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SFD (0202-019)79845 Memorial Pl 0202-019 ' 'LICENSED CONTRACTOR.DECLARATION U) I hereby affirm under penalty of perjury that I am licensed under provisions'of 17 . Chapter 9 (commencing with Section 7000) of Division 3 of the Business and 04 W Professionals Code, and my License is in full force and effect. License # Lic. Class Exp. Date . f-CY Lo LU T- r` .71 a 188 10/3 3 /21 Z r- Date ., /f''y .1-'7 Signature of Contractor' s 4/;:7 "'1/4•I CID U . w OWNER -BUILDER DECLARATION W Lu. I hereby affirm under penalty of perjury that I am exempt from the Contractor's ~ a ' License Law for the following reason: N - Z ( ) 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 & Prof essionals'Code). > ( ) I,, as owner-,of/the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business & Professionals • v Code), O I am exempt under. Section B&P.C. for this reason N Date Signature of Owner Oma;; r U Q WORKER'S COMPENSATION DECLARATION ' p cr I.hEreby affirmLunder penalty of perjury one of the following declarations: Lo H, p O"1 have and will maintain a certificate of consent to self -insure for workers' X LLI compensation,'`as provided for by Section 3700 of the Labor Code, for,the O J Q performance of the work for which this permit is issued. m,Q U (z4i) µl`fiave and will maintain workers' compensation insurance, as required by d V. Qz : „Section 3700 of the Labor Code, for the performance of the work for which this L- ' i` permit is°issued. My workers' compensation insurance carrier &policy no. are:. O Camer Policy No. .t tiyb3' I.S I. 1 I ifS. 'p7i]ty :• 2 36 •03 . .:' ! r ri'. :.. g (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 ,x:, workers' compensation' laws of California, and agree that if I should become subject to the workers' compensation provisions of Section 3700 of the Labor 3., Code, I shall forthwith comply with those provisions. Date .4 /-I x; Applicant iik/ i 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 Applicatioh.is hereby made to the Director of Building and Safety r. for permit subject'' to the conditions and restrictions set forth on his application. • c, 1. Each person upon w ose behalf this application is made & each person at whose request and for whose benefit work is performed under or pursuant to c 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. Anypermit 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 ' xpermit, 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 • `r correct. I agree to comply with all City, and State laws relating to the building r,. construction, and hereby authorize representatives of this City to enter upon the above-mentioned property for inspection purposes. .r $• ry L Signature (Owner/Ageni)7, Date -Q •BUILDING PERMIT PERMIT# DATE VALUATION LOT iY802^d3:1 TRACT "4 JOB SITE j APN ' a,r ADDRESS .' OWNER CONTRACTOR / DESIGNER / ENGINEER i CIEVITUR— Y CTRL 3w,11ML E"U ST.