0202-186 (SFD)LICENSED CONTRACTOR DECLARATION
7tihereby 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
7)418R 1 CV3 AX
6ate7i ✓ Signature of Contractor
.-.. 6�+ {CVC.% dv v r v✓
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 &I 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'
• ( ) , 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 00d.Pi✓'EN t -M LE INS, " Policy No. ' t1
(This section need not be completed if the permit valuation is for $100.00 or less).
O' 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; l shall forthwith comply with those provisions
- 1
Dater 4 �'"" se i Applicant r r� -vr
-'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, damage's as provided for in Section 3706
of the Labor Code, interest and attorney's fees. n t
IMPORTANT Application is hereby made to the Director of Building and Safety7.
for a tpermit subject to. the conditions and restrictions set forth on, hi5�
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 thelabove information,y s F
correct.' l agree to comply with all City, and, State laws I�el'ating to the bullding�
Construction, and hereby authorize representatives of tfEls:Clty to enter upons `
the above-mentioned property for inspection purposes V
Si nature (Owner/A ent) Date
'IBUILDING PERMIT PERMT#
DATE I ? VALUATION LOT {- . TRACT.
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JOB SITE
APN
ADDRESS 44465 AWA�:Ya1v�«7.�vf:a7.RY O �.'�.�.'O-lt
OWNERENGINEER
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CONTRACTOR / DESIGNER / EN INEER
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USE OF PERMIT
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RECEIPT Y.141
DATE Vi
BY ,r
DATE FI ALED
INSPECTOR
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INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
73 2-
Underground Ducts
Forms & Footings
Ducts _
Slab Grade
—/Z Z
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
S =
F.A.U.
Framing
Compressor
Insulation
_ y _L
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
Al
Gas Test
Electric Final
Waste Linest/
Water Piping
Plumbing Top Out
—
_!t
_cam
—/ y
Heater Final
Plumbing Final
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
id'
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final
Utility Notice (Gas)
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 lot e"qu
Utility Notice (Perm) _.
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Installation Certificate: Residential CF -6R
Site Address PERMIT #
44-765 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: 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 80U14G4/5X-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
(2 � !il�lt.�.��.r — DATE: 12-14-0, L
Signature Installing HVAC Contractor
/l.iti./!�%/'/!X"/Y'b"//is sil:r.MffJM:ir'R!JVi1'%YO'A'Y/idA'C Hllha'YY,'p'?)/6!CP/'1LL•T'✓T:vAtW'/IWw!//Na"+Y�+✓+"'.-Y':wN':HM xv+: v'tr•/OOM1.I'NY///M'N',.Y.d � .//NMN/IIYvi'r."n:4'.r. L'✓
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INSULA ION CEFMFICATE
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: .
a -
44-765 Monticello Avenue, Lot 35, Monticello -Heritage, La Quinta, California
CEILINGS:
TYPE: BLOW MANUFACTURER: CERTAINTEED THICKNESS: R-38
S
WALLS:
TYPE: BATTS MANUFACTURER: CERTAINTEED THICKNESS: R-13
GENERA CONTRACTOR: CENTURY CROWELL COMMUNITIES LICENSE 4 %/y/dV
BY: TITLE: (9=s* Sew�i
F,
PARAGON SCHMID BUILDING PRODUCTS, A MASCO COMPANY LICENSE # 632072
BY: TITLE: ADMINISTRATIVE ASSISTANT DATE: 12/12/2002
l ,
'City of La QuintaIMF \1z1
Building.and Safety Department of Teti°�
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: 44-765 MONTICELLO AVENUE
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 0202-186
Occupancy Group: R-3 Type of Construction: VN Land Use Zone: RL
Owner of Building: CENTURY CROWELL COMM
Building Official
Address:: 1535 SO. "D" STREET #200
City: SAN BERNARDINO, CA 92408
By: 'STEVE TRAXEL
Date: 10-31-2002
POST IN A CONSPICUOUS PLACE