BMCH2018-0061r;
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78-495 CALLE TAMPICO
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LA QUINTA, CALIFORNIA 92253
DESIGN & DEVELOPMENT DEPARTMENT
BUILDING PERMIT
Permit Type/Subtype:
MECHANICAL/
Application Number:
BMCH52240
Property Address:
A ENIDA
52240 AVENIDA MADERO .D
APN:
773242003
Application Description:
COATS RESIDENCE / HVAC CHANGE 0
Property Zoning:
r
MAR 1 3 208
Application Valuation:
.$6,000.00
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 3/13/2018
Owner:
S OATS
A ENIDA MADERO
IfA U , CA 92253
[U)
CITY OF LA QUINTA ' Contractor:
STEVE COATS
Applicant: DESIGN AND DEVELOPMENT DEPAR /BUILDER
_
52240 AVENIDA MADERO
LA QUINTA, CA 92253
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: License No.:
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 contractors) licensed pursuant to
the Contractors' State License Law.).
(_) I am exemp 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
Lender's
LIc. No.:
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one o- the following declarations
I have and will maintain a certificate of consent to self -insure for workers'
compensation, as provided for by Section 370C of.the Labor Code, for the performance
of the work for which this permit is issued.
I have and will maintain workers' ccmpensation 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: _ Policy Number: _
I certify that in the performance of :he 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 Section 3700 of the Labor Code, I shall forthwith
comply with those provisions.
Date:
Applicant:
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL,
AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO
ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION TO THE COST OF
COMPENSATION, DAMAGES AS PROVIDED FOF_IN SECTION 3706 OF THE LABOR CODE,
INTEREST, AND ATTORNEY'S FEES.
APPLICANT ACKNOWLEDGEMENT
IMPORTANT: Application is hereby made to the Building Official for a permit subject to
the conditions and restrictions set forth on this 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 the applicant, each agrees to, and
shall defend, indemnify and hold harmless the Dty 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 cancel ation.
I certify that I have read this application and st: to 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 represenGs..
to enter upon the
above -me ion d property for inspection puDate: 1S Signature (Applica
Date: 3/13/2018
Application Number:
BMCH2O18-0061
Owner:
Property Address:
52240 AVENIDA MADERO
STEVE COATS
APN:
773242003
52240 AVENIDA MADERO
Application Description:
COATS RESIDENCE / HVAC CHANGE OUT
LA QUINTA, CA 92253
Property Zoning:
Application Valuation:
$6,000.00
Applicant:
Contractor:
STEVE COATS
OWNER / BUILDER
52240 AVENIDA MADERO
LA QUINTA, CA 92253
---------------------------------------------------------------------------------------------
LIc. No.:
Detail: HVAC CHANGE OUT - 14SEER/80AFUE PACKAGED SYSTEM. CARBON MONOXIDE ALARM.(S)
TO BE -INSTALLED PRIOR TO FINAL INSPECTION. 2016 .
CALIFORNIA BUILDING CODES.
FINANCIAL INFORMATION
DESCRIPTION ACCOUNT QTY AMOUNT
BSAS SB1473 FEE
101-0000-20306 0 $1.00
Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $1.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
HVAC CHANGEOUT - PACKAGED UNIT
101-0000-42402
0
$39.01
DESCRIPTION
ACCOUNT
QTY
AMOUNT
HVAC CHANGEOUT - PACKAGED UNIT PC
101-0000-42600
0
$26.01
Total Paid for CHANG=OUT: $65.02
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PERMIT ISSUANCE
101-0000-42404
0
$98.83 .
Total Paid for PERMIT ISSU.aNCE:. $98.83
DESCRIPTION
ACCOUNT
QTY
AMOUNT
RECORDS MANAGEMENT FEE
101-0000-42416
0
$10.00
Total Paid for RECORDS MANAGEMENT FEE: $10.00
DESCRIPTION.
ACCOUNT
QTY
AMOUNT
TECHNOLOGY ENHANCEMENT FEE
502-0000-43611
0
$5.00
Total Paid for TECHNOLOGY ENHANCEMENT FEE: $5.00
TOTALS: $179.85
i
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P:•O. BOX 1504
LA QUINTA, CALIFORNIA 92247-1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
BUILDING BZ SAFETY DEPARTMENT
PROPERTY OWNER'S PACKAGE
(760) 777-7012
FAX (760) 777-7011
Disclosures. & Forms for Owner -Builders Applying fo'.Construction Permits
IMPORTANT! NOTICE TO PROPERTY OWNER
Dear Property Owner:
An application for a building permit has been submitted in your name listing yourself as the builder of the properly
improvements specified at
We are providing you with an Owner -Builder Acknowledgment and Information Verification Form to make you aware of your
responsibilities and possible risk you may incur by having this pemiit issued in your name as the .
Owner -Builder. We will not issue a building permit until -you have read, initialed your understanding of each provision,
usigned, and returned this form to us at our official address indicated. An agent of the owner carrot execute this notice
nless you, the property owner, obtain the prior approval of the permitting authority.
OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION
IREC IONS: Read and initial each statement below to signs you understand or verify.this information.
I understand a frequent practice of unlicensed persons is to have the property owner _obtain an "Owner -Builder"
uilding permit that erroneously implies that the property owner is providing his or her,own laborand miterial personally. I, as
an Owner -Builder, may be held liable and subject to serious financial risk for any injuries sustained b✓.ari unlicensed person
and his or her employees while working on my property. My homeowner's insurance may not proVde.coverage for those
injuries. I am willfully acting as an Owner -Builder and am aware of the limits of my insurance coverage for injuries to workers
Von property'.
. I understand building permits are not required to be signed by property owners unless they are responsible for the ction and are not hiring a licensed Contractor to assume this responsibility.
I understand as an "Owner -Builder" I am the responsible party of record on the permit. I understand that I may protect
from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my
own.
4: I understand Contractors are required by law to be licensed and bonded in California and to list tiiru license numbers on
'ts- d contracts.
I understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total value
f my co 'truction is at least five hundred dollars ($500); including labor and materials, I may be considered an "employer"
der s e and federal law.
. I understand if I am considered an ".employer" under state and federal law, I must register. with the state and federal
v mment, withhold payroll taxes, provide workers' compensation disability insurance- and contribute to unemployment
Azegally
ach "employee." I also understand my failure to abide by these laws may subject me to.serious financial
under California Contractors' State License Law,an Owner -Builder who builds sinble-family residential
build them with the intent to offer them for sale, unless all work is pejformed by licensed
subcontractors and the number of structures does not exceed four within any calendar year, or all of the work is performed
under contract with a licensed general building Contractor.
gas
8. I understand as an Owner -Builder if I sell the property for which this permit is issued, I may be held liable for any
ancial or. personal injuries 'sustained by any subsequent owner(s) that result from any latent construction defects in the .
w rkmanship or materials.
I understand I may.obtain more information regarding my'obligations as an "employer" from the Internal Revenue
ervice, the United..States' Small -Business. Administration, the California Department. of Benefit Payments, and the California
Division of Industrial Accidents. I also understand I may contact the California Contractors' State License Board (CSLB) at 1-
800-321-CSLB (2752) or www.6slb.ca.gov-for more information about licensed contractors.
I"
am aware of and consent to an Owner -Builder building permit applied for in my name, and understand that I am the
legally, and financially responsible for proposed construction' activity at the following address:
/11. I agree that, as the party legally.and financially responsible for this proposed construction activity, I wili abide by all
applicable laws and requirement$ that -govern Owner -Builders as.well as employers.
12. I agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the information I
have provided on this form. Licensed contractors are regulated by laws designed .to protect the public. If you contract with
someone who does not have a license, the Contractors' State License Board may be unable to assist you with any financial loss
you may sustain as a result of a complaint. Your only remedy against:unlicensed Contractors may be in civil court. It is also
important for you to understand that 'if an unlicensed Contractor or employee of that individual or firm is injured while working
on your property, you may be held liable for damages: If you obtain a permit as Owner -Builder and. wish to hire"Contractors,
you will be responsible for verifying whether or `not those Contractors are properly licensed and the status of their workers'
compensation insurance coverage.
Before a building permit can be issued, this. form must be completed and signed, by the property owner and returned to
the agency responsible for issuing the permit. Note: A copy of the property owner's driver's. license, form notarization, or
other verification acceptable to the agency is required to be presentedd when the permit is issued to verify the property
owner's signature.
Signature of property o er Date: / 3
Note: The following Authorization Form is required to be completed by the property owner only when, designating
an agent of the property .owner to apply for a construction permit for the Owner -Builder.
AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF
Excluding the Notice to Property Owner, the 'execution of which I understand is my personal responsibility, I hereby authorize
the following persons) to act as my agent(s) to apply for, sign; and file the documents necessary to obtain an Owner -Builder
Permit for my project.
Scope of Construction Project (or Description of Work):
Project Location or Address:
Name of Authorized Agent:
Address of Authorized Agent:
Tel No
I declare under, penalty of perjury that I am the property owner for the address listed above and I personally filled out the above
o .
information and certify its accuracy. Note:.4 copy.of the.owner's driver's license, form notarization, or other verification
acceptable to the agency is required.to• bepresented when the pernift is issued to verify the property owner's signature.
