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SFD (0202-020)79859 Memorial Pl 0202-020 LICENSED CONTRACTOR DECLARATION I Q; oreby'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 J r'3 - 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, asrowner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business & Professionals Code). ; O I am exempt under Sectionr B&P.C. for this reason Date 1 ^ Signature'of Owner ' WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury'one of the following declarations: C. ) 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: Policy No. Carrier 001, N E.A. : 1 a V. i }c osa•n: (This section need not be completed if the permit valuation is for $100.00 or less). O I certify that in the performance of the work for which this permit is issued, 1 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, t Date. ': Fe7Y? APPlicant Warning:. Failure to secure Workers' Compensation coverage is unlawful and shall subject an employer to criminal penalties and civil fines up to $100,000, in addition to the cost of compensation, damages as provided for in Section 3706 of the Labor Code, interest and attorney's fees. IMPORTANT Application is hereby made to the Director of Building and Safety ; for a permit subject to the conditions and restrictions set forth on his , application. 1. Each person upon whose behalf this application -is made & each person at,-,, Whose request and for whose benefit work is performed under or pursuant to any permit issued as a result of this applicaton agrees to, & shall, indemnify & hold harmless the City of La Quinta, its officers, agents and employees 2. Any permit. issued as a result of this application becomes null and void if work is not commenced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that the above information is correct. I agree to comply with all City, and State laws relating to the building construction, and hereby authorize representatives of this City to enter upon the above-mentioned property for inspection purposes. , Signature (Owner/Agent)~ jr . 5 ' Datee BUILDING PERMIT, PERMT# r DATE VALUATION + LOT JrG$Iw ^S,,i1i. TRACT JOB SITE' - y APN r ADDRESS xwar u d• .' : .t S►. ,S :CJt S i, t ,ibx ` ' i'X ^Ql' ` ... . . OWNER CONTRACTOR/DESIGNER/EN (NEER (MnT7.'O'R Y dP(,7W+i` .1, ,L`!QPA6T_1Na;.1ES SAS BE107AP 0130 aA . M.08 SkO' B'E%dNAR 11140 C'.J(j,. SPUDS CAD# W1120 USE OF PERMIT SFVs 1X)T 11, PLAN Cr PERMIT 100 -NiOb n4 3.I:.Dt B:i.f-1("1C:' . , POOL DRIVEWAYAPPROAOR TRACT CONSTRUCTION '.. mv,d0 3t+ tiil;Cillir'A'$$G3 ` 11,00 Sri' s. 417.00 NDN ARV .q i y, s .y ,sy+i$(1 /'errs u i{.'j ( j e'er O NS UC 11.1 N AEE ' .9 01 -000•'71, -iODO 1Npr V47a it M MCYLAWiC.AY.S B 11EIG"1RICA!,PE1.. AM.59 R G 1A, :A,t # F. 7 7R'iR CDE70 1. ua(1ti E1Q ;40' STRONO1`,2i'S`MN I+' 2.1 SM v 01-060-241._000 $11.181 kIRADIN(11 ',•'E 101-000 4U-000 1%20100 01 Y► i,(3.1'k F IMPACT ' 1,9t3?'13rJ A \ '.!/V,Y'.a.:ASOC l t<VA3'. wy ai.17:7t . A' N:'1—'s S' i !lYa'39>?v t'VSi i3l, xAyi't!`AL FEB © '7.2002 J . a°3, -• ,sig, RECEIPT DATE DATE FINALED INSPECTOR INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs _ Z Underground Ducts Forms & Footings 2 - ' ? -Z Ducts Slab Grade - 7- Return Air - Steel Z - Z _ Combustion Air Roof Deck Exhaust Fans O.K. to Wrap F.A.U. Framing n95 - 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 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 I I Gas Piping PLUMBING APPROVALS Gas Test Electric Final Waste Lines _ Z ©d Heater Final Water Piping _�= Plumbing Final Plumbing Top Out y _ �?S- Equipment Enclosure Shower Pansjo O.K. for Finish Plaster Sewer Lateral Sewer Connection _ Z g - Z ..5 Pool Cover 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 -611 Site Address PERMIT # 79-859 