0202-040 (SFD)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
Date, � s�"� �%���r' 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).
O 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 jof the Labor Code, for the
performance of the work for which this permit is issued.
(:) 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:.
CarrierCCS} K� KAOLF INS. Policy No. 14WC:"-M4069-0;
(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 k •-•* Applicant—-—*."
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 personwoon 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) `' ! f Date-'%1"''+1lVf
f J
1. v w L. •.o,-. o
BUILDING PERMIT PERMIT #
DATE f VALUATION LOT 0201 TRACT
JOB SITE �"
APN
ADDRESS 44%365.10NI kMMO JAi "MEI-
Cl -
OWNER
CONTRACTOR / DESIGNER / EN (NEER
CWr[. RY
++p:;�C 2&Ctt:Flyf r
Cr,."y'AF'1'€.tl�.' 'l
• �+.���'1i•� �°�;::,s1
153:5 P.,10. V' a'f LJ.4+ IEVZT,r a7.Ed..:� 200
115 3:5
`�Ri�G`'�� H'^,"f���Cr�p��£P•Jfi;fJ
1 535 U01 02 IJ.l�;It d: T, 0112, 4:L+W -
UN' B NA:EtD.= CA. 92:$08
SAM B •MAl;i+ O r -A42 408
1 ±fL3U J C 1191 2120
,iz't
USE OF PERMIT
.^'a�P 4 LOT 31, PLAN 5C1'tlrV, PERKI f' DOES MC1.UT)F kt1.C7e;ke
'l i ISt; t, w51 YAPPRo.A...0 , (PL.Aw cHax F%a Rlv'£?t�onl v*,4
.a
MU1.>`F19'LZ ISSU.A'NC;E. OP SAME PLAN T.'YPF) '
'�fy/RA�,/CVT C�OpA7ffSy�i'�t 7C1i€ N I,�?3.Do 8F
11.0t0' DF
�iyMpyh�6}r�f�7yltt3"(,(y11dj.i�•O
�.TF0DW219d:6iD.f2.Yiai`�34d 4if'�.6Ji/'A7�
+;S'M+AITD C 0.1413T 4;d+'
C0W87R`IiyfCV0Tr3 FEE '}fit -000.418-000
PLAN CHEC 9 FEE 101_000-439-318
1&4IANHC'AI, FEB 101-000-421-000
p$0.00
101-000-420-000
XtLpE�y°,�Tyi�iy.�f'a..7;� F. �71-ZQ'4 Q'{0
1�Iri�CS./ CdV�A,iSr f 11` -0r^ -4y9-00 Siam
��sg�p'i�pfwg•9��gYOVIDIII !W k? lE- :sJO 101-pf�00-241-/CSA o $a�1.
y20y
}
O FEY.
DYMPLE31'IM IMPACT FEE". � � l,�3�i�•tJlti
�
FEB 07 2002
�•v n�a7PP•'
•. •ter.ru.d'.�.'tN�>M,.��1{4�fr'OL�y����{.E.rJ-'e0.•
MW. �J�
.p /•��y .�,�• �•��p�,q cam. �;s@� y •�•y �,q�y?'
._ --♦ :Lio'Cw
1,
2R7Y •dr�
.�;,F.6r7SC7.1:,'J:A:Ft,9lN�Rrimn/Ss�,l
a
RECEIPT
DATE / ✓✓
BY `��
DAT IN ED
INSPECTO
Cr-
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
- - Z • S
Underground Ducts
Forms & Footings
- L
Ducts
Slab Grade
/4 - Z
Return Air
Steel
31 - L
Combustion Air
Roof Deck41
.- L
Exhaust Fans
O.K. to Wrap
j /y-
F.A.U.
Framing
- Z-
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
- 2 -
Drywall
Drywall - Int. Lath
S _
Final
Final
BLOCKWALL APPROVALS
Steel
POOLS - SPAS
Set Backs
Electric Bond
Footings
Z
Main Drain
Bond Beam
- - 2
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
3-
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
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) - 7
COMMENTS:
Installation Certificate: Residential CF -6R
Site Address PERMIT #
44-365 Monticello Avenue
1. BUILDER INFORMATION
Century Homes
1535 South D St. #200
San Bernardino, CA 92408
INSTALLING CONTRACTOR:
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
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
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, n aa
IJP DATE:
Signature Installing HVAC Contractor
, 5 r
• � . ,.'
+ ;tract.#. �2'�Ilg�, -
`Duct Testing
: '` Lot # pFfi4s'caf -
Certification Form
System ®f
ti
..
- '
-L
(One form per system)
Builder Name:
Project Name: CA L3-,
Builder Fieid Contact: T 'V
Telephone No.
HVAC Company Name:.
HVAC Installer:
Teiephon-e+No of 1`yi. S7 j
Self -Certifier Results x
''
" Duct.Leakage Measured @ 25 PA '
CFM'
.
Indicate the maximum allowable Duct Leakage and the calculation method used:
❑ .- 0.7 x Afloor. x (0.06) for Climate Zone 8 through 15
CFM • . . . {.
