BMCH2014-1019Building Permit
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PERMIT NO 'BMCH2O14-1019
View Report
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78-495 CALLE TAMPICO
D ei�
VOICE (760) 777-7125
LA QUINTA, CALIFORNIA 92253
FAX (760) 777-7011COMMUNITY
DEVELOPMENT DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 7/14/2014
Application Number:
BMCH2O14-1019
Owner:
Property Address:
53965 AVENIDA CORTEZ
KARL KELLER
APN:
774141021
53965 AVENIDA CORTEZ
Application Description:
LA QUINTA, CA 92253
Property Zoning:
Application Valuation:
Applicant:
KARL KELLER
53965 AVENIDA CORTEZ
LA QUINTA, CA 92253
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: _ License No.::CONV:140528101254078697
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
W(_
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
Uerr of proving that he in r she did not build or improve for the purpose of sale.}.
I, as owner of the property, am exclusively contracting with licensed contractors
to c nstruct the project. (Sec. 7044, Business and Professlons Cade: 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
t ntractnrs' State License Law.).
I am exempt under Sec. . B.&P.C. for this
reason /, I
Date: —� Owner: R ! r
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
Contractor:
KARL KELLER
53965 AVENIDA CORTEZ
LA QUINTA, CA 92253
(760)619-3176
Llc. No.::CONV:140528101254078697
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:
Cartier: Pollcy Number.
I certify that in the performance of the work for which this permit is issued,
1 sh t 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. �ry
WARNING: FAILURETO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL,
AND SHALLSUBJECTAN 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 mentioned property for inspection purposes.
Date: -7I1(AlIa XLvaatua6•iAaarAntor
Agent)
http://laquinta.crw.comltrakit9lDocumentViewer.aspx?&report=lDocumentsIPERMITSIB..i 7/14/2014
STATE OF CALIFORNIA
ALTERATIONS - HVAC
01)
0EC-CFIR-ALT-04-E Revised 06II4 CALIFORNIA ENERGY COMMISSION
CERTIFICATE OF COMPLIANCE CFIR-ALT-04-E
Alterations - HVAC CZ 2, and 8-15 (formerly CF-IR-ALT-HVAC) (Page 1 of 1)
Site Address: .,
�.� ��
Enforcement Agency:
Date Prepared:
Permit#:
6
Equipment Type
uipment Efficiency
New Ducting, Plenums, Lineset:
Conditioned
Thermostat
Required R-value
Floor Area (sq ft)
_
❑ Packaged System
❑ Evaporator Coil
AFUE
COP
❑ R-6 (CZ 2, 8-13) Ducting
Served by system
Setback
Split System
❑ Condensing Unit
❑ R-8' (CZ 11, 14, 15) Ducting
�l sgft
(If not already
❑ Mini Split
❑Compressor
S SEER
HSPF
❑ R 6 (all CZ's) Plenums
present must
❑ Furnace
❑ Lineset
EER
❑ R-5 or R7.5) Lineset
be installed)
❑ TXV
HERS VERIFICATION SUMMARY Installer determines work to be completed and matches to one of the options below. At permit application this
form is allowed to be filled out by hand. For final inspection all forms are to be registered (no hand filled forms allowed) and a copy left on site.
1. HVAC Changeout/Repair
Required Compliance Documents to be left on site for Final:
All Equipment,
CF1R-ALT-02-E
Condenser Unit, Evaporator Coil,
CF2R: MECH-01, MECH-20-HERS, MECH-(23 or 24)'-HERS, MECH-25-HERS'
Compressor, TXV, Lineset,
CF3R: MECH-20-HERS, MECH-(23 or 24)-HERS', MECH-25-HERS'
Air Handler/Furnace' (Can include new ducting)
Installer Requirement: Duct leakage (< 15%, or < 10%to outside, or seal all accessible leaks), Air Flow >_ 300 CFM/ton, Refrigerant Charge.
Exempted from duct leakage testing if:
❑ 1. Duct system registered with HERS provider as previously sealed, or ❑ 2. There is less than 40 linear feet of duct in unconditioned space, or
❑ 3. Existing duct systems are constructed, insulated or sealed with asbestos (list manufacture date of building ..... .
