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BMCH2017-0308.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: C/2�0 License No.: 719570 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 ofthe 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: (951)797.-5669 Llc. No.: 719570 '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 wor or which this permit is issued. I have and will maintain workers' compensation insurance, as required by on 37 Secti00 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: INSURANCE COMPANY OF THE WEST Policy Number: WSD5031288 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 of Section 3700 of the Labor Code, I shall forthwith comply with thoseGprovisions. Datei k ` • Applican4a 417 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 ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon th above-mentioned property for inspection purposes. D"ale / r l Signature (Applicant or Ag`�nt) 6)= VOICE (760) 777-7125 78-495 CALLE TAMPICO V LA QUINTA, CALIFORNIA 92253 FAX (760) 777-7011 DESIGN & DEVELOPMENT DEPARTMENT INSPECTIONS (760) 777-7153 BUILDING PERMIT ate Trf97M. 7 Application Number: BMCH2O17-0308 Owner: W Property Address: 49940 MISSION DR W ROBERT TOPOR r� ¢ w APN: 602160009 5714 W VIEW DR o z Application Description: TOPOR / CHANGE OUT (1) 14SEER COIL ORANGE, CA 92253 O N z Property Zoning: Application Valuation: $1,820.00 { O w !S Applicant: Contractor: JOHN BORDEN HEATING AND AIR CONDITIONING JOHN BORDEN HEATING AND AI-[CO.NDITIONING o P 0 BOX 459 P 0 BOX 459 YUCAIPA, CA 92399 YUCAIPA, CA 92399 .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: C/2�0 License No.: 719570 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 ofthe 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: (951)797.-5669 Llc. No.: 719570 '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 wor or which this permit is issued. I have and will maintain workers' compensation insurance, as required by on 37 Secti00 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: INSURANCE COMPANY OF THE WEST Policy Number: WSD5031288 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 of Section 3700 of the Labor Code, I shall forthwith comply with thoseGprovisions. Datei k ` • Applican4a 417 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 ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon th above-mentioned property for inspection purposes. D"ale / r l Signature (Applicant or Ag`�nt) 6)= Date: 7/19/2017 Application.Number: . BMCH2O17-0308 Owner' Property. Address: 49940 MISSION DR W ROBERT TOPOR APN: 602160009 5714 W VIEW DR Application Description; TOPOR / CHANGE OUT (1) 14SEER COIL ORANGE, CA 92253 Property Zoning: Application Valuation: $1,820.00 Applicant: Contractor: JOHN BORDEN HEATING AND AIR CONDITIONING JOHN BORDEN HEATING AND AIR CONDITIONING P 0 BOX 459 P 0 BOX 459 YUCAIPA, CA 92399 YUCAIPA, CA 92399 (951)797-5669 --------------- ----------------------------------- Llc. No:: 719570 ----------=- - Detail: HVAC CHANGE OUT - (1) 14SEER COIL. CARBON MONOXIDE ALARMS) TO BE ------------------------------ INSTALLED PRIOR TO'FINAL INSPECTION. 2016 CALIFORNIA BUILDING CODES. • �1 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 - OTHER EQUIPMENT 101-0000-42402 0 $38.00 DESCRIPTION ACCOUNT QTY AMOUNT HVAC CHANGEOUT - OTHER EQUIPMENT PC 101-0000-42600 0 $38.00 Total Paid for CHANGEOUT: $76.00 DESCRIPTION ACCOUNT QTY AMOUNT PERMIT ISSUANCE 101-0000-42404 0 $96.27 Total Paidfor 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 ' Ory of, La Quinti ' Bl&ft 8c Safety Dtvh n P.O. Box 150-4,'78-49S Calle Tampico BU�r l.a..Qtrfita, CA 92233 -x(760) 777-7012 ung Permit'AMicadon and Tracking Sheet . Perink PmjectAddrem: S S.1 Owna's Name: . A P. Number:. Address: - I lam- v I ew r• Leg l Description: Address:Proj City, ST. zip Z 8 on: q n City, ST, Zip: LAUCD1WO c4q 1 9 2 " Telephone. C9191 State Lic. #: q S—% O Ct' Lic. Arck. Eng., Designer :. Address: UY.. ST. Zip: T&Pho er State Lie. #: Name of Comet Person:nnrl (tSq. CaalsttuctionType:. vAC, Oozy: Project type (cirde one): New Add'n Alter Repair FL: 2. / (?2.q # Stmiem # Unis Demo 2 Telephone # of Contact Person: • . • -J QQ 1 Estimated Value of Project ©'- APPLICANT: DO NOT WRITE BELOW Tm UNE p Submittal ReVd Reed TRACYMG PERlldti FEPS Plea Sets Pisa Cheek somitted• Ibrm Amonat S"Ctuial Cala. Revkwed, ready for boas Plan Check Deposit. . Traaa Cala. Called Contact Person Plan Check Balance line 24 Cates. Plans picked up Construction Flood plait plea Plana resubmitted _. Medknk d Giadtng plan 2`! Review, ready for correctionsriastke Electrical Sobcostactor List Called Contact Person Plumbing Grant Deed Plana picked ap S.M.I. H.O-A. Approval Plans raabmtthd Grading IN Exam.