SFD (0202-037)79854 Memorial Pl
0202-037
LICENSED CONTRACTOR DECLARATION
Ijhereby 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
'7141 1 fh 3l,tt)
bate '; --I f Uhf1.7-Signature of Contractor N )*5
OWNER -BUILDER DECLARATION
I hereby;afflrm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason:
( I ) 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 tlie property, am exclusively contracting with licensed'
contractors to construct the project (Seca 7044, Business & Professionals
Code).
( ) I am exempt under Section B&P.C. for this reason
Date Signature of Owner
WORKER'S COMPENSATION DECLARATION y
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. `
1(,.e) 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:
CarrierPolicy No.
(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:. ',') '" i / 9 Applicant " '7/ .! `/7t
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. -'Each person upon whose behalf this application -is made & each person at
whose request and for whose benefit work is performed under or pursuant. to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued.as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize.'representatives of this City to enter upon
the'above-mentioned property for inspection purposes.
Signature (Owner/Agent)
;Y .
, t-J,wr
BUILDING PERMIT PFRMTN
DATE / / VALUATION LOT 0.102"037 TRACT
-24197-3
JOB SITE
ADDRESS 79-&%4 AI a.: AORTA a PIAC E
APN
640114772'M8
OWNER
CONTRACTOR/ DESIGNER I ENINFER
N10 18z 9ROWS-L LOA97M2
.C7Y11TURY CROW'u, C/1IMUgI ES t
1535 so, 17). STIMMra'UrRe 92,00
3535 30. V *T.RJE:' r, MS RZ00
SAN RERN-4d)STO CA 92408
.4
(vogpsiwaxrl ca;'n* 21zo
USE OF PERMIT
MR. ?.FAMILY 15wi lum
S3DT 24, ;NI.RaP$ W", Pk`"IT MRS NOT INCLt1DIL OG, CK
WALL, 11001, l:alZfl h.:l A ARPRO. Alt (PLAN CHECK RM, R.8DUCTO FOR
MULTIPLE' 2:3SU A:NCZ C)1;' "Ut Ph&N 'f Y,14rO
fi4iACTMMOTRUMON 4, J,tIU sy
PMCHIPATM 51.01) SP
i7A"011 5:!`v:R. 012:1' 413,00 SF
\
95MIATKI) CKNS
103 i0160
A" ..a6T..TiILYi'd ,A1'k:I. r 9070H7,Y.xt,.Y
. .
COASTTA1rftTION,t,c20 1043,10
P> CHECK RE $136.02
ppcw>4. &N t Q A L re, F,191-000.421-100 s5v,slc+
101.000.420.600 11.°7.24
NIUMS146 1.1xE101 000.4.1 P- G3t)J
4, STRO1dO MOT101 MOM • 1D 1,01?f50Q-? !.'M i t1 tf9.33
(3 ID4140.FER 101.> 1.0001142111-060
0 V1E1,)PU' IMPAC:(' 1''i lGr
FEB 07 1 02
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$+3,034.W
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RECEIPT+
DATE p
BY c
DATE FINALED
C;L
INSPECTOR
I
`"
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & FootingsDucts
Slab Grade
_ „I
Return Air
Steel2
Combustion Air
Roof Deck
- 'a - Z
Exhaust Fans
O.K to Wrap
- - Z
F.A.U.
Framing
— 3- Z 4
Compressor
Insulation
Vents
Fireplace P.L.
