SFD (0202-024)79915 Memorial Pl
0202-024
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 # .• Lid. Class Exp. Date
%I F188 B 1 J Jy1(1. 1IOc
D`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 projectI(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:
Carrier t:10LT3)+3 I:, iE43 I3,31J . Policy No. ".70
(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: `:JT •;r i . Applicant y 1 1 l
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 behalfthisapplication-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.
Si nature (Owner/A ent) d # < N s - j'' Dated 1 L2—'
/BUILDING PERMIT PERMITk
t
DATE / p VALUATION LOT 02 —024 TRACT
$1 10PSOA0. 1-5 Z41 97,4
JOB SITE -
ADDRESS .6 T. p1,At k
APN
OWNER
CONTRACTOR / DESIGNER / EN INEER
:J'i"iJR' eR iiXTI. 0C1i'nIl r'.'
s Fi1>ri.'"cluL I, G(libt 33d1'1:11
1535 30, Tv" M►`.1°:L '. UA, #200
15-35 SO, eba ,71r I, ; Tf E` x<. 9200,
- 5' r' 3 M- 1- b' ,I MIrNO C.4), 9,2409
SANT'+3E:1a.1 yAi. 3WO CA J."c - 08
(909)381-60(n G":I3110 2120
USE `q ='.
gqO F •PEAARYMIT
'iri7lA.11.71 Y, FAMMY D W.C7ai...1fL.15 .'Y
t•
SPO . LOT 15, PLAN'SXC, PER1 IT ii083 NOT :FNtd.l..l.iDK B,:,OC,Y 11MAIA,
T 004 DRIVEWAYs .I'1?ii:OACFt. (hylar (,',HYCK FF& PY_'- 7i3, . D FOR
t t11.,T1P1,E Ic, SUANC t OF SAME P`t,,,A14 TYM)
TRACT CUMS r:R C 1 ION btk{•t.^ v1 .4 (t tv
0 A Oi{.,`C;, 131PORT : 11.411 3F
Xh1T l 7FX € 09'r Wr CONSI 3d1.7C."flon
. 38,0 , 0
COONS RUCT.K.Y. r FEE 101.000-418-000
PLAN CNC , :1C• I+EE 101-000-1,39-318 $14 7.17
hIFI'CH A 1 ICALt RF 101.000-41 si^ 000 tSt1 El
LI 'P5i',If;AL, V115M 101-000-4,20-000
i 1.01~iiI 131c31;I?i 101.00(> -119 -ow $14100,
TftO140 M.07 MW IFLF8 - RES1.0 101.000) 24-1-000 Eal
GRADINO FER 101-.000-4 3.000
i VE4.O 31'12 IMPACT 7 ; k )a9f17.ti[A
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- ,m..1.1.9 ", t.O. .f.' P.J ` ,+'i LO •I.\.i1i ' m.•+i mA.1 V Zer.
'15 WD F1
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5t X,n, :. : tYJIE INOW
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FEB 0
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RECEIPT---
DATE" J
BX'+,
DATE INA L
INSPECTOR
6.
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs Z, 22,
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap _/ - �_
F.A.U.
Framing
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 — - 2—S
Final
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
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines Z ZO
Heater Final
Water Piping
Plumbing Top Out
Plumbing Final
Equipment Enclosure
Shower Pans _ /A
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
_
Sewer Connection — —
Encapsulation
Gas Piping
Gas Tests
Appliances
Final
Final
Utility Notice (Gas)`" — , z
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) - pZ
COMMENTS:
Jan,28 OZ 11:37a Richard Simpson 661 947-6889, p.4
INSTALLATION CERTIFICATE .(Page 3 of 8) ' CF-6R
Site Addrag
9 tls*Mo it w, {.0 Permdt umbeir
WAS
DUCT LFAY{ACF AND DESIC.N DIAGNOSTICS
I'DUCT LEAKAGE REDUCTION
Pressuriiation'1'ost RC9uIl.i ((:1'M 62125 PA) C
'fest I'Cai:ggc (CFM)
Fan flow r
If I'an Flow is Caloulatod ns 400 ofioo/ton x numbor oftoga, or as 21.7.x I Tooling C:apaoity
in Thou-isnd:i of Idtu/6r. epler ealculatod valuo born _
if tan flow LR measured, entuT measured value hen: 1006 .
