SFD (0202-025)79929 Memorial Pl
0202-025
LICENSED CONTRACTOR DECLARATION
I h6eby 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 `? ' -^Signature of Contracto14
r
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:.
Carrier C, GILD ° EA01A, INS, Policy No. Aid+% ,
M41t48-03
(This section need not tie 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- r
Date ...f, fir •f>..--. Applicant -'Y is a f•"; a t >a i 3
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. r T
a
Signature (Owner/Agent) ' f1 AI r.a i !' Date -1
. .tea`
BUILDING PERMIT PERMIT#
//
DATE f VALUATION LOT TRACT
JOB SITE
APN
ADDRESS
?AKKOR1AA.LJ C,C1rL RS.`.C'n
5
'(04-072,408 a
OWNER
CONTRACTOR / DESIGNER / EN (NEER
RTa's
t'IM 'y {J 'ry . gCy f,"3 .pCy3 pL V ••" •.1.e C 'O +i 4200
t•..'.,7r(! ° ' y•,. kd k..U, Cy :oyy
rAa/
1535 so, S./` ,t7bd' rq_gy ATF. M,IG0
(yidry3LrryF31'1',wn
M JJ Lf s QaeJs b7d 111.31 p l7 4 Ss1 YYZCjV
t..X B–n- 'A 1iI3WO CA 92408
11
aI Rt' 3'3,GR1 3'A,T, .r aTo C - .924m
>L909 p S I-,rwo? Cf3,jA 2120
USE OF PERMIT.'...
SPT°i - f O Y 16, P ,F X XB:F:E4J,PERMIT byi E." `klOT INCLUDE Owcx
WRIA41 1,, DDR[ 6M? APPROACH. (PLAW WE= RIAWav)— FOR
'MU LTIPX2, n, S'31A4N Z OF SAME PLA141 TYPR) ;
T1 aWT t PJ'1 '!' 11C"f'3' 1 : 02E.00 i
PO1i,i,1IJ1,^ATIO
0AMOLUC.AR.PORT 4t .G OF
C017139'Tt.(.CT,1010 ME 31700,00
PLA)4 CHECK FIFE $147.17
MECKAlinSTt .11 FEE 101.000.421.0100 $60,00
ELEC f ,IMA1:. V99 101 -1000 -420 -ow $1;0159
PLUM_DTN0 FEW $148,00
S"Pl ONQ MOTION F a RES1D 101-01.00.249.000 11.31
i€pmr,wict ri 1.01 e000.4 3-000 $20.00
AMt.,[VEN, IJM.1'A.CT ,F12,
SI.
L(``1C1-.'i 3'.f1.R'1,t:°1:ai`'.ti 3tbCj9 ,AC,t C t +fq
1,005
430 •;79.,p;TF
G Ii -FB 0 7 2002 T' YXIMITYEA. SP,M NOW
RECEIPT
DATE
BY +'
DATE VNALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
2 2,
Underground Ducts
Forms 8 Footings
Ducts
Slab Grade
— 7i
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
-/G - Z
F.A.U.
Framing
Compressor
Insulation
Fireplace P.L.
- p -
Vents
Grills
Fireplace T.O.
Fans 8 Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
-2- -O�
_
Final — _
BLOCKWALL APPROVALS
steel
POOLS - SPAS
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
pp y
Heater Final
Water Piping_
Plumbing Top Out
�(O
Plumbing Final
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral_
Pool Cover
Sewer Connection
>
Encapsulation
Gas Piping
Gas Test
Appliances
e
Final
Final
Utility Notice (Gas) 6 ELECTRICAL APPROVALS
APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring 1-9
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G. F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
Certificate =Occupancy.of
.
City.of La Q*Uinta
Bu'ilding. and Safety. Department0- F
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:, 79-929 MEMORIAL PLACE
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 0202-025
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
Building Official
By: GARY SHOWALTER
Date: 07/29/02
. I
Installation Certificate: Residential CF -611
Site Address PERMIT #
79-929 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
Q,a L . C[w,• DATE: A— /,?'V
Signature Installing HVAC Contractor
-PAM
9 fY}9 !-IGr YO V / /.• a.P ,
is r
- Tract X
R r D. 'Uct Tresting! Lot t ( ,Har61t
`' • Certification Form
y y t X"" System®f
t ; ` < •1 ° t ` c, .
-(One form per system)
Builder Name:.
y Project Name:
Builder Field Contact:,..,.E . ' Telephone No:
:,HVAC Company Name: ' S!/ -F "t` . ,.
' S
HVAC,Installer. ', , r, + Telephorie No`s
l.' 1 ^. x • - " • • ! .. n. j .r7'r F. i. _ _ `' r t •+*
t - Self -Certifier Results {
,. •Duct Leakage Measurei.d @ 25 rPA CF
" - r
T
M
Indicate the.'maximum allowa'ble.Duct Leakage and the calculation method used. `
.
