BMCH2019-0459T-dY a 66P axi
78-495 CALLE TAMPICO Da
LA QUINTA, CALIFORNIA 92253 DESIGN & DEVELOPMENT DEPARTMENT
BUILDING PERMIT
Permit Type/Subtype: MECHANICAL/
Application Number:
BMCH2O19-0459
Property Address:
80580 VIA TALAVERA
APN:
777270014
Application Description:
RILEY / HVAC CHANGEOUT
Property Zoning:
Application Valuation:
$7,819.85
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Owner:
Riley Mickie L / Riley Hansi
LA QUINTA, CA 92253
Date: 12/12/2019
Applicant: Contractor:
BLAIR AIR INC DBA BLAIR HEATING & AIR BLAIR AIR INC DBA BLAIR HEATING & AIR
653 OLEANDER ROAD D
DEC 12 2019 'A' � 0 653 OLEANDER ROAD
PALM SPRINGS, CA 92264 PALM SPRINGS, CA 92264
0 (760)537-1120
cm OF LAQDINTA Llc. No.: 953427
PARTMENT
------------------------ ------p 51G&DEVELOPMEf��t7�-------------------------------------------------
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: C20 License No.: 953427
01
Date: I Z 117,111 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 Add
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.
-S-V 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: ACE AME91CAN INSURANCE COMPANY Policy Number: C66014447
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 ofthis 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):---I&e,,�
Date:. 12/12/2019
Application Number:
BMCH2019-0459
Property Address:
80580 VIA TALAVERA
APN:
777270014
Application Description:
RILEY / HVAC CHANGEOUT
Property Zoning:
Application Valuation:
$7,819.85
Applicant:
BLAIR AIR INC DBA BLAIR
HEATING & AIR
653 OLEANDER ROAD
PALM SPRINGS, CA 92264
Owner:
Riley Mickie L / Riley Hansi
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/80AFUE SPLIT SYSTEM HEAT PUMP. CARBON MONOXIDE ALARM(S) TO BE INSTALLED PRIOR TO FINAL INSPECTION.
2016 CALIFORNIA BUILDING CODES.
Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $1.00
DESCRIPTION
ACCOUNT
CITY
AMOUNT
HVAC CHANGEOUT - SPLIT -SYSTEM
101-0000-42402
0
$40.25
DESCRIPTION
ACCOUNT
CITY
AMOUNT
HVAC CHANGEOUT - SPLIT -SYSTEM PC
101-0000-42600
0
$80.50
Total Paid for MECHANICAL CHANGEOUT 2019: $120.75
DESCRIPTION
ACCOUNT
CITY
AMOUNT
PERMIT ISSUANCE
101-0000-42404
0
$101.97
Total Paid for PERMIT ISSUANCE: $101.97
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
ta 0"tra
-- GEM frlr I) SERF -
PERMIT Q
PLAN LOCATION:
ProjectAddress:
��S VINCI l dl 2
Project Description: Pool, Remodel, Add't, Elect, Plumb, Mech
APN#:
VAC C 1ir
Applicant Name:
t
Address: M5
K Skuo.
City, ST, Zip: SCACmnviJn,
Ca Gl
Telephone:
Email:
Valuation of Project S cl •p D
Contractor Name:
I a� r
r
New SFD Construction:
Address:
G
Conditioned Space SF
City, St, Zip
r►�
r� j
Garage SF
Telephone:
_ l(�
Patio/Porch SF
Email:
Fire Sprinklers SF
State Lic: lJ 2 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: r Z1
New Commercial / Tenant Improvements:
Address: V D Uc, '—
Total Building SF
City, ST, Zip L4 Q,,%eX
Construction Type: Occupancy:
Telephone: o
78495 CALLE TAMPICO
LA QU I NTA, CA 92253
760-777-7000
OFFICE USE ONLY
#
Submittal
Plan Sets
Req'd
Ree'd
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
ANN
Agent Authorization for Contractor
Company Name:
Contractor's Name:
Contractor's License Number:
Email:4-M t
The below listed individual employee(s) are au&orized to apply to the city/county for a building permit
and purchase of a business license 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 flied, 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 for the above identified licensed
contractor:
1. Aliyah Quiroz
12• Kedar Sotomy
23, Stephanie Smith
32. Kyle Au Coin
2. Bruce Edgar
13- Laura Johnson
24. Stephen Krale
33. Josh Horney
3. Carolyn Christian
14• Mark Becker
25. Stephen Swlnney
34. Nancy Risl
4. Charles Shaw
15• Matt McHattie
26. Teresa Kump
35. RIM Niemeyer
5. Jacob Kinney
16• Nate Colyott
27. Tim Lane
36. Rob Cleaver
6. Cody Chicourrat
17. Omar Espinoza Mora
28. Tony Thai
37. Sam Lee
7. Dan Ochipinti
19 Peter Lujan
29. Tracy Shampine
38. Daniel Brizuela
8. Evan Volkwein
19• Ronald Lai
30. Alyssa Ross
39. Breeana Peterson
9. Harry Chi 0
20. Samuel Vallejo
31. Bri McLaughlin
40. Jessica Barajas
10. Jasna Sikic
21- Shaun Hogue
32. Brinder Grewal
11. John Maltman
22• Shawn Kurpemiller
33. Kyle Au Coin
Printed name and title of stroor:
Authorized (- . � Date: =I2
This certificate is attached to a _page document dealing with/entitled and dated
Witness of Signature
STATE OF d(I-, COUNTY OF Vag fL
On this day of 202before me, the undersigned notary public d
{nam arson acknowledging) proved to satisfactory evidence, which
was (type D ide a person whose name is signed on the preceding or
attached d sence.