_
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
--�
Drywall - Int. Lath
Final
r
Final �
BLOCKWALL APPROVALS
steel
POOLS -SPAS
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 _
c-12-
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)
COMMENTS:
Installation Certificate: Residential CF -6R
Site Address PERMIT #
79-854 . 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
l7 1011. 4 DATE: Jo — 8—CMZ
Signature Installing HVAC Contractor s
.. X _
Jan, 28 OZ 11:37a Richat^d Simpson 661 947-6889 p.4
INSTALLATION CERTIFICATE (Page 3 of S) CF-6R
`
Site AU tea Permit Number
. h µSE s.1L q— ?s` ( ,: - . •
DUCT LEAKAGE XND DESIGN DIAGNOSTIC
DUCT LEAKAGE REDUC"HON
Yn tiuriialion Test Rcsu]Ir (CFM 0125 PA) 0
'roti( Lcakagc (CFM) 0
Fan Flow
If Fan Flow iv Caloulatod es 4110 olm/ton x number of tons, or as 21.7x. 1loating.Capacity"
in Thoumda of I;IAr. oplor Calolrlmod value baro
If fan Claw i.. nrmrsured, caller mcasurul value hen
Leakage Fraotion ']'a-1 Loakagd('N(aasured of Caloulatcd 14aa flow) - - -
Pa.. ifloakogo fraotian 51).06' ❑
Pass Fail
❑ For A F ROSOL TYPE SEALANTS ONLY - The following diagnostic testing was completed:
. Dodi Fan Prumurrualion at Tough-in ua:asunzi7cakagc (CFM) ✓ '
CHECK AFTER FINISHING WALL: + ,
❑ Yes ❑ No ❑ l'niuro pan 104 or l louse pry-•.urination ten '
❑ Yes ❑ No ❑ Visual inspeution of Duel Connuotionv 4 ❑ ❑
• • 1'acs bail. ,
THERMOSTATIC EXPANSION VALVE (TXV). .
YMN ® No Thcymo%lalio Exp4n,60ft Valvc (or COMMISSIOrt approved '
oquivalont) is inslallod and Acuum.4 is provided for inVcotion [
• YI.N i.• a paha ya.s fail
Q DUCT OEMON
l ®Yet; ®No ACCs Manual I) Design calculations have bixin eumplolud,
Mot lkvign iv on tho plans and duct installation matoho;
plans. '
? ® Yes .❑ No, TXV is iastallod or Vin flow ha+ boon voritiud. Ifoo TXV, ,
•vorillud fan flow mnicha. dueign from CFA R '
Measured Fan I"low=
Ycs Ibr both 1 and 2 iw a 1'en. Pass Fall
®, 1, (ho undaraigacd, vwky that tho aboyc diagnoMW t4'at rc;wlty and the work I performed amocialcd with the tcst(s) is in
confbretaaw with the requimmants lbr compliance credit ('tiro builder shall provido dru I U;Rs pruvidor n copy of Iho CF-OR'
xigu J by the budder employees or sub-contractors ecdil'ying that diagausliv (oming and in..tallation nwut (ho rvtloiremo k Ibr
compliance credit.)
7 vsls Signature, Date htatalling Subcontraotor (Co. Name) OR
IlLd'onned ' . Gcocr'al Contractor (Co. Name)
C()PY'1'0:. Building Department ;
IMRS PTovidor (il'applioablc) ,
Building Owner tit Occupollcy.
January 4, 2001
.. ,
Tract L 1
Duct Testing.
-hot
..• Certification F®rrn a r"
q;
System OLL
(One form per system)
Builder Name: ,l .
•
Project Name: CkSS
+Builder Field Contact 3 Telephone Na J
•HVAC Company Name:.
HVAC Installer: T^ ' ' ,c. `" Telephone No.,%)q.13°I -11 ( `
Self -Certifier Reslults
'
Duct'Leakage Measured @ 25 PA
CFM
'Indicate the maximum allowable Duct Leakage and the calculation method used. }
- - ❑• 0:7 x Anoo x (0.06) for Climate,Zone,8 through 15
' CFM
M.
0' '0.5 x A'floor x,(0.06) for'Climat'e.Zone 1 through 7 & .16 • r
CFM
400 x (Cooling Capacity in Tons) k (0:06) A
Z 4. CFM '
❑ , 21.7 x (HeatingCapacity. in Thousands of output BTU per hour) x (0:06)
` CFM,," -
o
Print Name Signal
. Date
mm
Certificate of Occupancy
CityQuinta.-V of La.
Building and Safety Department OF
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: 79-854 MEMORIAL PLACE
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 0202-037
Occupancy Group: R-3 .Type of Construction: V -N Larid Use Zone: R -L'
Owner of Building: CENTURY CROWELL Address: 1535 S. "D" STREET
COMMUNITIES
City: SAN BERNARDINO, CA 92408
By: GARY SHOWALTER
Date: JULY 26, 2002
DuiiUiny U111yal, .
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