BMCH2017-01268 D "i �NtiM�il/ VOICE (760) 777-7125
t 7$-495 CALLE TAMPICO FAX (760) 777-7011
LA.QUINTA, CALIFORNIA 92253 DESIGN & DEVELOPMENT DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
Application Number: BMCH2O17-0126 Owner:
Property Address: 52110AVENIDA NAVARRO CKY ROSENF=LD
APN: 773235005 ®Q 2 10 AVENIDA NAVARRO
Application Description: ROSENFELED / HVAC CHANGEOUT - 81AFUE SPLIT SYS UINTA, CA 92253
Property Zoning:
Application Valuation: $6,500.00 MAY 3 0 2017
Applicant:
1 ANTHONY. PLUMBING HEATING & AIR CONDITI
72216 NORTH SHORE ST #101
THOUSAND PALMS, CA 92276
Date: 4/12/2017
CITY OF (A OUINTA Contractor:
DESIGN AND DEVELOPMENTDEPARTME, PLUMBING HEATING & AIR CONDITI
ANTHONY216 NORTH SHORE ST #101
THOUSAND PALMS, CA 92276
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licens " under provisions of Chapter 9
(commencing with Section 7000) of Division 3 of the B iness and Professions Code, and
my License is in full force and effect.
License Class: C20, C36 License No.: 77779
Date: -lit 14 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 io 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 Na
Lender's Address:
(760)328-8096
Llc. No.: 777794
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 pr vided for by Section 3700 of the Labor Code, for the performance
of the work f ich this permit is issued.
ave 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: MIDWEST EMPLOYERS CASUALTY COMPANY Policy Number:
BNUWC0135300
I certify that irf the performance of the work for which this permit is issued, I
shall not employ any person in any manner so as to beome subject to the workers'
compensation laws of California, and agree that, if I s ould become subject to the
workers' compensation provisions of Section 3700 the Labor Code, I shall forthwith
comply with those provisions.
Date: . Applicant:
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVER S 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*l have read this application and s=ate that the ab a information is correct.
I agree to comply with all city and county ordinances nd sta laws relating to building
construction, and hereby authorize representatives o this - y to enter upon the above-
mentio roper for inspection purposes.
Date:'A Signature (Applicant or Ag
nt):
' ' ^ Date: 4/12/2017
{
Application Number: BMCH2O17-0126 Owner:
Property Address: 52110 AVENIDA NAVARRO VICKY ROSENFELD
APN: 773235005 52110 AVENIDA NAVARRO
Application Description: ROSENFELED / HVAC CHANGEOUT - 14SEER/81AFUE SPLIT SYSTEM LA QUINTA, CA 92253
Property Zoning:
Application Valuation: $6,500.00
Applicant: Contractor:
J ANTHONY PLUMBING HEATING & AIR CONDITI J ANTHONY PLUMBING HEATING & AIR CONDITI
72216 NORTH SHORE ST #101 72216 NORTH SHORE ST #101
THOUSAND PALMS, CA 92276 THOUSAND PALMS, CA 92276
(760)328-8096
LIc. No.: 777794
--------------------------------------------------------------------------------------------
Detail: HVAC CHANGE OUT - 14SEER/81AFUE SPLIT SYSTEM. CARBON MONOXIDE ALARM(S) TO BE INSTALLED PRIOR TO FINAL INSPECTION. 2016 \
CALIFORNIA BUILDING CODES.
f
n
r
21
21
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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 - 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
101-0000-42404
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
`13in#'
City- of La -Quin.ta
Building 8i Safety Division
Permit # 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-701,2
Building Permit Application and Tracking Sheet
Project Address: ZI�� � • Owner's Name:
A.T. Number:
Address:
Legal Description:
City, ST, Zip:
Contractor: "
Telephone:
Address:
Project Description: "% ',.^-f" Osvt�,
City, ST, Zip: 72216 NORTH SHORE STSTE 101
Telep hone:
State Lie. # : III n
City Lie. #;
Arch.,'Engr., Designer: "
Address:
City, ST, Zip:
Telephone.
one:
' "
Con tructi n Type: Occupancy:
u aneY
State ac_ #. •
roJ'ect tYPa circle one):: New Add'n Alter r Re
ar Demo
Name of Contact Person: �i A /UD A)
Sq. Ft.:
# Stories:
# Units:
Telephone # of Contact Person: '&9 ;1 '! "1,1 _24
Estimated Value of Project:.
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Rcc'd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Cafes.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Bala nce
Title 24 Calcs.
Plans picked up
Construction '
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
20° Review, ready for correctionsfissue
Electrical .
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
Ii.O.A. Approval
Plans resubmitted
Grading
IN ROUSE:-
'"! Reyiew, ready for corrcctionsrssue
Developer Impa_t Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees,
Total Permit Fe_s
CERTIFICATE OF COMPLIANCE
Alterations to Space Conditioning Systems (formerly CF -1R -ALT -HVAC)
a
CF1R-ALT 02-E
(Page 1 of 3)
Project Name: ROSENFELD I Date Prepared: 2017-04-12 I
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
ROSENFELD
02
Date Prepared
2017-04-12
03
Project Location
52110 AVENIDA NAVARRO
04
Building Type
Single family
OS
CA City
La Quinta
06
Dwelling Unit Name
ROSENFELD
SC System
Identification or
SC System
Location or Area
CFA served
by this SC
system a
ducted
Dwelling Unit Conditioned
Installing new SC
system
07
Zip
Zi Code
92253
08
Floor Area (ft)
1200
System (ft)
system?
component?
components?
feet of ducts?
dud system?
