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BMCH2018-049478-495 CALLE TAMPICO D 4 Q" LA QUINTA, CALIFORNIA 92253 DESIGN & DEVELOPMENT DEPARTMENT BUILDING PERMIT Permit Type/Subtype: MECHANICAL/ Application Number: BMCH2O18-0494 Property Address: 52300 AVENIDA VELASCO APN: 773265003 Application Description: SEGAL / HVAC CHANGEOUT - 14SEER/80AFUE SPLIT SYSTEM Property Zoning: Application Valuation: $8,000.00 VOICE (760) 777-7125 FAX (760) 777-7011 INSPECTIONS (760) 777-71S3 Owner: ROBERT SEGAL 52300 VELASCO LA QUINTA, CA 92253 Date: 12/14/2018 Applicant: �� Contractor: ADAM SIMMONS DBA SIMMONS AIR CONDITIO I / L� \ ADAM SIMMONS DBA SIMMONS AIR CONDITIONIN PO BOX314 D(J—�-1 PO BOX314 LA QUINTA, CA 92247 LA QUINTA, CA 92247 DEC 14 2018 0 (760)863-5254 CITY OF LA QUINTA Llc. No.: 780534 DESIGN & 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 70001 of Division 3 of the Business and Professions Code, and my License is in full force and effect. License Class- Ci7t,0.� License No.: 780534 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 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 th£ rk for which this permit is issued. Uf 4 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 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 those provisions. Date: {� Applicant: r� 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 the above -mentioned property for inspection purposes. J Uate:4 L. ? Signature (Applicant or Agent): C�� Date: 12/14/2018 Application Number: BMCH2O18-0494 Property Address: 52300 AVENIDA VELASCO APN: 773265003 Application Description: SEGAL / HVAC CHANGEOUT - 14SEER/80AFUE SPLIT SYSTEM Property Zoning: Application Valuation: $8,000.00 Applicant: ADAM SIMMONS DBA SIMMONS AIR CONDITIONIN P 0 BOX 314 LA QUINTA, CA 92247 Owner: ROBERT SEGAL 52300 VELASCO LA QUINTA, CA 92253 Contractor: ADAM SIMMONS DBA SIMMONS AIR CONDITIONIN P 0 BOX 314 LA QUINTA, CA 92247 (760)863-5254 Llc. No.: 780534 Detail: (1) 4-TON HVAC CHANGEOUT - 14SEER/80AFUE SPLIT SYSTEM. CARBON MONOXIDE ALARM(S) TO BE INSTALLED PRIOR TO FINAL INSPECTION. 2016 CALIFORNIA BUILDING CODES. FINANCIAL DESCRIPTION INFORMATION 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 $40.02 DESCRIPTION ACCOUNT QTY AMOUNT HVAC CHANGEOUT - SPLIT -SYSTEM PC 101-0000-42600 0 $80.05 Total Paid for CHANGEOUT: $120.07 DESCRIPTION ACCOUNT QTY AMOUNT PERMIT ISSUANCE 101-0000-42404 0 $101.40 Total Paid for PERMIT ISSUANCE: $101.40 DESCRIPTION ACCOUNT QTY AMOUNT RECORDS MANAGEMENT FEE 101-0000-42416 0 $10.00 Total Paid for RECORDS MANAGEMENT FEE: $10.00 DESCRIPTION ACCOUNT CITY AMOUNT TECHNOLOGY ENHANCEMENT FEE 502-0000-43611 0 $5.00 Total Paid for TECHNOLOGY ENHANCEMENT FEE: $5.00 �� II PERMIT #� PLAN LOCATION: Project Address: Z3� O EL�SC Project Description: Pool, Remodel, Add't, Elect, Plumb, Mech APN #: �� l d'1 r C C ch Applicant Name: Ct a! 1 ra- A a c hu�7 Address: f?82S` Cpeja,WP1`e, City, ST, Zip:_ Telephone• L q G 2P � Cj Email: / C%IC • !� . Qc �r.�� ICJ l� Valuation of Project $ U Contractor Name: New SFD Construction: Address: 5 qqy V, �m Y p� Conditioned Space SF City, St, Zip LR tLVl At � Garage SF Telephone( 76°% -7! �Zf Patio/Porch SF Email: 1� Fire Sprinklers SF State Lic: -7`?D5 3 1 City Bus Lic: Arch/Eng Name: Construction Type: Occupancy: Address: Grading: City, St, Zip Telephone: Bedrooms: i Stories: # Units: Email: State Lie: City Bus Lic: Property Owner's Name: b New Commercial / Tenant Improvements: Address: 50 Total Building SF City, ST, Zip j_6 ! r1 JA , Construction Type: Occupancy: Telephone: 7�� ) 7� O Email: A11A 78495 CALLE TAMPICO LA QUINTA, CA 92253 760-777-7000 A. General Information MR-ALT-02 is applicable to multiple space conditioning systems contained within a single dwelling