Property Owner's Signature: Date:
STATE OF CALIFOPS41A
ALTERATIONS - HVAC
CEC-CFIR-ALT-04-E (Revised 01/16) CALIFORN A ENERGY COMMISSION
CERTIFICATE OF COMPLIANCE CF1R-ALT-04-E
Alterations - HVAC CZ 2, and 8-15 (Page 1 of 1)
Site Address:
3227`��.,�/12-v
Enforcement Agency:
Date Prepared:
Permit#:
ent Type
Equipment Efficiency
New Ducting or Lineset:
Required R -value
Cond°tinnedThermostat
FloorArea
2iLackaged
❑ Evaporator Coil
AFUE
COP
❑ R-6 (CZ 1-10, 12&13) Ducts
Served by system
❑ Setback
❑ Condensing Unit
❑ R-8' (CZ 11, 14-16) Ducts
��e ft'
(If not already
❑ Compressor
SEER
HSPF
❑ z 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:
CFIR-ALT-02-E
Cone ,-Evaporator Coil, CF2R-MCH-01-E, MCH -20-H, MCH -(23 or 24)'-H, MCH -25-H'
Compressor, TXV, Lineset, CF3R-MCH-20-H, MCH -(23 or 24)-H', MCH -25-H'
Air Handler/Furnace' (Can include new ducting)
Installer Requirement: Duct leakage (< 15%, or 510% to outside, or seal all accessible leaks), Air Flow 2 300 CFM/ton, Refrigerant Charge.
Exempted from duct leakage testing if:
❑ 1. Duct system registered with HERS provider as previously sealed, or ❑ 2. There is less than 40 linear feet of duct rt 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 Ducts' CFIR-ALT-02-E
including Mini Split CF2R-MCH-01-E, MCH -20-H, MCH -22-H, MCH -(23 or 24)-H', MCH -25-1-1'
CF3R-MCH-20-H, MCH -22-H, MCH -(23 or 24)-H', MCH -25-H'
Mini Splits require CFIR-ALT-02-E, CF2R-MCH-01-E, and (CF2R-CF3F) MCH -25-H
Installer Requirement: Duct leakage < 5%, Fan Efficacy (0.58W/CFM), Air Flow 2 350 CFM/ton (or alternative), Refrigerant Charge
❑ 3. All New Ducts with Replacement
Required Compliance Documents to be left on site for Final:
All New Ducts3 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)-H, MCH -25-H
Compressor, TXV, Lineset, Furnace'
CF3R-MCH-20-H, MCH -(23 or 24)-H, MCH -25-H
Installer Requirement: Duct leakage < 5%, Air Flow 2 350 CFM/ton (or alternative), Refrigerant Charge
Exempted from duct leakage testing if: ❑ 1. Existing duct systems are constructed, insulated or sealed with asbestos
114. New Ducting over 40 feet Required Compliance Documents to be left on site for Final:
New ducting but less than All New Ducts' CFIR-ALT-02-E, CF2R-MCH-20-H, CF3R-MCH-20-H
Installer Required to: Duct leakage (5 15% or, 510% 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
than 40 ft installed. This includes in walls, between floors etc.
' 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 part! 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 for t.le building design or
system design identified on this Certificate of Compliance conform to the requirements of Title 24, Part 1 and Para 6 of the CCR.
5. The building design features or system design ' ntified on this Certificate of Compliance are consistent with the information
features
provided on other applicable compliance docu, tvor sheets, calculations, plans and specifications submittec to the enforcement
agency for approval with is building permitatio .
Responsible -D s ner/Nme- /
Respo ible Desig nature:
Date Signe : /
License:
Company:
Address:
City/ tate/Zip:
Phone:
Z�� X03
For assistance or questions regarding the Energy Standards, contact the Energy Lp6tlinefat: 1-800-:72-3300
.._........ ____ C:F.?\4 fi7r t:)d .\k:R:T` .—..._..--------
PERMIT # S
PLAN LOCATION:
Project Address: ZZy� Aveo ,Jp /'lpv O
Project Description: Pool, Remodel, Add't, Elect, Plumb, Mech
APN
Telephone:
Patio/Porch SF
Email:
Fire Sprinklers SF
Applicant Name:. . �� py„L�S CxlA*-Ts
Address:
City, ST, Zip:
Telephone: ,Cl D 33
Email:/
O �5 d /G�n / .c
Valuation of Project $ �-
�1/ I —v
Contractor Name:
`New SFD Construction:
Address:
Conditioned Space SF
City, St, Zip
Garage SF
Telephone:
Patio/Porch SF
Email:
Fire Sprinklers SF
State Lic: City Bus Lic:
Arch/Eng Name:
Construction Type: Occupancy:
Address:
Grading:
City, St, Zip
Construction Type: Occupancy:
Telephone:
Bedrooms:
Stories:
# Units:
Email:
State Lic: City Bus Lic:
Property Owner's Name: G C
11�Address:
ew Commercial / Tenant Improvements:
Total Building SF
City, ST, Zip
Construction Type: Occupancy:
Telephone:
Email:
78495 CALLE TAMPICO
LA QUINTA, CA 9.2253
760-777-7000
OFFICE USE ONLY
#�
Submittal
Req'd
-Reed
Plan Sets
Structural Calcs
Truss Calcs
,
Title 24 Calcs
}
Soils Report
Grading Plan (PM 10)
Landscape Plan
Subcontractor List
Grant Deed
HOA Approval
School Fees
Burrtec Debris Plan
t
Planning approval
Public Works approval
r•
Fire approval
City Business License
i
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t
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