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SFD (0202-032)79924 Memorial Pl 0202-032 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 4; '—,11 1 Q 188a •'✓`% f' 10/31 A)" Dater"'i " Signature of Contractor " k OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjurythat I am exempt from the Contractor's License'Law for the following reason: " ( , ). 1,., 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). ( ) 1, 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. Sec1 have and will maintain workers' compensation insurance, as required by tion 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. WIDEN RA.tllrrs 'ilk, XWC•544069- l l (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: 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. Signature (Owner/Agent)` - ` ' 7 a ; f f f %'*f : Date ;% , BUILDING PERMIT PERMIT# DATE VALUATION LOT h'Y :)21.0'32 TRACT f JOB SITE APN .ADDRESS %-•n y r:d' .; ,,`. E, , • :e OWNER CONTRACTOR/DESIGNER/ENGINEER (!F,_ ,L Vxi S F.r.Lti,owJL•1,t , E:.4o1`P+lhV .113 1wl. -'sk 1535 10. `7D` M.M !10, WEE, 0,200 S'AN BUMARINNO CA 92,408 ap-l"ni1 E1 r CROW)as, ti, C"mft omlu 1535 Va '"may "I mw, nE. a2av USE OF PERMIT yNIy)g- LOT P ;.,:q gfiy14 :R ip:PY, SEi .ItnIT 1L3at EN NOT iY;SC.t.iIM tlIx-)= ••8 y 'il.al'3LI, t•gJt,.+4 6J,Y AY '+ lkY APPRV.?S i.H, .. UACT CONSTRUCTION 1,stD ov Sig lb t Cl'lJ"' Ica 27.0 SY 41 01" ti t7ki k 412.04 SF E.InwhMD Coal, OF d".ONYMi)MEM WX430 CONSTRUCTION MW l 01-00,041 8-001D $594,30 PLAN CHECK M, 101.00"139;41 A 23 M1;iC1' M11CA'1, FSE -101-000-421-000 03150 TY; EC'f RIC.: ll MEQ 101-00"20-000 P'l;v "l911aJtii ' •} 3 it-9: '30 1 00'6 .1+ ,Oit.. ' ]#°!'1.{SiV:,t Li1,Gf 9"1Y3Ya I* • It di 1. i S ;7tr-2 i'1 »CJtJI'! N.f3 L'►T1t1W.HO FRE' 101,000 -42i -00L $ O,iit1 I7L+;'b ` MMM 1:ittiPd't,.C'i %TZ? sa c fat + Qx4_61xt'UMO :. MUM,' UM FRE-PA W. w'!JyM ! X19; i1T0. . si1i' . FCS 0 'i 2 02 . UIP14.RMTrFE ,a DUTUNTO <J RECEIPT DATE / "' BYDAT FI ALED INSPECTOR Q jS INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings Ducts Slab Grade Return Air Steel Combustion Air Roof Deck Exhaust Fans O.K. to Wrap -a . Z. F.A.U. Framing j --�o -Z Compressor Insulation -/S - z Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath Drywall - Int. Lath Z ' Final - p --OZ Final z— v , 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 Heater Final Water Piping Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral Pool Cover Sewer Connection - - 2 Encapsulation Gas Piping Gas Test Appliances Final Final �D-O Utility Notice (Gas) . %2 ELECTRICAL APPROVALS Temp. Power Pole Underground Conduit Rough Wiring f y Low Voltage Wiring Fixtures Main Service Sub Panels Exterior Receptacles G. F.I. Smoke Detectors Temp. Use of Power Final Utility Notice (Perm) COMMENTS: Jan 29 02 11:37a Richard Simpson INSTALLATION CERTIFICATE 661 947-6889 P.4 CF -6R r5 Site Address -7 9 2 y Mr- Permit IVramder DUCT LEAKAGE AND DESIGN ]DIAGNOSTICS, _ y . DUCT LEAKAGE REDUCTIOI+! Pressurization Test Rcsulls (CFM fit) 25 PA) fcsl I.cakagc (CNM)1(!'