0203-388 (SFD)LICENSED CONTRACTOR DECLARATION
a' 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 1
Professionals Code, and my License is in full force and effect.
License # '• Lic. Class Exp. Date ,.
714188 B
Date•" G Signature of Contractr
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 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
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:
Carder G* OLD&4 ACLS Policy No. N61FG-54068-03
(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, l shall forthwith comply with r those.provisi0 s'
Datei` �:� �? » Applicant )7 10: %t° . ,,f ✓ t
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:. X
application.
1. Each person upon whose behalf this application•is made &each person ate=
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 hermit 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 lto. the bull' ing
construction, and hereby authorize representatives of this Clty,to enter upon i
the above-mentioned property for inspection purposes
i e gp
Signature (Owner/Agent) _ �4 Date��
BUILDING PERMIT PERMITk
DATES VALUATION LOT �"4» TRACT'
qw,070.60 SSC
24197.5
JOB SITE ac_.. ?
ADDRESS 44_31y
-I3.Sp
APN
604-072--008
OWNER
CONTRACTOR / DESIGNER / ENGINEER
C .h�4`Ttyy6. KitC"�t�.Pii�kinl'��re��,. CO3�i,3Wl�f.'Ep�lA U
I
(2411711URY C''iaif9�-�
CCc`��(L1�nit�3^HM(14:8
535 ?3L.•'. 1y, i�;Xu:.b. Mm, W'ri+00
�a.�11�
1535 so. s. iS.id'.1Y T, s`�d.l�+, ileba�l/
SA14 9F.PWARDI O CA 91406
S.AWEMNARDINO
CA .92408
(909)381.6007
cmus 21-.0
USE OF PERMIT
VVtLYAWDVqLg sNG
LZMIT LOES -N4T INClt3EWEY,'
81'M . BOT32,P1.41..W 3C '. PERMIT
WALL, PJ%N,; & V:JAW A .AASRO CC. CHECKPEE
T:XIAICTI014 )?OR Cv UI-TI4'I. E ISSi.3•AWR OF Ski] E PLAY 7YPE
'~ TRACT t:C)1<F9Tg3. CTION 1,7 MOD OF
PORC UPATIO 91,In S.P
0ARA01WARPQ1'T 418,40 91+`
•-
w',
�^�c Rt # �C1rt F•t.7 .1+,R•.aA�7�+�p�.A•g•f �a.a ��,
c a�e7�d_.4vJLA.M ra) Cirf1'.�� �. r 1viJaYaY�.SiVV',�.KRon
n� !i �s s:,ff
.�gY31070.60
Cf. HS`PRCIC'1IONI`ilt, 103.000.41€-000 $453,30
PL,i14 CHECK FEE 101-000439-.318 $156.2
,
MSCI lANICAL, WE 101.000-421.000 $60,00
101-000-419-000 "x130100
TRO-1403VIO iON:PIE-9 F PIESID 101-000-'2-41-000 $30.31
CIRADDT # FEB 101-000-423-000 $20,;00
L' aE.VE•1L.(,t.PE3t IMPAC'T;q_V1? $5,4117.Bff
Yrs -
SUR `3:t')TM— t"C�RiYi°i1;TTMION AND �'A`y1�;
$3,034.0?
,��7�kq�F`SNy'�y� (9
1,.Q5. o !.F: .i1�4% ,C".f�el.LO J'dI
rPf1.NV
.00
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L! 44
U ri-P-M?MI' + ;DUE C," 1
MAY U
X13 e0`f
CITYPRAt2l1OEl�,gF
A . .•�
RECEIPTIV
DATE qFINALED
INSPECTOR
INSPECTION RECORD
OPERATION
I DATE
I INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
—/Z-
Underground Ducts ,
Forms & Footings
Ducts �+
Slab Grade
Return Air
Steel
_ —Z
Combustion Air
Roof Deck
— ,2_
Exhaust Fans
O.K. to Wrap125—Oz-
F.A.U.
Framing
—
Compressor
Insulation
p . eon
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Z
Final
Final
BLOCKWOVALS .
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
Heater Final
Water Piping
_
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
7
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) -�O a
COMMENTS:
.i4
11-11,1691
lri
rte.
