0203-387 (SFD)79767 America Ct
0203-387
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).
( ) 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.
(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 f101,IA1 N
FA.51Y,1? jt43. Policy No. 1 C 066-► 3
(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. ✓' ,
Date:.. rp Applicant r`) ;t''.rG .<'7•2
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 i
work is not commenced within 180 days from date of issuance of suc
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 i
correct. I agree to comply with all City, and State laws relating.to the buildin
construction, and hereby authorize representatives of this City.to enter upo
the above-mentioned property for insPection purposes.
Signature (Owner/Agent)Date?
BUILDING PERMIT PERMT#
DATE VALUATION LOT (r.03-387 TRACT
24.197 - 5
JOB SITE APN
' ADDRESS l-C FLlrt.p A> 'r F'YSq S
OWNER CONTRACTOR/DESIGNER/ENGINEER
CW UR.l! CItOWE^: i;L ('01 1UM-313.S 0LN'{%E21i CR0WM.L,C0W5MUHrrWG
1533 VO. OD' 09-RENY, 9i2, 0200 1,35 0,-..D",TTR L`%WX WO
9"IrBERNAIRDWO CA 9-2408 StN'BERNARDINO CA 92408
(909)381.6007 -111f 2120
USE OF PERMIT I - --
WNGI X NAM, Y"DWEVN0 I IIIIIII IIIII III IIIII IIII 54
IE
8FID • l"IF 31 PLAN=. PERMIT COM NOT INCLLtDE BLOCK -
W'At , P004 SPA OFd,1G DRIVEWAYA.PPRO'ACH, 73% KAHN CHECK FES.
RBOUC' 10111 FOP.'MULTIPL ISSUA.14CF, OF S,,hME 11I. VH TYPE
TRACT C0119TI1:UCTION %pupil OF
PORCWP.F TIC 41.00 FIF
Q.F RA0FJC*AR-PORT 417,00 SF
.1~` I ,t= 6°osr Cllr CO)VIIrrR iM @10H
PXPJ= FRE SUbIMAPLY
CONS! RUCTI" W.
101 -0,00 -418 -WO
$706.00
PLAN CHECK FEE
101-0004,39-.318
$147.1'i
MECHANICAL F "
101.000.421.000
$601110
E3,,EC9TR.lOAL, YZE
101.000.420-000
$1;4'!.53
PLUMBI"HO FER
101.000.419nC?i O
W&CO
S:TRONO VIOTION ?T -B - RMID
1014 00-211-000
$11,111
GRAD1140 FRF
101-000.423.001
$:2 r00
DEVELDPER IMPACT ",9
'gyp `.fi
I,gD?.1it1
.:1.
SM-10TAL CU9' XJC*1T0W AND PI -01 C'' .5 0K
[V11W U 12002
CtTYOF
BY f DATE FINALED SPECTOR
1181,9590)
(3,tEtl
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
-- 3 —y
Underground Ducts
Forms & Footings
—
Ducts
Slab Grade
Return Air
Steel
— 3 —
Combustion Air
Roof Deck
;: 3— u Z
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
-pz
Compressor
Insulation
p. (o.
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans 8 Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
o—Z!
Final
Final2—POOLS-SPAS
PP O
BLOCKWALL VALS
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
_
Waste Lines
Gas Test
Electric Final
Heater Final
Water Piping
F
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
, c7 2 S
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring fjZ_
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm) .o/ Y
COMMENTS:
t7
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: 79-767 AMERICA COURT
Use Classification:
Occupancy Group:
SINGLE FAMILY DWELLING Bldg. Permit No.: 0203-387
R-3 Type of Construction: VN Land Use Zone: RL
Owner of Building: CENTURY CROWELL COMM. Address: 1535 SO. "D" STREET #200
Building Official
City: SAN BERNARDINO, CA 92408
By: STEVE TRAXEL
Date: 12-18-2002
POST IN A CONSPICUOUS PLACE
INSULATION CERTIFICATE
This is to certify that insulation has been installed in conformance with the current energy
z0gulatiori, California Administrative Code, Title 24, State of California, in the building located at:
79.767 America Court, Lot 31, Monticello -Classics, 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 #
BY: TITLE: !/ i /'' •
PARAGON SCHMID BUILDING PRODUCTS, A MASCO COMPANY LICENSE # 632072
B TITLE: ADMINISTRATIVE ASSISTANT DATE: 12/5/2002
IIIIIII
VIII
III
VIII
IIII 55
IE
INSULATION CERTIFICATE
This is to certify that insulation has been installed in conformance with the current energy
z0gulatiori, California Administrative Code, Title 24, State of California, in the building located at:
79.767 America Court, Lot 31, Monticello -Classics, 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 #
BY: TITLE: !/ i /'' •
PARAGON SCHMID BUILDING PRODUCTS, A MASCO COMPANY LICENSE # 632072
B TITLE: ADMINISTRATIVE ASSISTANT DATE: 12/5/2002
CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING (Page 1 of 7) CF -4R
Iy01, I'
Pr iect Title
Project Address I ' ' '
Joe 90610 So ld 772- 3 15 0
Builder Contact / Telephone
hIe- NP.Qb r-i,2o..jS/,G•9od- --
FIER
Telephone
0 '(7- j qt"N RING/j2 L
Cenifying S' natureC Dtat e
Ed
Firm:DESERT dE<2
Street Address: c). F -Ox (oZ
Copies to: Builder, HERS Provider
Dates -e
C'.F-:JTLi I e --Z'
BuilderamT e —
FL t4, J 56,
Plan Number
GI 20 tJ P
Sample Group Number
Lo -r - '- 31 71• ►Ca
Sample House Number
HERS Provider: L°, E . E. R• `>
City/State/Zip: I o iPAr ,t , c'9A (2)14-77o
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 (fie 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.
❑ 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
❑ 1`es ❑ 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 - IR 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 A-16