Signature of Notary Public
Commission ExAhWVn Date of Notary Public
Phone:l-877-600-0123 www.energuy.com Fax.1-67-f-571-0123
Esquire Plaza 1215 K Street,17th Floor Sacramento, CA 95814 16e� Ar
:k6W00LQ,- D-CA WIF
CERTIFICATE OF COMPLIANCE
MR-ALT-02-E
Alterations to Space Conditioning Systems (formerly CF-IR-ALT HVAC)
(Page i of 3)
Project Name:
80580 Via Talavera I Date Prepared:
2019-12-10
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 80580 Via Talavera
02 Date Prepared
2019-12-10
03 Project Location 80580 Via Talavera
04 Building Type
Single family
05 CA City La Quinta
06 Dwelling Unit Name
80580 Via Talavera
07 Zip Code 92253
Dwelling Unit Conditioned
Og
600
Floor Area (fta)
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 (ft7) system? component?
components? feet of ducts?
duct system? SC system?
Alteration Type
System 1 Location 1 600 Yes Yes
Yes No
No No
Altered space
conditioning system
C. Extension of Existing Duct System, Greater Than 40 Feet (Section150.2(b)1D11b)
Registration Number: 419-A020135685A4=-000-0000000-0000
This section does not apply to this project.
Registration Date/Time: 2019-12-10 08:34:39
HERS Provider: CHEERS
CA Building Energy Efficiency Standards - 2016 Residential Compliance Report Version: 2018.0.001 Report Generated: 2019-12-10 08:34:45
CERTIFICATE OF COMPLIANCE
CFIR-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 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
Central split All new All new
System 1 HP p heating AFUE 81 CentHPsplit cooling SEER 14 Setback
This field or This field or
section is not section is not
components components
applicable applicable
Reauired Documentation:
CF2R-MCH-01-E - Space Conditioning Systems
- Duct insulation requirement for the new portions of supply4r 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 CF311-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.
Exceations:
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)lC)
Registration Number: 419-A020135685A-000-000-0000000-0000
This section does not apply to this project.
Registration Date/Time: 2019-12-10 08:34:39
HERS Provider: CHEERS
CA Building Energy Efficiency Standards - 2016 Residential Compliance Report Version: 2018.0.001 Report Generated: 2019-12-10 08:34:45
CERTIFICATE OF COMPLIANCE
Alterations to Space Conditioning Systems (formerly CF-IR-ALT-HVAC)
Documentation Author's Declaration Statement
1.1 certify that this Certificate of Compliance documentation is accurate and complete.
Documentation Author Name:
Marc-Antuan Enriquez
Company:
The Energuy
Address:
1215 K Street
City/State/Zip:
Sacramento C4 95814
Responsible Person's Declaration statement
Documentation Author Signature:
Signature Date:
2019-12-10
LEA/ HERS Certification Identification (if applicable):
Phone:
877-600-0123
CF1R-ALT-02-E
(Page 3 of 3)
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 budding 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:
Date Signed:
2019-12-10
license:
953427
Phone:
760-537-1120
Digitally signed by CHEERS'"'. This digital signature is provided in order to secure the content of this registered
document and in no way implies Registration provrder responsibility for the accuracy of the information.
Registration Number: 419-A020135685A4000-000-0000000-0000 Registration Date/Time: 2019-12-10 08:34:39
HERS Provider: CHEERS
CA Building Energy Efficiency Standards - 2016 Residential Compliance Report Version: 2018.0.001 Report Generated: 2019-12-10 08:34:45