SFD (0202-030)79952 Memorial Pl
0202-030
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. s
License•# Lic. Class Exp. Date ..,•,;t, .
Date - 'Signature of Contractor `' /I "V '•'`-•i'l 4;'L -,
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 SectionB&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 Policy No.
COLD Z:;SMNN, (:NS9aii4 •G3
(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 F 1— ./- 2 Applicant - " ti` i .i ? ✓>,y,I
i r rte• v , y:
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is,hereby made to the Director of Building and Safety
for apermit subject to the conditions and restrictions set forth on his,
application.
1. Each person upon whose behalf this application•is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees
2. Any permit issued as a result of this application becomes null and void if.
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
i certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection purposes. r
7 ) c //6 3 Date ? .t
Signature (Owner/Agent) v'i j• sz' a•
PERMIT PERMIT#
JJJBUILDING
DATE / VALUATION LOT TRACT
p yyo p p Yy
1:;;' AI/t„}!.. 77r !.i,P {•e2UR8 65"P,t "
JOB SITE -
APN
ADDRESS .9-•,ate.52 URMUM" ALPL A
014-0724lf/iP
OWNER
CONTRACTOR DESIGNER (NILEERCOaY
0.Edl!l3CIROEi--ClMYJy1I4-
t.JT7RbC'h/VENM
MiS
15.3530qYrMi 11 MTI' 4200
1,136 M "Du 9pRME, UTBA-2.00
AV yaV lD.fWO /1, 7d {h
4RF,TAR_*XNi.CA. 92409
(909)381.600 CXIL41 71120
USE OF PERMIT
811X37.Y,r1AW_1tDVJ M-12140{
SM n 1.66 21, 1-1,AN nAREV, PKRMIT DOES NdT 1140 UM, nslcx
`Vd:4.F,Ft 1P001m ORM09AY' APPROACH, (Pi AN wYc"K.FU fi'.VOUt'r'M FoR
MU$, IPLY, IMSUKNICF, € F :;,A4.W;t1, x,,'.ar'sN `3'`13 t..j
-TRACT CONSTRUCTION 1,5n- 00 SF
PO.RCHIPATIO 120.00 .SFS
tif'. 4 Jdpk1F$F't3FW F 414.,ttlt SF
ilt,. .A.15r.8•/ N..7da "F1 6o.G' 6. 4.jZ?hr'.&.KW.9/R .f.i6!F,if
rT+bpAe?fopW
t.•p • • Grp; Y7 dYJs6i29t7
3'L.A,N CEf P.,CX 'FF F 01-000-404 9-:3 i $ $137.02
MECHA1' M L, PEZ 1091 ~ 000-4•21'Q SAS0
r'f.,t+XT tCAL, FEZ 101 -000 -4233 -."AW
P1„tBMt33 NG ME 101.000.415-000 $T3t1,Qfj
STRONI ;s 140TION YFE o RE S1.0 101 -000-27,41 -000 $9.21
ORAWAG RE.- 101-,000-423,-0()0 $20.00
t}Nu'V`l L•'OTIER. JIMPAiCT FEE $1,4?07.Oq
."A
GAS .131+D PT' .t i C 11 CF(:
9 d.: '►
C i `. /A, 7 .I..nT7 ,y r•'. i' !l J .l?7.:, .5
'I toys A5.S.6 wj "ns .l'/, S 2 -tow
tt, i'.'p
.: FEB 07 2002
M
RECEIPT
DATE
Y+
DATE FINALED
INSPECTOR
<• i
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
7 ,
Underground Ducts
Forms & Footings
a
Ducts
Slab Grade
Return Air Z.
SteelCombustion
Air
Roof Deck
_' _ O'L
Exhaust Fans
O.K. to Wrap
$— _
F.A.U.
Framing
_ Z„— Z
Compressor
Insulation
51_
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
- p • T
Final —2 &-45,1
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 I
I
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
G Z _
Heater Final
_
Water Piping
f • 2= - S
Plumbing Final
Plumbing Top Out
—
Equipment Enclosure
Shower Pans
—
O.K. for Finish Plaster
Sewer Lateral
AA
Pool Cover
Sewer Connection
Gas Piping
Encapsulation
Gas Test
Appliances
Final
Final i
Utility Notice (Gas) / —
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring a -
Low Voltage Wiring
Fodures
Main Service _
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm) >
COMMENTS:
Installation Certificates Residential CF -6R
Site Address PERMIT #
79-952 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 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 I
V 1(u. [Ul1rl.(,d► ► DATE:
Signature Installing HVAC Contractor
Jan 29 02.11:37a Richard Simpson 661 947-6889 p.4
INSTALLATION CERTIFICATE. (Page 3 of g) CF-6R
,te Addms i9 fS.2 r Permits Number
Q SEII
DUCT LEAFAGE AND DESIGN DIACNOST16
-DUCT LEAKAGE REDUCTION .
