0203-364 (SFD)79802 Ambassador Cir
0203-364
LICENSED CONTRACTOR 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
Professionals Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
114188 13 1 Ora II
Date ;b '-Signature of Contractor
v
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason:
( ) 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 & Professionals Code). .
( ) I, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals
Code).
( ) I am exempt under Section B&P.C. for this reason
Date Signature of Owner
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
S tion 3700 of the Labor Code, for the performance of the work for which this
permit is issued. My workers' compensation insurance carrier & policy no. are:.
Cartier 001,D1_N F.AOId i &SPolicy No. t u- 4iib&•6:
BUILDING PERMIT PERMIT#
DATE VALUATION y . yy 4qC yC yf Rgt ,ry1, LOT TRACT
TRACT
JOB SITE APN
ADDRESS '799--802AMBASSADOR. MCME
OWNER CONTRACTOR/DESIGNER/ENGINEER
CE tomY €:OWUL CON IMS ;EM yURY r CRO VIE11 C M .Uex1Pi
t5,45 so, `Y MEET, 09-1 6200
SAN BE2.1'rARDWO CA. 92408 SPAT BERNAR'"INO C'a'd 92408
(909)381-6007 7020
USE OF PERMIT
SYD - L,LIT 9 PLAN 5XAR V. Pi?i;IJT DOMMOT INCLUDEBLOCK
CK
S7VrNLU, ,PON., SPA OR DRIVFWAYAPP1Y.c3ACK
RVIIUC,iTION ICOR M ULTIP1,8_ auS:3.¢ WCE, OF S&ME PLAV T•YPF s
TPACof WNUTRUCTION Z021.0 SP
I%:~aRCHWATT130 11.00 SY
RACECARPORT 417,00 Sly
VYMATED COS" OF Cd' NST:RUG.''F'ION'
PnIur r, EE gC imy
(This section need not be completed if the permit valuation is for $100.00 or less).
C.'ONSTRUCTION RM
101.000-118-000
MOP
( ) I certify that in the performance of the work for which this permit is issued,
PLAN CHECK 'VE 9
for a permit subject to the conditions and restrictions set forth on his
$1.41.17
1 shall not employ any person in any manner so as to become subject to the
MECIIANIOCAL `
101`000 X71`000
U.C O
workers' compensation laws of California, and agree that if I should become
^
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
subject to the workers' compensation provisions of Section 3700 of the Labor
9I.W'relC.tl. 1 YEr1;
101-0013420-000
••.,; WY0V:LAQU1M
Code, I shall forthwith comply with those provisionsr.,n. .. ,' n u
FLI,Tr. PINO j+` 2
I t11-000.4150-000
1 i1,Cif1
Date: Applicant
S`I'FC7ACi I+/If7'r10t g'1 • iik°.SII
1171 C3S f1-2 R1.4 i
$11.81
Warning: Failure to secure Workers' Compensation coverage is unlawful and
OPIAD1140AKF
101--000.42.3-000
$20 .00
shall subject an employer to criminal penalties and civil fines up to $100,000, in
DEYFi„S}.iIYR IINIPAVr FF1.
1,90.7.00
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
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 •=
D (rJ `1i1P
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
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 cancellations, -.
arr v
••.,; WY0V:LAQU1M
I certify that I have read this application and state that the above information is
FINANCE-
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection purposes.
e1 I
RECEIPT
DATE
.-_. F - r ,
Signature (Owner/Agent) E:-1:? +< ; Date .w
rl -
_1;12/ s16
IIIIIIIVIIIIIIVIIIIIII 10
IE
,, _ / INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
-0 Z
Underground Ducts
Forms & Footings
— / , —0.z
Ducts
Slab Grade
— - '
Return Air
Steel
Combustion Air
Roof Deck
p
Exhaust Fans
O.K to Wrap
.- 9 —
F.A.U.
Framing
Compressor
Insulation --
®Z
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans 8 Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
—
Final
Final _ _O Z
BLOCKWALL'AFfPROVALS
POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
—y
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
g
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
; . , ?/
Encapsulation
Gas Piping
Gas Test
Q• .S
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final O Y
Utility Notice (Perm) -_6 Z
COMMENTS:
11
Certificate of Occupancy
City of La Quinta
Building and Safety Department
This Certificate issued pursuant to the requirements of Section 109 of the Uniform Building Code,
certifying that, at the time of issuance, this structure was in compliance with the various ordinances
of the City regulating building construction or use. For the following:
BUILDING ADDRESS: 79-802 AMBASSADOR CIRCLE
Use Classification: SINGLE FAMILY DWELLING
Occupancy Group: R-3 Type of Construction:
Owner of Building: CENTURY CROWELL COMM
Building Official
vni
Bldg. Permit No.: 0203-364
Land Use Zone: RL
Address: 1535 S. "D" STREET #200
City: SAN BERNARDINO, CA 92408
By: STEVE TRAXEL
Date: 12-06-2002
POST IN A CONSPICUOUS PLACE
r.:rT.. Y/.✓n/C/ n•Jr✓:rr:.r.ryrl;:r!•a.'rw: u'r:•s.n•,r/isY.JA:aw%6 •s.:•,• ut7✓,r:/iY1r +Y........r.a• n«nr!^.wn..vrwwl+•.••.•r n ..:r..r .. n:n.« r;' - _._
IIIIIII VIII III VIII IIII 11 i
1NSULATI01V CERTIFICATE IE
i
This is to certify that insulation has been installed in conformance with the current energy
regulation, California Administrative Code, Tide 24, State of California, in the building loceted at.
