BMCH2018-049978-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Permit Type/Subtype:
Application Number:
Property Address:
APN:
Application Description:
Property Zoning:
Application Valuation:
Applicant:
NATE COLYOTT
26111 YNEZ ROAD
TEMECULA, CA 92589
MECHANICAL/
BM CH 2O18-0499
Tw4t 4 4 09ba
DESIGN & DEVELOPMENT DEPARTMENT
BUILDING PERMIT
57141 MEDINAH
762110035
,JUSTIS / HVAC CHANGE OUT - 14 SEER/81AFUE MINI -SPLIT SYSTEM
$10,000.00
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 12/21/2018
Owner:
LARRY & NANCY JUSTIS
57141 MEDINAH
LA QUINTA, CA 92253
LJ Contractor:
BLAIR AIR INC DBA BLAIR HEATING &AIR
653 OLEANDER ROAD
DEC Z 1 2018 PALM SPRINGS, CA 92264
0(760)537-1120
CITY OF LA QUINTA Llc. No.: 953427
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 7000) of Division 3 of the Business and Professions Code, and
my License is in full force and effect.
License Class: C20 License No.: 953427 _
Date: \ LI"LI 1 4 X 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).:
(_) 1, 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
Da
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
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 work for which this permit is issued.
X' I have anti 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: ACE AMERICAN INSURANCE COMPANY Policy Number: RWCC65181277
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 th Labor Code, I shall forthwith
comply with those provisions.
Date: IZI Applicant:
WARNING: FAILURE TO SECURE WORKERS' COMPENSAT 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 cit pon the above -
mentioned property for inspection purposes.
Date: Signature (Applicant or Agent):
Date: 12/21/2018
Application Number:
Property Address:
APN:
Application Description:
Property Zoning:
Application Valuation:
Applicant:
NATE COLYOTT
26111 YNEZ ROAD
TEMECULA, CA 92589
BMCH2018-0499
57141 MEDINAH
762110035
JUSTIS / HVAC CHANGE OUT - 14 SEER/81AFUE MINI -SPLIT SYSTEM
$10,000.00
Owner:
LARRY & NANCY JUSTIS
57141 MEDINAH
LA QUINTA, CA 92253
Contractor:
BLAIR AIR INC DBA BLAIR HEATING & AIR
653 OLEANDER ROAD
PALM SPRINGS, CA 92264
(760)537-1120
Llc. No.: 953427
Detail: HVAC CHANGE OUT - 14SEER/81AFUE MINI -SPLIT SYSTEM. CARBON MONOXIDE ALARM(S) TO BE INSTALLED PRIOR TO FINAL INSPECTION. 2016
CALIFORNIA BUILDING CODES.
FINANCIAL 1 •
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
$40.02
DESCRIPTION
ACCOUNT
CITY
AMOUNT
HVAC CHANGEOUT - SPLIT -SYSTEM PC
101-0000-42600
0
$80.05
Total Paid for CHANGEOUT: $120.07
DESCRIPTION
ACCOUNT
CITY
AMOUNT
PERMIT ISSUANCE
101-0000-42404
0
$101.40
Total Paid for PERMIT ISSUANCE: $101.40
DESCRIPTION
ACCOUNT
CITY
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
nf,b, L)LSERT —
PERMIT# 1 Jv_`L�`rZ
PLAN LOCATION:
Project Address: 7/Ly i
Project Description: Pool, Remodel, Add't, Elect, Plumb �ech)_
APN #:
NV AL D V G^ ua;.5
Applicant Name: •�-
Address: 2 4 W 2 i�
City, ST, Zip: 2 `J aj
Telephone: '7 &0 LMI '3 Q
Email:
eo
Valuation of Projects r,•
Contractor Name: �/ Address /. � 3 b I,ANd c
City, St, Zip I .
Gc �'t_�
Telephone: A o 271
Email:
State Lic:
Arch/Eng Name:
Address:
City, St, Zip
Telephone:
Email:
State Lic:
r
New SFD Construction:
( —
Conditioned Space SF
t
Garage SF
Patio/Porch SF
Fire Sprinklers SF
City Bus Lic: k 0 f S'a 1
City Bus Lic:
Construction Type:
Grading:
Bedrooms: I Stories:
Occupancy:
# Units:
Property Owner's Name: Ar S 1t�
New Commercial / Tenant Improvements:
Address: 5 e
Total Building SF
City, ST, ZipL O.-L
Construction Type: Occupancy:
Telephone: �� - 70 .-
Email:
78495 CALLE TAMPICO
LA QUINTA, CA 92253
760-777-7000
OFFICE USE ONLY
#
Submittal
Req'd
Rec'd
Plan Sets
Structural Calcs
Truss Calcs
Title 24 Calcs
Soils Report
Grading Plan (PM10)
Landscape Plan
Subcontractor List
Grant Deed
HOA Approval
School Fees
Burrtec Debris Plan
Planning approval
Public Works approval
Fire approval
City Business License
Agent Authorization for Contractor
Company Name: Blair Heating and Air
Contractor's Name: Shawn Blair
Contractor's License Number: 953427
Email: Jacqueline@blairheatingandair.com
The below listed individual employee(s) are authorized to apply to +�'It
for a building permit on behalf of the above identified licensed contractor.
