SFD (0202-026)79943 Memorial Pl
0202-026
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
1013 1 M,
"k r.
Date/ X Signature of Contractor` ' >
r. ....— .T.•- . / I'' O ;,^'" c•' Cwt,-.,C_.. .s"
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).
( )
11 -as owner of the' property, am exclusively contracting with licensed
contractors to .construct the project (Sec. 7044, Business & Professionals
Code). ,.
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. .
Se,) d have and will _ maintain workers' compensation insurance, as required by
ction 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:
(This section need not be'completed if the permit valuation is for $100.00 or less).
certify that in the performance of the work for which this permit is issued,
1 shall not employ any person in any mann_ er 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: i' /+ ;r APPlicant ~•• "i '' aL 7 +r !'s i i
'..x ` i f /6+r C,,.w,•..' ar yf; : '-7'"i..r(..t✓Sr+
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000; in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit ,subject to the conditions. and restrictions set forth' on his ;
application.
1. Each person upon whose Behalf this application is made & each person at
-whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of Le Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or. cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
'correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon 4
the above-mentioned property for inspection purposes.
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Signature (Owner/Agenti"'" ,,' l '-A t °' f Date.
BUILDING PERMIT PERMIT#
DATE / VALUATION . LOT. .. Q TRACT r„;•
UOU70M '17
JOB SITE' ”
APN -
ADDRESS
79-94:4MXMOR.IAi. F1,A(=
604-0724
OWNER
CONTRACTOR / DESIGNER / EN (NEER
,
(.'°EN=Z)r !Pt0'V07X CO1t9IV91,'t"I:'s.. HS mrl
apx r_. (' V4V _11 COMa IN 'Mas
53.5 30. "D" Er! %X"T, M, W{siit}
). i$Qy rho I~ kJ I', ill° t34J
SAWRF"ARDTNO CA 92408
VJWB]MkARrXqq0 CA, 92408
(M9)381 -60W (°.13LO 2120
- - -
USE OF PERMIT.-.. 4 - -
"1 + WE F'AIWIEE,Y MVEl1MG r
sm:) - %SOY' 17, 31%,.t mthwl' 0=3 NOT Iii 1,1.I04 BLOCK WALL,
P004 DIRIV.9WA?l APPROACH, (PUAN L"F3VWX PEW' i"iyDUCRD FOR
141JLTIPLE,.ISSUA1NCN OF SAME PL.A-N 'YYI$ )
`!'RACT C{rNO'i RUCTION . 1.M.0 SF
b'f71.CI1tT E 't`10 9.i.0it SP
,
GAARAOVC&PIPORT 418.00 OF
C. " ' .'i. 1 ' 1' " . CJ.M
. Eii bu4, 'y6b4 .i
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A LI•1 + '.ii J..fila. l O.+,LYIdJ.Y•.R1CC4J.•
,
CaN ST}1.iJCTION 1rZ 101 •t?(10418-wo 903150
Pl All CHECK kf?i> 101-0400-4 x9418 $136.Q
W.?,CHkWMLFF.E 101-000-421-000 $60; Do
Ed.•i:;l:FRICA Y.EE 101-000-4120_000 $311142.4
PLUM11DW WE 101-000419-CXM 111301100
3TRX7tdOMOTION lWe • REV') 101-000-2414-00 1
1)EVELOPUR IMPACT 411,E,
11011 '. tl KAT".4 .. ,Y9AJ vi.,Id!e':r1ND PLANT
dL9N_SMCK
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1EW T1C^yAW- 194y S
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0.0V 0
$0.00
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aM1 @al' 'FEB. 0 /, L1919 • h
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WYON-NMN rA
RECEIPT
t
DATE %
DATE FINALEDINSPECTOR
7'02( " 7'
(its
(r 2
INSPECTION RECORD
OPERATION
I DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
_ Z
Return Air
Steel
,� . Z
Combustion Air
Roof Deck
3 - 7-555-
Exhaust Fans
O.K. to Wrap
—16- z
F.A.U.
