SFD (0202-023)79901 Memorial Pl
0202-023
LICENSED CONTRACTOR DECLARATION
!• reby 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 /'-71,. `^' Signature of Contractor
OWNER -BUILDER DECLARATION
I hereby affirm under penalty,pf 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 foreby 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.
GOVAN ZAOLK I(Z:
(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: l 1: 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, 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. K
1
Signature (Owner/Agent) ) ' •- a Dater !? ry' `
BUILDING PERMIT PERMIT#
DATE VALUATION LOT (Y'.W.R- 3 TRACT
is
(y
jJ/F j
1 4 7 e A197-3
197
JOB SITE
APN
ADDRESS ' 794-901 aaVN77AL ]PL.qCM
604-0112-M
OWNER
CONTRACTOR/DESIGNER/ENGINEER
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(939)3g1 y 0U7 C"M8 2120
USE PERMIT
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SPID - LOT lei, .PI,44, r1.y0g R.W91 ; k :isd.`v:N 7-oO'S Na INCLUDE BLOCK
i},)JrrL14 !°6' C 4 3.3 'x` 11'r. rJ"kPF':R0,A H, (KAN C HTEXX VEM.R.M.- tICED FOR
MUf:1'i IP La ISSMANC 9 OF S.Nme n. J`I ': ,)
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PU C.`HMATIO 91,00 3?
(WIAM 41&00 OF
MP WSIX coil, COMMaz'UCTAO
.WTITU
WHOTRUCITION yFlt 101-000-418-000 $651,10
.KLAN C;I•i.WX WE 101-000-43V-318
r; l i rt :F 10I-000-421-000
7.24
1.,.X(Yr1UCAL WE $117.24
PZsy; MBINQ 118E 1 t31 v100b1 1 a :: g0 Z 90:Q0
snxymo mC:Ynow f?s» . P.ZSID im..-i300--.gul-000
0RL_t)9140 IFF131, 101.-000-423-000 920,00
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-
RECEIPT
DATE
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
? — C,?--
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
_ _
F.A.U.
Framing
— 2 G
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 ?—_
BLOCKWALL APPROVALS
Final —
POOLS - SPAS
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
_ p
Heater Final
Water Piping
Plumbing Top Out
_
Plumbing Final
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Sewer Connection
ZS
Pool Cover
Encapsulation
Gas Piping
Gas Test
S
Appliances
Final
Final
Utility Notice (Gas) l
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles F/
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm) `6 -
COMMENTS:
Installation Certificate: Residential CF -6R
Site Address PERMIT #
79-901 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 jBY
" 1 DATE: a' ("OL
Signature Installing HVAC Contractor
Jan 29 02 11:37a Richard Simpson 661 947-6889 p.4
INSTALLATION CERTIFICATE (Page 3 of 8) CF -6R
Site AttUYPa9R19-90/ PEIt'riti Number '
DUCT LEAKAGE AND DESIGN DIAGNOSTICS
DUCT LEAKAGE REDUC71ON
Pre%suriialion Test Results (CTM 67) 25 PA) ,
'feel Leakage (CFM)
Fnn Plow
If Tan Flow is Caloulatod as W) ofm/ton x numtbcr of tons, or as 21.7 x I leading. Capacity
in Thousands of Mu/b,r, onler calculatod vnluo hero
If fan (low is mcasun:d, center measured value hen; 2(700 ,
Leakage Fraction = To l Loakagot(Moamm-d. or k4joulatod Fan flow) - 0.0 Lf
Pax loakogo frootion Sti,tl6 ❑
• Pass Fail
❑ For A E ROSOL TYPE SEALANTS ONLY -The following dlagnosde tasting was complete&
Ihrol Tan Pre.%muriiation at rough -in measunxl leakage (CFM)
CHECK AFTER FINISHING WALL:
❑ Yox ❑ No ❑ Prorxuro pan WA or 11011%0 prosxuriyation tart
❑ Yes ❑ No ❑ Visual Inspection of Duct Connections ❑ ❑
pats Toil
KTHERMOSTATIC EXPANSION VALVE (TXV) _ — --
Yw»: ❑ No 'I'llortrtostatic lixpan,:ioa Volvo (or Commission approved
oquivalont) is installed and Acusm4 is provided for mapeo ion ]
Ykw i.• a pass pass Tail
,❑ DUCT DESIGN
I. ❑ Yos ❑ No UCCA Manual 1) Design calculations have been oumplolud,
Duet Iksign is on the plans and duct inslaltalion mnlohox
plans.
2. ❑ .Yea ' ❑ No TXV is mstallud or Ftm flow hmc bum vorilied. If mo TXV,
verified fan flow matchkw deign from CF -I R.
Measured Fair Flow =
❑ ❑
Yea for both I and 2 is a Pana Pass Fail
® 1, the undmigncd, vwit'y that tho above diagnostic toot rC"lk aqd tlrc work 1 performud associated with thu last(s) is in
ounfurmanG: with the requirements lire compliance urudit ('Cho buildur shall provido Uro 111:11S pnrvidor a Copy of'.Iho CF -6]t
Kigucd by dte builder employcen or sub -contractors uurtifying that diagnoslio tasting and immallation moot oho roquirctnonk 1'ar
compliance credit.]
re:—L -07 - s Wei C
, Q :" (I_: L
1,cets Signatu, I ata I»vtalling Subcontractor (Co. Naouo) OR
Perl'urmcd Gcocral Contractor (Co. Name)
COPY TO: lioilding vepartrnoat
1112,85 Providoir (il'app55cah1c)
Building Ownex- ut Occupancy .`
5
Jannary 4, 2001
''. - �• 1• r. .t TJ•„q! d - �,''�..�i111"1'•••1 �" .� F: 'r
Duct -Testing Lot ,#
Certificati®nFormy yl
System ' [of ./
t (One form, per system) '
Builder Name:,Qm
S
Project Name: �"t(,'��S1C.� .
Builder Field Contact: r' \\ � Telephone No.',
HVAC Company Name;
HVAC Installer` ¢
*' Telephone No0�� : ��� 5�
Self -Certifier Results
Duct.Leakage Measured @ 25 PA CFM '
Indicate the maximum allowable Duct Leakage and the'calculation inethod used.
„ 1110.7 x AFloor x-(0.06) for Climate Zone 8 through 15 �' CFM
a.
❑/ 0.5 x Af,00� x (0.06) for Climate Zone through,? `& 1"6' #:': r , R� CFM
E 400' x (Cooling Capacity in Tons)"x (0.06) r %`
12,0 CFM
1
• 1 . -.. _ - - - ♦ 1.
❑ . 21.7 x (Heating' Capacity, in Thousands of output BTU. per .hour) x (0.06) ° CFM ..
-47
` Print Name ' • Si a ure Date
4
{i
Certificate of Occupancy -
Oil
.
L-
City of La Quinta
V
Building and Safety Department
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 at,
building construction or use. For the following:
BUILDING ADDRESS: 79-901 MEMORIAL PLACE
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 0202-023
Occupancy Group: R-3 Type of Construction: V -N Land Use Zone: R -L
Owner.of Building: CENTURY CROWELL
COMMUNITIES
Building Official
Address: 1535 SO. "D" STREET, STE. 200
City: SAN BERNARDINO, CA 92408
By: GARY SHOWALTER
Date: JULY 26, 2002
IN