0203-384 (SFD)79743 America Ct
0203-384
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
714183 B
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).
( ) 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
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 041,I)ENEACLgftlS Policy No. -°*fSS-
(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 those. provisions.
Date: V Applicant
-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 purauant 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) '` i{' t ` Date fh)
BUILDING PERMIT PERMIT#
DATE VALUATION LOT M03 -MO TRACT
JOB SITE p,p g y/ } p • y+
ADDRESS ?9-743 1:Mf.A d :B•M .riJgl,Rib
APN t^ 1 ,t t 4
04 -072 -MIS
OWNER
CONTRACTOR/'DESIGNER/EN (NEER
C` mm, le C.»12Ci ML C>;)Yvil',9IJ`"iMMS
C'"FN:Ei3RY C"#iii' €s .. . COW610WINS
1,535 8C?1 °Lt" 3°'CE$1 :J"r -MIR 0200
1535 so, °:C10 SMOrr, ME, 0,;1'10
M 11 . T::Ei1~ WO CA 9 408
SAM EzEAKARDINO CA 92AOR
(9t3 )3 1> 0iJ3 tw-k F zlv)
USE OF PrERRMIITy
FpMIL t WE Y a T
SIPD - LDT 78 PLJ'kN 5X,,17; , PERMIT 3]088 NOT INCI.,UDL SLOCK:
WALLS, P004 410A OR DRTS EWAY APPIZ.OAC K 75% 11LAN CHECK 14KE
MUCTICIA FOR MUI TI >LE 15SU'.hNCZ ON S.A'IA..8 PIAN TYPE
TRACT CONSTRUCTION 40211001111F
PORCHMATIO 11.00 3
Q4s1IAQEfC" AR9PORT 417,011 OF
U'S"MMATED COST OF CONIMUCT(O-K
1181".60
=:`omiriur oki nex 101.000-418.000 $766.00
PLAN CHECK PE,101-000-139-318 $141.17
MEC"cM1dI ALIt"4 i3 101.000.421.000 S leo
P.LIrC;`f .RJCA1.. FEZ 101-000-420S000 $1n. sd
PLUMBING FIR 1011.000.419-000 $1410,.00
31120NO MOT1GN FEE - R2.S1ID 101-000-2d 1-000 $11.81
ORADING FEE 101.000, 423.OW, $20,00
? ltl'L17E'i1t IIt8PAC7 PZi;TzQf37.t}0
,a
MIB-TM,AL, C,9.1`1'M1. CITION ANT.) PLAN CHIN0%,.
$3,127.56
11, 0 11-11A1X3 EMS
$0,00
Fma1i' : ' s I)I1'. .Now
12 1.
;' I III II VIII III I I III) 34
C11Y OF LAQUIRTA
FINANCEDEPT.
IE
RECEIPT
DATE..
BY°
DAT INALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
- 3 -
Underground Ducts
Forms & Footings
3--2
Ducts .f
Slab Grade
-p z
eturn Air
Steel
— ?
Combustion Air
Roof Deck
--
Exhaust Fans
O.K. to Wrap --
-J e57
F.A.U.
Framing
Compressor
Insulation
40 - f' -'o 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 to. .v S
Final
Final
POOLS - SPAS
BLOCKWALL//A
PROVALS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location,
Underground Electric
Underground PI . Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping
/
Plumbing Final
Plumbing Top Out
`
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
%
Encapsulation
Gas Piping
Gas Test,
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring f,
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm) /(- .py57
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:
Use Classification: SINGLE FAMILY DWELLING
79-743 AMERICA COURT
Bldg. Permit No.: 0203--384
Occupancy Group: R-3 Type of Construction: VN Land Use Zone: RL
Owner of Building: CENTURY CROWELL COMM. -
Building Official
Address: 1535 S. "D" STREET #200
City: SAN BERNARDINO, CA 92408
By: STEVE TRAXEL
Date: 12-16-2002
POST IN A CONSPICUOUS PLACE
'fir::,, N:: IIIIIIIIIIIIIIIIIIIIIIIII 35,E
- - - _ IE - -- - -
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:
79-743 America Court, Lot 28, Monticello -Classics, La Quinta, California
CEILINGS: -
TYPE: BLOW MANUFACTURER: CERTAINTEED THICKNESS: R-38
WALLS:
TYPE: BATTS MANUFACTURER: CERTAINTEED THICKNESS: R-13
GENERAL CONTRACTOR: CENTU Y CROWELL COMMUNITIES LICENSE
BY: TITLE: v /
PARAGON SCHMID BUILDING PRODUCTS, A MASCO COMPANY LICENSE # 632072
BY: TITLE: ,ADMINISTRATIVE ASSISTANT DATE: 12/5/2002
CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING (Page 1 of 7) CF -411
ject Title
Project Address I '
Joe 10610 so d 772- 3 15 0
B Ider Contact — 11 Telephone
Finn:f ESE2T 1 I. E(2.. ( -ERx/I E
Street Address: j c). F-1,LX to
Copies to: Builder, HERS Provider
F 5 D ►" 14-/0
Dat—re ——
TtJ 2, I n tv7 E
Builder ame
SLA ,d 5X
Plan Number
G 20 LJ
Sample Group Number
1"0 T # Z 6 7 i' - 7'f 3 Hen eye teA
Sample House Number
HERS Provider:
Ciry/State/Zip: AVIP_tio (1t( A ,t` jPA• 7a
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 diagnostic 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.
❑ : IINIMUM 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 now 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 (TXV)
❑ 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 flow matches design from CF - IR.
Measured Fan Flow =
❑ ❑
Yes for both I and 2 is a Pass Pass Fail
Compliance Forms
August 2001
ow