0202-075 (SFD)LICENSED CONTRACTOR DECLARATION -
(.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
71,413-9 B '-- � � 10rl3/0"2
Dater; `� fi�Signature of Contractor��°�f
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.
:(w j I have and will maintain workers' compensation insurance, as required by
Sect on 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:
Cartier 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: 2 /: ii;' Applicant " l 1'%.Z/ .r
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 r•,
application. a ,r
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) �� ! �' �U/ Date' '•. fPNf ; I
. c
BUILDING PERMIT PERMIT # vt
VALUATION. LOT G2(V2• 0'f:'i TRACT
DATE/j�
//
rte// �I /F:J $132NIE320 is
JOB SITE
APN
ADDRESS
OWNER
CONTRACTOR/ DESIGNER/ EN INEER
CENTURY
£NxURY uRC�mRT1, wOMiNTYS
,11"y, fROm�',1C01WiNrll
1535 30D'i��T37,7t1�. 000
1535 80. Y, SUMMIT, 'm, 0200
SAL'MJNfARD190 CA 9Z408
RANBE211MMINO CA. 924018
USE OyF�PERMIT
( p/p y/.ry yy��ry
M.LX'V V • Y J.�,�1L� I •8 .4.� i. and1.R1 O
..;FD «LOT 39. MTONTIt;as+".d. O Nipha•n;r€ W PIA141 Y..PN.R;IT
34OTNCltJEBLOCKAEtSPOOLAPE'iUIPRIMAY AiP2CAC}tILAN
C" 6YPEE pLetYCECF011 M L %PLF, ACadOp2OF yME «iA.Nt TYPE.
ACS CO NSTRUc : ION 2;215.00 o
PC3P.0 YPA21.O a .ao SY
GARAMUCAUCORT 625,00 RF
RMHAU a CVST M, C0JRY1 MC*r1n>?a
1321910.2-111
CONSTRUMIS'MM. 101.000.418.000 rY.".'1,
-
PLANt CHECK' FEW 101 00009-318
MECIM141C:A1. FEE 101-00.0-421-000 3Sf�.t19
NX-C,'I TICAL PEE 101.000-420-000 i13�C.53
PLLrMF3 AIIFEE 101-000419-000 a� v
STRONG MU,[tt30iISE-RW:ITt 101-000.241-000
ng ts��w OOU,423-000
Ol?��.nrr�e
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FEB J 4.1002
-
. MAN,l•CC:.6=
RECEIPT
DATE t ; + '� BY
DATE FjJALED
INSPECT
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms& Footings
— J—
Ducts
Slab Grade
Return Air
Steel
/ _
Combustion Air
Roof Deck
J j - /S -
Exhaust Fans
O.K. to Wrap
Z —
F.A.U.
Framing
- Z
Compressor
Insulation
y
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
—2 -
ZDrywall
Drywall - Int. Lath
�Q -
Final -
Final _
BLOCKWALL A ROVALS
POOLS - SPAS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
I I
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
-
Heater Final
Water Piping
Plumbing Top Out
�C'
Plumbing Final
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Gas Piping
7/
Encapsulation
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
Utility Notice (Perm) _ p�j
COMMENTS:
Installation Certificate: Residential CF -611
Site Address PERMIT #
44-690 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 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 BYAj
.-'.1!+ ✓1� DATE:
Signature Installing HVAC Contractor
!, uu.w•/.rrYlNNi:^N'Nxx MNYrN/,'%Y'i.'GN//"A`xmp/rqp//,yY,JI:II.%r:IYAY/N.%R%7!YK/ir!•W1RFm^.q'ylN'X.Yi:IYiY.:YIJV/y1:7YY14%.yu.i.•n<•Y':V'lA'W'Wwu.Yw.v;wyryirnvxaor.raNtY.rn.n•:
INSULATION CERTIFICATE
r 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 '
44.690 Monticello Avenue, Lot 38, Monticello -Heritage, La Quints, California
CEILINGS:
TYPE: BLOW MANUFACTURER: CERTAINTEED THICKNESS: R-38
f WALLS: - t
TYPE: BATTS MANUFACTURER: CERTAINTEED THICKNESS: R-13
.r
GENERAL CONT TOR: CENTURY CROWELL COMMUNITIES LICENSE # 7/
3Y: TITLE: �c-sc t.