Lookago Frautiott = Tost Ixakagolftasux-d or Coloulatcd I'ea flow) - _ L,
Pam if leakako fraotiou S 0.06 ❑
as,
fail
❑ For A EROSOL TYPE SEALANTS ONLY - The, following diagnostic testing was completed:
Duct 1'nn I'n;in;uriialiun al rough-in mca.Nunxl ICakagC (CI'M)
CHECK AF'T'ER FINISHING WALL: '
` ❑ Yes ❑ No ❑ l'ro c%uro pan I" or I louse pres a rr/ation to n
❑ Ycs ❑ No ❑ Visual In. wution of Ducl Connoetioxw ❑ ❑
Pass Fail
k-TNERIVIOS'FA11C EXPANSION VALVE ('TXV)
Yom. ❑ No 'l'honllorlali4 Expansion VAIv4 (or Commission appl+oved
oquivalont) is installed and Awe-=# is provided fc;r m:mlion []
r il.W L a paJ?: f/'A 1 fall
❑ DUCT DESIGN
1' ❑ Yo' ❑ No ACOA Manual 1) lksign onlculations hnvo bixin oomploled;
1)uc;t Ih ign iv on tho plans and dual instfllfation matches
plans. ^
2• ❑ Yon ' ❑ No '1'XV by mstallul or i'tm flow hwx boon vordiod: If no TXV,
verified fan. flow n►atchww doeign from CF-I It
Monsurad Fan blow =
Yea for both 1 and 2 it; a Pars Pass Fpil
y
❑ 1, the undvrsigaul, verily that lo abovo diaguoatiG tv,t romlb. and the work I perIbnned amociatcd with the tcat(s) is in
confafmaaw with the mquimments Ibr compliame orudiL ('lila buildur shall provido tllu 1 U3RS provider a copy ol'tho CF-0 It
siguvJ by the buiWe culployceq or sub-contractor,; cortifying that diagaau•6o tu.%liug and iutitallaliou nmol the rogairunlcal..li4•
compliance credit.]
s c . -
1'et;t:; Signature:, Date 10trilling Subcomtraolor (Co. Na000) OR
Performed General Contractor (Co. Name)
COPYTO: fO: lluildinV Dcpurhuvhd
111AS Providor (il'applicablc)
Building Ownex- ut Occupancy
{
January 4, 2001
Installation Certificate: Residential CF -6R
Site Address PERMIT #
79-915 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
Signature Installing HVAC Contractor
DATE: — IFS•- VL
TrAct
_{ Duct Testing: 4 L®t#= 1 `,O#We-
Certificati®n r Sw. , . j a !
y k T. System % of
c (One form per system)
rte. "` I : i { r ' tL i s '• + ` + ' r "
Builder Name:P i1' ' 14 , . _ w. <8 t
t Project Name: f GS51C:
,r y
j Builder Field Contact. Telephone No. z
HVAC Company Name: #.. V.iP.oel: L
HVAC Installer Telephone No` l)'1-"l ` (
Self=Certifier Re ults `
z
Duct Leakage Measured @ 25.PA '' t '` y " r•y a CFM*
w`
Irialicate the 'maizimum allowable Duct-Leakage and the calculation' method used { `
❑ - .0.7, x Afloo, x`(0,06) for Climate Zone 8 through 15
A x (0:06),for Climate Zone 1 through,7;& 16., ,R ., , CFM.' '
floor $ L
E 1 400 x (Cooling'Capacity,inTons) x (0 06) `.CFM
0,'-,21.7 x (Heating Capacity in Thousands of output BTU per hour)`x (OM)" CFM
Print Name _ • Signatu Date
*Certificate of Occupancy
City of La Quinta
R"i►dina and 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: 79-915 MEMORIAL PLACE
Use Classification: SINGEL FAMILY DWELLING Bldg. Permit No.: 0202-024
Occupancy Group: R-3 Type of Construction: VNLand Use Zone: RL
Owner of Building: CENTURY CROWELL
COMMUNITIES
Building Official
Address: 1535 SO."D" STREET,STE #200
City:. SAN BERNARDINO CA. 92408
By: GARY SHOWALTER
Date: 07/30/02
10