❑ 2. New HVAC System
Required Compliance Documents to be left on site for Final:
All new equipment and All New Ducts'
CF1R-ALT-02-E
including Mini Split
CF2R: MECH-01, MECH-20-HERS, MECH-22-HERS, MECH-(23 or 24)-HERS', MECH-25-HERS'
CF3R: MECH-20-HERS, MECH-22-HERS, MECH-(23 or 24)-HERS', MECH-25-HERS'
Mini Splits require CFIR-ALT-02-E, CF2R-MECH-01, and (CF2R-CF3R) MECH-25-HERS
Installer Requirement: Duct leakage < 6%, Fan Efficacy (.58W/CFM), Air Flow 2 350 CFM/ton (or alternative), Refrigerant Charge
❑ 3. All New Ducts with Replacement
Required Compliance Documents to be left on site for Final:
All New Ducts' and one or more of the following
CF1R-ALT-02-E
replaced: Condenser Unit, Evaporator Coil,
CF2R: MECH-01, MECH-20-HERS, MECH-(23 or 24)-HERS, MECH-25-HERS
Compressor, TXV, Lineset, Furnace'
CF3R: MECH-20-HERS, MECH-(23 or 24)-HERS, MECH-25-HERS
Installer Requirement: Duct leakage < 6%, Air Flow Z 350 CFM/ton (or alternative), Refrigerant Charge
Exempted from duct leakage testing if: ❑ 1. Existing duct systems are constructed, insulated or sealed with asbestos
114. New Ducting over 40 feet
Required Compliance Documents to be left on site for Final:
New ducting but less than All New Ducts'
I CF1R-ALT-02-E, CF2R: MECH-20-HERS, CF3R: MECH-20-HERS
Installer Required to: Duct leakage (:S_15% or, < 10% to outside or, or seal all accessible leaks)
❑ EXCEPTION: Existing duct systems constructed, insulated or sealed with asbestos.
' All new ducting R-8 required when more than 40 ft installed and R-6 when less than 40 ft installed. This includes in walls, between floors etc.
' Heating only systems and Air Handler/Furnace changes do not require Air Flow MECH-(23 or 24), or Refrigerant Charge verification MECH-25
' All New Ducts is when at least 75 percent of the duct system is new duct material, and up to 25 percent may consist of reused parts from the
dwelling unit's existing duct system (e.g., registers, grilles, boots, air handler, coil, plenums, duct material)
° R-5 W' thick insulation) for linesets 1" and less. R-7.5 (1.5" thick insulation) for linesets over 1 inch. Most mfg will require Suction line Diameter
with insulation as the following 1.5-2T-2%", 2.5-3T-2'/,", 3.5 to 4T-2Ya", 5T-4%"
Contractor (Documentation Author's /Responsible Designer'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 California Business and Professions Code to accept responsibility for the information on this document.
3. 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 (CCR).
4. 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 CCR.
5. 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.
Res sihle D Igner Na
Responsible Designer signatur • oateSigned:
License:
Company:
AdtJress:
City/Sta a/21p; Phone:
For assistance or questions regarding the Energy Standards, contact the Energy Hotline at:1-800-772-3300
T4,19V 4 so
78-495 CALLS TAMPICO
LA QUINTA, CALFFORNIA 92253
BUILDING & SAFETY DEPARTMENT
(760) 777-7012
FAX (760) 777-7011
Considering Becoming an Owner -Builder?
Important information you need to know BTYFORE pulling your permit!
The term "ONvner-Builder" can mean three different things:
"Owner as Worker", "Owner as Contractor" or "Owner as Employer"
Understand each has Benefits or Risk, and it is possible to combine them!
Hiring a California Licensed Contractor means you do not personally perform any of the construction work, the permit is not taken
out iq yaur name, you are not perc<,nally responsible for the construction and you are not an Owner -Builder. Instead, you become a
"Cu tamer" and California law provides you the benefit of protection from poor workmanship. failure to finish the job and financial
Jury -
risk ue to worker injury.
Benefit/Wsk: Hip -hest Benefits and the Least amount of Risk
Owner -as -Worker is a type of Owner -Builder where you personally perform the construction work. the permit is taken out in your
name and you are personally responsible for the construction management, knowledge, workmanship, and completion of the job. You
benefit by not paying others to perform this work for you and your risk depends on your own ability to complete the job successfully.
Benefit/Risk: Possible Benefit with Low Financial Risk
Owner -as -Contractor is a type of Owner -Builder where you personally act as your own General Contractor, the permit is taken out in
your name and you hire California licensed sub -contractors to perform portions of the construction work. WARNING: The benefit of
protection provided by law when you hire only California licensed sob -contractors can turn to serious financial risk if you hue
licen _k.