PARAGON SCHMID BUILDING PRODUCTS, A MASCO COMPANY LICENSE # 632072
B TITLE: ADMINISTRATIVE ASSISTANT DATE: 12/12/2002
Jan 29 02 11:37a Richard Simpson 661,947-6868' p.4
INSTALLATION CERTIFICATE (Page 3 of 8 CF-6R
r�r' 2G
i e Adems 4444-96 Ma NT1 L%72 1 a ✓ L Permit umber
DUCT LEAKAGE AND DESIGN DIAGNOSTICS
DUCT LEAKAGE REDUCTION -
Pressurization Test Results ((:1 M (u125 PA)
T04 Lcakagc (CFM)
flan flow
If Fan Flow is Caloulatod aq 400 olioa/ton s awabor of tons, or as 21.7 x I loafing Capaoity
in nouaanda of litufhr, entor caloolmod valuo boyo
IE fan flow L% mansumd, cmtc,T measured value hum
Luakago fraction -'Too Loakagi;!(Moasurod or Caloulatcd Fan flow)
Paxcil'loAkngu Iraoliou SI),IKr ❑
Pass fail
❑ For AEROSOL TYPE SEALANTS ONLY -The following'dlagooatle teAing was com4leted: ;
Dual Fan Pressuricatiou al rough -in measured Lcakagc (CFM)
CHECK AFTER FINISHING WALL:
❑ YaK ❑ No ❑ llwwuvropan t" or I louw pro �urrrelion t�Ms1
❑ Yes ❑ No ❑ Visual Inspection of Duct Connuatialm . ❑ ❑
. • Bass 1'aiJ,
M THER(VIOSTATIC EXPANSION VALVE ji)(V)
1 Y4y ❑ No '1'h"MoAalrc Empaneion Vatv.: (fir Commission approved
oquivalont) is installed and Acur- s is ptovidod for mspcotion ❑
YW is a pang Pass bail
❑ DUCT DESIGN
1 • ❑ Yv`a ❑ No RCCA Manual D MAgn oalaulaliona havo lxxm oomplolud,
Duet Design is on tbo plans and duct installation matchos
plans.
2. ❑ Yaq [] No TXV is mmtallyd or lhm ]low hus bona vurdiod, If no TXV,
vvriliud fan flow matchati doxigp from CF- IIlr
Measured Fan Flow =
❑ ❑
Yos t'or both 1 and 2 is a 1'anPASS Foil
® 1, tho undcasignod, Ywi(;y (hut Zhu tlbOYO diagao+tie M4 roMI1N and till; worfc I pertiumud amoeiatvd with the tvst(s) is in
Ounformauxl with Iho fequimmonts lire compliant crudit_ ITho buiWor shall provida Ilio 1111,118 providor a copy ol• Iho CF -!R
AguW by the buildar cu►pl a:s or sub-cwntraotors vortifying that diagaoslio Ioming and installation mw Iho ruquiromoat, Ibr _
complianoci cmdii.1 `
:7 2002
sf 6-4�
Posts Sipaturc, Dat ' Iu.Mallittg Subcontractor (Co. amo) OR
Performed Goaera) Contmetar (Co. Name)
CONI TO: lluifdint;DcpnrtnxlA
111IRS Providor (if applicable)
Building Ovmex• ut• OCCugailcy
January 4, 2001
r
0 A4
®uct Testing trot 3 ,
` Certification Form -
: System Of' -'
f L
(One form per system)
- a
Builder Name:
Project.Name: (1,•�/� T �i1
t 3„
Builder Field Contact: Telephone No.
HVAC Company Name:
HVAC Installer` s _ Telephone No: •V.
,Self,Certifier Results
Duct Leakage Measured @ 25 PA �= * CFM'
Indicate the maximum "allowable Duct Leakage and the calculation method used: .
❑ ' 0.7 x Anoor x (0.06) for Climate Zone 8 through,15. CFM
❑ 0.5-x An.., x,(0.06) for Climate Zone 1 through .7 & 16 CFM
.400 x (Cooling Capacity in Tons) x (0.06) .CFM `
21.7 x (Heating Capacity in Th°ousands of output BTU per hour) x'1(0.06) CFM
-041
Print NameSignature .1 - Date <
Jan P3 02 11:37a Richard Simpson. 661 947-6889 p.4
INSTALLAT16N CERTIFICATE (Page 3 of 8) CF -6R
Sitt!AddMS
DUCT LEAKAGE AND DESIGN WAGNOSTICS
DUCT LEAKAGE REDUCTION
Pressurization Tem Rcsulls (CFM (a) 25 PA)
Tcst [.cat-agc (CFM)
Ilan I'low
IfTnia Flow isCaloulatod as 400 oful/toaxnumber oftons, or wi2l.7 x I loixiing Capaoity
innouttland.4 of Iftfiv, wiler oalculatod valuo koro too
If fan flow is measured, center measured valuu.hura
Loakago 1-mlion =TOA [Aakfigo/(M"surod of Caloulatod Fan Flow) - 0 .03
PA,%,; if loakago fftotiou& 0.06 ❑
Pass Fail
13 For AEROSOL TYPE SEALANTS ONLY -The fiillow'InR diagnoxdc teAlng was completed:'
Mal Fan ft(muriz.alion a[ rough -in uwasuFal lcakagc (CFM)
CHECK AFTER FINISHING WALL.
