BMCH2017-037378-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253 DESIGN & DEVELOPMENT DEPARTMENT
BUILDING PERMIT
Application Number: BMCH2O17-0373
Property Address: 77185 CALLE MONTEREY
APN: 774033004
Application Description: HAG00D RESIDENCE / HVAC CHANGE OUT n
Property Zoning: Ii II Lrz1 li�i
Application Valuation: $7,900.00
Applicant:
ADAM SIMMONS
P 0 BOX 314
LA QUINTA, CA 92247
AUG 2 5.2017
CITY OF LA QUINTA
COMMUNITY DEVELOPMENT DEPARTMENT
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 ClaZ�;�Ccintr5cto�r.�645��/
C20 License No.., 7805
dr&D.te:'
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 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 Nam
Lender's Address:
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 8/25/2017
- Owner:
LINDA HAGOOD
77185 CALLE MC NTEREY
'jLA QUINTA, CA S2253
Contractor:
ADAM SIMMONS
P O BOX 314
LA'QUINTA, CA E2247
(760)564-7525
Llc. No.: 780534
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
I have and will maintain a certificaae 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. y�
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: 9054788
I certify that in the performance o' 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 those previsions.
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL,
AND SHALL SUBJECT AN EMPLOYER TO CRIMNAL 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 tie 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 owrer, and the applicant, each agrees to, and
shall defend, indemnify and hold harmless th � 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 or 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 nate that the above information is correct.
I agree to comply with all city and cem
ounty orances and state laws relating to building
construction, and hereby authorize representatives of this city to enter upon the
above -men Toned property for inspection purposes.
Date: /�a Signature-(Applicarl: or Agent):
`
Date: 8/25/2017
Application Number:
BMCH2017-0373
Owner:
Property Address:
77185 CALLE MONTEREY
LINDA HAGOOD
APN:
774033004
77185 CALLE MC NTEREY
Application Description:
HAGOOD RESIDENCE / HVAC CHANGE OUT
LA QUINTA, CA 52253
Property Zoning:
Application Valuation:
$7,900.00
Applicant:
Contractor:
ADAM SIMMONS
ADAM SIMMONS
PO BOX 314
PO BOX 314
LA QUINTA, CA 92247
LA QUINTA, CA E2247
(760)564-7525
---------------------------------------------------------------------------------------------
Llc. No.: 780534
Detail: HVAC CHANGE OUT
- 16 SEER/80AFUE SPLIT SYSTEM. CARBON MONOXIDE ALARM(S) TO BE INSTALLED PRIOR TO FINAL INSPECTION. 2016
CALIFORNIA BUILDING CODES.
a
FINANCIAL INFORMATION
DESCRIPTION ACCOUNT CITY AMOUNT
BSAS SB1473 FEE
101-0000-20306 0 $1.00
Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $1.00 ..
DESCRIPTION
ACCOUNT
CITY
AMOUNT
HVAC CHANGEOUT - SPLIT -SYSTEM
101-0000-42402
•0
$76.00
DESCRIPTION
ACCOUNT
CITY ,
AMOUNT
HVAC CHANGEOUT- SPLIT -SYSTEM PC
101-0000-42600
0
$38.00
Total Paid for CHANGEOUT: $114.00
DESCRIPTION
ACCOUNT
CITY
AMOUNT
PERMIT ISSUANCE
101-0000-42404
0
$96.27
Total Paid for PERMIT ISSUANCE: $96.27
DESCRIPTION
ACCOUNT
CITY
AMOUNT
TECHNOLOGY ENHANCEMENT FEE
502-0000-43611.
0
$5.00
Total Paid for TECHNOLOGY ENHANCEMENT FEE: $5.00
TOTALS: $216.27
0
L
7,
0
L
Bin #
City of La Qulnta
Building 8z; Safety Division
P.O. Box 1504, 78-495 Calle Tampico .
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
Project Address: —7
Owner's Name: 06
A. P. Number:
Address:Q—
Legal Description:
City, ST, Zip:
Con � f S Iq..i 2
Telephone: (/ _x/
er>;:»;;.:•;;::;:<;.<.:::;:.
Address: U 3 tie 3 (l�
Project Description: C 41te—
City, ST, Zip: `,A, faZ�t`K i CA 0111, r_3
ypiL
Telcphone:760
State Lie. #:-7 b 5.3 If City Lie. #..
Arch., Engr., Designer:
Address:
City., ST, Zip:
lephone:
State Lie.
:::•:: <:;:<:»:;::; ;::»:,»,»
Construction Type: Occupancy:
Project type circle one): New Add'n Alter Repair Demo
Name of Contact Person: /H �� U f
Sq. Ft.:.
# Stories:
# Units:
Telephone # of Contact Person: 6 d / 0'z 0 0
Estimated Value of Proj ect: 417106
APPLICANT: DO NOT WRITE BELOW THIS LINE
tS
Submittal
Req'd
Recd
TRACKING
PERMIT FEES.
Plan Sets
PIan Check submitted
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Cala.
Called Contact Person
Plan Check Balance
Title 24 Cales.
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
IN HOUSE:-
'rd Review, ready for corrections/issue
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
Alterations to Space Conditioning Systems (formerly CF -1R -ALT -HVAC) (Page 1 of 3)
Project Name: 77185 Calle Monterey bate Prepared: 2017-08-25
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
CFIR-ALT-02 document for.each dwelling unit.
01
Project Name
77185 Calle Monterey
02
Date Prepared
2017-08-25
03
Project Location
77185 Calle Monterey
04
Building Type.
