BMCH2017-032278-495 CALLE D . VOICE (760) 777-7125
TAMPICO.
LA QUINTA, CALIFORNIA 92253 FAX (760) 777-7011DESIGN & DEVELOPMENT DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 7/28/2017
Application Number:
BMCH2O17-0322
Owner:
Property Address:
S372S AVENIDA MENDOZA
DOUGLAS LUKENS
APN:
Application Description:
774132022
LUKENS RESIDENCE / HVAC CHANGE OUT
53725 AVENIDA MENDOZA
D LA QUINTA, CA 92253
Property Zoning:
Application Valuation:
$5,200.00
/
2 8
Applicant
FRAGUZ A/C & HEATING
2017;-71)
(, P Contractor:
Cc 'A"��'t YC- "A C&,,j'yjj-1ERAGUZ
A/C & HEATING
65778 SYCAMORE RD
65718 SYCAMORE RD
DESERT HOT SPRINGS, CA 92240
_cNJ(DEp
"�DESERT HOT SPRINGS, CA 92240
(760)567-0748
Uc. No.: 924785
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 License No.: 4785
�Date�` 7iU 7 Coner:
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 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:
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:
Carrier: STATE COMPENSATION INSURANCE FUND Policy Number: 9115056
I certify that in the performance of the 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 o ;Z&_D1Ck_ of the Labor Code, I hall forthwith
comply with those
provisions.
DPP) 7 LD / 7 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 FOR 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 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 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.
I certify that I have read this application and state that the above information is correct.
I agree to comply with all city and county Ord inanc a laws relating to building
construction, and hereby authorize represents ' es of this city o enter upon th
above-mentioned,property for inspection pur oses.
Date I goat re (Applicant or Agent):
Date: 7/28/2017
Application Number: BMCH2O17-0322
Owner:
Property Address: S372S AVENIDA MENDOZA
DOUGLAS LUKENS
APN: 774132022
53725 AVENIDA MENDOZA
Application Description: LUKENS RESIDENCE / HVAC CHANGE OUT
LA QUINTA, CA 92253
-Property Zoning:
Application Valuation: $5,200.00
Applicant:
Contractor:
FRAGUZ A/C & HEATING
FRAGUZ A/C & HEATING
65778 SYCAMORE RD
65778 SYCAMORE RD
DESERT HOT SPRINGS, CA 92240
DESERT HOT SPRINGS, CA 92240
(760)567-0748
------------------------ ---------------------------------------------------------------
LIc..No.: 924785
Detail: HVAC CHANGE OUT - 145EER/80AFUE SPLIT SYSTEM. CARBON MONOXIDE
ALARM(S) TO BE INSTALLED PRIOR TO FINAL INSPECTION..2016 CALIFORNIA BUILDING CODES.
I
FINANCIAL •• •
.;DESCRIPTION ACCOUNTQTY 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 - 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 CHANGEOUT: $114.00
DESCRIPTION
ACCOUNT.
QTY
AMOUNT
PERMIT ISSUANCE
101-0000742404
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
Bin #
City of La Quinta
'Building 8F Safety Division
78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
Project Address: pC� A , ()
�(�
Owner's Name: vn
A. P. Number:
Address -
Legal Description:
City, ST, Zip:
Contractor: UZ A- 1C.
Telephone:
Address:
Project Description:
City, ST, Zip:S 2
Tele hon : v
P 6 S 7 d
State Lic. # : Z
City Lia #.-
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone:
h one:
-n
-
Co stru lion Type: Pe: O ccu an
P cy:
State to Lic. #:
Project type (circle one)•N w Add'n Alter Repair Demo
Name of Contact Person:Sq.
Ft:
# Stories:
# Units:
Telephone # of Contact Person:
Estimated Value of Project:�Q.
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Rec'd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Cales.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance
Title 24 Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
T' Review, ready for correctionsfissue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A: Approval
Plans resubmitted
Grading
IN HOUSE:
'"' Review, ready for corre' dionstissue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees
CERTIFICATE OF COMPLIANCE CF1R-ALT-02-E
Alterationsrto Space Conditioning Systems (formerly CF-lR-ALT-HVAC) (Page 1 of 3)
Project Name: LUKENS, DOUGLAS Date Prepared: 2017-07-26
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
CFIR-ALT-02 do'cuinent for'each dwelling unit.
01'
Project Name -
LUKENS, DOUGLAS
02
Date Prepared
2017-07-26
09
10
"Ifs the TC
03
Project Location
53725 AVENIDA MENDOZA
04
Building Type
Single family
05
CA City
La Quinta
06
Dwelling Unit Name
LUKENS, DOUGLAS
Anstalling -
J
Installing
Dwelling Unit -Conditioned
Location or Area
07
Zip, Code
92253
08
Floor Area (ftz)
1609
entirely new
Name
Served
Numberof Space
system?
