed to be filled out by hand. For final inspection all forms are to be registered (no hand filled forms allowed) and a copy left on site.
1. HVAC Changeout/Repair Required Compliance Documents to be left on site for Final:
All Equipment, CF1R-ALT-02-E
Condenser Unit, Evaporator Coil, CF2R-MCH-01-E, MCH -20-1-1, MCH -(23 or 24)2-H, MCH -25-1-12.
Compressor, TXV, Lineset, CF3R-MCH-20-H, MCH -(23 or 24)-H2, MCH -25 -HZ
Air Handler/Furnace2 (Can indude new ducting)
Installer Requirement: Dud leakage L15%. or 5_10% to outside, or seal all accessible leaks), Air Flow >_ 300 CFM/ton, Refrigerant Charge.
Exempted from duct leakage testing if:
111. Duct system registered with HERS provider as previously sealed, or ❑ 2. There is less than 40 linear feet of ductin unconditioned space, or
❑ 3. Existing duct systems are constructed, insulated or sealed with asbestos (list manufacture date of building --------
❑ 2. New HVAC System
Required Compliance Documents to be left on site for Final:
All new equipment and All New Ducts3
CF1R-ALT-02-E ,
including Mini Split
CF2R-MCH-01-E, MCH -20-H, MCH -22-H, MCH -(23 or 24)-H2, MCH -?5 -HZ
CF3R-MCH-20-H, MCH -22-H, MCH -(23 or 24)-H2, MCH -25 -HZ
Mini Splits require CF1R-ALT-02-E, CF2R-MCH-01-E, and (CF2R-CF3R) MCH -25-H
Installer Requirement: Duct leakage < 5%, Fan Efficacy (0.58W/CFM), Air Flow >_ 350 CFM/ton (or alternative), Refrigerant Charge
❑ 3. All New Ducts with Replacement
Required Compliance Documents to be left on site for Final:
All New Duds; and one or more of the following
CFIR-ALT-02-E
replaced: Condenser Unit, Evaporator Coil,
CF2R-MCH-01-E, MCH -20-H, MCH -(23 or 24)7H, MCH -25-H
Compressor, TXV, Lineset, Furnace2
CF3R-MCH-20-H, MCH -(23 or 24)-H, MCH -25-H
Installer Requirement: Duct leakage < 5%, Air Flow >_ 350 CFM/ton (or alternative), Refrigerant Charge
Exempted from duct leakage testing if: ❑ 1. Existing duct systems are constructed, insulated or sealed with asbestoe
❑ 4. New Ducting over 40 feet Required Compliance Documents to be left on site for Final:
New ducting but less than All New Ducts3 CF1R-ALT-02-E, CF2R-MCH-20-H, CF3R-MCH-20-H
Installer Required to: Duct leakage L15% or, 5510% to outside or, or seal all accessible leaks)
❑ EXCEPTION: Existing duct systems constructed, insulated or sealed with asbestos.
'All new ducting requires R-8 insulation when more than 40 ft installed in CZs 11 & 14-16 and R-6 in CZs 1-10, 12 &13, and R-6 insulation when less
tha6 40 ft installed. This includes in walls, between floors etc.
2 Heating only systems and Air Handler/Furnace changes do not require Air Flow MCH -(23 or 24), or Refrigerant Charge verification MCH -25
3 All New Ducts is when at least 75%of the duct system is new duct material, and up to 25%may consist of reused parts from the dwelling unit's
existing duct system (e.g., registers, grilles, boots, air handler, coil, plenums, duct material)
" R-2.8 (1" thick insulation) for linesets 1" and less.
Contractor (Documentation Author's /Responsible Designer'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 California Business and Professions Code to accept responsibility for the information on this document.
3. That the energy features and performance specifications for the design identified on this Certificate of Compliance conform to the
requirements of Title 24, Parts 1 and 6 of the California Code of Regulations (CCR).
4. That the energy features and performance specifications, materials, components, and manufactured devices fo- 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 CCR.
5. The building design features or system design features identified on this Certificate of Compliance are consistert 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.
Responsible Designer ame:
Re nsible Designer naturree:
Dat Signed•
License:
�
1 �. �•4 t'l
EoB b 310
Company:
e e �r
Address:
31170 �e_sexve �c
City/State/Zip:
11.o�sa ?1\ 922
Phone:
--7c.0-3`13,-7`188
For assistance or questions regarding the Energy Standards, contact the Energy Hotline at: 1-800-772-3300
ait, #.:.,
Permit #
Project Address: -7% 5 6)
arty of La Uinta :
Building 8i' Safety Division
78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-701,2
Building Permit Application and Tracking Sh3et
Owner's Name: Gr ^ L�
'A. P. Number:
Address: -7-156\
Legal Description:
City, ST, Zip: � Q i r�� a G A 9
a
SContractor:CS
Telephone: nc: '7 bo to-) - 3 �o
Address:
Project Description: _Qj Mr-c- <--i� G Coy I 4
City, ST, Zip: 1\,o
aZ b
coo �,' �7
aO vr�ticZC_
--A00__34-
Telephone: 3 '-1 �8
State Lic. # : (e aU 31 O
City Lic. #;
Arch.,'Engr., Designer:
Address:
City, ST, Zip:
Telephone. .
> >«;.
Construction Type: e•
a ,.
State i .i.
Lc
Project type (circle ne • New Add'n Alter. Repair r Demo
Name of Contact Person: Ski, eh :z- erer
Sq. Ft-:
#Stories:
#Units:
Telephone # of Contact Person:
lo
Estimated Value of Project: 1 1 S' , L 7. 00
APPLICANT: DO NOT WRITE BELOW THIS LINE
# Submittal Req'd Rcc'd TRACKING P7,RMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Cafes.
Called Contact Person
Plan Check Balance
Title 24 Cates.
Pians 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.0.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
'rd RcYiew, ready for corrections/issue.
Developer Impart Fee
Planning Approval
Called Contact Person
A.T.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees,
Total Permit Fc_s