0202-165 (SFD)t 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
Datey'Signature of Contractor j ' `• .t / l"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 ,
( ) 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 ofthe following declarations:
( ) I have and will maintain a certificate of consent to self -insure for workers'
compensation, as provided for 'by Section 3700f 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 d10 1�I?P� L qI E 1N3. Policy No. NWC444068 03
(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 1 shall forthwith comply with' those provisions.
Date .-* 1--w ?---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
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 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) !1t • i Date
BUILDING PERMIT PERMIT#
DATE VALUATION LOT �� TRACT
F • ''7 . i �b4r�"t1 14 U197-4
JOB SITE -
ADDRESS
%
APN
Ip+,i- 60"11
OWNER ,
CONTRACTOR/DESIGNER/EN INFER
:'.P�, " +I3:'11yy-�y''�'M. kliq'�r��' r..�l'.t+�wjft
CSI 4�'IiJ/%�t�''i'��Ql`rW9111 �y'!C'iRlSt�iWrl:d/�i��.''d'!i.ya
'� yjls{i(C'��J'ITES
S 5i ai -so, SIS MTS.Y�'i.a.4 . sm ��'.�2,00
A6g i�� so, �.t•�tl :.r. k=, t�P_.br'.E� 7P20t.r
SAN RMP.£dWO 04 92408
SAW BERNARDWO CA 92408
USE OF PERMIT
,WNGL � .141; 'x' DWE 11-40
SIm ry L X)T 14, PLA14 4Z8. PERMIT DOX'SA NOT INCLUDE BLOCK
WAUA Po('K, OPAORDW EW.Y A-M,c AC -H. 7W RMUCTION TO PLAN
PE.
MECK PEls FOR ML3L-TIPIOL1 ISSUA NCZ OF TS.hMLE PLAN TYPE.
TRACT C(?1`tSTRUC'i ION 216SaM S
PORCHIPATIO Sr
As�■.,�.iv.t•ct�dR'.`� `k.°i✓b�9�.' u�'ia'W�.'bF:7"A[d�Vl'4`.R:F4ri'E
d+i7f3w ,'�.+ti�.C►�f'
fi`ONSITRUCI1ON FE -9 101.000.41 ON000 $ F►.94
PLAN CHECK Y.0 101.1000-4; -31Ii
MEM011C.Al., FEE 101-000421-000
FK$.,;?VI1'..IL"AL gel? ?J1-CkL l tt- d;ii ` r± $153.33
ta[�A+iazll�dY (Ia 101-000.419.00 aT 11404
:s9"1ZOMO IbgO" ION I-EE� • R8S:TJ: 101-000-241-006' ' s • smo
(RA►:d11443 MR
1:11"VELOPER IMPACT �T-3
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Sum -,To .i . i4J �. r.�Aft .. ..
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(➢!aAgpY �f
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR'
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
- g- Z
Underground Ducts
Forms & Footings
g
Ducts
Slab Grade
—Z
Return Air
Steel
a -,5 - Z
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
- 2
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
r
l
Final
- �a
Final
BLOCKWALL APPROVALS
Steel
POOLS - SPAS
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
- 2Z. Z
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
O'Z
Appliances -
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring - 2
Low Voltage Wiring
Fixtures -
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final - Z
Utility Notice (Perm)
COMMENTS:
INSULATION 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:
79-752 Morris Avenue, Lot 14 Monticello -Heritage, La Quinta, California
CEILINGS:
TYPE: BLOW MANUFACTURER: Certainteed Thickness: R-38
WALLS:
TYPE: BATTS MANUFACTURER: Certainteed Thickness: R-13
GENERAL CONTRACTOR: CENTURY CROWELL COMMUNITITES LICENSE #
BY: TITLE:
PARAGON SCHMID BUILDING PRODUCTS, A MASCO COMPANY LICENSE # 632072
TITLE: ADMINISTRATIVE ASSISTANT DATE: 12/12/2002
Installation Certificate: Residential CF -6R
Site Address PERMIT #
79-752 Morris Avenue
1. BUILDER INFORMATION
Century Homes
1535 South D St. #200
San Bernardino, CA 92408
SUBDIVISION: Heritage
CITY: La Quinta
COUNTY: Riverside
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 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. SUBMITTED BY
qojiJQ,k,�'�le'4A,- DATE: /1o'L—
Signature Installing HVAC Contractor
10;17/2013
02:22 FAX la005
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• •
is
INSULATION CERTIFIgATE
This is to certify that insulation has been installed in conformance with the current energy
California Administrative Cade, Title 24, State of Califomia, in the building located at:
i
regulation,
79-752 Morris Avenue, Lot 14 Monticello-Heritage, La Cuinta, California
r
CEILINGS,si
TYPE: BLOW MANUFACTURER: Certaintesd Thickness: R-38
WALLS_
TYPE: 6ATTS MANUFACTURER: Certainteed Thickness: R-13
#
,i
GENERAL CONTRACTOR: CENTURY CROWELL COMMUNITITES LICENSE
By.. TITLE: (9 S-yAQed
PARAGON SCHMID BUILDING PRODUCTS, A MASCO COMPANY LICENSE # 632072
r
i!