79-802 Ambassador Circle, Lot 8, La Quanta, California
CEILINGS:
TYPE: BLOW MANUFACTURER: CERTAINTEED THICKNESS: R-38
i
W&I-S:
TYPE: BATTS MANUFACTURER: CERTAINTEED THICKNESS: R-13
i;
r
GENERAL CONTRACTOR: CENTURY CROWELL COMMUNITIES LICENSE # 7/1//ff
BY: TITLE:_
PARAGON SCHMID BUILDING PRODUCTS, A MASCO COMPANY LICENSE 0 632072
BY: TITLE: ADMINISTRATIVE ASSISTANT DATE: 11/26/2002
INSULATION CERTIFICATE
This is to certify that insulation has been installed in conformance with the current energy
regulation, California Administrative Code, Title 24, State of California, in the building located at:
79-802 Ambassador Circle, Lot 8, La Quinta, California
.CEILINGS:
TYPE: BLOW MANUFACTURER: CERTAINTEED THICKNESS: R-38
WALLS:
TYPE: BATTS MANUFACTURER: CERTAINTEED THICKNESS: R-13
GENERAL CONTRACTOR: CENTURY CROWELL COMMUNITIES LICENSE # -7
BY: TITLE:
F4RAGON SCHMID BUILDING PRODUCTS, A MASCO COMPANY 'LICENSE # 632072
BY: TITLE: ADMINISTRATIVE ASSISTANT DATE: 11/26/2002
CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING (Page 1 of 7) CF -4R
Joe 9061dsoo 772-3 158
Builder Contact Telephone
I r{ R Raw tJ 76o) 56 4.2 o l- 4-
HER Ra ' Telephone '
/ Z ufx, C -e -N f 6 A7-:)iz - IIit)JA L_
It -ing Signature
Firm:
Street Address: 0 x oZ
Copies to: Builder, HERS Provider
ate
F 5 T% :7 D r 1/ 4-/o z_
DatDat—re --,
Builder ame
FLAA 15 Ah,
Ian Number
G, (2.o L1 P
Sample Group Number AMAass,gpOR.,
La T 41- g3 _P • 8oz
Sample House Number
HERS Provider: 4f., s -
Ciry/State/Zip: G&_r o rjiKA!,te6,2214-77o
HERS RATER COMPLIANCE STATEMENT
I -lie house was: . ❑ Tested Approved as part of sample testing, but was not tested
As the HERS rater providing diagnostic testing and field verification, I certify that the houses identified on this form comply
ith the dias4nostic tested compliance requirements as checked on this form.
❑ The installer has provided a copy of CF -6R (Installation Certificate.
❑ Distribution system is fully ducted (i.e., does not use building cavities as plenums or platform returns in lieu of ducts)
❑ Where cloth backed, rubber adhesive duct tape is installed, mastic and drawbands are used in combination with cloth
backed. rubber adhesive duct tape to seal leaks at duct connections.
❑ MINIMUM REQUIREMENTS FOR DUCT LEAKAGE REDUCTION COMPLIANCE CREDIT
Duct Diagnostic Leakage Testing Results (Maximum 6% Duct Leakage)
Measured
Duct Pressurization Test Results (CFM @ 25 Pa) values
Test Leakage Flow in CFM
If fan flow is calculated as 400cfm/ton x number of tons enter calculated
value here
If fan flow is measured enter measured value here
Leakage Percentage (100 x Test Leakage/Fan Flow) =
Check Box for Pass or Fail (Pass=6% or less) ❑ ❑
Pass Fail
❑ THERMOSTATIC EXPANSION VALVE (TX
❑ yes ❑ NO Thermostatic Expansion Valve is installed and Access is
provided for inspection ❑ ❑
Yes is a pass Pass Fail
❑ MINIMUM REQUIREMENTS FOR DUCT DESIGN COMPLIANCE CREDIT
❑ Yes ❑ No ACCA Manual D Design requirements have been met (rater has
verified that actual installation matches values in CF -I R and
design on plan.
Yes ❑ No TXV is installed or Fan flow has been verified. If no TXV,
verified fan now matches design from CF - IR.
Measured Fan Flow =
Yes for both I and 2 is a Pass Pass Fail
Compliance Forms August 2001 A-16