I SC system?
I Alteration Type
System 1
Location 1
Number of Space
Yes
09
Climate Zone
15 '� . .
10
Conditioning (SC) Systems in
1
Ithis Dwelling Unit:
_'J.
3
$6§Y�
B. Space Conditioning (SC) System Information
01
02
03
04
05,
06
07
08
09
10
1"s the SCS
Installing a
SC System
Identification or
SC System
Location or Area
CFA served
by this SC
system a
ducted
refrigerant
containing
Installing new SC
system
Installing
more than 40
Installing
entirely new
Installing
entirely new
Name
Served
System (ft)
system?
component?
components?
feet of ducts?
dud system?
I SC system?
I Alteration Type
System 1
Location 1
1200
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-A020119270A-000-000-0000000-0000
Registration Date/Time: 2017-04-12 11:27:57
HERS Provider: CaICERTS
CA Building Energy Efficiency Standards - 2016 Residential Compliance Report Version: 2016.1.005 Report Generated: 2017-04-12 11:28:24
Schema Version: rev 10/16
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)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
Outdoor
This field or
This field or
System 1
Central gas
Gas furnace
AFUE
81
Central split
condensing
SEER
14
Setback
section is not
section is not
furnace
AHU
AC
unit
applicable
applicable
Rea !red Documentation:
CF2R-MCH-01-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 CF311-MCH-20-11- 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 <= 301% leakage to outsid;Nr 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 CF311-MCH-23 Airflow Rate > 300 CFM per too required when MCH 25 is required
4
Exceptions:
--"M , n.
- Duct systems registered with HERS provider as previously sealed are exempt from MCH 20 Dud Leakage Testiogrequirements�7iC
- Heating -only systems and Air Handler Furnace changes do not require venficatlpn'o— ' Flow MC 2 RefngP�rant Cha e mMExisting
dud systems constructed, insulated or sealedwith:as6estos htfrom MCF`2 a 1e*age TesUrtgsr e4uirem ts
exem;'
are
iP F :; rte. AN 3�x _ ►F #`� t� �rr�. _ 6? R� 3*i AC ar, 1Ax W, iv W, r1m,.__
i �i w.���zr m: saw' esv s
E. Entirely New or Complete Replacement Duct4ystem, with or without, Equipment Changeout (Sections. 0 2(.)wiDnaaand150.2(b)lE, F)
"+ It
This section does not apply to this project.
F. Entirely New or Complete Replacement Space Conditioning System (Section 1S0.2(b)IC)
This section does not apply to this project.
Registration Number: 217-A020119270A-000-000-0000000-0000
Registration Date/Time:
2017-04-12 11:27:57
HERS Provider: CalCERTS
CA Building Energy Efficiency Standards - 2016 Residential Compliance Report Version: 2016.1.005 Report Generated: 2017-04-12 11:28:24
Schema Version: rev 10/16
11
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:
;va~
Robinson, Kevin
lww w ow
/� I�D�
Company:
Signature Date:
J ANTHONY PLUMBING HEATING & AIR CONDITIONING
2017-04-12 11:27:57
Address:
CEA/ HERS Certification Identification (if applicable):
72216 NORTH SHORE ST #101
City/State/Zip:
Phone:
THOUSAND PALMS CA 92276
1760-343-2121
Responsible Person's Declaration statement
I certify the following under penalty of perjury, under the'Iaai fs of the State of California:
1. The information provided on this Certificate of Compliance,is truad.correct.
2. I am eligible under Division 3`of the;Business and Professions Code to,accept',,responsibihty'forthe building design or system design identified on this Certificate of Compliance (responsible designer).
ance specifications,matenals,co ponents, and manufactured devices.for the building design o system design identified on this Certificate of Compliance conform to the
3. That the energy features and performlot
requirements of Title 24, Part 1 and Part the Cahfomla'Code of Reg fations,
7.
4. The building design features or system design features identified onthis Cernfiof Compliance are con istentfwi ;the inform provided on:Othex h1%,
licaG a pliance documents, worksheets,
calculations, plans and specifications submitted.td'the enforcement 0gency for`ap` v I: 4k this building permit ap licatiop. t
5. I will ensure that a registered copy of this`.CertificMe of m�pliance shall bexmadeFavail le'AWthe;buildl g permit(s). issued fo the building and made avaitab eto,ttieenforcement agency for all applicable
inspections. I understand that a registered copy of tHi"srticate of Complanceis requjir„Wd tote le" itch thedocumentionthetbuilder provides to the buldng owner at occupancy.
Responsible Designer Name: :171 F'
Respon ble DeViAer Si�nature: V t
�P,!/ulfii�e�cY.OB�rr'/
Robinson, Kevin
Company:
Date Signed:
J ANTHONY PLUMBING HEATING & AIR CONDITIONING
2017-04-12 11:27:57
Address:
License:
72216 NORTH SHORE ST #101
777794
City/State/Zip:
Phone:
THOUSAND PALMS CA 92276
760-343-2121
Digitally signed by Ca/CERTS. This digital signature is provided in order to secure the content of this registered document, and in noway implies Registration Provider
responsibility for the accuracy of the information.
Registration Number: 217-A020119270A-000-000-0000000-0000
Registration Date/Time
2017-04-12 11:27:57
HERS Provider: CaICERTS
CA Building Energy Efficiency Standards - 2016 Residential Compliance Report Version: 2016.1.005 Report Generated: 2017-04-12 11:28:24
Schema Version: rev 10/16