TITLE: ADMINISTRATIVE ASSISTANT DATE: 12/12/2002
i�
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Jan 29 02 11:37a Richard Simpson, 661 947-6889
p.4
INSTALLATION CERTIFICATE (Page 3 of 8)
CF -6R
Site Addrems Permitum el; r
DUCT- LEAKAGE AND DESIGN DIAGNOSTICS
DUCT LEAKAGE REDUCTION
PreNsurvahon 1 ext Results (CFM fat 25 PA)
Test Leakage (CFM).
Fnu Flow
IfF nn Flow is Caloulat,od as 4011 otlou/ton x number of tons, or ax 21.7 x l kali ng, Capacity
in Thousands of BtAr. Order oaloulntod value koro
_
If tan flow is mumsured, enter measured value hen: % OQ
Leakage Fraction = TcA IA%kngcf(M: s turW or (:aloulatcd Fan Flow)
Pim; if loakago freotiou 5 0.06
0
® For AEROSOL TYPE SEALANTS ONLY -The follow Ing diagnostic testing was completed:
Pass Fnil
[)net Fan Pramurrialiou at rough -in measured leakage (CFM)
CHECK AFTER FINISHING WALL:
❑ Yes ❑ No ❑ Prcrron; pan Icst or l louw pru+svtcrarration test
❑ Yes No ❑ Visual Inspection of Duet Connections
❑ ❑ .
Pam ]'ail
THERMOSTATIC EJQPANSION Vd►t_V@ (TXVj
Y'y ❑' No TI►cxYno+t0ti0.i;xpa6gi0n Valvc: (or Comission approved
oquivalont) is installed and Access is provided for inmtion
❑
Yrs+ Ls a pn-%1'
'a.. ' fall
❑ DUCT DEMON
1' ❑ YCc ®NO RCCA Manual I) I)exign calculations have been completed,
Duct Design is on the plans and duct installation mnlchv�s
plans.
2; ® Yoq ❑ No TXV 6 mtiTallod or Fan flow hen buvn vot'iliud. If no TXV,
verified lkn flow mntchati dasign form Cly_jIL
Measured Pan Flow =
!❑ ❑
Yes for both 1 and 2 u: a Pars
Pass Feil
1, the undaraignod, verify Ihnt tho abovo diaguoMic Wqt rm its and the work I pertormc:d amociated with
We tust(ss) it; in
cuntbnns ;v With the requirements Ibr camplianc L credit. to builder shall rovido dto 1 - .
I p U,Rti PrOvidUr n.wpy ol'thc CF -OR
xigusd by the builder cdrployceq or sub-contraolois certifying that dingaw-110 lc s --ting and im,6110110a Owed Ihu riquirvrinunf_,4 liar
compliance credit.]
