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SFD (0202-028)79971 Memorial Pl 0202-028 LICENSED CONTRACTOR DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of f;hapter 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 014 V01; Da 2.1 Signature of Contractor 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 Section B&P.C. for this reason Date Signature of Owner WORKER'S COMPENSATION DECLARATION I hereby, affirm underpenalty 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. 1) I have and will maintain workers' compensation insurance, as required by Se ion 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:. Cartier Policy No. cafa2,nS 4 FAME I14S, y RWI -X14960-.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:l lw / Applicantp. 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 p & 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) rS 1. c. 1 /' )% Date mv:2' r BUILDING PERMIT PERMIT# t DATE ` VALUATION LOT :1 l n TRACT 3.9 JOB SITE ! APN ADDRESS WXWOi AL PLAC P, tg §D41 -072 -Mg OWNER CONTRACTOR/ DESIGNER/ ENGINEER r.'1P' D. WRY CR VWXT„z., C0kWONITIMS d.`° WURY Gt3O ;L',1.,L t. a +l'1`t{f% ial 1 J35 Swi,w mi um"t' ..p-, A200 SM BE99 .IRDINNC) (,A 92408 SAN BERNATCY) TO CA. !YZ408 .,(909)381-60T1 C"ir',u; 2120 ' USE OF PERMIT SFO - 'LOT i9, PLAN $. I A.PFV, i v4 MAT DOU NOT tltlGLUDE UL,O{: X WA1A4 P00417N•,1VrWAY APPR ROACH. (PIAN CkI'W i'. ,MS rtEDUCIVFOR .AAs.}g,'.f,10UK t5S13ANCEOF S10M;f,.itLA1 7"SfPE), T -R&C r CONSTRUCTION 310-21.00 8 1?L?RGH/PATIO I Lab :,'ir . lahmapiCA"OV 417,00 ff, . . Er. ," . IPIAM) C OSA, OSI VIONS1`ITUC.".i:. a' X .$.16469 AOTRUCTION ITT 1M-000-418440 MUD PLAN CHIaf IG. 1+ .I.P 101-000-x$39- o 18 $147.17 MECHANICAL VZE %0.00 Et,WTRICAL VIM 101-000-4:,M-000 $127.59 PLUMBING ME 101.000.4M,000 S14S.0 STRONt"a )lfitd7f'ION 1129 - ?MID 101.000-2 13 -0d 0 V 1.21 (MAW 0HKE 101-M-423-000 Volvo DZ t LC,P'9R IMPACT :tr}?M9t3x00 t • . ..Nr ? . Y . ` ,-""sem . * -1OTAL ICONS x"€3=00' AIND PI–ON C:%R = s3,1.gy.56 it l'P ..,,. ';.EP .1"I ;i.l.9' •-°.d,'.C:r':43.ii.0 NO TY FEB. ©i 2002 1 DATE INALE INSPECTOR INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms 8 Footings Ducts Slab Grade - Z Return Air Steel . Z Combustion Air Roof Deck - g- y Exhaust Fans O.K. to Wrap _� _ e F.A.U. Framing_ Compressor Insulation - Z Vents Fireplace P.L. Grills Fireplace T.O. Fans 8 Controls Party Wall Insulation ZZCondensate Lines Party Wall Firewall Exterior Lath - Drywall - Int. lath _ Z Final p, Final 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 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) 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: Installation Certificate: Residential CF -6R Site Address PERMIT # 79-971 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 EfficiencyStandards for residential buildings. 3. HEATING INFORMATION HEATING MANUFACT HEATING UNIT ACTUAL EFF. _ . HEATING EQUIP HEATING EQUIP. MAKE MODEL # AFUE CAPACITY LOAD Furnace Lennox 80UHG46X-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 GAia. . . 1Jt-ke .t.P.r ..