BMCH2020-004978-495 CALLE TAMPICO 'D�
� a VOICE (760) 777-7125
LA QUINTA, CALIFORNIA 92253 FAX (760) 777-7011
DESIGN & DEVELOPMENT DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 3/9/2020
Permit Type/Subtype:
MECHANICAL/ Owner:
Application Number:
BMCH2O20-0049 JODY GOOD
Property Address:
53025 AVENIDA RUBIO
APN:
774042025
Application Description:
GOOD / HVAC CHANGEOUT- 14SEER/80 AFUE SPLIT SYSTEM
Property Zoning:
Application Valuation:
$6,500.00
Applicant: Contractor:
JODY GOOD LLLJJJ OWNER BUILDER
MAR 0 9 2020
CITY OF LA OUINTA
DESIGN & DEVELOPMENT DEPARTMENT Llc. No.:
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: License No.:
Date:
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
(SSW) :
`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
t she did not bui[d or improve for the purpose of sale.).
l,s owner of the property, am exclusively contracting with licensed contractors
to c nstruct 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. 'ner:
CONSTRUCT# LE G AGENCY
I hereby affirm under penalty of perju that ere 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
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` Policy Number:_
i certify that in the performance of the work for which this permit is issued, I
shalt 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. f
Date: pplicanl:
WARNING: FAILURE TO SECURE WORKERS" MP SATION COVERAGE IS UNLAWFUL,
AND SHALL SUBJECT AN EMPLOYER TO CR MINAL 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.
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
-onstruction, and hereby authorize representatives of this city to enter upon the 7
)bove-me tinned property for inspection purposes.
3a1e' ' ature (Applicant or Agent): -
Date: 3/9/2020
Application Number: BMCH2020-0049 Owner:
Property Address: 53025 AVENIDA RUBIO JODY GOOD
Application Description: GOOD / HVAC CHANGEOUT-145EER/80 AFUE SPLIT SYSTEM
Property Zoning:
Application Valuation: $6,500.00
Applicant: Contractor:
JODY GOOD OWNER BUILDER
Llc. No.:
Detail: HVAC CHANGE OUT - 14SEER/80AFUE PACKAGED SYSTEM. CARBON MONOXIDE ALARM(S) TO BE INSTALLED PRIOR TO FINAL INSPECTION. 2019
CALIFORNIA BUILDING CODES.
DESCRIPTION ACCOUNT CITY AMOUNT
BSAS SB1473 FEE 101-0000-20306 0 $1.00
Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $2.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
HVAC CHANGEOUT - PACKAGED UNIT
101-0000-42402
0
$40.25
DESCRIPTION
ACCOUNT
CITY
AMOUNT
HVAC CHANGEOUT - PACKAGED UNIT PC
101-0000-42600
0
$26.83
Total Paid for MECHANICAL CHANGEOUT 2019: $67.08
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
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PERMIT # RN ( -- OO
PLAN LOCATION:
Project Address:
j�Dp2s / Z �v 0
j $tr eseriptlo- Pool Remodel, dd't, Elect, Plumb, Mech
APN #:
Address:
ity ST, Zip:
Telephone:
Email:
•► $ pp,-'
Gff�iti�atarfVfi�e; i Q�
Address:
New SFD Construction:
Conditioned Space SF
City, St, Zip
Garage SF
Telephone:
Patio/Porch SF
Email:
Fire Sprinklers SF
State Lic: City Bus Lie:
Arch/Eng Name: Construction Type: Occupancy:
Address: Grading:
City, St, Zip
Telephone: Bedrooms: Stories: # Units:
Email:
State Lie: City Bus Lie,.
78495 CALLE TAMPICO
LA QUINTA, CA 92253
760-777-7000
P.O. Box 1504
LA QUINTA, CALIFORNIA 92247-1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
BUILDING & SAFETY DEPARTMENT
PROPERTY OWNER'S PACKAGE
(760)777-7012
FAX (760) 777-7011
Disclosures & Forms for Owner -Builders Applying for Construction Permits
IMPORTANT! NOTICE TO PROPERTY OWNER
Dear Property Owner:
An application for a building permit has been submitted in your name listing yourself as the builder of the property
improvements specified at
We are providing you with an Owner -Builder Acknowledgment and Information Verification Form to make you aware of your
responsibilities and possible risk you may incur by having this permit issued in your name as the
Owner -Builder. We will not issue a building permit until you have read, initialed your understanding of each provision,
signed, and returned this form to us at our official address indicated. An agent of the owner cannot execute this notice
unless you, the property owner, obtain the prior approval of the permitting authority.
OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION
DIRECTIONS: Read and initial each statement below to signify you understand or verify this information.
_, -'I. I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner -Builder"
building permit that erroneously implies that the property owner is providing his or her own labor and material personally. I, as
an Owner -Builder, may be held liable and subject to serious financial risk for any injuries sustained by an unlicensed person
and his or her employees while working on my property. My homeowner's insurance may not provide coverage for those
injuries. I am willfully acting as an Owner -Builder and am aware of the limits of my insurance coverage for injuries to workers
on my property.
2. I understand building permits are not required to be signed by property owners unless they are responsible for the
construction and are not hiring a licensed Contractor to assume this responsibility.
1-4&3. I understand as an "Owner -Builder" I am the responsible party of record on the permit. I understand that I may protect
myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my
own.
4. I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on
permits and contracts.
5. I understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total value
of my construction is at least five hundred dollars ($500), including labor and materials, I may be considered an "employer"
under state and federal law.
6. I understand if I am considered an "employer" under state and federal law, I must register with the state and federal
government, withhold payroll taxes, provide workers' compensation disability insurance, and contribute to unemployment
compensation for each "employee." I also understand my failure to abide by these laws may subject me to serious financial
risk.
7. I understand under California Contractors' State License Law, an Owner -Builder who builds single-family residential
structures cannot legally build them with the intent to offer them for sale, unless all work is performed by licensed
subcontractors and the number of structures does not exceed four within any calendar year, or all of the work is performed
under contract with a licensed general building Contractor.
c-A8. I understand as an Owner -Builder if I sell the property for which this permit is issued, I may be held liable for any
financial or personal injuries sustained by any subsequent owner(s) that result from any latent construction defects in the
workmanship or materials.
<::60. I understand I may obtain more information regarding my obligations as an "employer" from the Internal Revenue
Service, the United States Small Business Administration, the California Department of Benefit Payments, and the California
Division of Industrial Accidents. I also understand I may contact the California Contractors' State License Board (CSLB) at 1-
800-321-CSLB (2752) or www.cslb.ca.gov for more information about licensed contractors.
�110. 1 am aware of and consent to an Owner -Builder building permit applied for in my name, and understand that I am the
party legally and financially responsible for proposed construction activity at the following address:
4KA11. I agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by all
applicable laws and requirements that govern Owner -Builders as well as employers.
C 12. I agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the information I
have provided on this form. Licensed contractors are regulated by laws designed to protect the public. If you contract with
someone who does not have a license, the Contractors' State License Board may be unable to assist you with any financial loss
you may sustain as a result of a complaint. Your only remedy against unlicensed Contractors may be in civil court. It is also
important for you to understand that if an unlicensed Contractor or employee of that individual or firm is injured while working
on your property, you may be held liable for damages. If you obtain a permit as Owner -Builder and wish to hire Contractors,
you will be responsible for verifying whether or not those Contractors are properly licensed and the status of their workers'
compensation insurance coverage.
Before a building permit can be issued, this form must be completed and signed by the property owner and returned to
the agency responsible for issuing the permit. Note: A copy of the property owner's driver's license, form notarization, or
other verification acceptable to the agency is required to be presented when the permit is issued to verify the property
owner's signature.
Signature of property owner Date:
Note: The following Authorization Form is required to be completed by the property owner only when designating
an agent of the property owner to apply for a construction permit for the Owner -Builder.
AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF
Excluding the Notice to Property Owner, the execution of which I understand is my personal responsibility, I hereby authorize
the following person(s) to act as my agent(s) to apply for, sign, and file the documents necessary to obtain an Owner -Builder
Permit for my project.
Scope of Construction Project (or Description of Work):
Project Location or Address:
Name of Authorized Agent:
Address of Authorized Agent:
Tel No
I declare under penalty of perjury that I am the property owner for the address listed above and I personally filled out the above
information and certify its accuracy. Note: A copy of the owner's driver's license, form notarization, or other verification
acceptable to the agency is required to be presented when the permit is issued to verify the property owner's signature.
