0202-041 (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
71.4188 D _ 10131 d0:.
Datet"�? ff�`
IV 7 Signature of Contractor
P -
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).
O I,am exempt under Section B&P.C. for this reason
Date Signature of Owner
WORKER'S COMPENSATION DECLARATION 4
1 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.
(IA), 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:
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 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 ,. a P /:r 7 Applicant .�'�> .► , � e `�`
..r7 /"' W ._.
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall spbject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon.whose behalf this application•is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a resultof this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection purposes.
Signature (Owner/Agent)�1�}'�% Datefrr��
BUILDING PERMIT PERMIT #
DATE VALUATION LOT ft.cifi. TRACT
N 241sad-
JOB SITE
ADDRESS
APN
OWNER
CONTRACTOR / DESIGNER / EN INEER
Cl♦.:i' 'i.TRY C: J�. ;.{WGY�,�x,�x%ILa+i�iT '$
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�tg�s5�(i?t
1.5515 so, W�E A.71�.5:,..L g u��:s:i, `/tf?��1dr
•��?�t�tti�CyT��il]
'� .�j 3� �)�,. !�n �d.5u!�w:A,a t7,'!Il'..5::ri �7'�?✓�1
�� 3�•$,i'N,t�i.4��:7�.& O CA 9240
i3Sv
e ;F? Ii � %� 7 i f`r MOS
(!?()9)381.6007 0_:L", 212,0
USE OF PERMIT
SY0 - LOT 32, PLAN 3a;, PFRMiT 3:kOPS NOT MICL:l.tM 8i ICK WALL,
P004 DRIVEWAY APPROACH; (P LAX C"t04K.' PEK R$a17i3M hDPI
MUL'i'EM' ISSUANCE OF SAME KAN TYPE)
TRACT CONSTRUCTION 1,W9,00 Slr
Pe;,RCWPk' .710 91.00 SIF
K%ARAOUCARPORT 913.00 SP
�CS?1r'�'Or C°�.s1�8":01CO�:'�_ION
10.1110.79.69
ryry��yy,� �• yyy��g� �y.1�:.y�!�i9Y
EIRM' M 13 0.i3,Y.f�P�.GS- ,L
CtaNS`!'RUCT1ON PER 101.000-418«000 $1553.so
PLAN CHECK rIEE
mEIvHA1•d1m P£;iEk U0.0
ZLBE'l WC,.AL 11.91E, 101 -000-420-100 S1t 171�t4
V 31Mbi1 a PID s'° 101 *0€}0-419a006.,
TP,0 CHk46,r1.iapsLr1ZF 31 X05 -0a0-241-0061
1 S� I �04Q- at90f�`: .04
CR Al INQ I R JU-'r
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i� i7i.t31=Ed+ IPd1Y�:9C"i FE, `�"
FEB ® 7 2002. ({� `
+
il OR, 00
Sim4C1'1'i L CQNS`3`it.UCTl:ON AND ?Y -AIT Cum' c
.t�i.p.; :, �...r� ,r�TLJ ...1•:�.a3
t�+U. i)�
b:. ?k431'AL PEPUMS.V M n'N DUR. i
&1, 03. 4,.t.9"t
RECEIPT
DATE /
BY ` �,a
DAT FIN ED `
INSPECT
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms &Footings
— _Z
Ductszr".r-�.,
Slab Grade
_Z
Return Air -'�`�
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
Z
F.A.U.
Framing
_ l— 2
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
6M7Condensate
Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. LathaL
Final Cj2
Final V _
BLOCKWALL APPROVALS
POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings
— 2
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
_
CJ "-I/
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Af — 3 — Z
Encapsulation
Gas Piping
_
_
Gas Test
Appliances
_
Final
Final. e
Utility Notice (Gas) --GS
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring �L
Low Voltage Wiring
Fixtures
Main Service
-Sub Panels
Exterior Receptacles _
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm) Lj
COMMENTS:
Installation Certificate: Residential
Site Address
44-395 Monticello Avenue
1. BUILDER INFORMATION
Century Homes
1535 South D St. #200
San Bernardino, CA 92408
CF -6R.
PERMIT #
SUBDIVISION: Classics
CITY: La Quinta
COUNTY: Riverside
INSTALLING CONTRACTOR: WEST PAC AIR CONDITIONING
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
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
4. COOLING INFORMATION
COOLING
MANUFACT
COMPRESSOR
EQUIP.
