SFD (0202-034)79896 Memorial Pl
0202-034
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
71$154_ 10/31X.
r"
Date... 'I /_1 X1 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:
( ) 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).
() 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:.
CarrierPolicy No.
(JOL OLE MS.,.NW-MOR-Ce.
(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: - Applicant—
Warning:
pplicant 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. r
Signature (Owner/Agent) ' qtr } k"A,?J f r ' Date' -L7 X, 7-
BUILDING PERMIT PERMIT#
/J
DATE .- VALUATION LOT ^° TRACT
/ 25 7A 19743
JOB SITE ° r
APN t
ADDRESS 79 '06.1' b` . -OFt`IAL FLA
4•072i-001r'
OWNER
CONTRACTOR / DESIGNER / EN (NEER
COY-TRYCROSCOMMIM4 ES
1535 90. "V" tT,1 r'T, 'Mrf*., 0 10Q
? 535 SCS. I'D" SMIURT, ME, 4200
WAX MARD:C O CA 92409
SPS M16T,i3RDWO CA W,4t)8
(9 0 Or., 81.60G7 Mtff 2120
USE OF PERMIT
ZK) • kOT'25; Pl.;AV SX.M-MV, PERM IT X7teUS NOT J1 4ci tyr)z I'Sldwit;:.K
WALM, P0014 DRIVEWAY APPROACH. OPLAN CHECK VK9 R&DUCED FOR'
muVrIPLE ISS,UPMCP Off' S.A.Mz m,.:AN `j'ynj
'I RAbCT OC)MMIet;1ION :,0.21.00 4,w
ncal . 1 p rs 1l.tx f Sr
1t f' I Cc ; • C+ ~ s C'%t; l~t
1.: QO
PK'. ,rE:UIP Rn—IMMARY
CONSTRUCTION I7:a Y '101.00041 U-000
PLA14'CH/—KFEE $147.3"1
MUFLANIE:AL :E; 101-0 70.121 X000
w2 ii.G'1'11.IGRE.Y4 ;f; ;.,; t.U1-(iff{1- ixtJ-tlGtl .J$I:t'1.5t
_
PI..IJi-JiN140 FEZ % :' 101-000-419-0,00 9,1ff3
ST901,10 NO XYkA FEE • MW I M430 ?-241 F60
013 4:)iRIO t1E1f103
L)kid'I:;In.[J.P1RI-NIPAC'A FUS
FSCs 07Ll
ONSs`I 'tliyx50W AND 11
n
' L03
a1Cl.t tj
1 r gc.;Pl w t s VU
a+o 71
RECEIPT
DATEBY
, .
DATE FINALED
INSPECTOR
F,
7
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
- 2
Underground Ducts
Forms & Footings
— Z
Ducts
Slab Grade
. / —
Return Air
- -
Steel
_ 25"- z
Combustion Air
Roof Deck
o-2,
Exhaust Fans
_4-i,
0. K. to Wrap
- 2 - Z
F.A.U.
Framing
- __'2_
Compressor
Insulation
- -Z
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
- -
Drywall - Int. Lath
Final
e -;;—.j 1
Final
— G, - ��
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
I
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
2 - off,
Heater Final
Water Piping
_
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
�`
Pool Cover
Sewer Connection
:= �� -
Encapsulation
Gas Piping
-
Gas Test
Appliances
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 o
Utility Notice (Perm) - Z
Installation Certificate: Residential CF -6R
Site Address PERMIT #
79-896 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
AANL ob DATE: ?I - O'y
Signature Installing HVAC Contractor
Jan 29 02 11:37a Richard Simpson 661 347-6889 p.4
INSTALLATION CERTIFICATE (Page 3 of 8) CF -GIS
-, 1"%C S
site AeaMs 19-15 6 M c l� 012!A 1 164o ue Permit Number
(DUCT LEAKAGE AND DESIGN DIAGNOSTICS
DUCT LEAKAGE REDUCTION
Pressurization Test Results (CPM 01 25 PA) F7
'fest l.cakagc (CFM)
Fan Flow
If Ilan Flow is Caloulatod aK 400 ofkatton x numbor of tops, or as 21.7.x I looting Capacity
in Thou.nnda (if BtAr. oatvr caloulatod value horn
If fad flow is measured, ender measured value hen; Od
Lockage 1'ractiou =Test Loakagc/(Mcasured or C olculatod Fan I'low) 0,C7�
Pa-,., iI' lonknga lraotion 5 il,U6 ❑
Nass Fail
❑ For AEROSOL TITS SEALANTS ONLY -The following diagnoatle testing was completed:
DuuI Fan Pressurization at rough -in mcasureJ leakage (CFM)
CHECK AFTER FINISHING WALL:
❑ 'Yes ❑ Nu ❑ 1're cure pante or l louse preurncntion test
❑ Ym ❑ No ❑ Visual Inspection of Duct Connuoliow; ❑ ❑
Pass Fail
kTNERMOSTATIC EXPANSION VALVE (TXV)
KY,N ❑ No 1'1►citrtu.latio Ilxpap,iop.Valvc(or Commission approved
equivalent) is inslallexf and Acaews is provided for m:pcction [�
Ye„ -v is a pan, Pass Tail
❑ DUCT DESIGN
1. ®Yv`fi ®NV RCCA Manual I) I)csigrt aaloulntions have bixin completudy
Dutut Dalign is on tho plans and duct imlallalion makihos
plans.
