0203-381 (SFD)79738 America Ct
0203-381
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
Date ^ '' ' ' Signature of Contractor
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).
( ) 1, 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.
4, 1 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 & policy no. are:
Carrier (:OLDEN t, AOLE INS, Policy No.N f`-544#68 10
(This section need not be completed if the permit valuation is for $100.00 or less).
( ) 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 become
subject to the workers' compensation provisions of Section 3700 of the Labor
Code, I.shall forthwith comply with thoseprovisions..2
Date: Applicant 7-} `'.
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection purposes.
Signature (Owner/Agent) .' -<--.ate Date
BUILDING PERMIT PERMIT#
3.381
DATE VALUATION LOT TRACT
JOB SITE
APN
ADDRESS V-1 ARWRTCA COT M,'
(4)"724X).8 ,
OWNER
CONTRACTOR / DESIGNER / ENGINEER
0111-E dl:URYCROW14,Li. CC5WALTIliMS
C1:,N:!"i3RY CIRC)Wal, f 0X4UU1]T 'F3$.:
1535 50, T-)" F11PNE Z am 0200
AW BERNARDIN0 I`., A 92458
UN £s ,. :1 fPaMINO CA 92A 08
(909)381 -60M O—B1X 21210
USE OFPERMIT
MOLEYAWS 1VVVMH0
SFD - LOT23 PLAN 28 PERMIT TOW'S IdO'T INCL1IM ULOCP:WALL.%
PrO14 SP,A 09, ONliEWAY APPROACH, ACH, 15100 PLAN CIF11•:CJ; FER
R' E-DUCTIC04 FOT.'. 'IviULTIPIX ISSUA14CE OFMW PLAN TYPE
iitACT CONSTRUCTION 11500,00 SF
PORC;HMATIO 37.00 S!?
0AR—A.MCARPORT 412.43P 9F
CONSTRUC".7PWX ME 101-00 0-418-000 R-000 ISA,s0
PLAN LINECK I+RE iol-00"39.318 $1,24.36
1`I.i?{. HAIMIA1 FEE 101-000-421-000 0150
FLoE:C` RIC:AL Nif?I! 101 _000-420-000 $ f 09.28.
PLUMB: YXIO ME 101.000.4.19-000 $130.00
S k`I7RSNO MOTIOW FFZ, REBID i 01-000-241 •-0007 $3109
O'.ViDIN(l HE 101.1100.4211-000 $210,00
OEVELOPE& IMPACT FEE $R,.Q0,7,00
SUB -TOTAL, a ONS'1RU`CII AND T11J% Wf•_.'K
$2,94,7,-9
tiRlMI, PEES DUE NCUW
M Ay U 1 ''_ IIIIIIIIIIIIIIIIIIIIIIIII
32
C1TYOFLAQ;Q1KTA►
EINANCEdEPT
E
RECEIPT
BY
DATE FINALED
INSPECTOR
a
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
— p
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
_ da S
Compressor
Insulation
- Z -o r— S
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wail Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final %
BLOCKWALL APPROVALS
POOLS - SPAS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines ( '
— Z
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Gas Piping
_
Encapsulation
Gas Test
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
Utility Notice (Penn) l -a
COMMENTS:
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: 79-738 AMERICA COURT
Use Classification: SINGLE FAMILY DWELLING
Occupancy Group: R-3 Type of Construction:
Owner of Building: CENTURY CROWELL COMM
frdt-x
Building Official
Bldg. Permit No.
VN Land Use Zone
0203-381
RL
Address: 1535 SO. "D" STREET
City: SAN BERNARDINO, CA 92408
By: STEVE TRAXEL
Date: 12-19-2002
POST IN A CONSPICUOUS PLACE
IIIIIII VIII III VIII IIII 33
IE
INSULATION CERTIFICATE
This is to certify that insulation has been installed in conformance with the current energy
zgulatiori, California Administrative Code, Title 24, State of California, in the building located at:
79-738 America Court, Lot 25, Monticello -Classics, La Quinta, California
CEILINGS:
TYPE: BLOW MANOFAtTURER: Certainteed Thickness: R-38
WALLS:
TYPE: BATTS MAN U FACTURP R: Certainteed Thickness: R-13
GENERAL CONTRACTOR: CENTURY CROWELL COMMUNITIES CENSE #
YGON
TITLE: SCHMID BUILDING PRODUCTS, A MASCO COMPANY LICENSE # 632072
TITLE: ADMINISTRATIVE ASSISTANT DATE: 12/5/2002
CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING (Page 1 of 7) CF -411
d
ect Title
Project Address I ' ' ' .
Joe R0e'ldsoo 772-3 150
Builder Contact Telephone
►zow 4-
H E R 7aWr Telephone
#"NtkG/3z 0)7-
Cenihlirig S!1nature Date
Fin -n: DE SE RT E
Street Address: ic7.r-LoX 62
Copies to: Builder, HERS Provider
5 'rE D I 4 -LO
Dat—T e —
Builder Name
_[EL t4, IJ 2 g
Ian Number
GI 20 y P
Sample Group Number
LO T #- L S 74-138 Ameg tcA
Sample House Number
HERS Provider:
City/State/Zip: ISA. &H y (`1 1-77o
HERS RATER COMPLIANCE STATEMENT
The 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 dia;nostic 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)
Duct Pressurization Test Results (CFM @ 25 Pa)
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)
❑ THERMOSTATIC EXPANSION VALVE (TXV)
❑ ),es ❑ f 0 Thermostatic Expansion Valve is installed and Access is
provided for inspection
Measured
values
Yes is a pass
❑
MINIMUM REQUIREMENTS FOR DUCT DESIGN COMPLIANCE CREDIT
1 ❑ Yes ❑ No ACCA Manual D Design requirements have been met (rater has
verified that actual installation matches values in CF - IR and
design on plan.
I. 11:1y' es
❑ No
TXV is installed or Fan flow has been verified. If no TXV,
verified fan now matches design from CF -I R.
Measured Fan Flow =
Yes for both I and 2 is a Pass
❑ ❑
Pass Fail
❑ ❑
Pass Fail
❑ ❑
Pass Fail
Compliance Forms August 2001 A-16