SFD (0202-021)79873 Memorial Pl
0202-021
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
"14113€3 T3 101.31An
Date_ % "'' Signature of Contractor -4 )`1 -4
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).
( ) 1, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals
Code). .
( ) I 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 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 ,(1tJ'LDEN tn,'AM9 IN41111 Policy No. ,• 4flb€S
(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.
Date:f... ell Applicant
1. 1111111.5r_
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.
e
nature (Owner/A ent)it Date'
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BUILDING PERMIT PERMIT#
DATE VALUATION LOT TRACT
JOB SITE' r/ .w
APN
ADDRESS
79-6173UMORWO Fr. AUS.
044072..1
OWNER
CONTRACTOR DESIGNER EER
.
CutlMqAY CRVoGV,4®TNV dWS
JRAN1OLj\EJ9AL V/TVtS
1535 :ItNW!, SIT. 0.200
7/cEN c(AN
AVL
7r/^
u'uPJ hJ1>, .6✓C +,}diir, .L' &,, n A:n Yi 9/l8 .
SAN :r31KM.ARl-0 WO CA 92408
SAW . EMNAR,UWO CA 92 -SOS
( 09)s81 a£0.07 G':f3W 2120
USE OF PERMIT
K:Ie1.OLE 2TA - ' IMMLING
SYD JOT 14 PLKNIZREV, PER?.F. IT IDOLS?+ NOT Y2iCLU DS BLOCK
WAL.4 P001A.DRIM:MAYAk°PRO, A.01, (PL+A.?. CREEK FRI :1F DUCEP FOR,
U..3]L,"fl.PL.E.115S tANCIF: OF SuAMt PI,AI+?'t'S!°P O
TRACTC'O]J48TRU(,4T10N 1,70,00,011?
POYtiCl'- I ATIO 91.06 v
0ARAOFICARPORT 410,00 0,
k simw EDT XrMU:L; Y
C19NLr'I"'€''e-tJ6.1'M FUe 101-000-418-000 0 1,6 3.50
PLAR C:ii>~CI,',. F+'VE 101-000-439-318 $136,02
MEfy.NfMI.ICAL. FEE. 101 -000-4,21 -000 $61 o
MW 1.01-0O".2.l4000
PLUM,01,140 FE -9 101 -000-419-000
SrYZO.NO NOT ION l''I - RFS10 101-000-241-000
c'If' ADIWO YZE 101. _000-4213-000 920:0€
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$0,"00
2002 rlu l ff YkU DUE
FEB 0 7 P!
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3
RECEIPT
DATE JA,
'7 ti
.BYr
DAT IN E
INSPECTOR
/ .•
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.wt!
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
.2 -
Underground Ducts
Forms & Footings
4Z _�2 7 -Z
Ducts
Slab Grade
- - csZ S
Return Air
Steel
_cl-,
Combustion Air
Roof Deck
- Z y
Exhaust Fans
0. K. to Wrap
- J,� _
F.A.U.
Framing
_ ZaNiCompressor
Insulation
- -
Vents
Fireplace P.L.
J
Grills
Fireplace T.O.
_2
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
- ®.
Final - z 9-
BLOCKWALL APPROVALS
Steel
POOLS - SPAS
Set Backs
Electric Bond
Footin s
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 r7lf
212 L90
Heater Final
Water Piping
_may
Plumbing Final
Plumbing Top Out
- -r _ Z
Equipment Enclosure
Shower Pans
Sewer Lateral
lf_ S. Z
O.K. for Finish Plaster
Pool Cover
Sewer Connection
- Z
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring $- 2
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I. _
Smoke Detectors
Temp. Use of Power
Final 2g
Utility Notice (Perm)
COMMENTS:
Installation Certificate: Residential
Site Address
79-873 Memorial Place
1. BUILDER INFORMATION
Century Homes
1535 South D St. #200
San Bernardino, CA 92408
INSTALLING CONTRACTOR:
2. PROJECT INFORMATION
DISTRIBUTION
TYPE
Flexible Ductwork
in Attic and
Between Floors
DUCT -OR PIPING R -
VALUE
Flexible Ductwork
Will have a R -Value
of 4.2 or Better
CF -6R
PERMIT #
SUBDIVISION: Classics,
CITY: La Quinta
COUNTY: Riverside
WEST PAC AIR CONDITIONING
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 Installing HVAC Contractor
Jan 29 02 11:37a Richard Simpson 661.947-6089 p.4
INSTALLATION CERTIFICATE (Page 3 of 8) CF-611
Site Addrtws1 9- 972 MedM nfa/ P/.4e G Permit umber
NAS t- DUCT LEAKAGE AND DESIGN DIXGNOSTICS
DUCT LEAKAGE REDUCTION
Prc::ruruahon'I cst Rcsulls (CFM (4)25 PA)
Tosl Leakage (CFM)
Fan Flow
If Fan Flow iv Caloulatod as 41X1 ofm1to6s number of tons, or as 21.7 x I looting Capeoity
in Thourandy of l0w%r. opfi)r oaloulntod value hero
If tan flow i.% uumsun:d, cmWr mcasunsd value hen:
' Lookage Fraotion -,I" l.p►kagcl(Mca+urs or Cfdotilatod Fan Flow) - "`L_
Pam ifloakage fraoliou 50.06
Pass Fail
❑ For AEROSOL TYPE SEALANTS ONLY -the following diagnontle testing was completed:
thiel Fan Pressurization al rough-in mcasunxl leakage (CFM)
CHECK AFTER FINISHING WALL:
❑ 'Yes ❑ No ❑ jw&vro pan wA or I lousu•pros terizatiun lora
❑ Yes ❑ No' ❑ Visual lnspcutiion of Duct Connuutiotw ❑ ❑
Pass Fail, .