2. ® Yon ❑ No TXV is installed ur Fim flow hus buem verified. If no TXV,
vuriliud fan flow mntchkw dosigu front CT -1R.
Measured Fan Flow =
Yes Ibr both 1 and 2 is a Yams PASS Frill.
❑ 1, tho undcraigaed, vwily that tho nboyo diaguoslic tom r;mWq and the worse 1 performud associalcd with the tcst(s) is in
uunii nnanw With Ike ticquimmentH lire compliance erudit. I'lito builder shall provido Ute I MRS provider n copy of Iho CF -GR
sigu%:d by tho builder eutployocn or sub-twntraetors cortil'ying that diaguu...60 tasting and immallation Divot Ilio roquiromoAl. lire
compliance credit.] /
1'c.04; tiignattuu, Date htstalling Subcontractor (Co. Naouo) OR
I'Lrlbrmed - General Contractor (Co. Name)
COPY •1'O: liaildiug D partrrtent
III3RS Providor (il'applicahlc) :
Building Ownez- ut Occupancy
January 4, 2001
+.�; K.r y �` f ,et ° ,+,• Its,. P + � r . �c - ,
i Duct Testing,®t
. ',.�
Certification Form
~
System , .
40, 5 f
r (One form per system) `
Builder Name:
Project Name: .J
Builder Field Contact:
Telephone No: -
I
HVAC Company Name.��
HVAC Installer: e r�
Tele Phone'Nog0GI
� r5
a Self -Certifier
.Results
Duct Leakage Measured @ 25 PA
�� CFM -.
Indicate the maximum allowable Duct Leakage and the calculation method used. ti •+� ,
0, 0.7,x Afloor x (0.0,6), for Climate Zone 8 through 15,
CF
❑ 0.5 x Aeoor x (0.06) for Climate Zone .1 through 7 & 16, ' =v.
CFM
400 x (Cooling Capacity in Tons) x (0.06) ' 4 ;
Z.0 " `CFM r
f' =r
r ❑. 21.7. x H.eatin Capacity in Thousands of out+ ut BTU pet hour)'x 0 06 ,= . F `
( 9 P Y, P p _ ) ( ) CFM
21
Print Name ure.
Y- Date .
+.�; K.r y �` f ,et ° ,+,• Its,. P + � r . �c - ,
Certificate,
of
fi
Cit of ` La Quintzi.
Bulldln and'Safety Department. MOF
This Certificate issued pursuant. to the requirements of Section 1,09 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: 79-896 MEMORIAL PLACE .
Use Classification:. SINGLE FAMILY DWELLING Bldg. Permit No.: ' 0202-034
Occupancy Group: R-3_ Type of Construction: V -N - Land Use Zone:. R -L
Owner of Building: CENTURY CROWELL Address: •1535 S. "D" STREET
COMMUNITIES
City:- SAN BERNARDINO, CA 9240.8
By: GARY SHOWALTER
(J:y
. Date: JULY 26, 2002
Building Official