- ''' Review; ready for eoneetionalissoe Developer Impact Fee Pknaing Approval- Called Contact Person AJ-P.P. Pub. Wks. Appr • Date of permit Issue Sdtool Fen Total Permit Fees CERTIFICATE OF COMPLIANCE Alterations to Space Conditioning Systems (formerly CF -1R -ALT -HVAC) Project Name: ROBERT TOPOR I Date Prepared: CF111-ALT 02-E (Page 1 of 3) 2017-07-19 A. General Information ' CF1R-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 ROBERT TOPOR 02 Date Prepared 2017-07-19 03 Project Location 49940 MISSION DR W 04 Building Type Single family 05 CA City La Quinta 06 Dwelling Unit Name SYSTEM SC System SC System served system a refrigerant Installing new SC` Installing '$ Installing ,Dwelling Unit Conditioned Identification or 07 Zip Code 92253 " 08 d ;Floor Area (ftz) 2942 entirely new entirely new Name Served System (ft2) system? component? components? i" Number of Space SC system? 09 Climate Zone 15 '' 10 Conditioning (SC) Systems in 1 Yes No No No this Dwelling Unit: B. Space Conditioning (SC) System Information 01 02 03 04 N,,A' 4 f 0S 07 08 09 10 CFA Is the SC ��ttV ,Installing a �.� SC System SC System 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 (ft2) system? component? components? feet of ducts? duct system? SC system? Alteration Type SYSTEM HOUSE 2942 Yes Yes Yes No No No Altered space conditioning system C. Extension of Existing Duct System, Greater Than 40 Feet (Section150.2(b)1Diib) This section does not apply to this project. Registration Number: 417-A020103930A-000-000-0000000-0000 CA Building Energy Efficiency Standards - 2016 Residential Compliance Registration Date/Time: 2017-07-19 08:15:02 Report Version; 2016;1,006 CeVFem� V..eeirm en!r 111/1C HERS Provider: CHEERS Report Generated: 2017-07-19 08:15:02 CERTIFICATE OF COMPLIANCE CFiR-ALT 02-E Alterations to -Space Conditioning Systems (formerly CF -IR -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 Central gas No heating This field or This field or Central split All new Less than or SYSTEM furnace component section is not section is not AC cooling SEER 14 Setback equal to 40 R-8 altered applicable applicable components feet Reouired Documentation: x+ a CF2R-MCH-03-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 m�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.` CF211 and CF3R-MCH-25-H Refrigerant Charge verification required when refrigerant containing compinstalled 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: E,'yT •:' 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. a' E. Entirely New or Complete Replacement Duct System, with or without Equipment ChangeoUt (Sections 150.2(b)1Diia and 150.2(b)lE, F) This section does not'apply tdithls*oject. F. Entirely New or Complete Replacement Space Conditioning. System (Section 150.2(b)1C) This section does not apply to this project. Registration Number: 417-A020103930A-000-000-0000000-0000 Registration Date/Time: 2017-07-19 08:15:02 HERS Provider: CHEERS CA Building Energy Efficiency Standards - 2016 Residential Compliance Report Version-, 2016,1,006 Report Generated: 2017-07-19 08:15:02 ,� CERTIFICATE OF COMPLIANCE CF1R-ALT 02-E Alterations to Space Conditioning Systems (formerly CF -1R -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: Connie Goe Covuue�Goe. Company: Signature Date: Russells Heating & Air Conditioning 2017-07-19 Address: CEA/ HERS Certification Identification (If applicable): 33145 Yucaipa Boulevard City/State/Zip:� ,Phone: Yucaipa CA 92399 —::r'. ; 909-:797-5669 Responsible Person's Declaration statement �_,.. I certify the following under penalty of perjury, under the laws of the State of California: f t7 r 1. The information provided on this Certificate of Compliance is true and correct., 2. lam eligible under Division 3 of the Business and Professions Code to accept responsibility for the'bu lding 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 requirements of Title 24, Part 1 and Part 6 of the California Code of Regulations. 4. The building design features or system design features identified on this Certificate of Compliance are consistent with the information provided on other applicable compliance documents, worksheets, calculations, plans and specifications submitted to the enforcement age. cy for_ap oval,With this building permit application. 5. I will ensure that a registered copy of this Certificate of Compliance shall be madeveila le with thhe building.peimit(sj'is$ued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a registered copy of this Certificate of tomplan a is requi�red�to be included witli'the documentation the builder provides to the building owner at occupancy. Responsible Designer Name: lr tt ,!.:� t'y r �'ii:t:Covuu�0 Responsible Designer Signature: rt Connie Goe• 4.v Company: Date Signed: Russells Heating & Air Conditioning 2017-07-19 Address: License: 33145 Yucaipa Boulevard 719570 City/State/Zip: Phone: Yucaipa CA 92399 909-797-5669 Digitally signed by CHEERS•m. This digital signature • is provided in order to secure the content of this registered document, and in no way implies Registration Provider responsibility for the accuracy of the Information. Registration Number: 417-A020103930A-000-000-0000000-0000 Registration Date/Time: 2017-07-19 08:15:02 HERS Provider: CHEERS CA Building Energy Efficiency Standards - 2016 Residential Compliance Report Version: X016.1.006 Report Generated: 2017-07-19 08:15:02 rrhPmAXtArcinn? rm! 1n/1F 4