`t i°i: C MUEY ? Y CROWFU, COMMUMIUS 15,35 um s3 „ mm tvr, aiz tno 1.533 ;9401 ". , St--TrMI ", 9019200 3 1c3 .b t t14Tf3T*1°i'l1 Ti3 4:` 3I: `+3 i 51It4.V DERNARDi1d0 CA, YN68 (909,1361-60M CB14; 212o USE OF PERMIT 91WOLE FAWLY LtdUL NG WD • W7' M P-1,KN Xf EN't I 4'FN3I`i Z9f= NOT MIC—LI-IDE 11,1:St* WALL, POOL, DR1VE%VAYAPlPROA.t.Nf. ' .... TldAC`i`" CONSTIBUCTIt`,N 3,2 ;0 HF PORCMPAT'Iti .'g7a.Ot1 cW, ` CtAlA'►t3.FIC- RPORT I .tt iii' t t Ca " 'i: 'i'd"149;Iwi q. vv • aa.r+e yy **ll 4 ,// ryry {y'• qq l:nr[NAdR ".UT TYER 41r0,:Ras.i Z?, k91.1Av,F.IIY:C IRX.a.di, .. C+rJl` i1 t' U.0 TION FEE 10 $053,50 ' PLAN CHECK K'11r, 101-000.439-3113 S544.06 a; ; 1jQ 'l.•t3 f0(0- gb21.0gC tLn ,lgk '• ,.:X• . yM.E}yCryk 91y3rICpAL{{77t iEpE ErIX•(11`f IS.ALR FiX, EiJ1^ilV i-ak6YJ^'Wli6} $1J7. 2A Mr :Pj,!;IMB3. O FF ,: 101.000.40-000- 011R "iNO fah.ErfTION FBI?, - R&OU TD 101 _000-241-0(:Q. $1639 I".fY:Is IKT d 2?t_i. ,,,, 1t11• C1t3(3 q.?.3-oI3iD a2 .f?G , 13KVEE:•TAFEP,IMIP CTfrft $1;9(ry.no ' S.1 '+-1`.t"rFCAL 0031 i:_+MCDS AIND 1 VW CSI s ' $3j4412. ti 1 IMM PRFIFAM MITES 0. ri -. .• - /" q y} •y'( • $ ] ` y Dap 1 . . '•4!&/ f.-7 wx{3::5.&SV:L4. S S: rKus, 1ll.i/ `,:.1 NLi'l,Y Q /J y.+y q V5,447, 11 I;` Cf f At'L, ftE. RECEIPT DATE. BY.'• •/ `(" DAT FINAL INSPECTOR INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS . MECHANICAL APPROVALS Set Backs — Underground Ducts Forms & Footings _Z Ducts Slab Grade Return Air Steel Combustion Air Roof Deck Exhaust Fans O.K. to Wrap _ F.A.U. Framing — Compressor / Insulation M Vents Fireplace P.L. Grills Fireplace T.O. _ Fans & Controls Party Wall 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 2 z�_ on- 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 C Final Final — —©.� Utility Notice (Gas) ELECTRICAL APPROVALS Temp. Power_ Pole Underground Conduit Rough Wiring _141„ - Low Voltage Wiring Fbdures Main Service Sub Panels Exterior Receptacles G.F.I. Smoke Detectors Temp. Use of Power Final Utility Notice (Perm) rj COMMENTA; ?7'' 7,,, o — - S S,Y y„ZS Installation Certificate: Residential CF -6R Site Address PERMIT # 79-845 Memorial Place 1. BUILDER INFORMATION SUBDIVISION: Classics Century Homes CITY: La Quinta 1535 South D St. #200 COUNTY: Riverside San Bernardino, CA 92408 INSTALLING CONTRACTOR: WEST PAC AIR CONDITIONING 2. PROJECT INFORMATION DISTRIBUTION 'DUCT OR PIPING R - TYPE VALUE 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. HEATING 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 gain rate 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 nn CSC DATE: I •• — ' - vg.. Signature Installing HVAC Contractor —%q -845 ML'MOY I PIQc. r Jan 29 02-11:37a Richard Simpson 661`347-6889 INSTALLATION CERTIFICATE (Page 3 of 8) ,c a Wv/ rta ( c.04to Site Addr&A G Secs DUCT LEAKAGE AND DESIGN DIAGNOSTICS DUCT LEAK IGE REDUCTION P•4 CF -6R Pressuriialion'I'est Rcsulls (CPM (a) 25 PA) CJ .'I'cs( Leakage (CFM) y Fan Flow If I'M FIow is Caloulatod as 4110 ofkation x nvjr bcr of ions, or ax 21.7.x heating ("aphoity in Thouaanda of Htu/hr. opter caloula od value horn ZV 60Iffan flow LR rul mcasurcd, enter mcasuvalue huru Leakago traction = 'fvi1 I,oalcngcl(Mcayarcd or Calculated 11an flow) - (' • U l.l'. , Yaw%il'loaktigu frnotion S0.06 El . xp'.", Fail ® For A EROSOL TYPE SEALANTS ONLY - The following dlagnontle texting was completed.