SFD (0202-033)79910 Memorial Pl
0202-033
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
7141 A$ Y, • d r P d A d P «
Date • <A ,,, • Sign atuire of Contractor
d
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 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 1C3.lk: Policy No
' N'tN'ty-34406843
(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 provlslonsy
Date:."'ti a } , Applicant
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to • the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under.or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work" is not. commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify`that 1 have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
Construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection purposes. f,
Signature (Owner/Agent) ..%1a Date
{ BUILDING PERMIT PERMIT#
LOT 02.02r6;F+J.'>3 TRACT
DATE /p VALUATION 99 (• ag pp yy , qg :yy
;ryt
24 ..3+•x'7 1 .9 T yy rp -3
JOB SITE
APN
ADDRESS W-9XID MFEMORLM PLACE
604-072,.00$
OWNER
CONTRACTOR/DESIGNER/ENGINEER
rr '0RY CR.0 COWt3; TSIES
(mewnMy CyRovraL C;om'[3Ft!3 INS
MOO
1535 30, va 'a E<:Esv"f, Vm 4200
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POOte DRAVVINVAYAt PROACH,
TRACT c0NS d'A:UcT;,0N 102510 aF
PORCHMA:TTti 91-00 SF
GARAOF J ,ARPORT 41.8,00 8F
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C'ONS'I AUC:TiOX YZE 101.00041 B-000 $651$10
1''i..KIR CHECK. $1346102
WC."3Y L. PYi] tlgn- ] G3g 1 ; 36u.Up
44. 101.000-420.000
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RECEIPT
DAT-E
BY
DATE NALED
INSPECTOR
q /
/.
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
I INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
- //- L
Return Air
Steel
-2 _Z_
Combustion Air
Roof Deck
_ e-0
Exhaust Fans
O.K. to Wrap
-2
F.A.U.
Framing
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 1 7-
Final
-BLOCKWALL APPROVALS
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
- _ _ _ a z, _
Heater Final
Water Piping
7 _ _
Plumbing Final'
Plumbing Top Out
�G_
Equipment Enclosure
Shower Pans
/
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
_� -
Encapsulation
Gas Piping
Gas Test
Appliances
Final
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
Utility Notice (Perm)
COMMENTS:
Tract #", ,'Zq . G=
Duct Testing . "Lot*''Iohca
4. '. 'Certification, Form
t System * f I
,r . (One _formper.system)Y
Builder Name: .; i , _ +. .r,, ,, ;.,•4 + , ,_.
Project Name:,.,,C"S l
• Builder Field Contact:# Telephone No:°
HVAC Company Name r a A
HVAC'Installer c r, Telephone No.ot. cl. + G.-!15D
s ° r , ,Self-Cei-#ifier. Results , .
Duct Leakage Measured @ 25 PA '' ,1. e • ' ♦ ;CFMM.
Iridicate the maximum a/lowatile Duct Leakage aird the calculation used ' , ;•'°
. 0.7 x Afloor x (0,06) for.C1itimate7Zone.8 through 15* ::CFM
} 4
1 Z
❑ 0.5 x Anoor x (0..06) for.Climate Zone 1 througFi7 & 16 .t s1 t' CFM
400 x (Cooling Capacity irrTons) x (0.06) '' ' f2 CFM
,
❑ 2.1.7 x'(Heating Capacity. in Tho.usands'of output BTU per hour) x'(0:06) 'JCFM
. r R tom. - , • , . E" ,
r ' .e -; 4,. j • .. -far ; h `. : t - t
y . •
Print, Name ' ." .. nature- Date.
Installation Certificate: Residential CF -6R
Site Address PERMIT #
79-910 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
a4 DATE:
Signature- Installing HVAC Contractor
Jan•29 Oz 11:37A Richard Simpson 661 947-6889 p.4
INSTALLATION CERTIFICATE (Page 3 of 8) CF-6R
-f . 2 • - liL /i G Si lis
` Snte Adtims 19.9!0 Fermin umher
DUCT LEAKAGE AND 1DESIG,N DIAGNOSTICS' ' f
DUCT LEAKAGE REDUC71ON j.
PressurizationTest Rcsulls (CPM (it! 25 PA)
l'od I.cakage (CFM)
Inn flow J
16"na Flow•is Cnloulatcd to 01 ofmhon x iaumber of tou, or as 21.7,x l loaiing Capaoity
111 7'116u!landA ArBtAr. Ciller caloulnt d vnluo het'o
If fan flow is uunlsun d, eller mcasun:d value here( J
Lunkago Fraotion = Tc+t Lwlkagoffta4ured or (!aloulated 1'an 1'low) r
Pa.,; if leakage rrnetiou 5 om ❑
r Pasco Fail
❑ For AEROSOL TYPE SEALANTS ONLY -Tho following diagnostic testing was completed:
[)not Fan Prvssurrcolion at rough-in mcasural leakage (CFM)
CHECK AFTER FINISHING WALL:
❑ Yes ❑ No ❑ fiv ocam pan lostor I louuz prc:rsurrrnlion tom
❑ Ycs ❑ No ❑ Visual In-vpcution of Duct Connoutions ❑
Pam Fail
gTNERMOSTAM EXPANSION VALVE (TXV) — — --- — - --
xwY'N ❑ No Theymostalic Tsxpan ion Valvc (or Commission approved ;
otluivalont) is installed and Acu,.44 is providW for inspcciion [
Yuw i. a pas. ,a" Vail
❑ DUCT DE5161v '
1. ® Yew ❑ No RCCA Manual 1) Dcsign calculations havo bean oumpletud,
DmA ksign is on Ilio plans and ducsl installation lnatuhun
plans: ... 1 .
2 ® Yen ❑ No TXV 6 inmaped or Fan flow hax Iteott vofflvd. If no TXV, '
verif ud fan flow mntchwi &,4iga froni CF=1It `
Memsniod Fan Flow=
❑ ❑
Yes for both 1 and Z is a farm Pass Fail
❑ 1, tho undwsignud, vwily (lust tho abbvo diagtto tic MA r=lts and the work I perfonncd associated with the lcst(s) is in
eonlifmtance With the requirements lbr compliance uredit. I'llic builder shall provide die I IERS provider a copy of Iho CI'-GR
Agued by the builder cotployoex or sub-oontractom cortil' iug that diepw-liu testing and iu.-tallation ouzo( thu roquireniuM.-4 Ibr
compliance credit.]
1'csts Sipaturo, Uato Installing Subcomraotor (Co. Nano) OR
Nrlormed Cencml Contractor (Co. Name)
COPY TO: Building Vcpartrncul
1112RS Proirider (il'applioahlc)
BuUdinq Ovmez- tit. Occupancy
January 4, 2001
t
Now
Certificate of Occupancy
City
Building - Safety Department
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: 79-910 MEMORIAL PLACE
Use Classification:. SINGLE FAMILY DWELLING Bldg. Permit No.: 0202-033
Occupancy Group: R-3 Type of Construction: VNLand Use Zone: RL
Owner of Building: - CENTURY CROWELL Address: 1535 SO."D"STREET STE#200
COMMUNITIES
City: SAN BERNARDINO CA.92408
By: GARY SHOWALTER
Date: 07/29/02
Building Official
13