SFD (0202-035)79882 Memorial Pl
0202-035
r, LICENSED CONTRACTOR DECLARATION
It .ereby 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 J.,,e % Signature of Contractor
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason: -
( ) 1, 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).
( ) I am exempt under Section B&P.C. for this reason
Date I 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.
1 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 001,1>94. MOLE INS, Policy No. NIC -S4068.03 ,
(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:,..'?tom••';n7 Applicant ,? J.< P?•
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application -is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnity
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not -commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection purposes.
Signature (Owner/Agent) _ - Dates
i -m
BUILDING PERMIT PERMIT#
LOT -035,
DATE VALUATION TRACT
yy q e / }n C p ryry
JOB SITE
ADDRESS 79-8e,,2 M,L' O :AL K A3M
APN
CFU • SYQS
OWNER
CONTRACTOR / DESIGNER / EN (NEER
(M URY CRC)WFUE, C01\ iKMS
C;`E:h3`1."C. RY CROWIRML PO.LvCM-'CNIU
1535m), To !'ML MT- ROD
Is 35 iso, I). own 4 ,i:', rf-zf., #2-0t)
.SS.%iiV i3'+ R.ARi.?INO CA 92.40£
".A'e°+i OA- 92Avu
(909)361-61007 C` ILO 2120
USE OF PERMIT
MA , FfibffLlf DW£' LUL)
Sl t'J ,. LOT 26, PLAN 35R.W, PERMIT DORM NOT INCV1119 81XIC .
WA1,1, POO), DRUPWAY AOPPROAC111. (PLAN CHEM FOE 1>EnUCKID F ti
M.uL r1ME ISS UA14t3t, OF Sa13eJ X P1dAN T4'PX)
7$ ACT CONS;OTt,UCT1014 LIMA SY
PO C.Ffl ATIO 91.00 SF
' !! 't"£" 3 fi:C+*T 09 C5),IV I'd l J4' :i'dON
lia 4)7t)o t
MAW FM ffOAOSARY
CONSTRUCTION FEE 101 X000-•18 MOO $dk D
PLAN CHWK "F,
MECHANICAL ANICAL AM 1. R,1.000.421.000 ""0.00
f10' - &t2{o ..ryQ/00 G ct
EL, r'grm(l yyac/A{>.:y IME a ... 1911-a400-419-000
P1JU TSI iFJ 1 .0 t i 101 400.4 9, 7 ;
y00 -.".$110"00
5
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93,034,07
RECEIPT
DATEj
%A, /i .
BY
D LED O
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade-
5 9 ye,
Return Air
-
Steel
g —2
Combustion Air
Roof Deck
-� — Z
Exhaust Fans
O.K. to Wrap
— -
F.A.U.
Framing
Insulation
- -
—((9 - Z
Compressor
Vents
Fireplace P.L.
Grills
Fireplace T.O.
