SFD (0202-036)79868 Memorial Pl
0202-036
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 the7Business and
Professionals Code, and my License is in full force and effect.
License #I:. Lic. Class Exp. Date
7141 ' 1 OP 1 /tar
Date Signature of Contractor
OWNER -BUILDER DECLARATION r.
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).
( ) ,l 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..
i(y) 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:.
Carrier OGUIIDAH M-03M,12d . Policy No. "C-544068-0
(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 those provisions. s)
Date "^ 1` 7 lw, A Applicant _y ) Lei)
i1' r is ✓ T '
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. f
rfiY t }t
Signature (Owner/Agent) _ Date^' r + -f ••••-
BUILDING PERMIT PERMIT#
DATE i VALUATION LOT r9 TRACT
g[.ry rs
24197-2
JOB SITE` s _
ADDRESS 19--fl(A' AWW'VMA1. IPTAC
APN
^E t-t9tlii
OWNER
CONTRACTOR / DESIGNER / ENGINEER
CNIMIRY F.ObI M' L C OMMO EM
C.'' N TURY C.RO' M- L C01,9Xi 'rr. .
1535 SO, 1Y S R. ..t. T '.t , 4.200
1 X3.5 so. VI). yffm t, nx ft 00
8A14,BERNA kDD410 CIN V*A-08
SM DERNAP=90 CA. .9V06
(9113)381 a(Ap77 MIX 2120
USE OF PERMIT
SPO - WT 27, PSN TX -C, PBRM IT WEI14OT INC,1.MOF, 31-GC'X VfJAj -
PCC,)`TV(WAV .A P3tAL (PLM CHECK, PER :l~tlIDUCD K)R
MUVIPIZ IrS31I.At3iwt0.V SAM& PI414 7 YPE) '
TRACIT CGtNS'.1RUC`1'r09 2,021;00 Sri
POR,MPA.T O 11.00 3F
0.4AAC;WC.A1tP0RT 417.1008F
PkIRMYT, F. MR 9014MM15'r
u.ktiiik''1 iC:'T1G 1dFRE 101 -000 -418 -WO $y'ri✓✓6ff,0ibf
ALAN riHKVEM 101-000-439-313 S•90:Yf
NFICHAN1t;A,idYEE, l6.pf id-F 4 S' 421.000
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11,11
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MtrMJ ING FEEt .00
101 90-2A100"zp MOTION ?t&fi. u 0
t55 .Fldlll iC31+ ?FN' 10143tlt7423,x0 0 0 $20.00
i?>aVESdrJPY'r,IMPACI 1+1UF93f+
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RECEIPT
DATE
`f 1
BY,/ '
D AL
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
2 -,2
Underground Ducts
Forms &Footings_fig—
Z
Ducts
Slab Grade
—
Return Air
Steel
Combustion Air
Roof Deck
- y -Z
Exhaust Fans
0. K. to Wrap
— - y
F.A.U.
Framing
s -
Compressor
Insulation
- G - Z
Vents
Fireplace P.L.
z
Grills
Fireplace T.O.
��
Fans & Controls
Party Wall insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final - Z_
Final
- - d
POOLS - SPAS
BLOCKWALL
APPROVALS
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��,
_
Heater Final
Water Piping
_
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
_
- y
Encapsulation
Gas Piping
Gas Test
Appliances
— l/
Final
COMMENTS:
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) -
Installation Certificate: Residential CF -6R
Site Address" PERMIT #
79-868 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 liste&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
-Aa hww_IA ►c.. DATE: ►- g'uZ
Signature Installing HVAC Contractor
cate of ccupancy,-
CitQuintaof La F
y.
