0203-380 (SFD)79746 America Ct
0203-380
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
714)88 1`3rj , ..10/:4 110-c
Date • r" Signature of Contractor ' ' 1'' "<,o
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 (}Ckl.rrlFAir.AjLXCIq Policy No. NWO-M4063-0114
(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:, w_, f_. r: APPlicant ,, J .'Jf.✓.( .E%
_ e
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employ$;es.
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.
A
Signature (Owner/Agent) of'TI`t Date ”
BUILDING PERMIT PERMIT#
V//
TRACT
DATE VALUATION LOT TRACT
24 2AI97-5
JOB SITE
APN
ADDRESS 79-746 Ah"' C:C3YiJ[df
M4 -O2,008
OWNER
CONTRACTOR / DESIGNER / ENGINEER
C. ,rfCIRY CRt1WELL COAM-Ti10
CHIMik
1535 Lua V Urr T, urx #200
1535 h9a -P - oo
SAN BF". ARDIN'O CA MOV,
SAID B:I;'WARD1'90 CA 92408
USE OF PERMIT
SWUM FAM:U.YDW9GiN0
SM'- LOT 24 PI,.F►9Nf 34=W. }°??'.RMIT DOE'S 1101' ME CLLTLIE S OCK
WALI, n, P004 SPA OR DRIVEW.A`1" APPI OhIr,'Is,
IUMUC.'3'I0N FOR MULTIPLE ISSUANCE OF SAME PLO14 TYPE
TRACT C-'ON5TTd.t16". T)ON 1,ws, ;0 8F
P0172XFMP.r!1.'f IO 01,00 :IIS
GABA WPORT 418,00 SF
RMIUMAIrm COST (Ar COTI&MC1170PI
1.031107040
MUM FU SUMIYURY
CONSTRUCTION F)—?P 101-000416-000 $453,50
PLAN CHECK FEE 101--000-139-318 $1,36.0:2
IVIWHANIC.AL FEE 101•-000.421-000 S40310
ELECTRICAL, TRIC.AL, FEW, 101-0M.420-000 .420-000 $1 I'11A
P1.UMI1'INO DRE 101,000.419-000 $I"1 100
5TRONO 1!AOTION F89 - ReSID 101.000-241..000 $10,31
(1,' ADD10.f"EX 101.000.423.000 $20,00
,,r
t
OWD-I'al'l x:, MWi°R1JI:'ml70NAND PI -AAT" (11lEC
$ 3;;tm.ol
W U 1XW I'°1r.E?r-7 ' .P +
s(t. C O
/ V U 1rlU
CITYOFIRQtDI ITA
IIIIIIIIIIIIIIIIIIIIII 36
FINANCEDEPT. JK
IE
RECEIPT
DATE, r. t;
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
_ %O —Z
Ducts
Slab Grade
6—_?6 -
Return Air
Steel
_ p . c
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
B. -,p i 7
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans 8 Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
1-04
Drywall - Int. Lath
Final 02- •o y
BLOCKWALL APPROVALS
Final
POOLS -SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final I
I
Gas Piping
PLUMBING APPROVALS
Waste Lines 2f— _
Gas Test
Electric Final
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
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 (Perm) /! o
COMMENTS:
4
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
Occupancy Group: R-3 Type of Construction: VN
79-746 AMERICA COURT
Owner of Building: CENTURY-CROWELL COMM.
Building Official
_ Bldg. Permit No.: 0203-380
Land Use Zone: RL
Address: _1535 S. "D" STREET #200
City: SAN BERNARDINO, CA 92408
By: STEVE TRAXEL
Date: 12-16-2002
POST IN A CONSPICUOUS PLACE
( xs -yam, IIIIIIIIIIIIIIIIIIIIIIIII 37
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:
79-746 America Court, Lot 24, Monticello -Classics, La Quinta, California
CEILINGS:
TYPE: BLOW MANUFACTURER: CERTAINTEED THICKNESS: R-38
WALLS:
TYPE: BATTS MANUFACTURER: CERTAINTEED THICKNESS: R-13
GENERAL CONTRACTOR:* CENT Y CROWELL COMMUNITI 177
SE #
BY: TITLE: (/
PARAGON SCHMID BUILDING PRODUCTS, A MASCO COMPANY LICENSE # 632072
BY: TITLE: ADMINISTRATIVE ASSISTANT DATE: 12/5/2002
0
j CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING (Page 1 of 7) CF -4R
Plydject Title '
J r= F,T LA Q Ll I -7A
Project Address
Joe 90610SOIJ a))77,2- 3 150
Builder Contact Telephone
I &- H P, P, D r I' R.c.gv.l d 766) 66 4 ' % 4- 4—
A7Jr
O"N21C&/3ZO)Z
Telephone
C`ertih ink S'i;natureC Date
Street Address: t c).F—,;pX.(o
Copies to: Builder, HERS Provider
:TE s Ti✓ ► / 4-/o z
Datto --
' I Li '0 E
BuilderName
FLO,J 3A
Plan Number
2.o IJ F
Sample Group Number
1.0T-#-24 -79-7y/„ AmeelcA
Sample House Number
HERS Provider: L°, I— fZ, S.
City/State/Zip: do rl (P^ 7o
HERS RATER COMPLIANCE STATEMENT
The house was: ❑ Tested Approved as pan 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
With 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 retums 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 now 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 now matches design from CF -I R.
Measured Fan Flow =
❑ ❑
Yes for both I and 2 is a Pass Pass Fail
Compliance Forms August 2001 A-16