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0202-039 (SFD)LICENSED CONTRACTOR DECLARATION Ae I hereby,affirm.under, penalty ofIperlury that I am licensed under provisions of Chapter 9 (commencing wlth'Sectiori'7000) '6f 'Division 3 of the Business and Professionals Code, and my License is in full force and effect. License # Lic. Class Exp. Date Date" !� Signature of Contractor �F?� ��.- 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: Cartier 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 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:_'"r�" �! Applicant'.i,%7' �s r r�rs' 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 & 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. f +� ;Z'� //r•�a.. Signature (Owner/Agent) Jyajr) h/11P � Date' -BUILDING PERMIT PERMIT// y may, DATE A/4 VALUATION r 02024 TRACTg® n;LOT /ry {�2,'�,,. .dl5iii'061 I �1's 30 .l:A'71e� J��.JOB SITE'r APN 7 ADDRESS -335. W0k, n.CF_1A. 0 AN -ENO. 604-0724= OWNER CONTRACTOR/( / EN (NEER CMUs2:�m."�C1��i4}�'C��'�1�.yi� ,�t�tCf7:;+is0f,+ �:UxaR� IV 1�Y * r onil�:T.tTI I.51.36 t`o�r . 2 �P 1 i.b'td9 1111 5!r..,5:n 1 200 C.Nt1����7�7+[�p'a?�:�i:te'y`�".(it3�.+?'J,�}.t�;s�nitiJ�",£TF8 1535 11"S101 117 STRI 3Ta 0111,1. Ynoo S-0 BRl>,.)<+J;:ftiaRM10 CIA. 924 08. SAN BE'r t`!M40. CA, 92A09 USE OF PERMIT S11) ,' LOT 30, PL A14 313RLIVI Pi?,%'MIT, 00n,1101" I'h C..LVI PI fil..{i0K � WAJA',n POOL, NAi�l�i�MIAT,'PROACK (PIAN CHECK 0,12 RIMUCEW 'OR' ItbULTIPLIt. ISSUANCZ OF &&ME PLAN TYPE) TRACT C Wt+I!STRAICTIS9N 0125.00 5 PO C€3OATIO 91.00 sy 438,00 SF MiSTJTUCTION FRE. 101 '0064`18.000 PILAR CHI= ME 'MMIMNU2;AII FM 3 01.000.421 -000 $60.00 f�k.I�'t'.6�3C.1►.d.�` !G�•�t)tlt;J�4�t?-ti>�iJ �1.i7.�4d S'd`I'wd7lm Mu1` m M - Iekm 101-000-242-000 ei3 IriAt�i r""k �fi=t�ti0 $20,00 DZYW"ER Ii4if.l°ACT FEE .. ,., . t..: _ F f .. 1';anl x.00 P+7y ,0/�34t /fir ' X,163 i?�?T'.s��3J✓�P`g7��`�: ���i.�� 11l Il Y '�S11 ITTO.9dr.¢ 14 es Duk, dYO�HY' • • 161: ,QiFh+4,0 RECEIPT DATE/ 2 /7 DAT NAL INSPECT R INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE I INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs — Underground Ducts Forms & Footings —L Ducts Slab Grade / — Return Air Steel 3 - — L Combustion Air Roof Deck Exhaust Fans O.K. to Wrap -/ — Z F.A.U. Framing _ Compressor Insulation -a 15Vents Fireplace P.L. Fireplace T.O. Grills Fans & Controls Party Wali Insulation Condensate Lines Party Wall Firewall Exterior Lath © — Drywall - Int. Lath Final — Final — BLOCKWALL APPROVALS Steel POOLS - SPAS Set Backs Electric Bond Footings Main Drain Bond Beam 73 —,13 - Z Approval to Cover Equipment Location Underground Electric Underground Plbg. Test Final Gas Piping PLUMBING APPROVALS Gas Test Electric Final Waste Lines _ _S ^ Heater Final Water Piping Plumbing Top Out Plumbing Final Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral X, Pool Cover Sewer Connection Encapsulation Gas Piping Gas Test _ GZ Appliances G�` Final Final Utility Notice (Gas) , 02 , 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) Q Z COMMENTS: Installation Certificate: Residential CF -6R Site Address 44-335 Monticello Avenue 1. BUILDER INFORMATION Century Homes 1535 South D St. 9200 San Bernardino, CA 92408 INSTALLING CONTRACTOR: 2. PROJECT INFORMATION DISTRIBUTION TYPE Flexible Ductwork in Attic and Between Floors DUCT OR PIPING R - VALUE Flexible Ductwork Will have a R -Value of 4.2 or Better PERMIT # SUBDIVISION: Classics CITY: La Quinta COUNTY: Riverside WEST PAC AIR CONDITIONING 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 EQUIP. A/C MANUFACT COMPRESSOR ACTUAL EFF.. COOLING EQUIP MAKE MODEL # SEER CAPACITY Lennox 12ACB60 12 COOLING LOAD 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 I..Q� ld.Gt.P�.t Gb•. DATE: I — B -Oz - Signature Installing HVAC Contractor 4—� 33 A4 r-' C41 a,4 Tract # -q19 � Duct Testing L®t Certificatioln Form ` -System (One form per system) - Builder Name: e�/V� �✓1 Project Name: Builder Field Contact:'� t ,Telephone No. HVAC•Company Name: HVAC Installer:Telephone No:Uw`1 -qj� ' .*K -Se lf-Certifier.ResuIts" ' Du'ct Leakage Measured @,25 PA , CFM,f Indicate the maximum allowable Duct Leakage and the calculation method used:' ,• 0.7 x Afloor x (0.06) for Climate Zone 8-through 1`5 , CFM-. ❑ 0.5 x Afloor x (0.06) for Climate Zone 1 through 7.& 16 CFM 400 x (Cooling' Capacity in Tons) x (0.06) 1. CFM ❑ -21.7 x•(Heating Capacity in Thousands of output BTU per hour) x (0.06) CFM J .- oz Print NameSigna Date Ceiew.v�a'���'ams`ziK4�bY-.�'f�..%'.i��5'e•�5]7tss$`•.�+.i5"E,?`»P:i.�iE. �.'.�5. .�R'ii. Ari61�$!Y4-�"�.:.7«a�',�+�SifLP�ffvkK•�tA`4Y1,'::.a�_SYu.'r;.i1r'":.G�ms^.+c'�au^rzr ;*:i-�:rrc:'.n....<...�:.,.w.ti. .. 4 � y F . � Y a: -ti • Certificate of Occupancy City of La Quinta Building and Safety Department MoFT�o -This Certificate issued pursuant to the requirements of Section 109 of the Uniform Bui/ding Code, certifying that, at the time of issuance, this structure was in comp/lance with the various ordinances of the City regulating building construction or use. For the following: BUILDING ADDRESS: 44-335 MONTICELLO AVENUE Use Classification: SINGLE FAMILY DWELLING. Bldg. Permit No.: 0202-039 t Occupancy Group: R-3 Type of.Construction: VN Land Use Zone: R/L Owner of Building: CENTURY CROWELL COMM. Address: 1535 SO. "D" STREET STE #200 City: , SAN BERNARDINO CA. 92408 By: GARY SHOWALTER Date: 08/09/02 %u ding Official POST IN A CONSPICUOUS PLACE l