I understand that it is the licensed contractor's responsibility to provide a copy of this form with each
building permit application. If a copy of this form is not provided at the time that a building permit
application is filed, an agent(s) of the above identified licensed contractor may not apply for a building
permit.
The below listed employees are authorized to apply for permits or the above identified licensed
contractor:
Print Name(s) of authorized employees:
1.Stephanie Smith —2.Natecolyotv��A-
3.Evan Volkwein
S.Dan Ochipinti
7.Dan Brizuela
9.
Printed name and title of signor:
Authorized signature
4.Rob Cleaver _
6. Kyle Au Coin _
8. David Painter
M
SAQ,„ in 2))A 1 r-
Date: W-2 -f/1
Phone:1-877-600-0123 www.energuy.com Fax:1-877-571-0123
Esquire Plaza 1215 K Street, 17th Floor Sacramento, CA 95814
CERTIFICATE OF COMPLIANCE
Alterations to Space Conditioning Systems (formerly CF-IR-ALT HVAC)
Project Name:
CF1R-ALT 02-E
(Page 1 of 3)
LarryJustis Date Prepared: 2018-12-20
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 Larry Justis 02 Date Prepared P 2018-12-20
03 Project Location 57141 Medinah 04 BuildingType
Single family
05 CA City La Quinta 06 Dwelling Unit Name 57141 Medinah
07 Zip Code 92253 08 Dwelling Unit Conditioned
Floor Area (ft) 400
Number of Space
09 Climate Zone 15 10 Conditioning (SC) Systems in 1
this Dwelling Unit:
B. Space Conditioning (SC) System Information
01
1 02
03
04
Is the SC
SC System
SC System
CFA served
system a
Identification or
Location or Area
by this SC
ducted
Name
Served
System (ftZ)
system?
System 1
Location 1
400
No
05
1 06
1 07
08
09
Installing a
refrigerant
Installing new SC
Installing
Installing
Installing
containing
system
more than 40
entirely new
entirely new
component?
components?
feet of ducts?
duct system?
SC system?
Yes
Yes
No
No
No
C. Extension of Existing Duct System, Greater Than 40 Feet (Section150.2(b)1Diib)
This section does not apply to this project.
10
Alteration Type
Altered space
conditioning system
Registration Number: 418-A020100645A-000-000-00o00o0-0000 Registration
i; Date/Time: 2018-12-20 10:02:19 HERS Provider: CHEERS
CA Building Energy Efficiency Standards - 2016 Residential Compliance Report Version: 2018.0.001
Report Generated: 2018-12-20 10:02:19
Schema Version: rev 20180426
CERTIFICATE OF COMPLIANCE
CF111-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
9 1
Heating
12
System Heating Altered Heating Minimum Altered Cooling
System Heating Efficiency Efficiency
ing
orIdentification
Cooling Cooling Efficiency
orName Type Components Type Value System Type Components Type
!Minimum
ncy Tlaced New Duct
gTypeDuct
All newAll
ue Length R-Value
Central gas
newSystem 1 heating AFUE 81 Ductless
cooling SEER
furnacecomponents
ield or This field or
mini -split AC
components
n is not section is not
Required Documentation:
cable applicable
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 CF313-MCH-20-H - Duct Leakage Test required when heating or cooling components
are installed in ducted systems, or when more than 40 ft
-Leakage rate compliance: <= 15 percent or <=10 percent leakage to outside, or seal all accessible leaks.
of duct length 1s replaced
CF2R and CF3R-MCH-25-H Refrigerant Charge verification required when refrigerant containing components are installed or altered (applicable in CZ 2,
CF2R and MR-MCH-23 Airflow Rate >= 300 CFM
8-15).
per ton required when MCH-25 is required.
x Po ion •
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)1Diia and 150.2(b)IE, F)
This section does not apply to this project.
F. Entirely New or Complete Replacement Space Conditioning System (Section 150.2(b)IC)
Registration Number: 418-A020100645A-000-000-0000000-0000
This section does not apply to this project.
Registration Date/Time: 2018-12-20 10:02:19
HERS Provider: CHEERS
CA Building Energy Efficiency Standards - 2016 Residential Compliance Report Version: 2018.0.001
Report Generated: 2015-12-20 10:02:19
Schema Version: rev 20180426
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:
Nicole Godina
Company:
The Energuy
Address:
1215 K Street
City/State/Zip:
Sacramento CA 95814
Responsible Person's Declaration statement
Documentation Author Signature:
NFco� Godlna,
Signature Date:
2018-12-20
CEA/ HERS Certification Identification (if applicable):
Phone:
877-600-0123
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. I will ensure that a registered copy of this Certificate of 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:
Adam Fuson
Company:
Blair Air Inc dba Blair Heating & Air
Address:
653 Oleander Road
City/State/Zip:
Palm Springs CA 92264
Responsible Designer Signature:
Admovl u6ew
Date Signed:
2018-12-20
License:
953427
Phone:
760-537-1120
Digitally signed by CHEERsTm. 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: 418-A020100645A-000-000-0000000-0000
Registration Date/Time: 2018-12-20 10:02:19
CA Building Energy Efficiency Standards - 2016 Residential Compliance Report Version: 2018.0.001
Schema Version: rev 20180426
HERS Provider: CHEERS
Report Generated: 2018-12-20 10:02:19