❑ -0.5 x Aeoor x (0.06) for Climate Zone 1 through 7 & 16
_
•' CFM
400 x (Cooling Capacity in Tons) x (0.06)
CFM n
❑ 2.1.7,x (Heating Capacity in Thousands of output BTU per hour) x (0.06), '. ; . CFM, '
Print Name , `Signatu
�f`S 'C''s='¢�'y''4 _.YA ti :A L* ...7T r -ax5Y 1+E x ^t •. t ti
{ sj `�'���:.
�i :.If ` 9 F ,•" t� -. 2T QtNer ults�,
. VW�.M ,�, . .. �• # %b c .•avF. �;
T J6'AR '6&Ystemxwas,q k F, fiested T y;4 t Aper, Ged� spa=oft'�s
�a
1..-�r��+'����.iF;,: .t,.� u..... ;' _- . 'w'>��,��P:� .- .^t.m �1�.7,4' ,6n yf3�r..�a`•'.�`�����i
Date
.. K e �. ..
yFds fiJr +il,'ii Lcys'f
at `4��t4�� r. r: �{'y�, �y"+tr �'``} r�%�"t'-FE• .
mple testing bu > . ,as not tested.
x`��'F:c�as�.i�'?��`°�{?;. d.+`�dh.�a.+'�"�.'n�':`� _..i`�; kdi!
, 5 r
Jan 29 OF 11t37a Richard Simpson 661 947-6889 p.4
INSTALLATION CERTIFICATE (Page 3 .of 8) CF -6R
U -f- 3 i t'.� �llVc% Gly -s CS
Site Addrea9s—'Permitil umber
4`%•- tbb MoAjT7cis1lo Ane..
DUCT LEAKACI& AND rDI;SYCN DIAGNOSTICS
_ DUCT LEAKAGE REDUCTION
Pressurization "i'esl Rcsulls (CPM 61125 PA)
Tod Leakage (CFM) --
Fan flow
If I'm Flow is Caloulatod as 400 ofwliou x numbor of tour, or m 21.7 N.l loali ti? C:apaoity
in nouAanda of Of Ar. olnlvr calouldod vnluo baro
If fan ftow'i.-; mosqured, canter meanured value hurl
Lookago Fmtiou ='I" I,cv►lcngcltT'lcaatrrcd or C:oloulatatl Fnu flow) - o,O
Pam itloakago f aotion 50,06 �T ❑
Pass Fail
❑ For AEROSOL TYPE SEALANTS ONLV - Tho following diagnoatie tenting ivss completed.-
Duct
ompleted:Duct Fan Prassurizaliou at rough -in mcasuFud leakage (CFM)
CHECK AFTER FINISHING WALL:
❑ Yes ❑ No ❑ 1'mm(%uro pan t(xat or 1louse pro. cki&%lion teat
❑ YON ❑ No ❑ Viyuel inspection of Duct Connuolionv • ❑ • ❑
Pass Fail
THERIVIOSTAM EXPANSION VALVE (TXV)
)dy y ❑ No '1'he=oslaho Expaurion Valvo (or Commission approved
otluivalont) is installed and Acus -m; is provided for inVt notion [�
Ytsisapn` 1'a.. '.Pail
❑ DUCT DESIGN
1 • ❑ Yes ❑ No ACOA Manual 1)1)cnign oalaulations havo bcwn eomplatud, '
Duct lksign is on Iho plans and duel installation mntchos
plank.
2. ® Yon ❑ No TXV 6 installed or Fan flow hors boort verdied, If no TXV,
voriliud fan flow matchm; do::ign from CF -I IL
Mcmurod Fan Flow,=
❑ ❑
Yea for bulb 1 turd 2 u It fans Pass FII
❑ I, Iho undarsigavd, vvzily unit tho aboyo diaguofittc tUyt fomIts and 1hr, work I perti►nned amociatcd with the 1aRt(s) is in
conformance with the requiromenta lire complianu: urodit. ('!'ho builder shall provide Ilio I MRS proviclur n raspy of Iho CF -6R
AV-u%xI by the buildc:t' curployoas or nub-dontractory ocrtilying that diagnuslio uhsting and inistallalion otuul the rogouuiuuntx li►r
compliance endit.J
_ r
I'csts Signaturu, Data Imctalling Subcontraotor (Co. Namo) OR
Performed Goiacral Contractor (Co. Name)
COPY '1'O: lluildinl Mpartmornt
111;113 I'rovidar (il'applicablc)
Building Ovmex• ut Occupal)cy
January 4, 2001
City, of La Quinta
Building and Safety Department -OFrti
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 fol%wing:
BUILDING ADDRESS: 44-365 MONTICELLO AVENUE
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 0202-040
Occupancy Group: R-3 Type of Construction: VN Land Use Zone: R/L
Owner of Building: CENTURY CROWELL COMM.
7
Building Official
1
Address: 1535 SO. "D" STREET STE #200.
City: SAN BERNARDINO CA. 92408
By: 'GARY SHOWALTER
Date: 08/09/02
.POST IN A CONSPICUOUS PLACE