0202-042 (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 '
714108 1.3 10/31Ar,
Date ' /-7 /+� 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). <
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
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.
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.
COLDEN #FACILE INS. WWC.-544069•,13
(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: -'s /—, ,fin '7 Applicant-
17-7
pplicant �" -` i i .•1,� /.
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code' interest and attorney's'fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers; agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection purposes. l3
� l
Signature (Owner/Agent) '�, 5'fi.rr`.� Date's .�r}+�`ol.
t PERMIT#
BUILDING PERMIT
DATE ! VALUATION LOT TRACT
JOB SITE
ADDRESS 44-42$ M0iv=0.=X0 AWKi,
APN
i� • i ' Qa`D13
OWNER
CONTRACTOR / DESIGNER / ENGINEER
2NTURY C'ROWTUL C'ONI1ViM-01T ffs
Mrruay c R.0WkaLL COWIIV Urwims
1535 ,30. Tn URM sTZ 420.0
`; $1Q1NA1RlX1,TO CA 914(}8
SAMBMW' I 190 CA. 924.08
(909).381.6007 MUM 2120
USE OF PERMIT
sm . I m 53, PIAN VXHRXV, F1pMT #SOV; NOT ,1+I0,U0Z isl.Da'wY.
WDA"U, POO.I, ..1*3k[Vf,'W.,,k tiPPROAC"1'1, (PLAN CHR X FEF 1'.J IDUCED FOR!
MtDUIP'IX ISSU.ANC ? OP SAME MAN TYPE)
li!#f �' C C1A1 ti I21 1'lf? 2,(t33.f,4 OF
PORCG ,it'PATIO 1'1.On SF
GAR A,WC...UPORT 417,0I1.18
IMMIX= C OSE OF f„ C?id&r'1C MC.I10N
1 191011SM ,
nal %, rvxr, sum -MARY
CONSIT4RUCT106F, )01-000-416.000 $X101M
;V:f,J'wC11,0K FFE 9fa2-f tX9«x _31 $141,17
Ar1UCHAKit"A,iy ME 101-00 0-421-000 tan
91., W, RtC.AL?T.2" ° 101-000.42.0-000
"L11 %T1a4 ' Fw V ' i 101 -000-419-OW %;4&$0
,
STRONG MOTION FEW RE31Z) 107-000-241-000
OR:ADY00 pe
F 1 0 7 2002
y
:lOB-'LTY .' .: SnTAI C 'AND PLkV i CHF:, t
TMAL E.LY55.�° �'I+. °S.�i W.�: .LSV Ai'YM
RECEIPT
DATE iI /
BY r
DAT INA ED
2-
JINSPECTOR (\�
r -�J
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
— ,_ Z
Underground Ducts
Forms & Footings
—
Ducts
Slab Grade
'y —
Return Air
ej
Steel
_
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
, �/ _ �_
Compressor
Insulation
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
/
Drywall - Int. Lath
—�
Final
Final
- —
POOLS - SPAS
BLOCKWALL
APPROVALS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
_ /3 — Z
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
I I
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
3 •—j— 2
Heater Final
Water Piping
Plumbing Top Out
"
Plumbing Final
Equipment Enclosure
Shower Pans
r„
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection ;
-- _7
Encapsulation
Gas Piping
Gas Test
_
Appliances
_
Final
COMMENTS:
Final �j—
Utility Notice (Gas) / o
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring— Z
Low Voltage Wiring
_
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp, Use of Power
Final
Utility Notice (Perm) r '�
Installation Certificate: Residential CF -6R
Site Address PERMIT #
44-425 Monticello Avenue
1. BUILDER INFORMATION
Century Homes
1535 South D St. #200
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
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
Signature Installing HVAC Contractor
DATE: )ot 8 -0 -L-
W
-0- -
W
• _ • . yy� y_�MQ�jG� :ifs .�v� ,
;. Tract # •
` . Duct Testing®tV # ' .33 p�4s
•.�• r< Cerfificati®n f6rm 6
System ofd
•- r' -
• (One form per system)
Builder Name: .i
Project Name;
Builder*Field Contact: ' , Telephone No. '
HVAC Company Name: C ,
HVAC Installer: Telephone No. bAq
t e
Self-Certifier Results,.�r • .
