BMCH2019-008878-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Permit Type/Subtype:
Application Number:
Property Address:
APN:
Application Description:
Property Zoning:
Application Valuation:
Applicant:
CLAIRE BACHUS
77825 DELAWARE PL
PALM DESERT, CA 92211
c&'!t 4 to Qu4tw
DESIGN & DEVELOPMENT DEPARTMENT
BUILDING PERMIT
MECHANICAL/
BMCH2O19-0088
79955 RANCHO LA QUINTA DR
602370001
HICKS / HVAC CHANGE OUT - 14SEER/80AFUE SPLIT SYSTEM
$20,000.00
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 3/25/2019
Owner:
MARY HICKS
79955 RANCHO LA QUINTA DRIVE
LA QUINTA, CA 92253
Contractor:
D AUSTIN SIMMONS DBA SIMMONS AIR CONDITION
P 0 BOX 314
MAR 2 5 2019 LA QUINTA, CA 92247
CITY 4F LA QuiNTA (760)863-5254
DESIGN &DEVELOPMDNT DEPARTMENT Llc. No.: 780534
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 Cla : C License No.: 780534
Date- A 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 the work for which this permit is issued.
0J 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:13054780
C&s 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: ?,�����
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.
7
Date: Signature (Applicant or Agent):
Date: 3/25/2019
Application Number:
Property Address:
APN:
Application Description
Property Zoning:
Application Valuation:
Applicant:
CLAIRE BACHUS
77825 DELAWARE PL
PALM DESERT, CA 92211
BMCH2019-0088
79955 RANCHO LA QUINTA DR
602370001
HICKS / HVAC CHANGE OUT- 14SEER/80AFUE SPLIT SYSTEM
$20,000.00
Owner:
MARY HICKS
79955 RANCHO LA QUINTA DRIVE
LA QUINTA, CA 92253
Contractor:
AUSTIN SIMMONS DBA SIMMONS AIR CONDITION
P 0 BOX 314
LA QUINTA, CA 92247
(760)863-5254
Llc. No.: 780534
Detail: 3-TON & 4-TON HVAC CHANGE OUTS - 14SEER/80AFUE SPLIT SYSTEM. CARBON MONOXIDE ALARM(S) TO BE INSTALLED PRIOR TO FINAL
INSPECTION. 2016 CALIFORNIA BUILDING CODES.
DESCRIPTION ACCOUNT CITY 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
$80.04
DESCRIPTION
ACCOUNT
CITY
AMOUNT
HVAC CHANGEOUT - SPLIT -SYSTEM PC
101-0000-42600
0
$160.10
Total Paid for CHANGEOUT: $240.14
DESCRIPTION
ACCOUNT
QTY
AMOUNT
Credit Card Fee
101-0000-43505
0
$6.44
Total Paid for Credit Card Fee: $6.44
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
QTY
AMOUNT
TECHNOLOGY ENHANCEMENT FEE
502-0000-43611
0
$5.00
Total Paid for TECHNOLOGY ENHANCEMENT FEE: $5.00
tev 0"tra
PERMIT # —b " 1(- (4 2O k (3� — C7 C)458
PLAN LOCATION:
Project Address:
Project Description: Pool, Remodel, Add't, Elect, Plumb, Mech
APN #:
o ' ❑
ti
Applicant Name: Clay ('- -, T:ac,�I'
Address: �7q. &82 r--
City, ST, Zip:OAr ),
Telephone: 6O
Email: �,/�,�
Valuation of Project $ a),
Contractor Name: IM vm� P) v&yo-
New SFD Construction:
Address: •P V , 130r�, U N
Conditioned Space SF
City, St, Zip L .a )NU k rr- � (A
Garage SF
Telephone: '1("' 15 5
Patio/Porch SF
Email: r(A
Fire Sprinklers SF
State Lic: q O 5 3 � City Bus Lic:
Arch/Eng Name:
Construction Type: Occupancy:
Address:
Grading:
City, St, Zip
Telephone:
Bedrooms: Stories: # Units:
Email:
State Lic: City Bus Lic:
Property Owner's Name: XT,�. �4, C KS,
New Commercial / Tenant Improvements:
Address: f\k) L& 0( ; Va,
Total Building SF
City, ST, Zip •vi +-A
Construction Type: Occupancy:
Telephone: • 6' � — T77 ?
Email: AIA
78495 CALLE TAMPICO
LA QUINTA, CA 92253
760-777-7000
CERTIFICATE OF COMPLIANCE
Alterations to Space Conditioning Systems (formerly CF-IR-ALT-HVAC)
Project Name:
79955 Rancho La quinta Or I Date Prepared:
CF1R-ALT-02-E
(Page 1 of 3)
2019-03-25
A. General Information
CFIR-ALT-02 is applicable to multiple space conditioning systems contained within a single dwelling unit. When multiple dwelling units must be documented, use one
CF111-ALT-02 document for each dwelling unit.
01
Project Name
79955 Rancho La quinta Dr
02
Date Prepared
2019-03-25
03
Project Location
79955 Rancho La quinta Dr
04
Building Type
Single family
05
CA City
La Quinta
06
Dwelling Unit Name
79955 Rancho La quinta Dr
07
Zip Code
92253
08
Dwelling Unit Conditioned
35000
Floor Area (ft2)
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 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 (ft)
system?
component? components?
feet of ducts?
duct system?
SC system?
Alteration Type
System 1 whole House 35000
Yes
Yes Yes
No
No
No
Altered space
conditioning system
C. Extension of Existing Duct System, Greater Than 40 Feet (Section150.2(b)1Diib)
Registration Number: 219-A020069458A-000-000-0000000-0000
This section does not apply to this project.
Registration Date/Time: 2019-03-25 10:38:04
HERS Provider: CalCERTS
CA Building Energy Efficiency Standards - 2016 Residential Compliance Report Version: 2018.0.001 Report Generated: 2019-03-25 10:37:58
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)
01 02 03 04 05 06 07 018 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 All new
Central gas Central split
System 1 heating AFUE 80 cooling SEER 14 Setback
Less than or
equal to 40 R-8
furnace AC
components components
feet
Reauired 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 MR-MCH-20-1-1 - 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)1Diia and 150.2(b)lE, 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: 219-A020069458A-000-000-0000000-0000
This section does not apply to this project.
Registration Date/Time: 2019-03-25 10:38:04
HERS Provider: CaICERTS
CA Building Energy Efficiency Standards - 2016 Residential Compliance Report Version: 2018.0.001 Report Generated: 2019-03-25 10:37:58
Schema Version: rev 20180426
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:
Simmons, Donna�����
Company:
Signature Date:
ADAM SIMMONS
2019-03-25 10:38:04
Address:
CEA/ HERS Certification Identification (if applicable):
54440 AVENIDA CARRANZA
City/State/Zip:
Phone:
LA QUINTA CA 92253
760-564-7525
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 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:
Responsible Designer Signature:
Simmons, Donna��
Company:
Date Signed:
ADAM SIMMONS
2019-03-25 10:38:04
Address:
License:
54440 AVENIDA CARRANZA
780534
City/State/Zip:
Phone:
LA QUINTA CA 92253
760-564-7525
Digitally signed by CaICERTS. 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: 219-A020069458A-000-000-0000000-0000 Registration Date/Time: 2019-03-25 10:38:04 HERS Provider: CaICERTS
CA Building Energy Efficiency Standards - 2016 Residential Compliance Report Version: 2018.0.001 Report Generated: 2019-03-25 10:37:58
Schema Version: rev 20180426