BMCH2019-047178-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Permit Type/Subtype:
Application Number:
Property Address:
APN:
Application Description:
Property Zoning:
Application Valuation:
c&iy/ 4 e(P Quiot
DESIGN & DEVELOPMENT DEPARTMENT
BUILDING PERMIT
MECHANICAL/
BMCH 2019-0471
57141 MEDINAH
762110035
JUSTIS / (2)HVAC CHANGEOUTS 14SEE/81AFUE SPLIT
$26,029.00
Applicant:
BLAIR AIR INC DBA BLAIR HEATING & AIR
653 OLEANDER ROAD
PALM SPRINGS, CA 92264
DEC 20 2019
CITY OF LA QUINTA
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: C20 License No.: 953427 n
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:
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 12/20/2019
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
LIc. No.: 953427
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 tfor which this permit is issued.
Vhave 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 AMERICAN 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 b came subject to the
workers' compensation provisions of Section 3700 of the L or 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 uilding
construction, and hereby authorize representatives of this city to en u the above -
mentioned property for inspection purposes.
Date: '%Y� I� Signature (Applicant or Agent):
Date: 12/20/2619
Application Number:
BMCH2019-0471
Property Address:
57141 MEDINAH
APN:
762110035
Application Description:
JUSTIS / (2)HVAC CHANGEOUTS 14SEE/81AFUE SPLIT
Property Zoning:
Application Valuation:
$26,029.00
Applicant:
BLAIR AIR INC DBA BLAIR
HEATING & AIR
653 OLEANDER ROAD
PALM SPRINGS, CA 92264
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: (2)HVAC CHANGE OUTS - (2)145EER/81AFUE SPLIT SYSTEMS. 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 $2.00
Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $2.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
HVAC CHANGEOUT - SPLIT -SYSTEM
101-0000-42402
0
$80.50
DESCRIPTION
ACCOUNT
CITY
AMOUNT
HVAC CHANGEOUT - SPLIT -SYSTEM PC
101-0000-42600
0
$161.00
Total Paid for MECHANICAL CHANGEOUT 2019: $241.50
DESCRIPTION
ACCOUNT
CITY
AMOUNT
PERMIT ISSUANCE
101-0000-42404
0
$101.97
Total Paid for PERMIT ISSUANCE: $101.97
DESCRIPTION
ACCOUNT
QTY
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
tev Q"Kra
— GE`i ql',b, DE:SF,kr —
PERMIT # I — 09-7
PLAN LOCATION:
Project Address• 5 v !
Project Description: Pool, Remodel, Add't, Elect, Plumb, Mech
APN #:
1
Applicant Name: �aLac
Address: r
City, ST, zip:
Telephone:
Email:
Valuation of Project $ . ,
Contractor Name:
S it IL
New SFD Construction:
Address: l� I _ r
Conditioned Space
55 SF
City, St, 'Zip ' �,
Garage
SF
Telephone:
Patio/Porch
SF
Email:
Fire Sprinklers
SF
State Lie: City Bus Lie:
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: A, f- V s
New Commercial / Tenant Improvements:
Address:
1 14a C
Total Building SF
City, ST, Zip
Construction Type: Occupancy:
Telephone: _
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
'W9114p*
Agent Authorization for Contractor
Company Name:
Contractor's Name:
contractor's License Number: (4.T ;�Q '-I--
Email:
The below listed individual employee(s) are auttfarized to apply to the city/county for a buildin
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 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 for the above identified licensed
contractor:
1. Aliyah Quiroz
2. Bruce Edgar
12. Kedar Sotomy
23, Stephanie Smith
32. Kyle Au Coin
3. Carolyn Christian
13. Laura Johnson
14. Mark Becker
24. Stephen Krale
33. Josh Horney
4. Charles Shaw
15. Matt McHattie
25. Stephen Swinney
26. Teresa Kum
34. Nancy Risi
5. Jacob Kinney
16. Nate Calyott
P
27. Tim Lane
35. Rikki Niemeyer
36. Rob Cleaver
G. Cody Chicourrat
7. Dan Ochipinti
17. Omar Espinoza Mora
28. Tony Thai
.
