BMCH2020-0011T^ht 44u4urKrw
DESIGN & DEVELOPMENT DEPARTMENT
BUILDING PERMIT
MECHANICAL/
BMCH2O20-0011
55403 RIVIERA
775153004
CULLIGAN / HVAC CHANGE OUT-14SEER MINI -SPLIT SYSTEM
$6,700.00
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 922-53
Permit Type/Subtype:
Application Number:
Property Address:
APN:
Application Description:
Property Zoning:
Application Valuation:
Applicant:NQJOHN MALTMAN - BLAIR AIR INC DBA BLAIR HEAT A
653 OLEANDER ROAD
PALM SPRINGS, CA 92264
W1
JAN 16 2020
11
CITY OF IAQUINTA
DESIGN & DEVELOPMENT DEPARTMENT
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter
9 (commencing with Section 7000) of Division 3 of the Business and Professions Code,
and my License is in full force and effect.
License Class:
PQ License No.: 953427
Date: �_L[/ 11 Contractor: Ilk
70111 JWL�G�_/
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State
License Law for the following reason (Sec. 7031.5, Business and Professions Code: Any
city or county that requires a permit to construct, alter, improve, demolish, or repair
any structure, prior to its issuance, also requires the applicant for the permit to file a
signed statement that he or she is licensed pursuant to the provisions of the
Contractor's State License Law (Chapter 9 (commencing with Section 7000) of Division
3 of the Business and Professions Code) or that he or she is exempt therefrom and the
basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a
permit subjects the applicant to a civil penalty of not more than five hundred dollars
($S00).:
(_) 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
Lender's Address:
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 1/16/2020
Owner:
THOMAS CULLIGAN
55403 RIVIERA
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
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 tUg—work for which this permit is issued.
I have and will maintain workers' compensation insurance, as required by
Sectio 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:6CE AMERICANJN$URAH E COMPANY Policy Number: C66014447
I certify that in the performance of the work for which this permit is issued,
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 de, I shall forthwith
comply with those provisions.
Date: 01—le—
Applicant: .. 4L
WARNING: FAILURE TO SECURE WOR S' 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-mentio ed property for inspection purposes.
Date: r' Signature (Applicant or Agent):
Date: 1/16/2020
Application Number:
BMCH2020-0011
Property Address:
55403 RIVIERA
APN:
775153004
Application Description:
CULLIGAN / HVAC CHANGE OUT-14SEER MINI -SPLIT SYSTEM
Property Zoning:
Application Valuation:
$6,700.00
Applicant:
JOHN MALTMAN - BLAIR AIR INC DBA BLAIR HEATING & AIR
653 OLEANDER ROAD
PALM SPRINGS, CA 92264
Owner:
THOMAS CULLIGAN
55403 RIVIERA
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
Detail: 14/SEER DUCLESS MINI -SPLIT CHANGE OUT OF EXISTING SYSTEM. CARBON MONOXIDE ALARM(S) TO BE INSTALLED PRIOR TO FINAL INSPECTION.
2019 CALIFORNIA BUILDING CODES.
FINANCIAL
DESCRIPTION
INFORMATION
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
$40.25
DESCRIPTION
ACCOUNT
QTY
AMOUNT
HVAC CHANGEOUT - SPLIT -SYSTEM PC
101-0000-42600
0
$80.50
Total Paid for MECHANICAL CHANGEOUT 2019: $120.75
DESCRIPTION
ACCOUNT QTY
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
QTY
AMOUNT
TECHNOLOGY ENHANCEMENT FEE
502-0000-43611
0
$5.00
Total Paid for TECHNOLOGY ENHANCEMENT FEE: $5.00
QaiK rev
Project Address:
APN #: V !
