SFD (0202-029)79966 Memorial Pl
0202-029
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
714188 B /W.
Dates;Signature of Contractor
rr
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).
( ) 1,. 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.
have and will maintain workers' compensation insurance, as required by
eection 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).
( ) I certify that in the performance of the work for which this permit is issued,
I shall riot 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,provis Tons^ a "I
Date 7 l 7 A'"r ' Applicant yd .A r"
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"
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 r
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. +
_ 1
Signature (Owner/Agent),
% /%% Date=s
BUILDING PERMIT PERMIT#
DATE y / r VALUATION LOTTRACT
20 2A 197 -3
JOB SITE
APN
ADDRESS
OWNER
CONTRACTOR / DESIGNER / EN- (NEER
CW T :, i";[yyZY•• CROfp4 tpY1 L C9 :, 7M .ed'r if' xvMES
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.0,4 ' 2'1<":'RNAL=TANO CA 91409
o ,AN 'M 'NARDWO 'CA 92,408
(909):4P1r-5007 C;M4 Z120
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USE OF PERMIT
$'F0 rt I.OT X0 )Pl.ftiN C, P&R.MIT DGES' 140)' 1.141"LLIDE HLOC1; V, -'All,,
P001.6 D..1UV WAYi' r9.i PT,,O,Ai, 1-
-TRAC T CONSTRUCTION %D21.00 47)0'
I%OIS.t:1WIaA310 11.00 SP
0ARAMWARPt?RT MUD SF
M1`17',1"1:_' ) COIST ("IF CONSMUMMOR
118MR19 so
A.•iS;+JY A J6y.f7 )Yu.'4`. 3l. iP,'.i,M1VAFkA!C.3[
:'.C31'bMti;"'PMN FU ) t)) _= 4181.0U0 $11,06,00
PLAN CIMCK i'SIX A 01-000-439-.; S 8 $J47,11
MCCIMiANICt+•..L, YEFtr 101 _000-421 _001D $60.00
ELW. TRIC A1,rFX 1011-400-420-0003 $.12758
P1.I1M;31NG = 101-000-419-000 $148.00
u"1"It013f I f;!°kxt 7rd l lw•,RiRa17 1071-0001-M-000 1b.dtl
C D3i :rlii c 1;` 1 fD3 mOtIC3 . Ca i $ OOtI
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b FEB O t, %•
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OF4A lNe
t:
r,fIECEIPT
DATE
B .
DA F ALEX
INSPECTOR
O (/ r
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
-
Underground Ducts
Forms & Footings
Slab Grade
22
25 d
Ducts
um Air
Steel
Combustion Air
Roof Deck
— L
Exhaust Fans
O.K. to Wrap
S . ., Z
F.A.U.
Framing—
Z
Compressor
Insulation
,-/y- 2
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 3 - z
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
C7_? _
Heater Final
Water Piping
s- _ _ 2,_
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
el
Final �--
Utility Notice (Gas) Z
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit _
Rough Wiring -::r- .T ^ 2
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final p^
Utility Notice (Perm) _ ^ Z
COMMENTS:
Jan 29 02 11:37a Richard Simpson' 661 947-6889 a p.4
INSTALLATION CC, RTIFICATE : (Pagc 3 of 8) CF -611
t✓G Z G rcr
Rile Addruwe 7 _ Permit Number
m6M 0 lz 141 WI41—a
N►+ jL IDUCi' LEAKAGE Alia DESIGN DIAGNOSTICS ,
DUCT LEAKAGE REDUCTION .
Pressurivalion •fest Rcsults (CFM (ir125 PA) -7
• '1'csl Lcakggc (CFM)
Fan flow .
