BMCH2019-036978-495 CALLE TAMPICO C� 0 D 4a
LA QUINTA, CALIFORNIA 92253 DESIGN & DEVELOPMENT DEPARTMENT
BUILDING PERMIT
Permit Type/Subtype:
MECHANICAL/
Application Number:
BMCH2O19-0369
Property Address:
51000 MANGO
APN:
776192009
Application Description,
ELLINGSEN / [2] HVAC CHANGEOUT
Property Zoning:
Application Valuation:
$16,000.00
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 9/12/2019
Owner:
Ellingsen James C / Ellingsen Tekla ...
51000 MANGO
LA QUINTA, CA 92253
Applicant: Contractor:
SAN'S AIR CONDITIONING & HEATING SAN'S AIR CONDITIONING & HEATING
51 -530 JACKSON STREET F
D51 -530 JACKSON STREET
COACHELLA, CA 92236-2737 SEP �12 2019 COACHELLA, CA 92236-2737
(760)398-8247
L
CITY OF LA QUINTA lc. No.: 522775
- -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:
fC�20� License No.: 2277
Date: �k \ V- Na_ 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.
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:aATE COMPENSATION INSURANCE FUND Policy Number: 9074503
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 370 of the Labor e, I shall forthwith
comply with those
provisions,
Date:. e" ` , \ 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
ssued 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 �nt¢rs ipon thel
above -mentioned property for inspection purposes. L&s � 11 n
Date: irA Signature (Applicant or Ag;ent6A%M14%1'
Date: 9/12/2019
Application Number:
BMCH2019-0369
Property Address:
51000 MANGO
APN:
776192009
Application Description:
ELLINGSEN / [2] HVAC CHANGEOUT
Property Zoning:
Application Valuation:
$16,000.00
Applicant:
SAWS AIR CONDITIONING & HEATING
51-530 JACKSON STREET
COACHELLA, CA 92236-2737
Owner:
Ellingsen James C / Ellingsen Tekla ...
51000 MANGO
LA QUINTA, CA 92253
Contractor:
SAN'S AIR CONDITIONING & HEATING
51 -530 JACKSON STREET
COACHELLA, CA 92236-2737
(760)398-8247
Llc. No.: 522775
Detail: CHANGE OUT (2)16SEER/80AFUE SPLIT SYSTEMS. CARBON MONOXIDE ALARM(S) TO BE INSTALLED PRIOR TO FINAL INSPECTION. 2016 CALIFORNIA
BUILDING CODES.
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
$80.04
DESCRIPTION
ACCOUNT
QTY
AMOUNT
HVAC CHANGEOUT - SPLIT -SYSTEM PC
101-0000-42600
0
$160.10
Total Paid for CHANGEOUT: $240.14
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: $5.00
taQaiora
PERMIT # 1 3
PLAN LOCATION:
Project Address:
Project Description: Pool, Remodel, Add't, Elect, Plumb, Mech
APN #:
ArA
Applicant Name-A-C:,k\A
Address:
City, ST, Zip:
Telephone:
Email: ,���(�(� r�p�C9M
Valuation of Project$
Contractor Name.c� +
New SFD Construction:
Address:` `—
Conditioned Space SF
City, St, Zip p�c�a
d�
Garage SF
Telephone: i2�AIPOL�) bll
Patio/Porch SF
Email: ���
Fire Sprinklers SF
State Lie: City Bus Lie: C)bo �
Arch/Eng Name:
Construction Type: Occupancy:
Address:
Grading:
City, St, Zip
Telephone:
Bedrooms:
Stories:
# Units:
Email:
State Lie: City Bus Lie:
Property Owner's Name:
New Commercial / Tenant Improvements:
Address:
Total Building SF
City, ST, Zip
Construction Type: Occupancy:
Telephone:
Email:
78495 CALLE TAMPICO
LA QU I NTA, CA 92253
760-777-7000
Z Simplified Prescriptive Certificate of Compliance: 2008 Residential HVA C Alterations CF-IR-ALT-HVAC I
Climate Zones 10 to 15
Site Address:
Enforcement Agency:
Date:
Permit #:
`��� C� ►J
qi.- � - q
Conditioned Floor
E ui ment Type'
List Minimum Efficiencyz
Duct insulation requirement
Area
Thermostat
❑
Packaged Unit
Furnace
❑ AFUR
® COP
Over 40 ft of ducts added or
❑ Setback
19Indoor
Coil
Condensing Unit
SEER �
BEER ►
HSPF
® Resistance
� Iaced in unconditioned space
R 6 (CZ 10-13)
Served by system
sf
(If not already
present, must be
0ther
R 8 (CZ 14-15)
installed)
1. Equipment Type: Choose the equipment being installed; if more than one system, use another CF-IR-ALT-HVAC for each system.
