0202-076 (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
"11413 B 1 OM 1 /G.
Date ''' ` %t 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). .
() 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.
Sc(') I have and will maintain workers' compensation insurance, as required by
ion 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: ^4 r'„ /r,, 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.
i .
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 z:
application. r,
1. Each person upon whose behalf this application is made & each person rat
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 employee)
2. Any permit issued as a result of this application becomes null and void ii
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 i
correct. I agree to comply with all City, and State laws relating to the buildin
construction, and hereby authorize representatives of this City to enter upo
the above-mentioned property for inspection purposes. i r
Signature (Owner/Agent) �...r-K ' / > {',f�a Date
BUILDING PERMIT PERMIT#
DATE VALUATION LOT `- t{�B TRACT
)/ q y ,r�ry
JOB SITED' '/ "
APN
ADDRESS
4- QNTIC 1..LQ AVENUE
OWNER,'
CONTRACTOR / DESIGNER ENGINEER
CWyURb bqVi♦C4WOyllg
1,,
wiL'JWAY COhFI....'L C0 fVMAIM
$ X`, It? VRML �I l200
1535 30, 11V 8700.1A 11. M-100
1w, T P, V21 N A�lx M CA 92409
RM SEAMMI)INO CA P2406
381 ,00V) MIN, 21M)
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USE OF PERMIT
:,'�"%�Ca�l✓ T+,A;`�'51..'3f' ^3:�t�,',1.''.:I.;�lr,'f.�TC
SIF0 T.1X)T Sri. MC?NTIC>ELLO 13i.,ANI 4Kk P.Kli;.R. VT DOM' 140T
3Nt"1,UDE D11OCK WAI.,W. Pt 01APA OR DRIVENVA'ti?'A1•°i*i1.c�,C9 'W.
TACT C ONS'T`R ld:`X'1014 Z6,50.00 £P
PO'C`eI A TIO 63.0099 ISP
iSY1Y.'!.AV.Mtli3'S5"'rJl4T 00 FdF
COA:J` RCICTION T U I W _000418.0150 19..00
PLAN CIM -K, ME 1101-000 4 39-318
MMMY1r ., rME M-000-421-000 SS
MEX,'TRICAL F221, 101 -000420 -WO $153.33
.
PMB510tS 101. 00.419-000 i1,I12,00
S`T'f..f NO..MOTION F -Ely,, d RESID 101 -CU42AI-000 415,66 .
0M13T11PO FU F. 101.000.42 3-000 $20.00
ne {
1
;1.1
.110M AND PLAN* CHECK
IMM XaT\RAI?AD FMS
$D, DID
a^ �a �q �y�sy !11 `,1�v 4 ., �•� y p�,� pnp
n j TOTAL d`9L .S R'sY MIT MES D •LA ' 17 �J V�
t
g� J55
WYOFLARIVANCE
RECEIPT
DATE %=
EW.�� f
DATE FINALED
INSPEC
111X)
0
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air —
Steelz
Combustion Air
Roof Deck A, J
— _ z
Exhaust Fans
O.K. to Wrap
— Z
F.A.U.
Framing
_
Compressor
Insulation
f —
Vents
Fireplace P.L.
Z
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
9 —
Final — d
Final
_ —
POOLS - SPAS
BLOCKWALL APPROVALS
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
7 — , z
Heater Final
Water Piping
_9
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
i
Final
COMMENTS:
z
Final
-
Utility Notice (Gas)
u
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
— —2,
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
_
GY.1.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
Q�
Installation Certificate: Residential CF -6R
Site Address PERMIT #
44-660 Monticello Avenue
1. BUILDER INFORMATION SUBDIVISION: Heritage
Century Homes CITY: La Quinta
1535 South D St. #200 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 86% 66000
4. COOLING INFORMATION.
COOLING MANUFACT COMPRESSOR ACTUAL EFF. COOLING EQUIP COOLING
EQUIP. MAKE MODEL # SEER CAPACITY LOAD
A/C Lennox 12ACB42 12
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. SUBMITTEDD BY
- n
Signature Installing HVAC Contractor
DATE: —0
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a�
iwit/ vii ut:4a rad
v R
INSULATION CERTIFICATE'
10007/014
This is to certify that insulation has been installed In conformance with the current energy
r
regulation, Cslifonnia Administrative Code, Title 24, State of California, in the building located at:
44.660 Monticello Avenue, Lot 39 Monticello -Heritage, La Qulnta, California
s CEILINGS:
TYPE. BLOW MANUFACTURER: Certainteed Thickness: R-38
WALLS:
P TYPE: BAITS MANUFACTURER: Certainteed Thickness: R-13
GENE CONT TOR: CENTURY CROWELL COMMIINITITES LICENSE #�
BY: TITLE: 1j-
PARAGON SCHMID 51.1ILDING PRODUCTS, A MASCO COMPANY _LICENSE # 632072
TITLE: ADMINISTRATIVE ASSISTANT DATE: 12/12/2002
1
�..r..r:i•.I./:.^//r'..;rl.y�.,�.wr.,,.wi+Nl•lNYlre:.i•/ rrlF!/Y/.rY/l:lr•riFif//!.%J/'I:rl:•Na;•//I•%!/,i IN.//I./J//•'dll..N1:`iwy :%J'/N.%!/.'V;i/�NI,.ri%%it /.'%fi7lry,Ill%O�•lir:j.
