0202-077 (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
9#A 7
r 37Y [� j :tC27rLic. Class Ex/p1 . �DySaVtte
s°�;PjDate^�Sinature of Contractor • ?" .f,
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%�J!yCAq
s
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). t
() 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.
"Q') 1 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.
GOLM VWU IMS, ltitiiV •5d4Q iG0
(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.1 should become
subject to the workers' compensation provisions of Section 3700 of the Labor
Code, I shall forthwith comply with those.pr•ovlsions^
Date.=7 �fi t`it� • Applicant—,
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director.of Building and Safety
for a permit . subject to the conditions and restrictions. set forth on 'his a
application. T
1. Each person upon whose behalf this application -is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify'
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as•a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for' 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is,.
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon ,
the above-mentioned property -for inspection purposes. /
Signature (Owner/Agent) 7�' � '� !�lf� `* Date�+✓4 •'�''{'�=
- ;
BUILDING, PERMIT PERMTk
DATE VALUATION LOT Wla.1i^077 TRACT
�s'I A
JOB SITE •
APN
ADDRESS
^��•-�+.� li'.F.�:.`7.Y,d+,.�NF,eM.A�e �Q�i�r�,��.
'���-�r•��S
OWNER,
CONTRACTOR/DESIGNER/ENGINEER rr
P
CF -MI.I'" Y c"kow_r .i, CON"(T.t NRIS
C'',EVAMY C ROWELL dOIN iVAUM, 8
15351 so, 617 SIRES ME 42.00
1535110/ °,a" Urm, "�,115M #200 - • y.
%AN 131?.MA1't1 WO CA 9?.. 08
RAN i�t'NJI?,RDWO CA 92408. t
(909)81.6001 C_'f Vf1 21201
A_
USE OF PERMIT
'
aE~p,) - Lar 40. 1A02`rTX'% t.,0110�&l't', IUR, PLAN :1:6Ik1KV, k EEKIT DO S-
NOT MUID,11 SLAXY TYALM POsJVOPAOR OWMAY APPROACH. KAN ..
C°'riFWK FEX X%D1.f FZ F09 MULTIP=P: t I ;S'tYA fCP OF MUS; PLAN TYPE. '
TRACT CONSTRUCTION SF
Pani WP A.TIO 29.00 SP
CARAGWAiP1;3RT 6.210 t 0IF
•
:]t$�j� MA ''D (.'Dh-r UP Li�A�i�"15.2ZUC.r10X
�.�.��,910 20
.�4q.� YY �•11�y✓y�1p ^j'�}¢
gy�r6 (b'y,
COM'EPtUCTIOZdI�'�.�,'� !QI-t00-43>S-ON9g,f39
KAN CHECK FRE 101-000-439.318. j<f64),1I
MECHANICAL VEM 101-000-,421.000
XUr,TR4CAL PEE 101-000-420-000
AX
PLklMBINQ FEE 101-000,419-000 WAX
SY'Fwr)WG MOTION FEE, - R SSID 101-000-2A• 3 -000 $13.29.
CIRAD 1+13 FES;. 101.000.423>000 $20.00
- — ..•....
, _.
" _ .. J gJ T`ic 9,t Nf> PLAN' HM.
$3,1'77.03
$0.00
FEB 14
Cny0FLAQu1KFA i
d - r•
•
RECEIPT
DAT�%!
By.,
DATE FINALED
INSPECTOR
,7. 1y
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
-55 - z—
Underground Ducts
Forms 8 Footings
— y
Ducts
Slab Grade
. _ ?iA44
Return Air
Steel
— Z
Combustion Air
Roof Deck
- /7- Z
Exhaust Fans
0. K. to Wrap
— p —
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
_
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
- --
Final
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
—1
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
_
C,
Encapsulation
Gas Piping
Gas Test
_
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring =� _p•
Low Voltage Wiring
Fixtures
Main Service
Sub Panels,
Exterior Receptacles
G.F.I. _
Smoke Detectors
Temp. Use of Power
Final �Oz
Utility Notice (Perm)
COMMENTS: 014iI F,,7N-7 3/5/2
1313 ol<--
Installation Certificate: Residential CF -6R '
Site Address PERMIT #
44-630 Monticello Avenue
1. BUILDER INFORMATION SUBDIVISION: Heritage
Century Homes CITY: La Quinta
1535 South D St. 4200 COUNTY: Riverside
San Bernardino, CA 92408
INSTALLING CONTRACTOR: WEST PAC AIR CONDITIONING
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
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
G40UH-36A-070X
80%
66000
4. COOLING INFORMATION
COOLING MANUFACT
COMPRESSOR
ACTUAL EFF.