2. Minimum Equipment Efficiencies: 13 SEER, 78%AFUE, 7.7HSPFfor typical residential systems.
HERS VERIFICATION SUMMARY Listed below are four HVAC alteration Options. The installer decides what work is being done and
picks one of the appropriate Options. Each Option lists the HERS measures that must be conducted. A copy of the forms shall be left on site for final
inspection and a copy given to the homeowner. At final, the inspector verifies that the work listed on this form was in fact the work completed by the
installer. The inspector also verifies that each appropriate CF-6R and registered CF-4R forms (no hand filled CF-4Rs allowed) are filled out and
signed. Beginning October 1, 2010 a registered copy of the CF-1R and CF-611 shall also be on site for final inspection.
1. HVAC Changeout
Required Forms:
• All HVAC Equipment replaced
CF-6R forms: MECH-04, MECH-2I-HERS and (for split systems) MECH-25-HERS
CF-4R forms: MECH-21 and (fors lit systems) MECH-25
� Condenser Coil and/or
CF-6R forms: MECH-2I-HERS and (for split systems) MECH-25-HERS
■ Indoor Coil and/or
CF-4R forms: MECH-21 and (for split systems) MECH-25
■ Furnace
For Split Systems: Duct leakage < 15 percent; RC, CCA > 300 CFM/ton(Minimum Air Flow Requirement), TMAH
For Packaged Units: Duct leakage < 15 percent
Exempted from duct leakage testing if:
B1. Duct system was documented to have been previously sealed and confirmed through HERS verification, or
2. Duct systems with less than 40 linear feet in unconditioned space, or
3. Existing ducts stems are constructed, insulated or sealed with asbestos
2. New HVAC System
Required Forms:
■ Cut in or Changeout with new
ducts: (all new ducting and all
CF-6R forms: MECH-04, MECH-20-HERS,and (for split systems) MECH-22-HERS, and MECH-25-HERS
new a ui ment)
CF-4R forms: MECH-20, and (for split systems) MECH-22, and MECH-25
For Split Systems: Duct leakage < 6 percent; RC, CCA > 350 CFM/ton, FWD, TMAH, STMS, and either HSPP or PSPP.
For Packaged Units: Duct leakage < 6 percent
❑ 3. New Ducts with Replacement
Required Forms:
• Includes replacing or installing all new ducting
CF-6R forms: MECH-04, MECH-20-HERS,and (for split systems) MECH-25-HERS
and/or outdoor condensing unit and/or indoor
CF-4R forms: MECH-20 and (for split systems) MECH-25
coil and/or furnace. Not all equipment changed.
For Split Systems: Duct leakage < 6 percent, RC, CCA > 300 CFM/ton, TMAH
For Packaged Units. Duct leakage < 6 percent
4. New Ducting over 40 feet
Re uired Forms:
■ Includes adding or replacing more than 40
linear feet of duct in unconditioned space.
CF-6R forms: MECH-04, MECH-2I-HERS CF-4R forms: MECH-21
For splits stem or packaged units: Duct leakage < 15 percent
EXCEPTION: Existing ducts stems constructed, insulated or sealed with asbestos.
Contractor (Documentation Author's /Responsible Designer's Declaration Statement)
■ I certify that this Certificate of Compliance documentation is accurate and complete.
• I am eligible under Division 3 of the California Business and Professions Code to accept responsibility for the design identified on this Certificate of Compliance.
• 1 certify that the energy features and performance specifications for the design identified on this Certificate of Compliance conform to the requirements of Title 24,
Parts 1 and 6 of the California Code of Regulations.
• The design features identified on this Certificate of Compliance are consistent with the information documented on other applicable compliance forms, worksheets,
calculations, plans and specifications submitted to the enforcement agencv for approval with the it lication.
Name: �,-3\ -- ` - � ���1 .
V
Signatus f= & L J
Company:, l ,, }}
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Date: r�
[L� 1 -
r tl'
Address: �\- f
License:
City/State/Zip: �� ��
Phone:
2008 Residential Comvliance Forms Julv 2010