❑ THmI mosTAT'IC EXPANSION VALVE (TXV)
❑ No '1'Itotnloxt8110 lixpansion Valve (or Commission approved
equivalent) is installed and Aotm;4 is provided for inVt cction
Ykw i• a p". p/ a', pail
❑ OUCT DESIGN
1.. ®yes ❑ No ACOA Manual D Design oalaulations have bixwn aomplolud,
Duct lksign is on.tho plans and duct in%lallalion innWhes
Plans.
2. ® ycq ❑ No TXV is hwalh d or Fan flow hax bwln vuriliod, If no TXV,
vorifiel fan flow watchati da,:ign from CF>IR.
Mcnsurad Fan Flow = -
' ❑ ❑
Yes lbr both Land 2 inn Yana Pass Fall
❑ 1, the undcraigacd, verily llrat rho aboyu diagnostic wsS results and the work I perfi rmui associated with the tcst(s) is in
ounforma lu/ with the requirements Ibr aomplianca arudit_ ('lino buildor shall provido Uro 1 MRS provider a Wpy of Iho CF-GR
nigued by the buildor cu►ployocs or sub-aontraotors acrtilying that disgaa lio touting and innlallation maul tho rogoiromeals for
compliance credit. mm• /n
l'Csls Signature, Onto Installing Subco rotor (Co. Na a OR
Pcrlurmed Goacral Contractor (Co. Name)
COPY TO: lheildin tkpartrnont i
1113RS Providor (il'applicablc) ,
Building •Owner ut. Occupancy
January 4, 2001
" 79 73'
7. MMo{t'
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L t ti t ',i: '' _ i 1 "'F i'vc ♦, t i i:.t •a - yl .q : .. Y ..
. - r 'L. .f. 1' k r. J •S r re- . a f "A, !,•'y'.
'Tract
3_ Duct Testing®t
Certification Form
,. System'
z J (One form per system) ;
,Buildef'Nam' e: ; : ' - •'
Project•Name:
Builder Field Contact y 'Telephone No 4 i
HVAC Company Name:
HVACAnstaller: . .F Telephone No
Self -Certifier Results y ,
Duct Leakage Measured @ 25 PA` as b ' CFM ;
' Indicate the maximum allowable buct Leakage, and'the'calculation method used. •, ,',r• '.'
F.0. 0.7. x Afloor x (0.06) for Climate Zone 8 through `15' , ' CFMs
U 0.5 x A x (0.06) for Climate Zone 1.tlirough.7 &'"16 s UK,.,f "
floor '' K
Q 400 x (CoolingCapacity inTon s) x (0 06) t ; r y 4 ( CFM L + , .
{
❑ 217-x (Heating,Capacity in Thousands of output BTU per hour) x,(0.06)41
CFM
in
y. Print Name Igna Date `
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LAa.9. .
Certificate of Occupancy
City of 'La' Quin ta
and-SafetyDepartment-
ing.
BuildingThis Certificate issued pursuant to the requirements of Section 109 of the Uniform BuildCode,
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: 79-873 MEMORIAL PLACE
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.:. 0202-021
Occupancy Group: R-3 'Type of Construction:. VN Land Use Zone: RL
Owner of Building: CENTURY CROWELL Address: 1535 SO."D"STREET STE#200
COMMUNITIES
Building Official
City: SAN BERNARDINO CA.92408
By: GARY SHOWALTER
Date: 07/.29/02