Single family
05
CA City
La Quinta
06
Dwelling Unit Name
77185 Calle Monterey
L- .J i
t
SC System
Dwelling Unit Conditioned
CFA served
07
Zip Code
92253
08
Floor Area (ft2)
1600
Identification or
Location or Area
by this SC
Number of Space
containing
09
Climate Zone
15
10
Conditioning (SC) Systems in
1
Served
System (W)
system?
component?
this Dwelling Unit:
feet of ducts?
dVI ) i —�Z- - A f _.. ) 1 lei .-3:. Vr ._ i l
B. Space Conditioning (SC) System Information
01
02
03 �•
04 ,-
..05..
_ --__>.06— _
07 V
08
09
10
Is the SCS
Installing'•a
'
il--; Al, t
L- .J i
t
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 (W)
system?
component?
components?
feet of ducts?
duct system?
SC system?
I Alteration Type
System 1
WHOLE HOUSE
1600
Yes
Yes
Yes
No
No
No
Altered space .
conditioning system
C. Extension of Existing Duct System, Greater Than 40 Feet (Section 150.2(b)1Diib)
This section does not apply to this project..
Registration Number: 217-A020291913A-000-000-0000000-0000 Registration Date/Time: 2017-08-25 08:25:32 HERS Provider: CalCERTS
CA Building Energy Efficiency Standards - 2016 Residential Compliance Report Version: 2016.1.006 Report Generated: 2017-08-25 08:25:37
Schema Version: rev 10/16
CERTIFICATE OF COMPLIANCE CF1R-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)1E 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 Dud
or Name
Type
Components
Type
Value
System Type
Components
Type
Value
Type
Dud Length
R -Value
Central gas
All new
Central split
All new
Less than or
System 1
furnace
heating
AFUE
81
AC
cooling
SEER
Ifeet
16
Setback
equal to 40
R-8
components
components
Reauired Documentation:
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)
CF211 and CF3R-MCH-20-H - Duct Leakage Test required when heating or cooling components are installed in 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.
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 >= 300 CFM per ton 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.
'RefngeraM
Heating -only systems and Air Handler Furnace changes do not require verificatio"CA, oir Flow MCH -23'o Charge MCH 25;
-Existing duct systems constructed, insulated or sealed with asbestos;are exempt:from MCH 20 Duct Leakage Testing-%qulrements.�-
:�^,:. t.'1 NN. t. b4 I3t i:r }:%, 1i sF ;;F A';
E. Entirely New or Complete Replacement Duct System, with or without -Equipment Changeout (Sections .150.2(b)1Diia=and 150.2(b)1E, F)
' t--4 *-,W
This section does not apply to this project.
F. Entirely New or Complete Replacement Space Conditioning System (Section 150.2(b)1C)
This section does not apply to this project.
I
Registration Number: 217-A020291913A-000-000-0000000-0000
CA Building Energy Efficiency Standards - 2016 Residential Compliance
Registration Date/Time: 2017-08-25 08:25:32
Report Version: 2016.1:006
Schema Version: rev 10/16
HERS Provider: CaICERTS
Report Generated: 2017-08-25 08:25:37
CERTIFICATE OF COMPLIANCE CF1R-ALT 02]3)
Alterations to.5pace Conditioning Systems (formerly CF -IR -ALT HVAC) {Page 3 of
Documentation Author's Declaration Statement
1. 1 certify that this Certificate of Compliance documentation is accurate and complete.
Documentation Author Name:
Documentation Author Signature: -
Bachus, Tom
Company:
Signature Date:
MLC Building Performance
2017-08-25 08:25:32
Address:
CEA/ HERS Certification Identification (if applicable):
77825 Delaware Place
City/State/Zip:
Phone:
Palm Desert CA 92211
1760-836-0066
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 of Compliance is true.and correct.
2. 1 am 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, materials, components, and manufactured devices for the building design, or system design identified on this Certificate of Compliance conform to the
{ , s ux
requirements of Title 24, Part 1 and Part 6 of the California Code of Re ulatlons .. (
4. The building design features or system design features identified on this Certificate of Compliance are consistent with'the information provided ori other applicable'c'�ompliance documents, worksheets,
calculations, plans and specifications submitted to the enforcement agency for approval'twith this building permit application. y t((y{ {i k`
�. ii 'f *k Ilit f .4 "( 1k x[ [I {L1
ems' Y. it i% gti C .t
5. 1 will ensure that a registered copy of this Certificate of, Compliance shall:be:made.available with.the buildIrrig permit(s), Issued forithe building, and`madi avallabI4!Aci_the,enforcement agency for all applicable
a-
inspections. I understand that a registered copy of this Certlfcate of Compliance. is, required to bewinciuded with the documentation�the builder provides to the building owner at occupancy.
Responsible Designer Name: x ` -=
Responsible Designer Signature:
Bachus, Tom.
a�
Company:
Date Signed:
MLC Building Performance
2017-08-25 08:25:32
'Address:
License:
77825 Delaware Place
City/State/Zip:
Phone:
Palm Desert CA 92211
760-836-0066
J
Easy to Verify M . a
at CaICERTS.com.
Digitally signed b COURTS. This digital signature is provided in order to secure the content of this registered document and in no way implies
9 Y 9 Y 9 9, P 9 Y P
Registration Provider for information.
h
Q
responsibility the accuracy of the
r,
Registration Number: 217-A020291913A-000-000-0000000-0000 Registration Date/Time: 2017-08-25 08:25:32 HERS Provider: CaICERTS
CA Building Energy Efficiency Standards - 2016 Residential Compliance Report Version: 2016.1.006 Report Generated: 2017-08-25 08:25:37
Schema Version: rev 10/16