Possible Beneht and Significant Fimancial Risk
Owner -as -Employer is a type of Owner -Builder where you pay any unlicensed individual to perform anu construction work valued at
more than $500.00, the permit is taken out in your name and you are personally responsible for their employment requirements.
supervision, performance, safety and welfare while on your property. WARNING: Cost savings benefit can turn to serious financial
risk if you fail to deduct payroll lazes or provide workers compensa ion insurance for each worker.
Benefit/Risk: Jlossibhl Brine fit with Si nificant Financial Risk
sty' 4 Sep Q194A
BUILDING & SAFETY DEPARTMENT
78-495 CAt_[.E TAMPICO
LA QUINTA, CALIFORNIA 92253
PROPERTY OWNER'S PACKAGE
(760) 777-7012
FAX (760) 777-7011
Disclosures & Forms for Owner -Builders Applying for Construction Permits
:► a CE e Tr 0WN R
Dear Property Owner.
An application for a buiidina& permit has been sub -tied in your name listing yourself as the builder of the property
improvements specified at y
We are providing you with an Owner -Builder Ackzeawl gmeat and Infot nation Vmfrcatice Forth to make you aware of your
respousbiMes and possible risk you may incur by having this permit issued in your name as the
Owner -Builder. We wiH not Issue a building•permit until you have read, initialed yourunderstanding of each prevision,
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 AC ).WLLnDcmwrcr AND VFRI nI A Olv of CN1B0A`1i'!E(]IN
DIREC77 Pn: Read and indial"each slatement below is signify you understand or verify (A is information.
. I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner -Builder"
d g permit that crroamusly implies that the property owner is providing his or her own labor and material persoually. 1, as
an Owner -Builder, may be held liable and subject to serious financial risk for any injuries .sustained by an unlicensed pet=
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 insurauce•coverage for injuries to workers
on my rvperty_
2. 1 understand building permits are not required to be signed by property owners unless they are responsible for the
o ion and are not hiring a licensed Contractor to assume this responsibility.
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
V5_c1c:understand
contracts.
if I employ or otherwise engage any persons, other than California licensed Contractors, and the total value
truction is at least five hundred dollars ($500), including labor and materials, I may be considered an "employee"
under sta and federal law_
understand if I am considered an "employer" under state and federal law, I must register with the state and federal
eve lent, -withhold-payroll-taxes,-provide-workers'--compensation-disability-insurance;-unemployment
compensation for each "employee." I also understand my failure to abide by these laws may subject me to serious financial
risk.
7. 1 underslazed under California Contractors' State License Law, an Owner -Builder who builds single -Family residential
Cos lures cannot legally build theta with the intent to offer therm for sale, unless all work is performed by licensed
subs utraetgrs and tine number of structures does not exceed fora- within any calendar year, or all of the work is performed
under contract with a licensed general building Contractor.
Bin #
Permit #
City of La Quinta
- Building &r Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Project Address:
Ownor's Name: ! .
A. P. Number:
�
Address: 3 yew,
��_,
G . ?' i-f-f z
C
Legal Description:
City, ST, Zip:
Contractor:
Telephone:(
Project Description: ` Al"'e,
Address:
City, ST, Zip:
Telephone:
f='
State Lie. #:
Arch., Engr., Designer:
City Lie.��
' j /V J
h� C� .0 T
Address:
City., ST, Zip:
Telephone:Construction
State Lie. #:�>,
Type: Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
Sq. Ft.: # Stories: #Units:
Name of Contact Person:
Telephone # of Contact Person:
Estimated Value of Project,
APPLICANT: DO NOT WRITE BELOW THIS LINE
# Submittal Req'd
Rec'd
TRACIC.ING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance_
Title 24 Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2°" Review, ready for corrections/issue
Electrical
Subeontactor List
Called Contact Person
Plumbing
1. Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
'"' Review, ready for correctionslissue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees
DESCRIPTION• QTY
PermitTRAK
PAID
$197.82
BMCH2O14-1019 Address: 53965 AVENIDA CORTEZ Apn: 774141021
$197.82
CHANGEOUT
$107.25
HVAC CHANGEOUT - SPLIT -SYSTEM PC
101-0000-42600
0
0
$35.75
$71.50
HVAC CHANGEOUT - SPLIT -SYSTEM
101-0000-42402
PERMIT ISSUANCE
$90.57
PERMIT ISSUANCE 101-0000-42404 0
TOTALBY RECEIPT:R379
$90.57
$197.82
Date Paid: Tuesday, July 15, 2014
Paid By: KARL KELLER
Cashier: SKH
Pay Method: CHECK 1371
Printed: Monday, July 14, 2014 4:36 PM 1 of 1�;y[TFAAC