3Sam Lee
8. Evan Volkwein
18. Peter Lujan
19. Ronald Lai
29. Tracy Shampine
38. Daniel Brizuela
9. Harry Chi 0
20. Ryan Faris
30. Alyssa Ross
31. Bri McLaughlin
39. Breeana Peterson
10. Jasna Sikic
21. Shaun Hogue
32. Brinder Grewal
40. Jessica Sarajas
41. Nicholas Settle
11. John Maltman
22. Shawn Kurjsemiller
33. Kyle Au Coin
Printed name and title of
Authorized
Date: ('
This certificate is attached to a _ page document dealing with/entitled and dated
WitnesS of Signature
STATE OF COUNTY OF
On this day of, 20 before me, the undersigned notary pubiic d
(nom of Mon acknowledging] proved to satisfactory evidence, which
was (type he ide a person whose name Is signed on the preceding or
attached do �ph�p
Commission
Phone: 1-877-600-0123 wwwenerguycom Fd:r 1-BT7-571-0i23
Esquire Plaza 1215 K Street, 17th Floor Sacraments CA 95814
Signature of Notary Public
Dot! of Notary Public
7t�� 4T U V-~
Ar(,KN0VL9bp4hWr
Scanned by CamScanner
CERTIFICATE OF COMPLIANCE
Alterations to Space Conditioning Systems (formerly CF-IR-ALT HVAC)
Project Name:
57141 Medinah I Date Prepared:
CF1R-ALT 02-E
(Page 1 of 3)
2019-12-20
A. General Information
CHR-ALT-02 is applicable to multiple space conditioning systems contained within a singlie:dwelling unit. When multiple dwelling units must be documented, use one
CHR-ALT-02 document for each dwelling unit. l� f loll
01
Project Name
57141 Medinah
02
Date Prepared
2019-12-20
03
Project Location
57141 Medinah
04
Building Type
Single family
05
CA City
La Quinta
06
Dwelling Unit Name
57141 Medinah
Dwelling UnitConditioned
07
Zip Code
92253
08
Floor Area (ft )
2205
Number of Space
09
Climate Zone
15
10
Conditioning (SC) Systems in
2
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(Sys 1)
Location 1
1103
Yes
Yes
Yes
Yes
No
No
Altered space
conditioning system
Altered space
System 2 (Sys 2)
Location 2
1102
Yes
Yes
Yes
Yes
No
No
conditioning system
C. Extension of Existing Duct System, Greater Than 40 Feet (Section 1S0.2(b)1Diib)
This section does not apply to this project.
Registration Number: 419-A020141311A-000-000-0000000-0000
Registration Date/Time: 2019-12-20 09:30:02
HERS Provider: CHEERS
CA Building Energy Efficiency Standards - 2016 Residential Compliance Report Version: 2018.0.001 Report Generated: 2019-12-20 09:30:11
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
11 112
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 gas
All new
Central split
All new
Greater than
System 1 (Sys 1)
furnace
heating
AFUE
81
AC
Cooling
SEER
14
Setback
40 feet
R 8
components
components
Central gas
All new
Central split
All new
Greater than
System 2 (Sys 2)
furnace
heating
AFUE
81
AC
cooling
SEER
14
Setback
40 feet
R 8
components
components
Required 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 (CZJ-1D, 12 and 231 and RS (CZ 11 and 14-16)
CF2R and CF3R-MCH-20-H - Duct Leakage Test required when heatingor 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 leakageto 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)1E, F)
This section does not apply to this project.
F. Entirely New or Complete Replacement Space Conditioning System (Section 150.2(b)1C)
This section does not apply to this project.
Registration Number:419-A020141311A-000-000-0000000-0000
Registration Date/Time: 2019-12-20 09:30:02
HERS Provider: CHEERS
CA Building Energy Efficiency Standards - 2016 Residential Compliance Report Version: 2018.0.001 Report Generated: 2019-12-20 09:30:11
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:
DtYcur4t7Yion Author Signature:
Marc-Antuan Enriquez
cwG_A n-uayV EYw
Company:
Signature Date:
The Energuy
2019-12-20
Address:
CEAf HERS Certification Identification (if applicable):
1215 K Street
City/State/Zip:
Phone -
Sacramento CA 95814
877-600-0123
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 buildingdesign 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 Pact 6 of the Callfomia 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:
Adam Fuson
A a ynl
Company:
Date Signed:
Blair Air Inc dba Blair Heating & Air
2019-12-20
Address:
License:
653 Oleander Road
953427
City/State/Zip:
Palm Springs CA 92264
760-537-1120
NOTICE. This certificate has been generated by California Energy Registry, Inc. ("Cal Energy) using information uploaded by third parties not affiliated or related to Cal Energy.
Therefore, Cal Energy is not responsible for, and cannot guarantee, the accuracy or completeness of the information contained in this certificate.
Registration Number: 419-A020141311A-000-000-0000000-0000
Registration Date/Time: 2019-12-20 09:30:02
HERS Provider: CHEERS
CA Building Energy Efficiency Standards - 2016 Residential Compliance Report Version: 2018.0.001 Report Generated: 2019-12-20 09:30:11
Schema Version: rev 20180426