SFD (0202-027)79957 Memorial Pl
0202-027
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
7)4188, I3 101131101,
Date" f r `""Signature of Contractor w/ ' °" c.•e;.a
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*X) 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.
L +1"DEN f< GLIr 1135, NWC-544069-03
(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 It V
v
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 hi's
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) a '• ' f--• - Date
BUILDING PERMIT PERMIT#
DATE 1, i VALUATION LOT ► ^#Y!7 TRACT
JOB SITE
APN
ADDRESS 7.9-557 W.V1!t'1!ORTA T, PlACK
15".0724
OWNER
CONTRACTOR/DESIGNER/ENGINEER
C.M'1 RY, CI.z.O1;I 01ML CoNavWXYM. a
MKTURY c 0V&U. CIOM1+1gCrAf1 93
30, A.r p U '1* I♦'St. ',1. 3M 4200
.`6 tJ , 2tp00
A // t
}7l'a7.Y I>EL:, xhi ie'Jl40 CA 9124 8
RAN
1?5v t5 s o,, °,a3; poq y. y :,yr r';
SAW .A33`r R,iR,C7S' .idlNO l..A ;sC408
(909)381-60007 MAIX 2120
USE OF PERMIT
W1101 tr J= t.Y
"n) - U)T 11, PJ.AN 20, PtVP.N+ T DOYS IVO tfJCLU1„'11: f11.=K W.WJ ,
P001.is 1 RfsfF.17if.A,'Y'.A,.PPR0A0*`K
7'1LWT CONSTRUCTION 1131E10 JP
PC3RCHIPa TIO, 1200 SF
CAR,A.fiha'G.A.MPOR
Fxt;i34'I14:O."D con op C:OI+fS.lwi.1mon
92,137,00
PM15 ITIt' ISTMN1'.A6:;1 Y
CONSTRUCTION YYZ 101 -MID -418 -OW MUD
PLAN CHECK F.1P 101-000439-318 W'SAY1
'11 EP-11A?1'!t'.A1.1E1? 1X11-000•4.21„000 $5150
X,f rY,€;TRiCtUlF'E .Ir $100,41
PlAY'M91146 "M 101-000.4.19.000 5130100
STT. 40 MOTION ME • ,RB ATL) 101-000-241.000
ORATANO KCi i =t a •c ,o o
tl"EU-111R.R 1IMPAsCT FT3 i,307.fs4
31Th-1WK. COY.rR.tRMN yN AND x I,t W CURCK
$3,M5,69.
x KK %H -PA' UK) T
$1 0,00
. -
--- _ - iAt4I"1s ta5 1 Ji%5.
3;4'."►a
RECqIPT
DATEBY-':
DATE FINALED
INSPECTOR
cad
65
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs _ `Z 2
Underground Ducts
Forms & Footings
Ducts
Slab Grade — — Z
Return Air
Steel ;Z2
Combustion Air
Roof Deck —,:38— 2
Exhaust Fans
O.K. to Wrap 6 — / — L
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O. �
Fans & Controls
Party Wail insulation
Condensate Lines
Party Wali Firewall
Exterior Lath y —
Drywall - Int. Lath
Final
Final v 6 —°a
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 p Z
Heater Final
Water Piping
Plumbing Top Out��
Shower Pans
Plumbing Final
Equipment Enclosure
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection _ Z
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final --zor—
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:
Do
Certifical.e. of -Occup
ancy
City of La. Quinta
BuildingnSafety Depatment 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: 79-957 MEMORIAL PLACE
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 0202-027
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
City: SAN BERNARDINO, CA 92408
By: GARY SHOWALTER.
d r Dater JULY -26, 2002
Building Official
9.9157 Mt;�MOM44 pJ
Jan 28 02 11:37a Richard Simpson 661 947-6883 p.4
INSTALLATION CERTIFICATE � (Page 3 of 8) CF -6R
Cd
Site AddMs Permit umber
Vq
I,VKACy ASV
(I)INICN DIAGNOSTICS
DUCT LEAKAGE REDUCTION
Yresuuriralion'1't:at Rcsulls ((a�M (a125 PA) ' _ .(.-
Tcsl Leakage (CVM)_
l'an Flow
If Fan Flow is Caloulatod ns 400 oiia/ton x iaumbci ofton�, or ns 21.7.x I loaning; Capaoity,
in Thouaindy of UtAr. voter ealoulatod valuo born
If tan flow is measured, entur mussurW value hen:
I.eakag o Fraction = Teit l,cakagc/(Nlvayurcd or l-:aloalalcd Fan I'low) - C-9 - 6 '
Pati if loakagu fraotion S 0.06� ElPak., Fail
❑ For AEROSOL TYPE SEALANTS ONLY- The following diagnostic texting was completed:
Dual Fan P'vwuriralion at rough -in mt:osuRA lcakagC (CFM)
CHECK AFTER FINISHING WALL:
❑ 'Yes ' ❑ No ❑ lo'`t or I louse prtmurrzatiun test `
❑ Yes ❑ No ❑ Visual Insimution of Duel Connuulimq ❑
l' 'as,R Fail
�TMERM IDSTAM EXPANSION "LVE. (TXV)
X
❑ No TheYn►ostatio 1''Apse ioa Valve (or Comi nission approved
oquivalent) is installed and Au:ews is provided for mspcotio'n []
Yes i,; a pn - p/ a hail
❑ DUCT DESIGN
1 • ❑ YCfi ®No RCCA Manual 1) Dcaign calculations have been oumplolud,
Doul Iksign is on lba plans and duel imlallation maichos
plans.
2• ❑ Yes No TXV is installed ur Fen flow ho, -4 bmi vurilivd, Ifoo TXV,
verified fan flow mntchkw design front C1141R
Measured Fan Flow =
YGt lbr both 1 and 2 it: a Pana Pass Fail
• ® 1, tha undcrsigacd, Yw y that the abovo drflg;,tl0�-,tlo t*st romith and tho work I perfonncd amsoeiat d with the tamt(s) is in
conformance with the mquiro mnis lbr compliant: urudit. ('liro'buildur shall pnwidu dor I MRS pmvidor it copy of the ULM
sigued by the builder cutploya u or sub-eontractom curtilying that diagausliu tasting tmj fiLmallaliun uloul the nsquuvtnuni. Air
compliance crudil. J '
Tctls Signature, Date hwittlling Subcontraotor (Co. Name) OR
Pcrlormed . (kncral Contmetor (Co. Name)
COPY '1.0: llttilding Departrnertl
MRS Provider (il'appliaahlc)
Building Owner- tit. Occui>onCq '
• ' .la,tuary 4, 2001
r
Installation Certificate: Residential CF -6R
Site Address PERMIT #
79-957 '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 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 Q
/ P aNt�► DATE:
Signature Installing HVAC Contractor
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