Certificate of Occupancy
City of La Quinta,
Building and Safety Department
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:
Use CI'assification: SINGLE FAMILY DWELLING
Occupancy Group: R-3 Type of Construction:
44-305 MONTICELLO AVENUE
Owner of Building: CENTURY CROWELL COMM.
Building Official
Bldg. Permit No:: 0203-388
Land Use Zone: RL
Address: 1535 SO. "D" STREET
City: SAN BERNARDINO, CA 92408
- By: STEVE TRAXEL
Date: 12-20-2002
POST IN A CONSPICUOUS PLACE
INSULATION CERTIFICATE
This is to certify that insulation has been .installed in conformance with the current energy
regulation, California Administrative Code, Title 24, State of California, in the building located at:
44-305 Monticello Avenue, Lot 32, Monticello -Classics, La Quinta, California
CEILINGS:
TYPE: BLOW MANUFACTURER: CERTAINTEED THICKNESS: R-38
WALLS: ;
TYPE:. BATTS ' . MANUFACTURER: CERTAINTEED THICKNESS: R-13
i
GENERAL CONTRACTOR:. CENTURY CROWELL COMMUNITIES LICENSE # 71 yl��
BY: TITLE: 4/ /
PARAGON SCHMID BUILDING PRODUCTS, A MASCO COMPANY LICENSE # 632072
B TITLE: ADMINISTRATIVE ASSISTANT DATE: 12/5/2002
�,
MsCERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING (Page 1 of 7)
ect Title
Project Address / ' ' ' `
Joe re",9610 so 0 22- 3 1
Budder Contact Telephone
I S H p. g D r, -o i d
H E R,te� Telephon
Ecal Qtw I z�z. I
Certifying SignatureatF
Firm: (�E SE 2T E d e( �( �Rx/ I C.E�
Street Address: j v. r 2FJX 6,2
Copies to: Builder, HERS Provider
CF -4R 6
�F 5 T� � ► I / 4-/0 2
Dat— ——
Builder Name
Ian Number
k 4 G+ 2D IJ P
e Sample Group Number
_[.o -r # 32 11y•3,,5.47.CW110
Sample House Number
HERS Provider: ifi d -E • E.• R. s.
City/State/Zip: �d- v i
HERS RATER COMPLIANCE STATEMENT
The house was: ❑ Tested ❑ Approved as part of sample testing, but was not tested
As the HERS rater providing diagnostic- testing and field verification, I certify that the houses identified on this form comply
with the diagnostic tested compliance requirements as checked on this form.
❑ The installer has provided a copy of CF -611 (Installation Certificate.
❑ Distribution system is fully ducted (i.e., does not use building cavities as plenums or platform returns in lieu of ducts)
❑ Where cloth backed, rubber adhesive duct tape is installed, mastic and drawbands are used in combination with cloth
backed. rubber adhesive duct tape to seal leaks at duct connections.
❑ MINIMUM REQUIREMENTS FOR DUCT LEAKAGE REDUCTION COMPLIANCE CREDIT
Duct Diagnostic Leakage Testing Results (Maximum 6% Duct Leakage)
Measured
Duct Pressurization Test Results (CFM @ 25 Pa) values
Test Leakage Flow in CFM
II' fan flow is calculated as 400cfm/ton x number of tons enter calculated
value here
If fan flow is measured enter measured value here
Leakage Percentage (100 x Test Leakage/Fan Flow) _
Check Box for Pass or Fail (Pass=6% or less) ❑ ❑
Pass Fail
❑ THERMOSTATIC EXPANSION VALVE (TXV
❑ Yes ❑ No Thermostatic Expansion Valve is installed and Access is
provided for inspection
Yes is a pass
❑ MINIMUM REQUIREMENTS FOR DUCT DESIGN COMPLIANCE CREDIT
❑ Yes ❑ No ACCA Manual D Design requirements have been met (rater has
verified that actual installation matches values in CF -I R and
design on plan.
- ❑ Yes ❑ No TXV is installed or Fan now has been verified. If no TXV,
verified fan flow matches design from CF- I R.
❑ ❑
Pass Fail
Measured Fan Flow =
❑ ❑
Yes for both I and 2 is a Pass Pass Fail
Compl ance Forms August 2001 A-16