Duct Leakage Measured CFM
@ 25 PA
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 Atloor- x (0.06)' for`Climate Zone' 1 through 7 & 16 ' CFM
XK400 x (Cooling Capacity in Tons) x (0106) ? ti 12-0 CFM =
❑.. 21.7 x (Heating Capacity, in Thousands of output l4•-per hour) x (0.06 a CFM
t
Print Name Signatur _ Date
Jan 29 02 11:37a Richard Simpson 661 347-6889
INSTALLATION CERTIFICATE. (Page 3 of 8) -
S
Permit Number ite Addms
DUCT LEAKAGE AND DIESIGN-DIAGNOSTICS
P[ _DUCT LEAKAGE REDUCTION
Pres.4urizalionTest Results (CFM Q 25 PA)
'1*6st l,cala.gc (CFM)
Fnd flow
If Fnn Flow iv Caloulatod. as 41x1 ofkatton x number of ions, or as 21.7.x I looting Capaoity
in Thousands of Of u1br. eater oalculatod value hero
If fan [low is mcamurud, onfLT measured value hum '6040 0
Ilookage Fraction =Tc -sl Leakngo/(Momurcd of Cploulatc'd Van Flow) 0 -0
Pam ifloakogo fraotiou5 0.116
For AEROSOL TYPE SEALANTS ONLY -The following diagnoxtic testing ivzs completed:
Duel
o mpleted.-
Duol Fan I'vassurization at rough -in ammmu" Idakage (CFM)
CHECK AFTER FINISHING WALL -
El Yes 13 No 0 Ilre&%uro pan I" or I lou%o pm.,mirizalion test
❑ Yds ❑ No ❑ Visual Inspection of Duct Connuotiorm
P.4
CF -6R
0 0
Pass Fail
THERMOSTAInk EXPANSION VALVE (TXV)
Y�N C] NO Expan4oft Valvc, (or Commission approved
equivalont) is instHlIed and A=-mLs provided for inV.xfi*n ❑
YW is a p"% /,W"" Fail
❑ ourT DESIGN
.0 Yos 0 No ACCA Manual 1) MAgn calculations have bum completed,
Duct DcAgn i4 on tho plans and duel in:lallalion ninicho.4
plan.,;.
2. 0 yen 13 No TXV ks installod or Fins flow hiv; bml Voriflod. If no TXV,
veriflud fan flow nintcho; dcwip from Cl -=1R..
Measurcd Fan Plow
0 0
YcH lbr both I imd 2 iN a llark4 Pass Fall
U 1, tho undersigned, vwity that the abovo diagnoslio test romlU and the work I performed amociatcd with the test(w) is in
conformsmw witb 1ho requirements Ibr compliance urudit. I'llo builder shall provido Uro I MRS petwidur u wpy of Tho CF -OR.
idgu%:d by the builder cuiploycon or sub-contraotor-4 ccv!.Hying that diaga"101 Lusting and imKieffalion OW01 the roquimineak- 1kir
complianuc credit.]
/C
Z 7
TCOR Signaturu, Date 1>Latalling SuItcoMraotor (Co. Name) OR
Purl'ormed 6cueral Contractor (Co. Nzane)
COPY'1'0. Building Depuffineat
111IRS Provider (il'applicab1c)
Building ovmer. ut ocmaupoiicy
January 4, 2001
S
Certificate of Occupancy
City of La-.Qu'inta
Ruilrlinir and Cafaty I]anarfmonf
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 regulatingbuilding construction or. use. For the following:
BUILDING ADDRESS: 44-425 MONTICELLO AVENUE
Y
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 0202-042
f 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
Building Official
City: SAN BERNARDINO CA. 92408
By: GARY SHOWALTER
Date: 08/09/02
POST IN A CONSPICUOUS PLACE
1 