Framing
Al -- Z G
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
— _ Z
Drywall - Int. Lath
Final
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
QQZ
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
j�(S�
Equipment Enclosure
Shower Pans
_
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Gas Piping
_
�?9 ;� -
Encapsulation
Gas Test
Appliances
_
Final
17
Final —Z
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:
Jan 29,02 11:37a Richard Simpson 661 947-6869 p.4
INSTALLATION CERTIFICATE (Page 3 of 8) . CF -6R
E,J
Site AdUI'Cva-79— T -Q Mt~ NI 0 R- Me I p ( permit Number
DUCT LEAKAGE AND.DESIGN DIAGNOSTIC&
DUCT LEAKAGE REDUC110N
Pressurmalion Test Rcsulls (CFM (a1 25 PA) • • y
Tcn-1 Leakage (CFM) b
Van Flow
If Ilan Flow is Calculatod as 400 olioulton s numbcr of Iow& or av 21.7 x I Icali ng Capacity
in Thomanda of OffI r. Omer oaleuletc d vnluc baro
if fan flow iti measuri:d, m1or measured value hen; —
Loakagu Fraction = Tc -A I.oalcagcJ(Mcavarcd or l oloalatC4 Fan flow) — V
PAl,c if loakagu fraction S 0.06
Pass ' Fail
❑ For AEROSOL TVPE SEALANTS ONLY - The following dingnoxdi testing Ives completed:
• Dual Fan Pn;vsuriiation al rough -in measured leakage (CFM) +'
CHECK AFTER FINISHING WALL:
❑ Yes ❑ No ❑ 1►rcresuro pan I" or l loose promilrr/aliun lesl
❑ Yc a ❑ No Visual Inapeudon of Duct Connoctions ❑ ❑
. Pnsc rail
X THF-WiDSTA7IC EXPANSION VALVE (TXV)
);rYw.g ❑ No 'l'I oymoslalio lixpanrioa Valvc (or Commission approved'
equivalont) is installed and Aa:c im is provided for m,•peetion ' ❑
Yu4 L. a pay, 1>as. fail
❑ DUCT DESIGN
I ❑ Yet ❑ No RCCA Manual 1) Design ealoulntions have been completed,
• Mut Dasign iv on the phms and dual inslallalion r6alche4
plans.
2. ❑ Yo l ❑ No •rXV is installed ur Fan now has boon voriiliud, If ilo TXV,
voriliLd fan lluiv ninichLt: dosip froth (:I,'-1lZ
Weasurod Iran I -low =
❑. ❑
Yee for both 1 and 2 it; a Parr . Pass fall
®' 1, tho underaiguml, vordy that tiro abow0 diagnostio t* -..1 rowlts and flip work I pctfformed associated with the tcst(s) is in
cunlbrmanc:o with 11to mquiremonts Ibr eomplianne credit. I'I1<o builder shall provido Uiu t [ERS provider o copy ul' Iho Cl,* -6R
siguvd by tho builder ctuployocs or sub-eontractonr codifying that diagaos1io testing and nwtallatiun wool the rugour luenk Ibr
compliance credit.]
I'c tis Signature;, Uatc 10etalling Subbcontraoior(Co. Namo) OR
Pcrl'urmed Genera) Contractor (Co, Name)
COPY TO: Building 1kpnrtruorit
1113RS Provider (it'applicablc)
Building Owner ut ocoupancy
January 4, 2001 } .. :•
Installation Certificate: Residential CF -6R
Site Address PERMIT #
79-943 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
1, 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 f
AQ. / JDATE: -^ g' O L-
Signature Installing HVAC Contractor
-79
• ;, tract #"
s Duct Testing ®t #` .
Certification .Form
System of
",'(One form per system)
Builder Name:'+ 1
Project Name:,LCASS
,'.
Builder Field Contact:;Telephone No:'`
HVAC Company Name
t
_ ,
HVAC Installer: , ' *',Telephon e:No.a
_r.,egults, 4,
Self
erfi ie
r -
Duct Leakage Measured @ 26 PA CFM
u.
Indicate the maximum. allowable Duct Leakage and the calculationmethod.used ;.j" < •x
r 0. 0.7 x Alcor x,(0.06) for Climate Zone 8 through -15 . ; CFMY
0",,0.5 x Afloor x'(0.06) for Climate -Zone 1 through 7 &'16 CFM
400 x (Cooling Capacity, in Tons) x (0 06) ti ; , Z' '.CFM ' t
„.
❑ 21;7 x (Heating Capacityin Thousands of output BTU per hour),x (0.06) F `.,''CFM
T `Print Name ,. ,y a SignaFre Datef
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L7uc Lea age ,Measured MAM
k 7 ' ' ae d' - R ,eti r. . r t. Pr T' . `'''r • tt! +, Y a
MR.
.
H} xCo.S °r tcr'' F. ii '• +j' t r r,Fter_ `'t'A ..
.. •:'fiik'.YT$ a ki" 8t1-,' =t t - rte' `''• ' '+ S. r ' ,,Y', h _'' 7. a.rii+x r c ry .vr ', rY al i T' ti n F
42 p m' w v¢e 1 nL t d <at v rrr yr ffnc x t
; "ignatur'' ` -' .'"'
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ficate of Oc cupancyCert y a
City of La'. Quinta"
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 building construction or use. For the following:
BUILDING ADDRESS: 79-943 MEMORIAL PLACE '
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 0202-.026 _
.r
Occupancy Group: R-3 Type of Construction: V-N Land Use Zone: -R-L
Owner of Building: CENTURY CROWELL Address: 1,535.SO. "D" STREET, STE. 200
COMMUNITIES `
City: SAN BERNARDINO, CA 92408
By: GARY SHOWALTER
Date: JULY 26, 2002
Building Official ti -