Applicant Name:
Address: 1�
City, ST, Zip: J Q
Telephone:
Email: f n�
Property Owner's Name:
Address:
City, ST, Zip
qvL
Telephone:
CALLE TAMPICO
LA QUINTA, CA 92253
760-777-7000
CERTIFICATE OF COMPLIANCE
Alterations to Space Conditioning Systems (formerly CF-IR-ALT-HVAC)
Project Name:
Tom Culligan I Date Prepared:
CF1R-ALT 02-E
(Page 1 of 3)
2020-01-15
A. General Information
CF1R-ALT-02 is applicable to multiple space conditioning systems contained within a single dwelling unit. When multiple dwelling units must be documented, use one
CF1R-ALT-02 document for each dwelling unit.
01
Project Name
Tom Culligan
02
Date Prepared
2020-01-15
03
Project Location
55403 Riviera
04
Building Type
Single family
05
CA City
La Quinta
06
Dwelling Unit Name
55403 Riviera
07
Zip Code
92253
08
Dwelling Unit Conditioned Floor
400
Area (ftZ)
Number of Space Conditioning
09
Climate Zone
15
30
(SC) Systems in this Dwelling
1
Unit:
B. Space Conditioning (SC) System Information
01
02
03
04
05
06
07
08
09
10
SC System ID or
SC System
CIA served by this
Is the SC system a
Installing a
refrigerant
Installing new SC
Installing more
Installing entirely
Installing entirely
Name
Location or Area
Served
2
SC System (ft)
�
ducted system.
containing
system
than 40 feet of
new duct system?
new ducted SC
Alteration T e
yP
component?
components?
ducts?
system?
Altered space
System 1
Location 1
400
No
Yes
Yes
No
No
No
conditioning
system
C. Extension of Existing Duct System, Greater Than 40 Feet (Section150.2(b)1Diib)
This section does not apply to this project.
Registration Number: 420-A020004985A-000-000-0000000-0000
Registration Date/Time: 2020-01-15 12:23:24
HERS Provider: CHEERS
CA Building Energy Efficiency Standards - 2019 Residential Compliance Report Version: 2019.1.002 Report Generated: 2020-01-15 12:23:47
Schema Version: rev 20191201
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)
O1
02
03
04
05
06
07
08
09
10
11
12
13
SC System
Heating
Cooling
Description
Altered
Heating
Minimum
Altered
Cooling
Minimum
Required
New or
System ID/
of Area
Heating
Heating
Efficiency
Efficiency
Cooling
Cooling
Efficiency
Efficiency
Thermostat
Replaced
New Duct
Name
Served
System Type
Components
Type
Value
System Type
Components
Type
Value
Type
Duct Length
R-Value
No Heating
Ductless
All new
System 1
Location 1
n/a
Component
n/a
n/a
mini -split AC
cooling
SEER
14
Setback
n/a
n/a
Altered
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 (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 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)3E, 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: 420-A020004985A-000-000-0000000-0000 Registration Date/Time: 2020-01-15 12:23:24 HERS Provider: CHEERS
CA Building Energy Efficiency Standards - 2019 Residential Compliance Report Version: 2019.1.002 Report Generated: 2020-01-15 12:23:47
Schema Version: rev 20191201
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:
Documentation Author Signature:
Marc-Antuan Enriquez
cwcl-A n-uvwL Evw.,
Company:
Signature Date: v
The Energuy
2020-01-15
Address:
CEA/ 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 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:
Adam Fuson
Ada4,nl
Company:
Date Signed:
Blair Air Inc dba Blair Heating & Air
2020-01-15
Address:
License:
653 Oleander Road
953427
City/State/Zip:
Phone:
Palm Springs CA 92264
760-537-1120
NOTICE: This certificate has been generated by Califomia 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: 420-A020004985A-000-000-0000000-0000
Registration Date/Time: 2020-01-15 12:23:24
HERS Provider: CHEERS
CA Building Energy Efficiency Standards - 2019 Residential Compliance Report Version: 2019.1.002 Report Generated: 2020-01-15 12:23:47
Schema Version: rev 20191201