/ Nan Flow If Fan blow is Caloulaicat ds 409 ofwlton x number oftous, or as 21.7.x I Ioaling C:apaoity - , in Thouandy of UtAr, oiler caloulatod value hero , ' = If Tan flow is mcauured, ,Lmlcr measured value hen; Leakage 1'raoiion = Tv-st I.cakngo1(Meaaurcd or C oloulatod Fan Flow)'r' - Paws if leaktigu Iraotlou :g 0,06 .... ❑ Pass . Nail ❑ For A F ROSOL TYPE SEALANTS ONLY - The following dfagnoatle testing vvas completed: rhrcl rw I'nssurrcalion el rough•in mcaxurud lcal ayc (CI?M) • CHECK AFTER FINISHING WALL: :. ❑ 'Yes ❑ No ❑ Pru, 4uro pan te:R or l lousy prosmorrration tort a ❑ Yee ❑ No ❑ Visual Inspection of Uuct Cunneotiomv ' " ❑ • ❑ Pasq Fail THERMOSTATIC EXPANSION VALVE (TXV) - -- + XYwN ❑ NO 71l'.YMONtow, Expan).ion Valve (or Coramission appmved oquivalont) is installed and Accaws is prvvideAl Tor in%,peCtion ❑ Yew is a pas-: r Pass l'a u ❑ DUCT UE916N 1.®Y ®1V0 ACOA Manual l) Iksign oaloulalions have been eomplutud, Duct Ih sifm is on tho plans and duel inmallation malchoa Plans. 2. ® Yca ❑ Nb 'FXV is mstallut or1'hn flow hus boon vutirtud. If so TXV,, voriliod fan flow matchas dosigtt from CT.I R Mcnsurod I an blow Yes tbrbuth 1 and Z i!: a Par;Y Pass Fail. ❑ 1, the undcrsrgnW, vvrdy that the above dlapo t:o W.1 rCdulth aqd tll¢ Work I performed as-wciated with the tast(s) is in cuntifrntanee tvitb Ike requimmenta lbr compliance urudit. ('l7ro builder shall provido dee I IERS providar'n copy u1' Iho Cl,* -GR dgued by the builder eu►plcryecs or sub -contractors Gcrtilying t4a'14iegauslio to liug and imutIatipn aml tLe rugairutnvul. lbr compliance crxdit.J 102- 1,0% - Signaturu, Date ]RO MWtg tiubcontraotor (Co. Namc) OR Performed Cicacral Contractor (Co. Name) ' CUPY'IY)_ Building.Uepartim*nl 3... 1113RS Provider (il'applicablc) Building Owner tit OcctiVa,ncy January 4, 2001. Installation Certificate: Residential CF -611 Site Address ACTUAL EFF. COOLING EQUIP COOLING PERMIT # 79-924 Memorial Place MODEL # SEER CAPACITY LOAD 1. BUILDER INFORMATION Lennox 12ACB48 _12 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 G40UH-48B-090X 80% 88000 80% 4. COOLING INFORMATION COOLING MANUFACT COMPRESSOR ACTUAL EFF. COOLING EQUIP COOLING EQUIP. MAKE MODEL # SEER CAPACITY LOAD A/C Lennox 12ACB48 _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: :- S- 0Z-- F F .' ' Tract #Lot V Certificatioln Form System sof y(One form per system) Builder Name: Project Name; Builder Field Contact: Telephone No. HVAC Company Name: HVAC Installer 'Tele'hone'NAVI Self -Certifier Results Duct Leakage Measured @ 25 PA r .. h,' ( 4 "CFM`' R Y 4 Indicate the maximum allowable Duct Leakage- and the calculation method used •: 0 0.7 x A x (0.06) for Climate Zone' 8 through X15 CFM floor _ 0 45 x Ano., x (0.06)'foir Climate Zone 1, thr6ugh_7 & 1 6CFM, 400'x ". 400'x (Cooling Capacity in Tons) x (0 06) .` ` r t w CFM 1:111 21.7 x,(Heating Capacity in -Thousands of output BTU•per hour) x (0 CFMx rt Print Name . • r tur\ . i Date Ths$e r •r. c v s'# 1. h. 2"a "eu `x i wA 9"Fa w$ 7 s" v1. . air N ..: • f , f ®Tes ed: a°© sme testrn but as n f fifes e=. r Was App oved gas P n 9 . . U NN u ctHeakageM:eas' • 'v' '' i ! r 5 ,;.t Y. t s G ,76 ,Y *4}k .#' ME, ' t Tv? ' d .- .air ,- .< ` .. '. '. ` ' . 5" f • 3 a ,s rm rn 5,i ' ' ..- .:s w' -- r"`. PI'•l)L`3NF3r71B ..tc w„ r3 'r "4r r _r..s s ;'t' aifg s+y35 Y : y w , Srnae. p Da% vcra x ...• ,•t- a + ' • s.., . Vii_ t- '.. •t 1 i r t Certificate of Occupancy City of La Quintal Building 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. 79-924 MEMORIAL PLACE - Use Classification: SINGEL .FAMILY DWELLING Bldg. Permit No.: 0202-032 Occupancy Group: R-3 Type of Construction: -VN Land 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: 07/30/02 Building Officia 4,