If Fan Flow is Cnloulatcd nR 40() olimltou x nuimibcr oflonv, or as 21.7.x l loaling Capaoiiy
_. in Thourandv of l;tullu', pplCr oaltsulaf l valuo hero ,
If ran now is mmrsurud, caller measured value here
1,tAago Fraotiou = TcA Loakag&(Nli:as" or Cploulatcd Fan Flow)
Pa c ifloakago Iraotion 5i1•IIb Z1. ❑
Pass Fail'
❑ For AEROSOL TYPE SEALANTS ONLY - The following dingnoatic testing was completed:
Duct Fan Pressurization at rough -in measured Icakage (CFM)
CHECK AFTER FINISHING WALL: '
❑ Yes ❑ No ❑ fins -euro pan t"t or 1'lotr a prc.surrratiun to st
❑ Yes ❑ No ❑ Visual lntipeution of Duol Connections '❑ ❑
PaRR Fail.
_ACTHFRM6STA7IC EXPANSION VALVE (TXV)
'AYew [TNo 111CM09101u I.N.Pugion Valva (or Commission' appmved
oquivalont) is installed and Access is provided for inV.ftiion 13
Yew is a pass Ya•,. Fail.
❑ DUCT DESIGN
I' ❑ Ye's ® Nu RCCA Manual 1) Iksign calculations have been oumplotud,
lhfu ixAgn is on Ibo plans and duct inslallalion maich'
plank.
2• ❑ Yon ❑ No TXV is imtallod or Ftm flow has boort verified, if up TXV,
verified 1'au Dow matches: dsisigit Eton► CFbl If '
Wisurod Pan Flow =
Ycs for both 1 and 2 u a Pam Pass Fail
❑ 1, tho undmsignccl, vm11y Ihut the a6yo diagnoslio M-4 resoW and IN; work I p4ormad amoeiatc d with the last(a) is in
aunlonnAnce With the mquimments lbr compliant urodit. 11Vo buihlur ~hall provido Uta I IE.R8 providar ti ti ipy of tho Cl,* -6R
Kiguod by tho builder cluployocu or sub -contractors ccrtilying that diagnostic lex.-ting and installation niml lho rvgou•oriaua►Iti licr
compliance credit.]
7'csts Signature, Data, Iitatalling tiubooatraok►r (Co. Naipno) OR
Performed Genera) Contractor (Co. Name)
COPY '1.0: Building Departinout
IMRS Provider (if applieabde) .
Building Ownez• ut. occupancy
January 4, 2001
Installation Certificate: Residential CF -6R
Site Address PERMIT#
79-966 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..S UBMITTED BY A
"& DATE:
Signature Installing HVAC Contractor
l
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,.; .,Tract
Duct •Testing
Lot:
Certification'. Form
,
.
system l of
a
l r ' i { .fit � ', y_
-
(one form per system)
Builder/Name:
Project Name: C%�C�sSI L J
3 Builder Field:•Contact �..
Telephone No:
• HVAC Company',Name: C,��,
HVAC Installer:
Telephone No.
Self -Certifier Resulte.
" Duct Leakage Measured @ 25 PA • .
g 1 'AFM .
Indicate the maximum allowable Duct Leakage and the calculation method used: - -
0 : 0.1 x Anoor x (0.06) for Climate Zone 8 through,16
CFM
Anoor X'(0.06) for Climate Zone;4 through 7 & 16
CFM0.
400 x. (Cooling, Capacity inTons) x'(0.06). ° r
,.
" ` t CFM `
q 21€7 x (Heating Capacity in Thousands of output -BTU per hour).x` (0.06) ' : CFM'`
7z"
v
• Print Name : Sign ralDate
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' +� er' '„ "'�tij�:q, A tiy'•.i� x �,..r� � M y,. y. .. ..t.
..�*Ak,.Y ;i�. .a'k a .2t. :��z� i� ♦ z I - .. ..
C
ertifica to of Occupancy a. k
Cit
Y. of La Q diata
Bu'ilding and Safety Department'.r, ,.
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
ollowing.BUILDING ADDRESS: 79-966 .MEMORIAL PLACE i.
Use Classification: SINGEL .FAMILY DWELLING. Bldg. Permit No.: • 0202-029
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
By:- GARY SHOWALTER
Date: 07/30/02
Building Official