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 DATE: Signature Installmg HVAC Contractor Jan 29 02 11:37x Richard Simpson 661 947-6889 p.4 INSTALLA`1CION CERTIFICATE (Parc 3 of 8) CF-6R' VCt 640eC 'iteAddreNs -791—gSs MzM Permit umber J9144X r- DUCT LEAKAGE AND DESIGN DIAGNOSTICS _ DUCT LEAKAGE REDUCTION Pressuriialion Test Rcsulls (CFM (u) 25 PA) T,ost Leakage (CFM) Fan !'low If Fan Flow is Caloulatcd as 400 olWton x number of tons, or as 21.7.x I loaiiaP Capaoity in 'I•houd®ndy of BtAr. onfor caloulatod valuo koro If fan flow is measured, cater measured value hen Loakago Fraction—'I'e.`st I.w►kagc!(Moadarcd or4aloalatcd Fan 1'I0w) -T,0q _ 1 Axe if loakagu liaodon 5 0.06 ❑ Pass Fail. ❑ For AFROSOL TYPE SEALANTS ONLY- The following diagnostic testing was completed: thwl Fw Piumuricalion al,rough-in measure! leakage (CFM) , CHECK AFTER FINISHING WALL: ❑ 'Yes ❑ No ❑ Pm stmt pan I" or I louse premkirivatiun test ❑ Ycs ❑ No ❑ Visual Inspection of Duct Cunnuution-s ❑ ❑ 1'asR Fait THER141OSTAilO EXPANSION VALVE (TXV) --_ _ ---. - _. __._-- •. Yw c ®No '1'h"moglatio lixpan+ion. Valvo (or Commission approved oquivalent) is installed and Access is provided for insTfttion )!c ❑ Yeas is a pans ❑ DUCT DESIGN 1. ❑ Yc ❑ No RCCA Manual 1) Design calculations have been complolud, Dant Dxsigri is on tho plans and duel inslallation maluhus plans. 2• ® Yea (3 No '1'XV is himallcd ur Ftnl flow hug bin► vodilod. (f no TXV, . veuilieal fan flow matches: di ip front CF-1R Measured Fan Flow = a Yca Ibr both 1 and 2 in a. Pare " Pass Fall ® 1, tho undmigaud, reui(y that iho abovo diaguoslio test remitsand the work I peribrmct associated with the tcal(s) is in ounformimee With Ike nequimmmia lire compliant ur:dit. (Tho buihlur shall provide tho I IERS provider a wpy of tho CF )R Aguod by tho builder curploya:s or sub-contraetois ecriilying that dingau•1io tosting and imstallaiiun owol the rugairomuail.-4 liir compliance crudil.J y fest% Signature, Dato Itlatalling Sabcoatraotor (Co. Name) OR Purlurmed Gcacral_Contraetor (Co. Name) COPY TO: lluildinl lxpartrnelkl HERS Providor-(il'appliicahic) Building Owner- at. Occupancy January 4,2001 x F •w '� �t 1 �- -I, .L��` r, a �..t. ` ter' J.la .. y 4 �,. • ;+' .i, x r `tract # 1 a t t • ? DUctle" sting .1 #I • i -Lot Certificati®n For For' System of sr +nM1 1` f 1 ` vy`•. r� ` (one form per system) . Builder Name: :'` Dj,, ,: �� V ' Pr`oject Name': .. Builder Field Contact Telephone No. ` ' £ , HVAC Company+Name i�(�.�• ;, s . ' HVAd iristaller 1 ''+ - - ; y ,Tele hone N p o -M ,°�s�:o. Self -Certifier Results • oi ,Duct Leakage Meas @ 25 PA aured V,wCFM '' ; 5 t, `Indicate the maximum allowable Duct Leakage and the ,'calculation method used: t ❑ ,0:7 x Ahwr x (0.06) for' Climate Zone 8 through 15 ;• CFM ' 0 0:5 x Afloor x (0.06)'f6r Climate Zone 1, through 7& 16* r t ' CFM r ft4400'x•(CoolingCapacity in Tons). x (0.06): CFM ❑ ' 21.7 x'(Heating-Capacity inaThousands of output BTU per hour) x`(0 06),' CFM.. Print Name - Signature . Date. x..ni�`a'.y.•,�f`.al�xrx'?.�i,%"'-.+�x.i'��F.�F rt�(S�i.f+?ic.$•'."�+�: �5'�.5°'7.�5•rAh'•:9?1a4."�a..dL�i'C9.tsR•B..'137&�'�;Srl.<N1f+t�4va:5:•aW:�rr;aetxa..rerw.+ ..x.+:.xrr-ra ... - .. _. •w '� �t 1 �- -I, .L��` r, a �..t. ` ter' J.la .. y 4 �,. Certificateof*occupaha city of La'Quinta Building and Safety Department IF 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 fol%wing: BUILDING ADDRESS: 79-859 MEMORIAL PLACE Use Classification: SINGLE FAMILY DWELLING Bldg. Permit -No.: 0202-020 Occupancy Group: R-3. Type of Construction: V -N Land Use Zone: R -L r Owner of Building: CENTURY CROWELL Address: 1535 SO. "D" STREET, STE #-200 COMMUNITIES City: SAN BERNARDINO CA. 92408 By: GARY SHOWALTER ( Date: 07-26-02 'Building Official