unit. When multiple dwelling units must be documented, use one MR-ALT-02 document for each dwelling unit. 01 Project Name Bob Segal 02 Date Prepared 2018-12-13 03 Project Location 52300 VELASCO 04 Building Type Single family 05 CA City La Quinta 06 Dwelling Unit Name Bob Segal 07 Zip Code 92253 08 Dwelling Unit Conditioned 1600 Floor Area (ft) Number of Space 09 Climate Zone 15 10 Conditioning (SC) Systems in 1 this Dwelling Unit: B. Space Conditioning (SC) System Information 01 02 03 04 05 06 07 08 09 10 Is the SC Installing a SC System SC System CIA 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 (ftZ) system? component? components? feet of ducts? duct system? SC system? 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)iDiib) Registration Number: 218-A020328987A-000-000-0000000-0000 This section does not apply to this project. Registration Date/Time: 2018-12-13 11:33:09 HERS Provider: CalCERTS CA Building Energy Efficiency Standards - 2016 Residential Compliance Report Version: 2018.0.001 Report Generated: 2018-12-13 11:32:41 Schema Version: rev 20180426 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)lE and F) O1 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 All new Centrals lit All new p cooling SEER 14 Setback System 1 Cfurnace entrals heating AFUE 80 Less than or equal to 40 R-8 AC components components feet Reouired 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 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 percent or <= 10 percent 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. 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. E. Entirely New or Complete Replacement Duct System, with or without Equipment Changeout (Sections 150.2(b)lDiia and 150.2(b)1E, F) This section does not apply to this project. F. Entirely New or Complete Replacement Space Conditioning System (Section 150.2(b)1C) Registration Number: 218-A020328987A-000-000-0000000-0000 This section does not apply to this project. Registration Date/Time: 2018-12-13 11:33:09 HERS Provider: CalCERTS CA Building Energy Efficiency Standards - 2016 Residential Compliance Report Version: 2018.0.001 Report Generated: 2018-12-13 11:32:41 Schema Version: rev 20180426 CERTIFICATE OF COMPLIANCE CF111-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: Simmons, Donna Company: Signature Date: ADAM SIMMONS 2018-12-13 11:33:09 Address: CEA/ HERS Certification Identification (if applicable): 54440 AVENIDA CARRANZA City/State/Zip: Phone: LA QUINTA CA 92253 760-S64-7525 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 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 agency for approval with this building permit application. 5. 1 will ensure that a registered copy of this Certificate o#,Compliance shall be made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a registered copy of this Certificate of Compliance is required to be included with the documentation the builder provides to.,the building owner at occupancy. Responsible Designer Name: Simmons, Donna Responsible Designer Signature:�� Company: Date Signed: ADAM SIMMONS 2018-12-13 11:33:09 Address: License: 54440 AVENIDA CARRANZA 780534 City/State/Zip: Phone: LA QUINTA CA 92253 760-564-7525 Easy to Verify FRI at CaICERTS.com Digitally signed by CaICERTS This digital signature is provided in order to secure the content of this registered document, and in noway implies R Registration Provider for the information. ❑ responsibility accuracy of the „ Registration Number: 218-A020328987A-000-000-0000000-0000 Registration Date/Time: 2018-12-13 11:33:09 HERS Provider: CaICERTS CA Building Energy Efficiency Standards - 2016 Residential Compliance Report Version: 2018.0.001 Report Generated: 2018-12-13 11:32:41 Schema Version: rev 20180426