Building and Safety.Department F,,,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:' 79-868 MEMORIAL PLACE
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 0202-036
Occupancy Group: R-3 Type of Construction: ,VN Land Use Zone: RL
Owner of Building: CENTURY CROWELL COMM. Address: 1535 SO. "D" STREET
City: SAN BERNARDINO, CA 92408
By: GARY SHOWALTER
Date: 07-31-02
Building Official
POST IN A CONSPICUOUS PLACE
Jan 29 02 11637a Richard Simpson 661 947-6089
p,4
-INSTALLATION CERTIFICATE (Page 3 of 8)
CF-6R
o-F ' 7-7 CQi� -�ir�y C lG S, l rC r
�dcAUUr�we 19 _ $6 S Mta rtioRlhl �l�v Permu'tNumber
DUCT LEAKAGE AND DESIGN DIAGNOSTICS
,
_ DUCT LEAKAGE REDUC'"ON
Pressurization TcKl Results (CTM (x)25 PA)
Trst Lcakagc (CFM)
Fon flow,
If Fatt Flow ix Caloulatod av 400 ol'm/toa x tauntbor often.-;, or as 21.7.x f loafing C:apaoity
in Thouaindy o1'UlAr. opler calouintod valuo hero
If fan [low is ntcaaured, (alter mcaxurul value here et.t%o
Leakage Fraotiou —Toil Loakagel(Memurod or Coloulalcd Tan flow)
Pa\s iflankagu ftautiou 50,116
❑
Pas.% Fail
❑ For A EROSOL TVPE SEALANTS ONLY - The following{ diagnonde textirig zeas completed:
Duel Tan Pwscurizalion at rough-in nwasurud leakage (CFM)
CHECK AFTER FINISHING WALL:
❑ Yes ❑ No ❑ Prutsury pan t4ka or I louse pro.:mrriation teal
❑ Yav ❑ No ❑ Visual ImImutlon (11 I)nal Connuutions
` ❑ O
OTNERMOSTATIC EXPANSION VALVE ('TkV)
Ycy ❑ No Valve (or Commission approved
oquiv3lont) is installed and Ac um; L4 provided for in%Vmtion
P ❑
Yuw is a Pas-,
pass 'fail
❑ DUCT DESIGN
1 • ® Yew ® No RCCA Manual D Design aaloulnlians bnvu bwn complolad,
Duct Iksign is on Iho plans and duct holallalion malchc� ;
plans.
2: ® Yoe C1 No TXV ix installwi or Ttm now hex been vordiod. If no TXV,
vorifiud fan lluw n►ntchet: dosigu from C:Ij-I IL
Momaurod Fan Flow =
Yus Ibr both 1 and 2 i1: a farm
Pass Fail ,
❑ 1, tho undcrsignud, verily that the nbovo diaguos-liG IN-A rorVlL, agd the work I performed associated with
the tcat(rc) is in
cuilbt4nance %vith the rotluiromcntx Gtr compliance arodit. 111to builder shall prow' idu lho I IRRN pttividur it copy ug' the CF-612
Agu%xl by the buildor ctnployp x or sub-contrialorx curtilying that diagaumio lasting and installation atucl the rogoirotnent. lbs,
compliance credit-1 ,
I'ctits Signature, Datalltatalling Subcotltraolor (Co. Name) OR
Pcrlbrmcd General Contractor (Co. Name)
COPY TO: liuildin(:13cparhnent
111111S Providor (il'appliaablc) r
Building Ownex, ut occuivncy r
Jaenary 4, 2001 ,
'7q=868 rulaoni .:p)ed"
', • {+ • r ' 'Y. _,• _ • `TreCt •iT. • • 1'(' 1! y ;
.,Duct Testing l.ot
Certification Formp
,gystem .0
{ (666 form, per system).:
• e r t .. meq•' ! .. 4 .
' Builder Name: C U (`' i
Project Name:
Builderfield Contact:' T ; Telephone:No.,
HVAC Company Name. '` ' UPJ C.
" HVAC Installer: .
a
r `
Telephone No lSa
• .. - • Self-C:ertifie r Resulfs.
r of •
f
4
;Duct Leakage Measuredi@ 25 `PA T .•
indicate the maximum'.allowable Duct Leakage and the calculation method used: { '
x 0 06 for Cl _
.y ❑ 0.7 x Afloor ( ) imate Zone 8 through 15' }' • s, CFM., _
:. 0. -0.5 x A x 0.06 for Climate Zone 1. through F
poor (. ) Ough 7 & 16 `
)PFM
s400 x (Cooling Capacity in Tons))x 0.06 '` E 1,2 {' .CFM
4 4
21:7 x (Heating Capacity in Thousands of °output BTU. per. hour) x (0.06) ` 3 ° #CFM.
A I ' 1 /. fi( /CrV V+ . w '! . A' r t • ` r "" . >!r t
z 0
' Print Name' s :. na Date
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