-4 DATE: - 6-01-- Signature —OLSignature Installing HVAC Contractor Jan 29 02 11:37a Richard Simpson 661 947-6889 p.4 INSTALLATION CERTIFICATE (Pagc 3 of 8) CF-6R L04- 10eP ey C la X61 or Site Address 9 _ 9 71 M er iM o R,Permit Number 1of c DUCT L EAI{AGE AND nFSIGN DIAGNOSTICS DUCT LEAKAGE REDUCTION PrP;surization Test Rcsulis (CTM 62125 PA) fest Leakage, (CTM) Van Flow If Ilatl Flow is Caloulatod a__q 400 ofioatton xaunibcr of tons, or as 21.7.x Iloatiag Capaoity in Thourlanda of OtAr, onfor caloulatod Valeo horn If fan Clow is mmsurcd, anter measured value how u» Leakage fraction = 'f est Loakagoffmoasury-d or C P101118tad Fna Flow) - . • _0L1 Pax, if loakngu fraolitiu S 0,06 0 Pass Fail ® For AEROSOLTYPE SEALANTS ONLY.-'Ile following dingnoxtic testing ivm completed: Duel Fan W suritalion al rough-in mcasurel leakage (CI M) CHECK AFTER FINISHING WALL: ❑ Yv ❑ No ❑ •Prvattiuro pan 10 q or.] lvusv pros:alrrration wall ❑ Yes ❑ No ❑ Visual In'spection of 1)uc1 Connections ` ❑ • ❑ Past Toil. THERMOSTAIM EXPANSION VALVE (TXV) Y-1❑ No Thcratuslaliv Expansion Valvo (Orr Commission approved oquivalont) is iostallal and Acc.am iti provided for in pvction . fur [] Ylw 6 a pn -. 1/'ass fail ❑ DUCT DESIGN I 0 YCc ❑ No RCCA Manual 1) Design calculations have boon completed; Duct ik;sign is on the plans and duel installation maivlivs ` plans. 2 ❑ Yea ❑ 1Vo ` 'fXV is iustallvd or Ftln flow hu+ hli xn vorifiod.. If no TXV, vorillel fan flow ninteho; da ign f m CF4I : Measured Tan Flow= Yes Ibr both 1 and 2 ix a Pam Pass Fall ® 1, rho undarsigaul, Ycnfy Halt tho nbovo dlaguosttc too moulb; and lllp wort( I per ormel asociated with the tcKt(s) is in coutbrnitntve With ileo requirements lire compliant credit. ('llm builder shall provido Ulu i MRS presider n copy of Iho Cl,*-6R Agucd by the buildor culployces or sub-'oontraolom certifying that diagnumiv testing and iu.%lallalion nuntl 1hv rvquireluvul,c I<v. compliance credit.) J4 1'c Is Si ftnaturo, Uatc Ltstalling lubcontractor (Co. Nanno) OR Pcrturmed Golacral Contractor (Co. Namc) COPY'I'O: Building Department ITERS Providor (il'applicahic) Building Ownez" cat: occuvailcy .12awary 4,2001 f . , ,• , ,Duct Testingr. CertificaForms ' + tion- : System of f` < • a y , (One form persystem) Builder Name:. Project Name: 3 ,ouSs ltd, Builder Field Contact: Telephone No. HVAC Company Name: ES(1r2: - HVAC Installer: Telephone No. ba -13` Sy Self -Certifier Results ! _ Duct.Leakage Measured @ 25 PA , g CFM Indicate the maximum allowable Duct Leakage'andthe calculation method used 0:7 x Anoor x (0.06) for Climate'Zone 8 through ,15 CFM ❑ 0.5 x An,), x (0.06) for Climate Zone 1 through 7'& 16 CFM } 400"x (Cooling Capacity:in Tons) x (0.06) Zl) CFM 0 21.7 x (Heating. Capacity in Thousands of output BTU'per hour)Jx (0:06) ` CFM.. Print Name afur . Date • YadY"„?c'_ i:'L%ield '.',T:1i. k`irLi.tFt . %'39?i`nal,.n"3rf-A"^: 'tik7r'dt2:eta'3;nttre 'G sA,m+trs,?lemMncraar,:km:s'. _:icrnis zor.vtrw.•au'...>.,aa>r:.,.a, _..,a... .,. ...,..,.,..., ....... .........._.. __.....__ ..._. .__.. __ k Certificate'. of Occupancy,,gip. City of La Qurota ^rw OFBuildin and SafetyDepartment 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 io compliance with the various ordinances of the City regulating building construction or use. 'For the following: + BUILDING ADDRESS: 79=971 MEMORIAL -PLACE Use Classification: SINGEL FAMILY DWELLING Bldg. Permit No.: 0202-028 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 k" City: SAN BERNARDINO CA. 92408 By: GARY SHOWALTER ( Date:' 07/30/02 Building Official o