,
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
5, zg _
Final
oZ
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
I
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines ,�
_ ,2�-U
Heater Final
Water Piping
_
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
Sewer Lateral
l
O.K. for Finish Plaster
Pool Cover
Sewer Connection
— 7:,Z
Encapsulation
Gas Piping
Gas Test
Appliances
!G
Final
Final
Utility Notice (Gas) — o
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring — Z
Low Voltage Wiring
Fixtures ,
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
C .-rti.fica
to pfoccupancy
City'of La Quinta
Building and Safety., Department OF roti
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:. 79-882 MEMORIAL PLACE
Use Classification: SINGLE FAMILY DWELLING. Bldg. Permit No.: 02027035
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
Installation Certificate: Residential CF -6R
Site Address PERMIT #
79-882 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
V ` DATE:
Signature
Signature Installing HVAC Contractor
Jan 29 02 11:37a Richard Simpson 661 947-6889 p.4'
INSTALLATION CERTIFICATE (Page 3 of 8) CF -611 ' *o
t.,o•F 2(0 Ge Gv iwt _
Site Addmgg 7 g _ B'Z M Permit Number
f
DUCT LEAKAGE AND DESIGN DIAGNOSTICS
DUCT LEAKAGE REDUC"nON'
1'n %+:urualion'1't t Result-; (CFM fat 25 PA)
" 1'crt Leakage (CFM)
Nan Flow
It' Fan Flow in CaloulaiW e -q 4M cWtou x Aumbor of tons, or as 21.7.x I looting Capacity
in Thouaandv of I3tu1$r, ontcr calculated value boro
If tan (tow in num%rued, tmtef measured value hen;
Leekage l-ractiou - 'rosl Loakngd(Mcasured or (:oloulaled Fan flow)
PAw il'leakhgu Iraoiion Stl,lffi
r„,
El Nail
❑
For AEROSOL TYPE SEALANTS ONLY - The following diagnostic teyting was completed:
Ihrcl Fan Prcy%urrcalion at rough -in awayured leakage (CFM) '
CHECK AFTER FINISHING WALL:
❑ Yes ❑ No ❑ ilws-,uru pan te``1 or I loose prossieriymion is cl
❑ Ycv ❑ No ❑ Visual In%pcutiun of Duct Connoulions ❑ . ❑
PaSR fail.
ZTHERMOSTATIC EXPANSION VALVE (TXV)
/gy4•; ❑ No 1'11%Ynloslatio Expansion valve (or Commission approved
oquivalont) it; in%talfed and Aeee” Iy is provided for im-poolion [
Yew i.s a PMN pa% .Phil
❑ OUoz DEIGN
1 • ❑ Yes ❑ No • ACCA Manual 1) lesion calculations have been complulud,
Ihari DcAgn iv on the plans and dual installation matchoa
plans. Y
.2. ❑ Yea GI No '1'XV is inMallod,or Ftm flow hus boort vodfivd. If'no TXV,
veriflud fan flow matchv:: dueign from CF -I IL
Mcasurad Pan Plow =
Yea ler both I and 2 int a Fam Pass Fall
❑ 1, the undcrsigaW, vwi y that the nboyo dlagnoslic W, t ro"16; aqd tlrq work 1 perfbrmud associalcd with the tcKt(to) is in
ounfbrramw with Ilse requirements lire compliance orvdit- I'Mo buildur shall provide Ulu I IliKti provider a copy of tho CF -GR
Agu%;d by the builder ctnploya:s or sub -contractor% certifying that diagnosiio tatting and imullolion ntvul the roquirel"VA,11% Ibt•
,.
compliance credit]
TCHN, siguattnv, Datu Ltctailutg tiabco atraoiar (Go. NaoDc) t)R
Pcrlurmed Goacm) Contractor. (Co. Name)
COPY ,F0: Building DBpartrnerlt
HIM Provider (il'applicahlc)
Buildinq Owner tit 0c:CUt)011C1Y
,
.la,lrrary 4, 2001
Duct Testing
Certification Form
Builder Name:
Project Name:
Builder Field Contact:
HVAC Company Name:
HVAC Installer:
Self -Certifier Results
Duct Leakage Measured @ 25 PA
?9- 88
Tra*ct#t Z q l q "l il
Lot # ? ,G Pli
System L of
(One form per system)
Telephone No.
Telephone N009 70-111-01
q CFM
Indicate the maximum allowable Duct Leakage and the calculation method used:
❑ 0.7 x Afloor x (0.06) for Climate Zone 8 through 15 CFM
❑ 0.5 x Afloor x (0.06) for Climate Zone 1 through 7 & 16 CFM
J2' 400 x (Cooling Capacity in Tons) x (0.06) .CFM
❑ 21.7 x (Heating Capacity in Thousands of output BTU per hour) x (0.06) CFM
fin '/L _ , 6
- - Cie- z Z7 2
7:1rint Name' ature Date