Jan 29 02 11:37a Richard Simpson 661 947-6869 p.4
INSTALLATION CERTIFICATE (Page 3 of 8) CF -6R
/2ad&V(j djmoi 710 24- -2_
SWAddYas Permit rqumbtr
DUCT LEAKAGE AND DESIGN DIAGNOSTICS
DUCT LEAKAGE REDUCTION
PFc%surivalion Test RcsulLr (CTM fal 25 PA) e
Tent l.cakagc (CTM)
Ilan Flow
If Iran Flaw in Caloula W as 400 oftn/ton x nummbor of to" or as 21.7 x f Icahn& (rapacity —
in Thomand.l of Olutbr. oinlor caloulatodl valuo hero oo
If fan flow IN manind W, enter mcasurud value huru
Lookago lrraotion - Tohl Loakago/(Nlomund or Calculated lean flow) - �j.. d°I
Pais if loakagu fraction S 0.06
El For AEROSOL TYPE SEALANTS ONLY -The following diagnostic testing was completed:
[)no[ Tan Prassuriiation at naugh-in mcasutud leakage (CTM)
CHECK AFTER FINISHING WALL:
❑ yes ❑ No ❑ Pwux-cru pan I" or I louw proxsu&.ation ii a
❑ Ycs ❑ No ❑ Visual lnspaction of Mat Connections
® THERMOSTATIC EXPANSION VALVE (TXV)
® Ycs❑ No 1. 6)=oAatio Expanhion Valvo (or Commission approved
oquivalont) in installed and Acu"44 is prvvidod I'vr hwpoolion
Yw is a pass
❑ DUCT OF -516M
1. ❑ Yes ❑ No ACOA Manual 1) Design calculations havo been complutud,
Dual MAP is on ibo plans and duct installalion malchot4
plans.
2. ❑ Yea ❑ No TXV is installed or Ftm flow box bean voril'iod. If no TXV,
verified fan flow matches diwign fiorn C11-1IL
Mcasumd Fan Flow =
Yen for both 1 and 2 ire a Pans
❑
Pass Dail
❑.
❑
Pass Fail
❑ ❑
Pass Fail
® 1, tho undwsignud, rarity that tho abovo diagllofitiV W,;t f9imlis and ibp work I porfiirmcd amociatud with the tants) in in
cutArmaaco with tho mquirouwnts lire complianue owdit_ IThu buildur shall pwvido dao I IIiR3 pmvidur a copy ol'thu Car -GR '
sigu%W by iho buildorcu►ploya s or sub-oontractorr coma *g that diagnu liu testing and installation muoi Iho lruquiminenLs RIO -
compliance credit.]
"14,11 nk
17 200?
Tcx1s;. Signature, Uatc Installing Subcontractor (0. Namo) OR '
Pcrlurmud Gcopra) Contactor (Co. Name)
COPY TO: ' fluilding Departmonl
111:11311roAdor (if applicable)
Building Owner at Occupancy ,
January 4, 2001
F t Ptae. ..
Uact
T,!Duct 'Testing Lot's
Certificati®n Form. .
System '®f L`
'(One form per system) ,
Builder Name:
Project Name:
Builder Field Contact: S Telephone No. • .
HVAC Company Nam_ e: ✓ '✓�l t.
HVAC, Installer: , _ Telephone No.
t
` - -
Self!
Certifier' Results=
Duct Leakage Measured @ 25 PA • ' £' _ CFM ;
Indicate the maximum'allowable Duct Leakage and the calculation method used. '
L x
❑ =0.7 x Aaoor x (0.06)'f6r Climate'Zone 8 through 15 - CFM
❑ 0:5 x Anoor x (0.06) for Climate Zone 1 through ,7 &16 ' r CFM
400 x (Cooling Capacity in Tons) x (0.06) ` r CFM ,
❑ 21:7 x (Heating Capacity in Thousa_ nds,of output yBTU per hour) x (0.06) CFM,,
Print Name "Signature' t y Date
! f �
fOccupan' o
Certificate
.Cit of La Quinta F
Building and Safety Department c�MoF,o
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: 44-660 MONTICELLO AVE.
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 03202-076
Occupancy Group: R/3 Type of Construction: V/N Land Use Zone: R/L
Owner of Building: CENTURY CROWELL COMM.
Building- Official, /
Address: 1535 SO. "D" STREET, STE # 200
City: SAN BERNARDINO CA.92408
By: GARY SHOWALTER
Date: 08/15/02
POST IN A CONSPICUOUS PLACE