El Yes El No 0 Immvto pan tw or I Idow pros%uri/ution text
11 Yes 11 No 13 Visual Inspection of Duct Connections 0 0
Pass Tail
JA THF-mbsum EXPANSION VALVE (TXV)
El YEN C] No Theymoslatio Expan4oft Valvc. (or'Commissiork approved
aquivalont) is installed and Access is ptuvidotl for inspeouOu
YWL
0 DUCT DESIGN
1. 13Yl 13 No ACOA Manual 1) Design calculations have been complolud,
Duot Design is on tho plans and dual installation ranichos
plans.
2. ❑ yoj' No TXV is in.-Aallod or Fim flow Mix boon vordiod. If no TXV,
vcmiflud fim flow match*; dwp from CF- I IL
momumd Fan Flow
&8%s Fait
Yes for bulb I and 2 it; a ViNS Pass Fall
13 1, tho undguigaud, verify that Iho abovo diapoAlio; t*. -.t m -quits a*d the work I performed associated with the tast(s) is in
Ounformanewl With the voquirommis ibr oompliance crudit- ITho builder shall provide tho I MRS providar a copy of 1ho CF -611
sigu%W by tho buil&-r ctuploycen or4ub-contractorm codifying that dingum-6c tasting and fiLmahation mool the rol,loiromonfi.- lbr
compliance credit.]
APR 7 '2 102-...
TCsIr, KivatuT6, I)atu loxtalliagSubcontraolor (Co. Name) OR I
Purlormcd (;gnera) Contractor (Co. Name)
COPY TU: liuilding, Dcpnilmont
HERS Providor (Wapplicab1c)
Building Owner ut OCCuVallcy
January 4, 2001
L4,� CPS0 MonlTtC.o.��
!., Tract ;#
't. Duct Testis
L�" * .r
Testing -
Lot, # 5' �-
Certification Form
y System • 0f
(one form per system)
Builder.Name: = s ; - vi+vV
'Project Name:
Builder Field Contact:,
Telephone No.
HVAC Company Name:
HVAC Installer: Telephone N0
.3�SU
Self -Certifier Results
Duct Leakage Measured @-25 PA �� ' •F r CFM. '
Indicate the maximum allowable Duct Leakage and the calculation method used., ;i•; •:
.,
❑ 0.7 x Aeoor x (0.06) for Climate Zone`8 through 15 CFM
-
11
~ - � -`
❑ '0.5 x An.., x (0.06) for Climate Zone 1 through 7 & 16" _ CFM
400 x (Cooling Capacity in Tons) x (0.06) CFM j
a -
11 21.7 x (Heating Capacity in Thousands`of output BTU per hour) x(0.06) r . CFM~
rt Print Name , 4, . ignature 7j Date L
r ,��' 'a, a7'� - ��;. .��.•'va 1,4''' fi iry •_ fi_,-a - u F} :r ' to v G �� '{t r7 z ti '
xsn .*- '±s~ra v�'L. 7 'i .moi �R. `����tp` W 's, €}, u �itc ) �'s,f�.-rth��� ,�•��.�.' .
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�tegu/ating building construction or use. 'For the following:
BUILDING ADDRESS: , 44-690 MONTICELLO AVE.
Use Classification: SINGLE FAMILY DWELLING
Occupancy Group: R/3 Type of Construction:
Owner of Building: CENTURY CROWELL COMM.
7-1 ^fit
Building Official
Bldg. Permit No.: 03202-075
Land Use Zone: R/L
Address: 1535 SO. "D" STREET, STE # 200
City: SAN BERNARDINO CA.92408
By: GARY SHOWALTER
Date: 08/15/02
POST IN A CONSPICUOUS PLACE
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