BMCH2019-010478-495 CALLE TAMPICO T4,tvl DVOICE (760) 777-7125
LA QUINTA, CALIFORNIA 92253 FAX (760) 777-7011DESIGN & DEVELOPMENT DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 4/4/2019
Permit Type/Subtype: MECHANICAL/ Owner:
Application Number: BMCH2O19-0104 DONALD PETITE
Property Address: 79830 RANCHO LA QUINTA DR 79830 RANCID LA QUINTA DR.
APN: 602220003 LA QUINTA, CA 92253
Application Description. PETTIE / HVAC CHANGE OUT - 14SEER/80AFUE SPLIT SYSTEM
Property Zoning:
Application Valuation:
Applicant: Contractor:
CLAIRE BACHUSAUSTIN SIMMONS DBA SIMMONS AIR CONDITION
77825 DELAWARE PLACE D P 0 BOX 314
PALM DESERT, CA 92211 APR 0 4 2019 ID
LA QUINTA, CA 92247
CITY OF LA QUINTA (760)863-5254
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 7000) of Division 3 of the Business and Professions Code,
and my License is in full force and effect.
License Clas : C2 License No.: ?80534 .y �y [�f
Date: t J I [I Contractor; (�lri1-----
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 thework For which this permit is issued.
C S2 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 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 thgse provisions.
Date: i�I � t�� Applicant: ��l'I, "c 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.
Date: Signature (Applicant or Agent);
Application Number:
Property Address:
APN:
Application Description
Property Zoning:
Application Valuation:
Applicant:
CLAIRE BACHUS
77825 DELAWARE PLACE
PALM DESERT, CA 92211
BMCH2O19-0104
79830 RANCHO LA QUINTA DR
602220003
PETTIE / HVAC CHANGE OUT - 14SEER/80AFUE SPLIT SYSTEM
Date: 4/4/2019
Owner:
DONALD PETITE
79830 RANCO LA QUINTA DR.
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: 5 -TON HVAC CHANGE OUT-14SEER/80AFUE SPLIT SYSTEM. CARBON MONOXIDE ALARM(S) TO BE INSTALLED PRIOR TO FINAL INSPECTION. 2016
CALIFORNIA BUILDING CODES.
FINANCIAL • + •
DESCRIPTION ACCOUNT
QTY
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
QTY
AMOUNT
TECHNOLOGY ENHANCEMENT FEE
502-0000-43611
0
$5.00
Total Paid for TECHNOLOGY ENHANCEMENT FEE: $5.00
Contractor Name: fl6pmNew
f+ .Q�Ara
— c;r.�s Ufa. ryr.+rtze"c —
PERMIT # ZU l b (if
PLAN LOCATION:
Project Address: 71,530 R}p Lpr
Project Description: Pool, Remodel, Add't, Elect, Plumb, Mech
APN
Patio/Porch SF
Email: N / A
Fire Sprinklers SF
State Lic: "-7t? 85 3y City Bus Lic:
r
Applicant Name: C� CA -V
Address: 74�
�, jQ r\--
\City,
City,ST, Zip:
r-�' Ca al►
Telephone:
L ✓ t7 'g
Email:
jjl
Valuation of Project $�' , 000
Contractor Name: fl6pmNew
SFD Construction:
Address:' C
Conditioned Space SF
City, St, Zips n I A l ��7
Garage SF
Te 7�(,) �� --7S -
Patio/Porch SF
Email: N / A
Fire Sprinklers SF
State Lic: "-7t? 85 3y 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: ���, ; �° New Commercial / Tenant Improvements:
Address:—�" V)'Y-) k� �U %rJ 1 r Total Building SF
City, ST, Zip PLUAr' Construction Type- Occupancy:
Telepl�one• � C; s 6% FEmail:
/8495 CALLE TAMPICO
LA QU I NTA, CA 92253
760-777-7000
CERTIFICATE OF COMPLIANCE
CF111-ALT 02-E
Alterations to Space Conditioning Systems (formerly CF -IR -ALT -HVAC)
(Page 1 of 3)
Project Name: 79830 Rancho La Quinta drive Date Prepared:
2019-04-04
A. General Information
CF111-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 79830 Rancho La Quinta drive 02 Date Prepared 2019-04-04
03 Project Location 9830 Rancho La Quinta drive 04 Building Type Single family
05 CA City La Quinta 06 Dwelling Unit Name 179830 Rancho La Quinta drive
07 Zip Code 92253 08 Dwelling Unit Conditioned 2000
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
SC System
Identification or
Name
SC System
Location or Area
Served
CFA served
by this SC
System (ft)
Is the SC
system a
ducted
system?
Installing a
refrigerant
containing
component?
Installing new SC
system
components?
Installing
more than 40
feet of ducts?
Installing
entirely new
duct system?
Installing
entirely new
SC system?
System 1
Whole House
2000
Yes
Yes
Yes
No
No
No
C. Extension of Existing Duct System, Greater Than 40 Feet (Section 150.2(b)1Diib)
This section does not apply to this project.
10
Alteration Type
Altered space
conditioning system
Registration Number: 219-A020078466A-000-000-0000000-0000 Registration Date/Time: 2019-04-04 11:02:36
HERS Provider: CaICERTS
CA Building Energy Efficiency Standards - 2016 Residential Compliance Report Version: 2018.0.001
Report Generated: 2019-04-04 11:02:28
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)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 Duct
or Name Type Components Type Value System Type Components Type Value Type
Duct Length R -Value
System
System 1
Centralas
g
furnace
All new
heating
AFUE
80
Cent split
All new
cooling
SEER
14
Setback
Less than or
equal to 40
R-8
components
components
feet
Required Documentation:
MR -MCH -01-E - Space Conditioning Systems
- Duct insulation requirement for the new portions of supply -air and return -air ducts or plenums: R6 (CZ 1-50, 12 and 13) and R8 (CZ 11 and 14-16)
CF2R and CF311-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 MR -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 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 Dud 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)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: 219-A020078466A-000-000-0000000-0000
This section does not apply to this project.
Registration Date/Time: 2019-04-04 11:02:36
HERS Provider: CaICERTS
CA Building Energy Efficiency Standards - 2016 Residential Compliance Report Version: 2018.0.001 Report Generated: 2019-04-04 11:02:28
Srhpma Vpminn• rpv )n1Rna7F;
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:
Bachus, Tom
fYfG�
/G040
Company:
Signature Date:
MLC Building Performance
2019-04-04 11:02:36
Address:
CEA/ HERS Certification Identification (if applicable):
77825 Delaware Place
City/State/Zip:
Phone:
Palm Desert CA 92211
760-836-0066
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
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:
Bachus, Tom
Company:
Date Signed:
MLC Building Performance
2019-04-04 11:02:36
Address:
License:
77825 Delaware Place
780534
City/State/Zip: Phone:
Palm Desert CA 92211 760-836-0066
Easy to Verify 0
at CaICERTS.com'
Digitally signed byCaICERTS. This digital signature is provided in order to secure the conrenf or this registered document and in noway implies ■ - ti
Registration Provider responsibility for the accuracy of the irdorn+ation. "
Registration Number: 219-A020078466A-000-000-0000000-0000
CA Building Energy Efficiency Standards - 2016 Residential Compliance
Registration Date/Time: 2019-04-04 11:02:36
Report Version: 2018.0.001
Schema Version: rev 20180426
HERS Provider: CaICERTS
Report Generated: 2019-04-04 11:02:28