SFD (0202-031)79938 Memorial Pl
0202-031
r 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 -;fit
License # t a Lic. Class Exp. Date
Date" wef Signature of Contractor
OWNER -BUILDER DECLARATION '
I hereby affirm under penalty of perjury that 1 am exempt from the Contractor's
License Law for the following reason:
a
(.) • 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).
( ) I,.as owner of . property, am exclusively 'contracting with licensed
contractors to construct the'project (Sec. 7044, Business & Professionals
Code). + '
( )' I am exempt under Section B&RC. 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 -Policy No.
COWEN? MOLE IN J. WWC-544Et R -U3
(This section need not be completed if the permit valuation is for $100.00 or less).
O I certify that in the performance of the work for which this permit is issued,
I shall -noi employ any person in any manner so as to become subject to the
'workerscomperisation 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.thoserprovlslons
Date . 1 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 herebymade to the Director of Building and Safety 1
fora 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 `j
2 Any permit.issued as a result, of this application becomes null and void if k
work is not commenced within 180 days from date of issuance of such h
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. f 1 t
Signature (Owner/Agent) j=' " r Date -1 , -/h.;
✓
N PERMIT, PERMIT#
JJBUILDING
DATE { VALUATION LOT 02024X,9, TRACT
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JOB SITE 4 _. , i
APN
ADDRESSr 9-W..W Wa i. }MAL. 1, AG,
OWNER
CONTRACTOR/DESIGNER/EN (NEER
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15 3,5 Sad, TP `09.r,, ON)
1,535 ,30,"e-5T'R1.WrTx 1•AS, in,00
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(90 )381,4007
USE OF PERMIT
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QAQIYVARPORT 418,00 817
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`i..i .141 CHECK FEL - 1 Cl fi '%Gr 3t^r .35'1- 1 SIX.03
l4K'';•3ANIC,f,L 1W., $60.00
El„Ei.".` RIC,A1.;+`RX 101-000-4'a0,t3ill p at11.44
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P1,10MRma FEE 101 -WO-419-000
SP1ONJf"T30+ ,,% RKSID 101-000-241,000 „ ='
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RECEIPT
DATE
BY` •
DATE INALED
INSPECTOR
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
Z
Exhaust Fans
O.K to Wrap
F.A.U.
Framing
Compressor
Insulation
_/ii
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
-
Final
Final r
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
I
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
,— z X - _
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Z
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final
Utility Notice (Gas) sL
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 —8
Utility Notice (Perm) 0
COMMENTS:
Jan 29 OF 11:37a., Richard Simpson
INSTALIXF10N CERTIFICATE
(o
661 847-6889
(Pauc 3 of 8)
P.4
CF -6R
Site Addr18 Mc M 01211 Pfgttr Permit Number
p?+ str
DUCTLEAKAGE AND DESIGN DIAGNOSTICS
Cj-DUCT. LEAKAGE REDUCTION
Pressurizalion Ted Rcsulls ((:1'M (6125 PA)
'fest I.cakggc (CFM)
Nan Flow
If FOR flaw is Cnloulatod ns 40(1 ofkation x numbor of loos, or as 21.7.x I loaling "C:apaoity
in Thou:fan[Iy of'l;tlrlltr, cl1IVr caloulatod valuo be)m
If ran flow LN measured, ender me mmed value here;
I,oakare Nra.ctiou = 'fo+1 I.0akag0f(M0aautr:d or ('.aloulated ball flow) - O- U Lt
Ya. i1'loai:nge I'raotiou 5(1,116 ❑
Pass I ail
❑ For AEROSOL TYPE SEALANTS ONLY- The following diagnondc testing;vas completed:
Duel I an Prcxtiurization al rough -in mcasuiW,lcakagc (CI M)
CHECK AFTER FINISHING WALL:
❑ Yes ❑ No ❑ 11mmNuro pan levt or I loose pn--411rrrnlion lest
❑ Ycx ❑ No ❑ Visual Inspectiem•ol'DuclConnuetionx ❑ ❑
Past Fail
THERMOSTATIC EXPANSION VALVE (TXV)
❑ No Thermoslaw Empansion.Valvo (oir.Colmmsslon approved
oquivalont) is installed and Acua s is provided for mtycotion [
YW is a pans Pas' fail
❑ DUCT DESIGN . .
1. ❑ Y,,,4 ❑ No /1CCA Manual D Demign oaleulalions havo licon aompletud,
Duct Ikxign is on lho plans and dual installation rnatohos
plans.
2.. ❑ yen [a No, TXV 6 buitallcd ur Ftm flow We; beott yeriliud, . If no TXV,
vcriliLd fan flow niatChLN dogip from (:T-12
Meaaanod Fan Flow =
❑ ❑
Yes for both 1 imd 2 is a 1'at;4 Pass Fall
❑ 1, tho undorsignexl, nuily Mutt the nbovo diarll0iti0 tyst rorulln and the work 1 peribrme:d associated with the tcal(s) iy in
conlbrinftaco With the r quiromenls lire compliance urvdit. ('fho builder shtdl provido.tho I MRS provider n copy of tho CN -6R
sigusd by the) buildar i wployocx or sub-contraetons ccrtilying that diagnun1ic tustiug and iuitallalion nwot thu requirentonk 1iir
compliance credit.]
L
lC i5-Sigpaltuv, Date ]tlatalling 4nbcontraolor (O.•Naluo) OR
Pcrl'ormcd Gvecral Contractor (Co. Namc)
COPY'fO: Huilt!4 Vapartrncrll
I113118 Provident' (il'applicablc)
Building Owner kit OccuT>01)Cy
Jantuary d, 2001.
Installation Certificate: Residential CF -6R
Site Address PERMIT #
79-938 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.
G
( / .l DATE:
Signature Installing HVAC Contractor
-. ,> - ! -y Y, •, .. y. a , +f_., 4 t, 5+a S . P M x Ty. r;' .. v,
T'r'act.# 'L OFT
.. '
Duct Testing . j lot #
Certification Form.Systu
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• a ..a r • t '. Y ` .yin s.
{One form peg system) ++ 1•
" '*jai ,', `t -. ` ' , +-, fi 'jy• k'"+, );`^. `' :y- ' F /' r .x' ;. < «. a.
Builder Name:i
a
Project Name: l': ti l (: s • E , . 4
Builder Field Contact Telephone No.' ' a
`
.'HVAC Company Name:
f
HVAC Installer. Telephone,No90GI o _ LS l
,' ...
Self -Certifier Results
Duct. Leakage Measured @ 25 PA P "- f ''CFM
Indicate the maximum allowable Duct Leakage and the calculation method used. ;
' ❑ 0.7 x Anoo y x (0.06) for Ciimate Zone 8 through -15 + .f t CFM
7 +
❑" 0.5 x Afloor' x (0.06)'for Climate Zone l` througH 7 & 16 s ° ` CFM'-; " }
- •' +
• JET=, 400 x .(Cooling Capacity in Tons): x (0.06) ,
,r -
A ❑ 21'.7 x (Heating' Capacity, in Thousands" of output BTU per hour)x (0.06)' CFM
RPrint Name Signature - Date.
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+ 1 f`:y" a r'" t is 4 .`, z; 5•'lfi,
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Certificate.of Otcopancy Od
City of La Quints
-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 regulating but/ding construction or use. For the .fol%wing:
BUILDING ADDRESS: 79-938 MEMORIAL PLACE
Use Classification:' SINGLE FAMILY DWELLING •Bldg. Permit No:: 020.2-031
Occupancy Group: R-3 Type, of._Construction: YN 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: 07/29/02
Building Official