SFD (0202-038)79840 Memorial Pl
0202-038
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 '
f
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).
O I am exempt under Section B&P.C. for this reason
Date Signature of Owner
a
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:
Cartier Policy No.'
. GOLDEN MOLE Ma NWC-541406"3
(This'section need not be completed if the permit valuation is for $100.00 or less).
( y 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: , 7/' 1r>,r.F' Applicant
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to'the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the ',conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application -is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees:
2. Any permit issued as a result of this application becomes null and void if.
work is not commenced within 180 days from date of issuance of such?
permit, or cessation of work for 180 days will subject permit to cancellation.
(,certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection purposes. Jl
Signature (Owner/Agent) . ' - Date 1'ir
d, t/':.
1. . . _ 10
BUILDING PERMIT PERMIT#
DATE VALUATION LOT 4A.'$P.32••?F. i TRACT
/
. 7fir,%7 .-. 111_9112.t9 29 2414" -3
JOB SITE -
APN
ADDRESS ap`Sr/ C1h y PLACE
1 7 'K,7°fa L'.dqN.A.+.fvJttd.6l..dRR.9.A./,' 'e:a' , nL:.
d S 7p 4es
OWNER
CONTRACTOR/ DESIGNER/ EN INEER
,EIv1T. R C C.".ROWELL t`:01,2E4Ui UJES
Ci9' b' i.ARY, C '!? OV1:k -L COti MI.M.0
351.45 S01 TO ;ITC MXA ' . ^, 1M)
B 35 30, °Da 91PYRE , zAT, X200
► NT 9MIARD . O CA 9
I ]AIM AR NONTO CO.. 97408
USE OF PERMIT
OW all-,' FAMILY 1D 14M _M401
UD . IO? 29, PLAN 5,A, 114f,-LUD , 1.F:10w
POOL, DRWRWAYAPPRIDACK
TRACT CMISTRVIC"TI N 1,£0A*'S
PORCHAMT10 I f.00 RF
A .!8L'S8' . .vld h.c..f•.KI' .T.' 3 A Y ,U17 ,7 c1
I'V14,01TRtil:`f'If. N MIR 101.000-4•18-000
PLAN CHECK: FEE 101-000-4,39-318 $5W.31
MECIAIMI'ALRE ! O1 Ci00 d 1 i ti0 60:g9
)
'°419 taC z-t pryt [e •- t
e.7-000
ly
E - '.000- STRONG 7 E ' —UOT
ORADINO WE
DEVE—S,KFI'JY..l!, a:P.#WWT My,
FEB ® 2002
SUB-TCYKATu C01 'i .1 SON .t 's? PI.A1 C C 1} t , , .
1,3,5.x.1.15
TMAL IT"UPFRES? DUE NO
RECEIPT
DATE
BY ter''
DATE VNALEY
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
_ 2- g --,Z
Underground Ducts
Forms & Footings
—
Ducts
Slab Grade
_
Return Air
Steel
—
Combustion Air
Roof Deck
— Z-2-
Exhaust Fans
O.K. to Wrap
— — Z
F.A.U.
Framing
— Z
Compressor
Insulation
Vents
Fireplace P.L.
z
Grills
Fireplace T.O.
—
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Z C%
Final — —o 7 --Final
— 'v
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
I
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
2— 2j— pZ
Heater Final
Water Piping
Plumbing Top Out
_ -
%/�
Plumbing Final
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
— Z
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final O 2_
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 pL
Utility Notice (Perm) 3 �a2
COMMENTS:/3�
Installation Certificate: Residential CF -6R
Site Address - PERMIT #
79-840 Memorial Place
1. BUILDER INFORMATION •{ SUBDIVISION: Classics
Century Homes CITY: La Quinta
1535 South D St. #200 COUNTY: Riverside
San Bernardino, CA 92408 r
INSTALLING CONTRACTOR: WEST PAC AIR CONDITIONING
2. PROJECT INFORMATION '
DISTRIBUTION DUCT OR PIPING R -
TYPE VALUE A
Flexible Ductwork Flexible Ductwork
in Attic and Will have a R -Value
Between Floors of 4.2 or Better '
I, the undersigned, verify that the equipment listed in the category above my signature is the actual equipment
installed and that the equipment meets or exceeds the requirements of the Appliance Efficiency Standards. In
addition, Ihave verified that the equipment is equivalent to or more efficient than the equipment specified on the
Certificate of Compliance submitted to demonstrate compliance with the Energy Efficiency Standards for
residential buildings.
3. BEATING INFORMATION
HEATING. MANUFACT HEATING UNIT , ACTUAL EFF. HEATING EQUIP HEATING
EQUIP. ' MAKE MODEL # AFUE - CAPACITY LOAD
Furnace Lennox 80UHG4/5X-100 80% 100000
80%
4. COOLING INFORMATION
COOLING MANUFACT COMPRESSOR ACTUAL EFF. COOLING EQUIP COOLING
EQUIP. MAKE MODEL # SEER CAPACITY LOAD
A/C Lennox 12ACB60 12
The building design heat loss and design heat gainrate have been determined using a method specified in Section
150(h) of the Energy, Efficiency Standards, and are two of the criteria used for equipment sizing and selection.
5. SUBMITTED BY L
l J DATE: i ($ -C .•L
Signature Installing HVAC Contractor' ,
Jan 29 02 11:37a Richard Simpson 661 947-6889 p.4 F
INSTALLATION CE, RTIFICATIE (Page 3 of 8) CF-6R ;
vi l/V GIS SS�cs.