COOLING EQUIP
COOLING
EQUIP. MAKE.
MODEL #
SEER
CAPACITY
LOAD
A/C Lennox
12ACB36
12
12ACB30
10
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 B -
" DATE:
Signature Installing HVAC Contractor
IN ION CERTIFICATE
This is to certify that insulation has been installed in conformance with the current energy
regulation, California Administrative Code, Title 24, State of California, in the building located at:
f
44-630 Monticello Avenue, Lot 40, Monticello -Heritage, La Quinta, California
s
F CEILINGS:
TYPE BLOW MANUFACTURER: CERTAINTEED THICKNESS: R-38
r
WALLS;
TYPE, BATT$ MANUFACTURER: CERTAINTEED
THICKNESS: R-13
GENE CONT CTOR: CENTURY CIROWELL COMMUNITIES LICENSE #
2 BY: TITLE:r
PARAGON SCHMID BUILDING PRODUCTS, A MASCO COMPANY ucEnIRE tt on2n7-2
A
B TITLE: ADMINISTRATIVE ASSISTANT DATE: 12/12/2002
Jan 29 02 11:37a Richard Simpson
INSTALLATION CERTIFICATE
661 947-6889
0 2 a k 2-
4' (i 50 MOO V I L CTi 1 l 0 ,i.� � (E a ca uu� a ivauuc�
DUCT LEAKAGE AND DESIGN DIAGNOSTICS
99 DUCT LEAKAGE REDUC710N
Prcwvurizalion'l'cit Rcsullti (CFM kil 21 PA)
'Cost I.cakagc (CFM) . `[
faa Flow
If I'an Flow in CaloulaW apt 4W ofwtton x nambor of tous, or aq 21.7 x I loafing Capaoity
in Thouainda of Utu/br. Opivr calotdatod valuo koro
If fan flow ix m=surcd, cmlcT mcasurcd valuu huru
LOakagO Fmlioa=Tcm I.aakagc/(MOavutod or'C:aloalatm Fan flow) n &09
pami if loakago lraolroa 50,116
❑ For A EROSOL TVP* SEALANTS ONLY - The following diagnostic teWing was completed:
Dull FUD Pressuriialiuu at rough -in mumurml lcakagc (CFM)
CHECK AH fER FINISHING WALL:
❑ Yes ❑ No ❑ Proto oro pan 16t or 1 leu.0 promurr/ation too
❑: Ycs ❑ No ❑ Visual Inspection of Duct Connuslioav
® THERMOSTATIC EXPANSION VALVE (TXV)
® Y,.q ❑ No '1'homlo"iAlio Expau+ion Valva (or Commission approved
Oquiv31011t) ix installai and Accems is providod for in.'•pix;tion
Yuw is a pass
❑ DUOT DESIGN
1' ® Y,'s ❑ No RCCA Manual D Iksign oaluulalions hnvu txx.n ewrnplulud, T
Duut Ik;Agn ki on lho plans and du(A fizi-allalion maloho.4
plans.
2. ®yap. ❑ No TXV is hiMalled or Fttn Ilow.hii,% boon vufiftvd. If no TXV,
varillud fan flow nlatchav dwdgu fiom C -I IL
Mcasurod Fan Flow =
p.4
CF -6R .
Y
❑
Pav:o .
Fail
❑
J
❑
PaSF
rail
❑
yam. Fail
❑ ❑
Yes for both I and 2 it; a I'Hss Pass Fail
® 1, tho undorsignul, yt y Ihut tho abovo diaguocliV MA fmlts and thr, work I pcifoniu:d associated with Ihu tenl(p) is in
Contbrwft=4 With tho ncqui tnantu tier compliance: urudiL (Tho buildur shall prpvido Ilia I MRS provider u copy ul' Iho CF -CR
AguW by the builelet• curph a s or sub-aontraotom curWi ing that dinguoglio t mtiug uuJ in.�lallation uWat Iho rugairumuul+ liar_
compliance credil.J
APR 1 7 2002
b_(ZIL-6 g
7'c to Signaturu, Uato 11MIAlUg Saboontraolof (Co. amo) flR
Pcrturmcd Uoncrat Contractor (Co. Namc) .