MAKE
MODEL #
A/C
Lennox
12ACB60
80 % 100000
80%
ACTUAL EFF. COOLING EQUIP
SEER . CAPACITY
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
Signature Installing HVAC Contractor
DATE: IA- ) 6-V%-
Jan 29 02 11:37a. Richard Simpson 661 947-6889
INSTALLATION CERTIFICATE (Page 3 of 8)
ct '{ �Z (;Laf /c s I . .
•ite Addreti+qy y-3 7'� FermitNumber
S NJo�vTCa//o
pHi4s� DUCT LEAKAGE AND D ESYCN DIAGNOSTICS
Q DUCT LEAKAGE REDUC71ON
Pressuricalion'rcccl Rcsuhy ((.'I'M (x12.5 PA)
Ted l.cakagc (CFM)
Van flow
If Fan flow is Caloulatod m 4M ofw/ton x iaumbor of tous, or as 21.7.x I loaling (.apaoity
in Thouaands of OlAr. Color oaloidatod value horn
If fan flow is measurcxl, curter mu -m unttl value hen; 7_004
Loakago Fraotion ='Cost Loakaga(Moaaured or (:aloalatod Fan flow)
Pari if lonkag0 ftauliou 5 0.06
❑ For AEROSOL TYPE SEALANTS ONLY -The following diagnoatle tevting was completed:'
Duct Iran Prcacsuriiatiou al rough -in measurc d Icekage (CFM) .
CHECK AF'I•ER FINISHING WALL:
❑ Yes ❑ No ❑ 1'rc t4vM pan ICA or 11011%0 prossurivntion 10.91 `
❑ Yo,,; ❑ No ❑ Visual Inspection of Duct Connuclionv
P.,
CF -6R
A ❑
Pass Fail
❑ ❑
Pass Fail
THERMOSTATIC EXPANSION VALVE (TXV)
Thatnlo::latia Expao,iot, Valvo (or Cort mission approved
xy equivalent) is inmallod and Acccws is provided for in j)-axtion [�
Yum i.. a paaN 1` 'as: fail
❑ DUCT DESIGN
1 • ❑ Yrs ❑ No ACOA Manual 1) Iksign calculations have boun eomploled,
Duct,lk-sign & on tho plans and duct inslallalion ulalohcw '
plans.
2. ® yen [j No TXV is ®stalled or Fan flow 11x% bmi voriliod. [Cup TXV,
veriflud fan flow nlatchoz dtwign from Cl'=1IL
Measured Fan Flow =
Yes Ibr both 1 and 2 is a Pam Pass Fail
❑ 1, Iho undcrsijwi d, vurify that Iho abovo diaguoslk tint rcewltm and tiro work I perfi>nrrcd w-sociatud with the tcm(w) is in
eonformAnw with the mquiromcnts lbr compliance cmdit. I'fhq builder shall provido Uro I i1:RS provider It copy o1' Iho CF -GR
Kiguvd by the builder ctuplorypen or mb-oontractors certifying that diaguo.lio lusting and fiLmallation moot the roclaimmunis Ibr
compliance cmdit. J
AA
lusts Siguaturo, l ate Installing Subeontraotor ((.1o. Name) OR
Perlbrrncd General Contmotor (Co. Name)
COPY TU: BuildirrE l)opnrtinoul
1113R5 Pro,%ridcr (il•applicabic)
Building Owner- tit OCCuT;ioncv
January 4, 2001
. + Tract #
Duct. Testing ,. Lot H,-sCIZ
•
Certification'* Form
System f of
(One form per system)
Builder'Name:
�av
Project Name: L° OSf��.S^.
-Builder Field Contact: Telephone -No.,
1 t
HVAC Company Name: C' I.qf'
HVAC Installer:Telephone No.
1 Self -Certifier Results
Duct Leakage Measured @ 25 PA CFM
Indicate: the maximum allowable Duct Leakage and the calculation method used. ,
0.7 x An,,r x (0.06 )for Climate Zone 8 through 15 CFM
0 0.5 x Atloor' x (0.06) for Climate.Zone 1 through 7 & 16 • CFM
4001x (Cooling Capacity in Tons) x(0,06) ZG CFM
a .
01 21.7 x (Heating Capacity in Thousands of output per ho ) x'(0.06), '' CFM.'
Print Name Lgignafure. Date
R -
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. comp/lance with the various ordinances
of the City regulating building construction or use. For the following:
BUILDING ADDRESS:. 44-395 MONTICELLO AVENUE
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 0202-041
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
Building Official
POST IN A CONSPICUOUS PLACE