,teAUUmx79 w4eL-
Permit Number
PI► DUCT LEAKAGE AIND'DESICN DIAGNOSTICS,
I, DUCT LEAKAGE REDUCTION
Pressurivalion Test Rcsulls (CFM (ul 25 PA) �
. 'I•cs(l.cakagc (CFM) r
Van Flow
If Fan Flow is Cnloulatod ati M) ofhthon x jawnbcr of lour, or as 21.7 x I Iaating C:apaoity
in Thouyanda of l;iAr. ontvr caloulnted vnluo bero t
If ran fluor u measured, iaalsr mcasurul value hum
Lcaltagc Fraction-'I•041 Lo4n,gcf(Momurod or (:nloulatod Fan flow) - .0
Pre% if leakat u fruoliun S thtlb ❑
P®ss Dail
® For AEROSOL TYPE SEALANTS ONLY -The following dlagnontic tevNng was completed-
Duct Fan Pressurization at tough-in mcasuFW Jcukage (CFM) '
CHECK ALTER FINISHING WALL: '
Yos ❑ No ❑ Pre cilm; pan I" or I louse prossurlrativn lust
❑ Ycs ❑ No ❑_ Visual Inspcuiion of Duel CunnwAions ❑ ❑
Pana: Fail
TI4ERM6STAi1C EXPANSION VALVE (TXV)
YMN ❑ Nu 'f•Itexnton'latio l:xpaugion Valve (or Commission approved f
oquivalent) is installed and Aex:ews is provided for inVi aelron �j Ej
Ylw a papa 1'ax. Fail
❑ DUCT DESIGN
1• ❑ Yea ❑ No RCCA Manual 1) ITcsign onluulations have bLva eompletud,
Jkmt Dcxign is on tho plans and duct instatillaiion mnichus
plans. w
2. ® Yon No TXV 6 installed or Fan flow hex boon vorifiod. If no TXV,
vorif ud fief flow mntcha s divign from CF-1 R
Measarad Fan Flow =
❑ ❑
Y_'lbr both I laud 2 ia: a Pum pnt33 Fail
❑ 1, tho undersigned, vwi y thut tho abovel diaguoxltc t05t romla: and Wt; work I performed associatcd wilh the leat(m) is in
cunibrAtl►nee with the rtctluimmenta lbr compliance urudil- j'fho buildur shall provido Uw I MRS pnividur a copy of Ibo CF-6R
t,igucJ by the builder c1►tployoen or sub-contractors certifying that dinguotlio lusting and lumtghation ntvrol thu roquiminua►l,t Jor
compliance credit. j '
• ` � •��29r�/'h, �( -5 ��z-' ties �� C__ �►'��.
Tc%lr, Sittnatur , li)ato 1tLatalling Sabcontraotor ((.o.Namo) OR
N-d'ormed Goacra) Contractor (Co. Name)
COPY TO: liuilding Departrnul►t
118118 Provider (il'applicahic)
Buildiri.g owner- tit. accuponcy
.lartwary 4 2001
' F .. •E , - • It w ..- ` e; - ' tiF. Y * F .
is
Tract #
Duct Testing
Ewa
t Certification
cation Form
s .
System hof r
(One foam per system)
• Builder Name:
Project Name:
Builder Field Contact. ' ' "`
Telephone NQ.,. t
'-HVAC.,Company.Name. ..)W, - i(i, : ( :.
• :
HVAC Installer
Telephone No.°`7..7 `1 .fir, t r
- Self -Certifier Results
=Y. ;.
,L
Duct Leakage Measured @ 25. PA
CFM •,. M
Indicate the Maximum, alloWable Duct Leakage and the calculationmethod used ,
❑ 0.7 x Anoon x'(0.06) for Climate Zone 8 through 15 `
FM
11,
- t ❑. 0:5 x Afloor x(0.06) for Climate Zone 1.through-7 06 '
t - CFM
,F
.
1;1' 400 400 x (Cooling Capacity in`Tons) xY(0 06) ` . ` a
( [ CFM
❑ 20 x (Heating ,Capacity in Thousands of output BTU per hour)
x•(0.06•) -"-, CFM
I
Print Name ignafure;
s: Date ,
-..ax
..
'
.
( t+Lair ¢ # ii - s ' y p' 5 °' 'v ' ' "-y p'-}, •` `
t Y'i is'.: t eGu Y -i :5ca Sy Jq .. x'LG wjw .w, vA .` io',L F..'' ..•- 4 #ry xr... L rir. 3 - +s.°,Y ',
•.
TF '•gar °fi 5F cf - ,
SS `45 :n'i -'i..,:u ii
' F .. •E , - • It w ..- ` e; - ' tiF. Y * F .
Certificate of'.O.Ccupancy_ -- -TEN
Ct of La Quinta
Building'and-Safe,t .De - artment AFM OF.
This Certificate issued,pursuant to the requirements'of-Section 109 of thes`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=840 MEMORIAL PLACE
('Jse Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 0202-038
Occupancy Group: R-3 Type of Construction: VN Land Use Zone: RL
Owner of Building: CENTURY, CROWELL COMM. Address.: 15351SO. "D'= STREET
City: SAWBERNARDINO, CA .92408
By: GARY SHOWALTER
Date: 07-31-02
Building Official .
POST IN A CONSPICUOUS PLACE
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