SFD (0202-022)79887 Memorial Pl
0202-022
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
Date It "Signature of Contractor ''7 s7"
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 (Se(?.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).
O 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 Policy No.
001MN EOLF.—TH:1, ii't'.- it►b - t
(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,sh4ll,forthwith comply with those provision .!` !
Dater7—Applicant
>- - u
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 'h sr -
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 inttspectionpurposes.
Signature (Owner/Agent) • ,•tea Date"" • --'
BUILDING PERMIT PERM T#
DATEVALUATION LOT '+ TRACT
/
2, 71
JOB SITE
APN
ADDRESS 79-687IFIVO dA.1A YLACJ04-604
OWNER i
CONTRACTOR /DESIGNER / EN (NEER
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SAN 92408
USE OF PERMIT
TRA,CT CONSTRUCTION
417,000
sumulvz
CO NSTI UCTION:Pin 101-Af 0.418-000 0
PLAN C.HFIC'K PIZ M-00"1 9-3I1s' $147.17
MR01.MCALF B. 101 -NO -121-000 tSO,t?Cf
-
VUUMBINQ FER 101-000,439-000 S10,00
S'TTtC"iNO MOTION ME * RX'Sly) too 1300-243-000 11.81
GRADING FET
PEWB{,Gal~PR tHPAC'F"i $l,4p7.0.p
a!Jd?'".0.a.1,4&'1 .YJLJ 'od lSlYl.IJ• J.ltl 1 Si. ;l. i: .iri•,V:`t C.,ME..LMa
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FED 0.7 ..2.002
',
RECEIPT
DATE
DATE F ALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
—
Underground Ducts
Forms & Footings
- ,2 2-
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
s . Z
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
—®
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
-per _
Heater Final
Water Piping
- 2 Z
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
2.
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Al a —
Gas Test
Appliances
_ _
Final
COMMENTS:
Final — p —
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit z�_
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
_
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final — ,per
Utility Notice (Perm) _ 7 J
Jan 29 Oz 11:37a Richard,Simpson 661 947-6885 p.4
INSTALLATION CERTIFICATE (Page 3 of 8) CF -6R
s
slceA/ldma701_887 M MoCL I p1Ac.E Permit t amber
DUCT LEAKAGE AND DESIGN DIAGNOSTICS
DUCT LEAKAGE REDUC71ON `
Piusuuiiralion Teed Rcsulls (CTM Iu1 25 PA) 7
'fest Leakage (CFM) 7
Fan flow
If Fan Flow ix Caloulatod as 400 ofi alton x numbor of tons, or aw 21.7 x I looling Capaoity
in Thougand.a of "NAr, ornlor oa 41fitod valuo koro
If fan Clow as m;atnucd, cater mvaaurul value hmu
Loakago Fraoiion or C ploalatod Fan flow) _ 0-0q
if leakago ftaotion S O.tui . ❑
Pass Tail
❑
For AEROSOL TYPE SEALANTS ONLY - The followlnR dlagnoatle texting ivas completed: • '
Duel Tan Prussuriration at ruugh-in mcwurul leakage (CTM)
CHECK AFTER FINISHING WALL:
❑ Yes ❑ No ❑ llm-:sura pan Ica or l louw M-."11rvaliun text
❑ Yes ❑ No ❑ Visual Inspection of Duct Connoctioro ❑ ❑
Pass Tail
MT-14ERMOSTA71c EVANSION VALVE (TXV)
1'hc,Ylttonlativ lixpm,:ion Valve, (or Commission appyo- Ved
equivalont) ix installc d and Au Lm; is provided for inV. Otion ❑
Yew i. a pft-% X118', fail
❑ DUCT OF-51GN
I• ❑ Ya,, ❑ No RCCA Manual D 11-Agn cnkulalions have, beam oumplolad,
Duct DcAgn is on the plana and duct installation maleba`x
plana.
2• ❑•Yca ❑ No TXV iy mstallod or Ftm flow Wvx bvutt vorifivd.' Ifno.TXV,
verified fan flow matclux. doeign from CF-IIf
Mcasairod Fan Flow =
Yca li)r both l and 2 ire a Par,% PASS Fall.
® 1. Iho undmignal, vcrrily Ibad tho above diapomk lot rcrrullN and the work I performed am-ocialed with the lc1d(1r) iia in
eontbrtuariee With the roquimmento lbr compliance: erudite (Tho builder shall provido die, I I] -"RS provider'n copy ul' Iho CILOR
r=igu,J by the, builder etnployocs or sub-eontractom certifying that diagn"io tcs1ing and installalion afoot the roquiroit►ont> liar
compliance credit.]
ler' ac rA
Teshti Signature, Date 110alling Subcontraoior (Co. Name) OR
Pc:rl'ormed (;meta) Contractor (Co. Name)
COPY TO: Building Depsirtmowl .
11t;R5 Providor (il'applicablc) '
Duilding..Ownex- ut: Occupancy ,
.January 4, 2001
Installation Certificate: Residential CF-6R
Site Address PERMIT #
79-887 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:Z—
Signature Insta ling HVAC Contractor
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Certificatel'of Occupancy
City of La Quin ta
Building and Safety Department
This Certificate issued pursuant to the requirements of Section 109 of the Uniform Bui/ding 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: 79-887 MEMORIAL PLACE
Use Classification: SINGEL FAMILY DWELLING
Occupancy Group: R-3 Type of Construction
Owner of Building: ' CENTURY CROWELL
COMMUNITIES
Building Official
vni
Bldg. Permit No.: 0202-022
Land Use Zone: RL
Address: 1535 SO."D" STREET,STE #200
City: SAN BERNARDINO CA. 92408
By: GARY SHOWALTER
Date: 07/30/02