El 0.7 x Aeoor x (0.06) for Climate Zone 8 through 15'• t. CFMA..t
t
O 0:5 x Angor x (0.06) for Climate Zone 1. through'? & 16 ` CFM
400 x (Cooling Capacity in Tons) xv(0 06,)' -CFM r
0 21.7 xHeatin Ca acit in Thousands,of output BTU er hour
x,(0.06), CFM *J
g P Y P p )( )
dre—
Print Name. Signa : J ` Date • :
C N4 i { = cy i • ' 'Y4 M.
Y Ei Yl'+•?,yYtO.
$ , , " y : tern's I -s , M E
MEq g i
r -P,r {fit { x 'tx [ i• ate+. ,. "'QK .fir , . ry P ,,n. a'4'' `va'.• -,e. . n .y' ,xtr .;;,`zx "7).r.y,t
> .e.• , 1 t -I
The#s ern :.as,T sed:: Ap o e +as pa of s inpletestmg but=w s of tested.-
' k ' • ew' , -,,, r .a. nt u j, ?^
F" .,e s np, aSt' '`e4 .- • i `
t ®ME
uct Leakag[ reds 25 PA S .ICFM.`
• . ts> Mrd s a e v ' ` ' 'i'{` f `'+ r 'F ,,•r` v '4 ` }FS S.d ,3tr
,r murn o :ati e'uL a a9 ' p M
F
_ 'C}" i 3a h r• i i' tR ' . f' 1`I X A jai-itv"L '`
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• Fes. - !' .{^.' . .. - 1y, '
leg
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• Fes. - !' .{^.' . .. - 1y, '
Jan E9 D2 11:37a Richard Simpson 661.947-6889
p.4 '
' INSTALLATION CERTIFICATE (Page 3 of 8)
CF -6R
SW
Addy v cy_ Mb MoK1/a- I }C1r Permit Number, .
DUCT LEAKAGE AND DESIGN DIAGNOSTICS
DUCT LEAKAGE REDUCTION
Pressuriialion Test Rcsults (CFM (ll 25 PA)
Ted Leakage (CFM)
Nicn Flow
If ('alt blow is Caloulated av W vtioa/ton x nombor of Ions, or as 21,7.x I Icatiung (:apaoity
in.Thouyandy of IlItdhr, cntervalaulatod value here
If fan Clow is measured, anter measured value here ;o»
Loakago Fraotion = 'I ast Loakapd(Meaaurcd or (:alculaied I'au 1,10w) - - f 0 Ll
Pax ifluakago l'teution 50,116
❑
•
Paso Fail
❑ For A EROSOL TYPE.SEALANTS ONLY - The following dingnostle texting was completed:
-
Due[ Fan PrussurV.alion at rough -in mcasurcxl leakage (CPM)
CHECK AF FEli FINISHING WALL:
❑ Yes . []No ❑ I to11so prin-4brb atiun tctih .
. ' ❑ YON ® No El Visual lnxpection of Duct Cln notions - -
® ❑ -
• •
I'ac5 1'a1I
THERMOSTATIC EXPANSION VALVE (TXV) _ _.. .. —.
_ —•_ -
'Y y ❑ No Thi W0811060 iispal*ion Valve (or Corl mission approved
oquivalont) is mstallud and Acccwa is provided for inspection
❑ .•
Yew is a pas;
Paso. fail
❑ DUCT DESIGN -
I: sign calculations have been eompletud,
®Yes 13 No RCCA Manual 1) Ik
Duct lksign is on the plans and duel installalion malehcre
plans.
.2. ❑ Ycs'0 No TXV its installed ur Fan flow hoN boml vorutiod. If so TXV,
verifies( fan flow mntchct: dtwign from CF -I IL
Mcmurod Fan Flow =•
❑• ❑
Yea Cur both I and 2 it; a Parr
PQSS Foll
1 ® 1, the undmignod,'Yurily that tho above drnguo zlio WA rotwl(h and the worts I -performed ammociatcd with the IcHt(H) is in
conformtmce with the mquimnacnig.lirc compliance urvdit. ITho buihiur'shall provide Ihu MRS pruvidur a copy ol'thu CF -61t
Agued by tho builder eueployacs or sub-auntraotors ucrti *g that dinguustiu tolling and imlausitiun Ince( Ike roquirvnlunl+ Air
compliance credit.] _
..
%`
V2, v`
I'c ls Sigoaturc, Vatu 110alling Subcont aolor (Co. Namc§
OR
Performed 4$vncral Contmetor (Co. Name)
COPY TU: 1)uilding 0epartrnorit .
HERS Provider (il'applicahac) -
Building owner ut occvvaiicy
{
lana. ary a, 2001
,