0202-078 (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
10/31%
Dater I "r jr 'Signature of Contractor 4i
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 I Signature of Owner
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
( ) I have and willmaintain 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.
(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�1s^ ? -Applicant h/�'
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 1
application.
1.* Each person upon whose behalf this application is made & each person at :r
whose request and for whose benefit work is performed under or pursuant to
f'ahy permit issued as a result of this applicaton agrees to, & shall, indemnify rl
& 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 1,
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 .•: ,t
the above-mentioned property for inspection purposes. a^1 r
�/ rJ <
Signature (Owner/Agent) � r� Date, +���. E,
BUILDING PERMIT PERMIT#
DATE VALUATION LOT),' TRACT
J013SIT
APN
ADDRESS
}Z) k-r40MICEM40 AVENUE
-0724M
OWNER
CONTRACTOR/DESIGNER/EN INEER
MMW� C AC)WX„L Cit,l.004LV .*U1,dA18,
%+MMYRr C1,1 bMF.. , Cq.rhOAT✓L /M1, -9
15.15 1C3. "DO `m�.i:''ei:.s:''r,
so, w -m >`I MY, 8"1M #200 ,
A*N[1tEVNAKYDT a CA 9'2408
IgM MYJ ARDIWO Cts 92406
ME ZA� 2120
USE OF PERMIT
SM w UX' 41. %t+4C,1NTICE1,Lr0 is1',a✓1lITAC H, Ned CC . AIWAIT
IWOLUDE KkC IC WALLS, POOLISPA 011 D.}t.IVrWAY APPROA:C111 1?I ,kt ;
CHECK YEF MDtJCZ0 FOR I ilLTl.VU? ISSUANCE OF SAME P3:AAN .C't�`I+✓,
TRAC7 CONSTRUCTION 2,40.00 SF
1?t�It.O"AlPATIO 5. SP
ttARA,.WCAR P41{.'1 U9.09 sp
. �.cM&L C:E�Tr0 CO_K91.€.01 R4CtiaN
983XM
COk°1 TRUCTI ag PP101-^000-4:18.000 SWO.00
PTIAV CHECK PEE loll 1100D-1.39-318 $165.28
MECk1.NOTC.A.L RE 101 i-000. 21 -OW
ULEC"1 WC'.:AL FIE;M 101-000-4M000 $144.38
t'im-ASPA 0FEE, 101 -000,419 -MO $1410
"i 1 ONCI MG+T1f:M FEC R .'113: tO 101.000.241-,000 $14.30
ORAD04G ME 1.411=WO-423,i,000 $20.00
!' EV'RE1:OPER 3A2P.P, I ME 1,9m oil
Y: S3 PRE -PAM F.MS
tAb13
F FES 14 2002 10TA. " to-w—""low
affOF Uk��a a
^
RECEIPT
DA r)E n
BY.,. C/
DATE FINALED
INSP R
C9 z
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS a.
MECHANICAL APPROVALS
Set Backs
3_5_,Z
Underground Ducts
Forms 8 Footings
13 - / - 21
Ducts
Slab Grade
— -2
Return Air
Steel
- z
Combustion Air
Roof Deck
-/ -
Exhaust Fans
O.K. to Wrap
g/- lze9- P-1
F.A.U.
Framing
- — Z
Compressor
Insulation
Vents X lie,
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
-17
Final - , 02
Final
BLOCKWALL APPROVALS
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
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 - `p
Utility Notice (Perm) �// O
COMMENTS: 1.,--,411
Installation Certificate: Residential CF -6R
Site Address
44-600 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
PERMIT #
SUBDIVISION: Heritage
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 G40UH-48B-090X 80% 88000
4. COOLING'INFORMATION
COOLING
MANUFACT
EQUIP.
MAKE
A/C
Lennox
G40UH-36A-070X 80%
COMPRESSOR ACTUAL EFF
MODEL # SEER
12ACB42 12
66000
COOLING EQUIP
CAPACITY
COOLING
LOAD
12ACB36 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
�j ,
V 1 Q JA
h.",A�t!^.— DATE:
Signature Installing HVAC Contractor
10/17/2013 01:29 FAX 10008/014
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,
INSULATION CERTIFICATE
This is to certify that insulation has been installed in conformance with the current energy
regulation, California Administrative Code, Tide 24, State of California, in the building located at:
44-600 Monticello Avenue, Lot 41 Monticello-Heritage, La Qu nta, California
i ICE L� INGS: 5 y ^
TYPE: BLOW MANUFACTURER: Certaintead - Thickness: Rti38
s ,
r WALLS:
TYPE: BATTS MANUFACTURER:.Certainteed Thickness: RA 3
r
d GENE CON CTOR: CENTURY CROWELL COMIMUNITITES LICENSE # / /
BY: TITLE:/2�i
a
PARAGON SCHMID BUILDING PRODUCTS, A MASCO COMPANY LICENSE # 632072
_ TITLE: ADMINISTRATIVE ASSISTANT DATE: 12/12/2002
ryo•.•i•lrr.Y.•i/:»rw::vr.2'/;i•i•v.✓�i•J/R'N1:%1 i..•...m.yrrnvv.n•.rriw/;•rnslw.•.v�;r,x•7ilavlirii�riliPrJ.'s.;�r'.a�s:rviii:,�,n...sravi;.a.a.:nvwrnnr.�i ,..r-.•ri/rwii.vii•:
It- (o 0 (9 . M o rJ�r 1� c,zAt d `•A4 rC
Duct Testing.Lot
'd b Certi'ficati®n-Form
. System 0* for
r► .. < .r 4 • (One form per system)'
Builder Name: -•
Project Name: • .: r e V l 7
Builder Field Contact: • • Telephone No.