COPY TO: fluildinF l.)opartruoul
IIIRRS Provider (if appliicahlc)
Building Owner ut• OCcupoix!v
Utuary 4, 2001
t
Jan 29 OF 11:37a Richard Simpson 661.947-6889
p.4
INSTALLATION CERTIFICATE (Page 3 of 8)
CF -6R
b -f 116 .14.z_
Sift! Ad recdMGN1Y( yyermit umber -�3o �I�o Ave.a�� .
DUCT LEAKAGE AND DESIGN DIAGNOSTICS
DUCT LEAKAGE REDUCTION
Pressurization Tesl Rcsulls ((:FM (a) 25 PA)
'feel Leakage (CFM)
Fan Flow
If Ilia Flow is Caloulatod ns 01 olioo/ton s number of tons, or as 21.7.x 110ali ng C:apaoity
in Thouainda of Btu/hr. only caloulatod value bvro
If tan flow is mcasurud, enter measured value hum
Luokagc Frae lion ='fort Loakagolftasurud or (:aloulatctl Fan l+low) r T0
Pa\y if loakagu fraotiou 511.116
❑
Patin I+ail
❑ For AEROSOL TYPE SEALANTS ONLY -The following dlagnosdc testing was completed:
Duct luau Pressurvatiou at rough -in measuru i leakage (CFM)
CHECK AFTER FINISHING WALL:
❑ Yes ❑ No ❑ I►ro:trurc pan I" or I louse promli&ntion tl-1
❑ Yes ❑ No ❑ Visual Inspection of Duct Connuelions
❑ ❑
Pass Tail
THERMOSTATIC EXPANSION VALVE (TXV)
Ya: ❑
NO l'1►4)tnloslaGo Expansion Valva (car Commission approved,
oquivalont) is installo i and Acwxis 6 providod for inspection ❑
Yuw is it pass &%N. fail
❑ DUCT RESIQN
1. ❑ Yom ❑ No ACOA Manual D Design calculations have been complutud,
Ducri Ik;sign is on Iho plans and duct imiallalion malchos
plana.
2. ❑ Ycs El No TXV is installed or Ftm flow huff bawa vutidiud, If no TXV,
vcriliud fun flow motcho•: domign from CF -11L
Mcmurod Fan Flow`:_
Ycs Ibr both 1 and 2 ir: a Parry Pass Fail
® 1, (ho undorsigncd, vewily that the abovo diagnostic ta;rl rorsults and thq work I perforruLd. associated with the teats) is in
cunfornitmw With 1114) mqui emente Ibr compliance orudit. )Tho builder shall provide the I UiRS providur a copy 4)l' Iho CFV R
.,igu%:d by tho builder eu►ployocs orsub-contractors coat ing that diagnoalio testing and imstallation mow the ruquirurnunt, liar
compliance crudd.l
11PP 1 7 2002
C
Tc%IN Silutatum, Date Itwtalling' Subcaatraotor (Co. Name) OR
Pcrformcd (Wacm) Contractor (Co. Namc)
COPY '1'U: Building Departrno,it
HERS Providaar (il'applicabic)
Building Ownev at Occuvancy
January a, 2001
30 Moa i tc.�
Tr'act #
®iict Testing : ' Lbt# f O
Certification Form
r :.Systerrr ®iZ'
(orie form per system) �
L _ Builder Name: � � _
Project Name: ...e i--1 r
Builder Field Contact:Telephone No.
.+
HVAC Company Name: r `
HVAC Installer: Telephone No: —7;�7/
-• '_'Self' Pert1fier Results • . +. • ,. '_ ;
Duct Leakage Measured @ 25 PA _ CFM -
Indicate the maximum allowable Duct Leakage and the calculation method used
❑ 0.7 x An.,,, x (0.06) for Climate Zone -8 through 15 CFM'..,,,
O 0.5 x Aaoor x (0.06) for Climate Zone 1 through 7. &16 `' : t I + CFM
400 x(Cooling Capacity in Tons) x (0.06) ' = "' �(�. , CFM h'
❑ 21.7 x (Heating Capacity in Thousands of output BTU per hour) x (0:06) : CFM.,.
Print Name ,: T " Signature -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 compliance with the various ordinances
of the City regulating building construction or use. For the following:
BUILDING ADDRESS: 44-630 MONTICELLO AVE.
Use Classification: SINGLE FAMILY DWELLING
Occupancy Group: R/3 Type of Construction:
Bldg. Permit No.: 03202-077
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
Il POST IN A CONSPICUOUS PLACE