Property Owner's Signature: Date:
CERTIFICATE OF COMPLIANCE
Alterations to Space Conditioning Systems (formerly CF-1R-ALT HVAC)
Project Name:
GOOD I Date Prepared:
CF1R-ALT 02-E
(Page 1 of 3)
2020-03-09
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
GOOD
02
Date Prepared
2020-03-09
03
Project Location
53025 AVENIDA RUBIO
04
Building Type
Single family
05
CA City
La Quinta
06
Dwelling Unit Name
GOOD
07
Zip Code
92253
08
Dwelling Unit Conditioned Floor
1200
Area (ft)
Number of Space Conditioning
09
Climate Zone
15
10
(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
Y
Location Area
CFA served by this
Is the SC system a
Installing a
refrigerant
Installing new SC
Installing more
Installing entirely
Installing entirely
Name
or
Served
Z
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
1200
Yes
Yes
Yes
No
No
No
conditioning
system
C. Extension of Existing Dud System, Greater Than 40 Feet (Section150.2(b)1Diib)
This section does not apply to this project.
Registration Number: 220-A020047460A-000-000-0000000-0000
Registration Date/Time: 2020-03-09 11:02:42
HERS Provider: CaICERTS
CA Building Energy Efficiency Standards - 2019 Residential Compliance Report Version: 2019.1.002 Report Generated: 2020-03-09 11:02:19
Schema Version: rev 20191201
CERTIFICATE OF COMPLIANCE
Alterations to Space Conditioning Systems (formerly CF-IR-ALT HVAC)
D. Altered Space Conditioning System (Sections 150.2(b)1E and F)
O1
02
03
04
05
06
07
08
SC System
Heating
Description
Altered
Heating
Minimum
Altered
System ID/
of Area
Heating
Heating
Efficiency
Efficiency
Cooling
Cooling
Name
Served
System Type
Components
Type
Value
System Type
Components
System 1
Location 1
Central
All new
heating
AFUE
80
Central large
All new
cooling
packaged HP
acka ed HP
p g
components
components
09
10
11
Cooling
Cooling
Minimum
Required
Efficiency
Efficiency
Thermostat
Type
Value
Type
CF1R-ALT-02-E
(Page 2 of 3)
12 1 13
New or
Replaced
Duct Length
SEER 1 14 ( Setback I n/a
Required Documenta i n:
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)lE, 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.
New Duct
R-Value
n/a
Registration Number: 220-A020047460A-000-000-0000000-0000 Registration Date/Time: 2020-03-09 11:02:42 HERS Provider: CalCERTS
CA Building Energy Efficiency Standards - 2019 Residential Compliance Report Version: 2019.1.002 Report Generated: 2020-03-09 11:02:19
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:
Mascarenas, Brannon
Documentation Author Signature:
Company:
Signature Date:
SABRINA SERVICES INC
2020-03-09 11:02:42
Address:
CEA/ HERS Certification Identification (if applicable):
72216 NORTHSHORE ST #101
City/State/Zip:
Phone:
THOUSAND PALMS CA 92276
760-343-2121 X123
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. I 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:
Mascarenas, Brannon
Responsible Designer Signature:
Company:
Date Signed:
SABRINA SERVICES INC
2020-03-09 11:02:42
Address:
License:
72216 NORTHSHORE ST #101
1042749
City/State/Zip: Phone:
THOUSAND PALMS CA 92276 760-343-2121 X123
Easy to Verify ❑■ +'� ❑■
f.-
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at CaICERTS.com T
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1 1
4f f� �tiL'
Digitally signed byCaICERTS. This digital signature is provided in order to secure the content of this registered document and in noway implies ■ �3
Registration Provider responsibility for the accuracy of the information.
Registration Number: 220-A020047460A-000-000-0000000-0000
Registration Date/Time: 2020-03-09 11:02:42
HERS Provider: CaICERTS
CA Building Energy Efficiency Standards - 2019 Residential Compliance Report Version: 2019.1.002 Report Generated: 2020-03-09 11:02:19
Schema Version: rev 20191201