09
Climate Zone
feet of ducts?
10
Conditioning (SC) Systems in
1
'SystemI
this Dwelling Unit:
B. Space Conditioning (SC) System Informatl
01
02
r 03
& 04
-
OS
09
10
"Ifs the TC
In6talli'hi-a 7>
I.
K_7 N7
FA
SC System
SC System
CFA served
• 'system a
refrigerant
Installing -new SO,
Anstalling -
Installing-
Installing
Identification or
Location or Area
by this SC
ducted
containing
. system
more than 40
entirely new
entirely new
Name
Served
System
stem (ft2)
system?
component?- -
ponents?
components?
feet of ducts?
dusystem? .
ct
SC system?
Alteration Type
'SystemI
Altered space
'Loc;W6n1..
1609
1,41. -
Yes
. .
Yes
"
Yes
No
No'
No
I cgnditioning.system
,
,
.
11
.
-
C. Extension of Existing Duct System, Greater Than 40 Feet ($pction150.2(b)1Di1b)
This section does not apply to this project.
Registration Number: 217-A020253813A-000-000-0000000-0000
CA Building Energy Efficiency Standards - 2016 Residential Compliance
Registration Date/Time: 2017-07-26 14:46:10
Report Version: 2016.1-006
Schema Version: rev 10/16
HERS Provider: CaICERTS
Report Generated: 2017-07-26 14:46:11
CERTIFICATE OF COMPLIANCE CFIR-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)IE 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 new -
Central split,
All new
Less than or
System 1
furnace
heating
AFUE
81
AC
cooling
SEER.
14
Setback
„r
equal to 40
R-8
components
components
feet
Reouired Documentation:
CF211-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)
CF211 and MR -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 verification_required when refrigerant containing components are Installed or altered (applicable in CZ 2, 8-15).
CF2R and CF3R-MCH-23 Airflow Rate >= $OO CFM per�ton required when MCH -25 is required._T_
- ,•_ ;_
Exce tip ons;
_ _ .. _ _
Duct systems registered with HERS provider as previously sealed are exempt from -MCH, -20 Duct Leakage Testing regyirements .
-Heating-only systems and Air Handler Furnace changes do not require verificatiprr of Air Flow MCH.23;'or Refrigerant Charge MCH -25' .
F
-Existing dud systems constructed, insulated or sealed with asbestos are exemptFfrom M6H=
CERTIFICATE OF COMPLIANCE CF1R-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:
guzman, rosa
Company:
Signature Date:
FRAGUZ A/C & HEATING
2017-07-26 14:46:10
Address:
CEA/ HERS Certification Identification (if applicable):
P 0 BOX 1243
924785
City/State/Zip: -
Phone:
desert hot springs CA 92240
760-567-0748
Responsible Person's Declaration statement'
I certify the following under penalty of perjury, under the lawsof 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:. he, 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 - building design, or system design identified on this Certificate of Compliance conform to the
go
requirements of Title 24, Part 1 and Part 6 -of the Cahfornla Code of R gulatlons. �" { 0 "
4. The building design features or system design features identified on;.this Certificate of Compliance are consistent wit ,the informatio -provided on t6- applicable compliance documents, worksheets,
¢ } {' .G
'
calculations, plans and specifications submitted to -the enforcementagency for approval with this building ;8
i g permit application. )f
' �,¢ � '�`
.c�'�.- * •'k � w: . . a . �e a:. kC{
5. 1 will ensure that a registered copy of this"Certificate of Compliance shall,be made;ayailable with the building permit(s);issued for:4he,6uilding, and made avallable to the enforcement agency for all applicable
N. <
Inspections. I understand that a registered copy of this C_ertlficate of Compliance is,regyjred to be,included,W[t�h the documentation�the builder provides to -the building owner at occupancy.
s
Responsible Designer Name: g' �S
Responsible Designer signature: V I' 1�1.lil
guzman, rosa
'ld�i�!!/Z.�►lsi
Company:
Date Signed:
FRAGUZ A/C & HEATING
2017-07-26 14:46:10
Address:
License:
P O BOX 1243
924785
City/State/Zip:
Phone:
desert hot springs CA 92240
760-567-0748
Easy to Verify 0E FRI
at CaiCERTS.com
Digitally signed by Ca10ERTS. This digital signature is provided in order to secure the content of this registered document, and in no way implies Registration Provider responsibility fc
r the accuracy of the inforr a -•
Registration Number: 217-A020253813A-000-000-0000000-0000
Registration Date/Time
2017-07-26 14:46:10
HERS Provider: CaICERTS
CA Building Energy Efficiency Standards - 2016 Residential Compliance Report Version: 2016.1.006 Report Generated: 2017-07-26 14:46:11
Grhpma %/Prcinn• rani 1 n11 F