- Mm[ ompleted:Duel Fan Pn:ssurilaliun at rough -in mcasural leakage (CFM) X CHECK AFTER FINISHING WALL: ❑ Yes ❑ No ❑ Pros-uru pan lout or 1 rouse pruxsttitration tc8tl ❑ Ycs O.No ❑ Visual Inspection ofI)uct Connuclionx 1• ❑ ❑ 1 PISS 1'nil. , ❑ THERM6STA71C EXPANSION VALVE &XV) --:-- Yew ❑ No '1'lteymoslatie l:xpat►';i0u"Va1w (or Commission appmVed oquivalont) is installed and Access is provided for insllootion Yi i it a pans Pass bail ❑ DUCT DESIGN a ❑ Yet ❑ No RCCA Manual I) lkxig i calculations have been eomplulud, [)not Ih;xiLrn is on tho plans and duel installation inatuhos plans. 2• ® Yoe ..- ❑. No '1'XV is mstallul ur Fan flow hay been v.odr ,1If no IrXV, voril➢cxl 1'tm llow matchk datiign from (`.1'=11Zr • Mcacurod Ijarcl low= . Yet; Ibr.buth 1 trod 2 is a 1'am Pass Fall ❑ l; Iho undoraigaml, rwi(y that the above diagnostic test molts and tiro work I performed ai,-;oeiatod with the tcat(M) it; in conformance with the rcquiromcnlx li►r compliance umdiL 1'11c buihlur shall provide Ilte I MRS provider n copy ol• the CF -GR`: Agu,A by the builder cinploya:x or sub-contraolors certifying that diagnustio justing and installmlon novel the regairvmoartx lift• ' compliance credit, j • Lr -z X0.3 1'csts Sigaatun ,1)atc 10talhe Subcontraotor (Co. amp) OR Pcrlbrmod (knera) Contmetar (Co. Name) COPY TO_ lloildinV Departrncat .1113RS Prox idor (it* applicable) Building Owner•.tit Occuponcy January 4, 2001 . i K':. 4 Y� .M� • . ,<, �, q^ P 11(1 s_ Duct Testing®t #~ .. Certification Form ' system 1 . of • . i M : �s . •- y . (One form per system) . , • 3 = • ' t•� ` S, �` r"' M _fZ • • � • as X ' Builder Name: Project Name: • C?.�C Builder Field Contact: "' Telephone No'.' HVAC Company Name: r ' HVACrinstaller: "Telephone No:�al �3�-�75L �• Self -Certifier Results' C)uct'Leakage Measured @ 26 PA CFM Indicate'the'maximum allowable Duct Leakage'and the calculation method used:,-'.. ❑= 0.7 x Afloor x (0.06) for. Climate Zorie:8 through 15 { CFM ' ,, J ' El0 5"x Afloor-x (0.06) for.;Climate Zone 1 through'7 & 16 . CFM ,a x K• E�1(,,400 x (Cooling .Capacity in, Tons) x (0.06)'i CFM21.7,x (Heating Capacity in Thousands,of output BTIJ per hour) x (0.06) _ CFM ;1 Print Name Signa ti Date a i K':. Certificate of Oil of -r- o of La u nta CityQ . Building- and Safety Pepartment." OF . This• Certificate_ issued pursuant to' the requirements of Section 109 of the Uniform Bui/ding Code, certifying that, at the time of isscian&e, this structure was in compliance with the various ordinances of the City,regu/ating building construction or use. ''For the fo/%wing:. ' BUILDING ADDRESS: 79-845 MEMORIAL PL: Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 0202-019 r Occupancy Group: R-3 Type of Construction:. VN Land Use Zone: _ RL Owner of Building: CENTURY CROWELL Address: 1,535 SO."D"STREET,STE#200 COMMUNITIES City: SAN BERNARDINO CA. 92408 By: GARY SHOWALTER . Date: 07/29/02 Building Official