;.
HVAC Company Name:
HVAC Installer:
Telephone,
No.
M• - .. ♦ -
Fi
!
Self�,Certifier Results" y
Duct Leakage Measured @ 25 PA ` > , CFM
f F or r•
Indicate the maximum.allowable Duct Leakage and the calculation method used:,
0 0.7 x Afloor. x (0.06) for Climate•Zone 8 through •15 r CFM '•
❑ 0.5 k Anoor x (0.06) for Climate Zone 1 through 7 & 16 , ' .. y CFM '
400 x.(Cooling Capacity in,Tons) x (0.06) r r • CFM Y `
❑• • 21.7 x (Heating Capacity in Thousands of output BTU per hour)'?< (0.06) CFM
' Print Name " . Signature Date ,
,. _ •r ,
''7 +illfir.SJcthi[x!S7.'.!i$'tn4Y:J°aR:2�.:�ai4'SY3P_�iAirAb4—rha5:t,flfaSBAN'dRv^FmW.trsxSY.kl:nYrttxlFP:r2aGtr.R, +`:s•�:±'.,2:m�afm9xz'da .mrtex tl-,src,r'J��nrr�rwrax..m �.;va:f+a,mcsvu:,xrur_.•-, a2 r,r.;nle. vN sr..:,o
A
Jan 23 Oz 11:37a Richard Simpson 661 947.6889 p,4
INSTALLATION CERTIFICATE (Pa
gc3 of 8 CF-6R--
(0,V
F-6R(0,V 6
Site Adillms Permit Number
DUCT LEAKAGE AND DESIGN DIAGNOSTICS
DUCT LEAKAGE REDUCTION
Pnssuriialion Tcst Rcsulls (CTM (al 21 PA)
'fest Leakage (CFM) 01
Faa Nlow
If Fan Flow is Caloulatod as 4(1) oWton x number of'tous, or as 21.7.x lfoaling Capaoity
in Thou:candy of Ofu/hr, only caloulato d valuo hdro
If tan flow i -c mcarsurcd, cmlLr mcasunA valuo hum
I.uakago Fraotion —TO -11 I.oakagc((Mvaautcd or Caloulalcd Fan flow) —
. 1 as,� il'lunktcgu Irautiou 5 {1.116 � ElPaS4 Tail
❑ For A EROSOL TYPE SEALANTS ONLY.- The followlnR dfagnoatic tenting was completed:
Duct Tan Prusxuriralion at rough -in mc:asurcA leakage (CTM)
CHECK AFTER FINISHING WALL:
❑ Yet; ❑ No ❑ I'rc telae pan 1" or 11ou::u Pru.VurrZation tuXl
. ❑ Yas ❑ No ❑ Visual Inspoudan of Duct Cunnuulionx ❑ ❑
Pam 1''ad
THEMY10STATIC EXPANSION VALVE (TXV) -- — - --- — - -- --
Yw-4 ❑"No 1'hcxnlo:.lalio 1sxpanriou Valve (or Commission approved
oquivalont) is installed and Au:cxr; is provided for mspe:rion 0
YW 6 a pass Y ss Fait
❑ DUCT oESIGN
1' ❑ Yes ❑ Nu RCCA Manual D Dr -sign aalaulati,ons have beim eomplulud,
Ihmt IkAgrn is on lbo plans and duct installalion maloho;c
plans.
2.. ❑ Yox C1 No TXV is intitaNd or Ftm flow hus boon voriflud, If no TXV,
vorifiud dim flow malchee: deecign from CF-IIL
Mcasurod Fan Flow=
Yea fur bulb 1 and 2 it; a Par,% Pass Fall
❑ 1, lho undersigned, Yem(,y that tho abo'Vo dragw tic MA iwivlts and thr, work I perfornud amoclatcd with the: ick(4) L`7 in
conforntanco with the mquiromunie fur compliant: urudit_ 111<o builder shall provido Uro I MRS providur a copy of Iho CF -6R
sigusd by the builder employs s or sub-oontraolors vvrtifying that. diagnumio 1w:tiug and iastabilon nwut oho ruquirolnout. Aircompliance' e:rx;ttil. J -
APR 17 2002
Tests Sipaturo, Dato h0alling Subcontraotor ((:o. Namo) OR
Pcdurmad Gcjacral Contractor (Co. Name)
COPY TO: Building Deparhuoill
DIMS Provider (irappbaablc)
Building Owner irt. Occupancy
January 4, 2001
L
Certificate of occupancy
City of La. Ouinta
Building a Y pnd Safet De artment
}
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: 44-600 MONTICELLO AVE.
Use Classification: SINGLE�FAMILY DWELLING Bldg. Permit No.: 03202-078
Occupancy Group: R/3 Type of Construction: V/N 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:. 08/15/02
Building Official
I
POST IN A CONSPICUOUS PLACE I