Pnstiuriiation Tc:tt Rcsulls (CTM (u) 25 PA)
'fest Leakage (CFM) _
71'an Flow .
If fall Flow iv Caloulatod aw 400 oWton x numbor of lou,, or m 21.7.x I Ioalitig Capacity
in Thouyinda of UtuV. ottfvr caloulatod valuo hero -i
If Ian [low Lit nuntan: 00
ured, ender measured value he
Lookal;o Fraotlon - I'osl I.oakngc/(Mcawuwd or Caloulatcd Ilan flow) z O - dq
Parc it luakago-frautiou 50.06 ❑
• Pass Fail
❑. For AEROSOL TYPE SEALANTS ONLY - The follow Ing dingnoitic texting was completed:
Duct Fan 11ramuriiatiun at rough-in memural leakage (CFM)
CHECK AFTER FINISHING WALL:
❑ Ya.s ❑ No ❑ 1'roxwu►v pan test or 1Now pnsaarr<aliun leaf
❑ Ycs ❑ No ❑ Visual Inspeudon of Duct Connoetionm ❑ ❑
Pass 1•nd.
KTNEWO- STATIC EXPANSION VALVE (TXV) _— _ _.. .-_--• __--•-•-•_--
'E f ❑ No Th"YM'O.S1411c Expausion.Valv,; (or Cornniission approved
oquivllont) is installed and Awews is provided for iaspecliOri []
Yew i; a pa„ 'ass. 1'ad
❑ DUCT• DESIGN
I• ❑ Yes ® No RCCA Manual I) lksign calculations have boon oumplulud, -
11uot i)cxign iw on the plana and duct iaslallalion maluhus
plans.
2. ® YcA . [] No TXV 6 installwl ur Ffm flow has boon vurilivd, if up TXV,
vcril!Ld fim flow ntatchen davign frons C'F-I R
Measurod Tan Flow = '
Yaw Cor both I and 2 iz; at Pars Pass Fail
® 1, the undarsignW, vuaily llud lhv abovo diagilo-.4io fust rosulbi and the work I pciformod i%ociated with the tcal(s) is in e
cuntifmtance with 1640 Mquiromenls li►r compliance utudit. ('Ilio buildui shall provido d►o I IER1 providur n copy ul' ihu Cl,-GR .
Agueul by tlto buildct• cn►ployccs or sub-contractors certifying ilial diapm-liu tumiug and iuwtallaliun owui tltu rugairuruvatx Ior
compliance mudil.)
Al
TC %I Signature, Ua[uL a Wlg Subcontractor (Co. Namo) OR
Pcrl'nrmcd (ieperal Contractor (Co. Name)
COPY TO: Building "arta mat
111:118 IW-6der (Xipplicahlc)
Building Owner- ut Oc cuptinCy
JnanAq 4, 2001
t
4- 4
JOY
5
TractZq I0t`
• Duct Testing Lot #
' , t
Certification F,orrri
:System , V of
+•. se f r' " ° * ` . ' (One form per system)
Builder Name:
Project Name:
A ,Builder Field Contact Q z. . "` T'Telephone No.
Iii. • L - w -c. . . 1 _,,
HVAC,Company Name ;w .WP, CUGt- C? 4. . , k s
HVAC In _ Telephone
rt.
.. Self-Certifier Results 4'
Duct Leakage Measured @ 25 PA
t .4 ,' " ..' ." °' •4.1 t . r .I j' , r it ',.' E
Indicate the maximum allowable Duct Leakage and the calculation method used t -• r
. • ,.
!] 0.7 x`Afloor x (0:06) for Cl,imate.Zone 8 through .15 ?; a s' CFM °, y
0 , 0:5 x A x (0.06).for Climate 1 through 7 & 16 ` • CFM
floor . _
• 400 x [• (Cooling Capacity in Tons) x(0.06) r F ':CFM •
0 •
❑ ..21:7'x (Heating Capacity in=Thousands of+output BTU per' hour)'x`(0.06) "-,,CFM
Print Name . Signature Date.
dF
1
OrCertificate-of Occupancy
City of La Quinta'
Building nd a 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'fol%wing: .
BUILDING ADDRESS: 79-952 MEMORIAL PLACE
Use. Classification: " SINGLE FAMILY DWELLING Bldg. Permit No.:: 0202-030
Occupancy Group: R-3 Type of Construction: V -N Land Use Zone: R -L
Owner of Building: CENTURY CROWELL Address: 1535 S. "D" STREET
COMMUNITIES
Building Official
City: SAN BERNARDINO,' CA 92408
By:. GARY SHOWALTER '
Date: JULY 26, 2002