d'e'eds Signature, Date
Installing tiubcoatraotor ( o. Name)
OR
Periormed 6ciacral Contractor (Co. Name)
COPY TO: Ifuildinl Department
1111,118 IWvidc r (irapplicablc)
Building owner -in occut)Jncy
January 4, 2001 /'
F
Jan 29 Oi' 11:37a Richard Simpson 661 947-6009
INSTALLATION CERT'IFICA'TE (Page 3 of 8)
ac Z_L4Z�Eiug SrttAddl�etoq 79 _ �J G �'I'IORR/S Au�NuE F� E�umb
DUCT LEAKAGEAND DESIGN DIAGNOSTICS
,I DUCT LEAKAGE REDUCTION
PrcNsurizaliun Text Rcsulfs (CTM (al 25 PA)
'fest l,cakagc (CTM) 3,17
Nan flow
If Fan Flow iq Caloulatod as 400 efm/ton x number of tons, or as 21.7 :c I Ioati b� Capacity
in Thousands of Btulhr. ontcr caloulafod value hors _
If fan flu* iu measured, cater mtmm7-d value here p o
Leakage Traoliou '='I" or C:aloalatctt,l'an blow)
Pa.% if leakage fraction S 0.(*
❑ For AEROSOI. TYPE SEALANTS ONLY -Tho following diagnostic testing was completed-
I)tcl Tan I'rasxurvalion al rough -in mc:asurcxl kakagC (CTM)
CHECK AFFER FINISHING WALL:
❑ Yes ❑ No ❑' 1►n,�:suro pan tc A at I louat: pnxsuritation 16
❑ Yos ❑ No ❑ Visual Inspection of Duct Connectionv
iHERMOSTAi1C EXPANSION VALVE (TXV)
YEN ® No Th"nloslatic lixpauxion Valvc (or Commission approved
equivalent) is installed .and Accc m is provided for inemtion
Yew is a pas::
❑ DUCT DESIGN
1.' ® Y,,,13No ACOA Manual D Dexign calculations have bexm eumplehcd,
Duct DcAgn is on the plans and duct installalion mnichc;e
plans.
2- ® Yca ❑ No TXV 6 insTailed or Fan flow hex boort vorileetd, If no TXV,
voriflud len Dow matches: de>nigp from Cly-IIL
Measured Fan Flow =
Ycs for both 1 and 2 in a Pam
p.4
-CF-6R
U
_ ❑
Pass Tail
❑ ❑
lass Hatt
Pass
Nail
❑
❑
Pass
Fall
Jan 29 Oi' 11:37a Richard Simpson 661 947-6009
INSTALLATION CERT'IFICA'TE (Page 3 of 8)
ac Z_L4Z�Eiug SrttAddl�etoq 79 _ �J G �'I'IORR/S Au�NuE F� E�umb
DUCT LEAKAGEAND DESIGN DIAGNOSTICS
,I DUCT LEAKAGE REDUCTION
PrcNsurizaliun Text Rcsulfs (CTM (al 25 PA)
'fest l,cakagc (CTM) 3,17
Nan flow
If Fan Flow iq Caloulatod as 400 efm/ton x number of tons, or as 21.7 :c I Ioati b� Capacity
in Thousands of Btulhr. ontcr caloulafod value hors _
If fan flu* iu measured, cater mtmm7-d value here p o
Leakage Traoliou '='I" or C:aloalatctt,l'an blow)
Pa.% if leakage fraction S 0.(*
❑ For AEROSOI. TYPE SEALANTS ONLY -Tho following diagnostic testing was completed-
I)tcl Tan I'rasxurvalion al rough -in mc:asurcxl kakagC (CTM)
CHECK AFFER FINISHING WALL:
❑ Yes ❑ No ❑' 1►n,�:suro pan tc A at I louat: pnxsuritation 16
❑ Yos ❑ No ❑ Visual Inspection of Duct Connectionv
iHERMOSTAi1C EXPANSION VALVE (TXV)
YEN ® No Th"nloslatic lixpauxion Valvc (or Commission approved
equivalent) is installed .and Accc m is provided for inemtion
Yew is a pas::
❑ DUCT DESIGN
1.' ® Y,,,13No ACOA Manual D Dexign calculations have bexm eumplehcd,
Duct DcAgn is on the plans and duct installalion mnichc;e
plans.
2- ® Yca ❑ No TXV 6 insTailed or Fan flow hex boort vorileetd, If no TXV,
voriflud len Dow matches: de>nigp from Cly-IIL
Measured Fan Flow =
Ycs for both 1 and 2 in a Pam
p.4
-CF-6R
U
_ ❑
Pass Tail
❑ ❑
lass Hatt
1, the undmignnxl, vwily that tho above: diAgtlofitio tort results and pie work I performed associated -with the: tcxl(s) in in
eoidbrmanc e with the requirements li►r compliance credit- ('rho builder shall pnrvido Wu 1 MRS ptovidai a copy of tho CILOR
AguW by the builder ctnployces or sub -contractors ecrtifying that diagnu do testing anJ ic:%tsL dation meet the require ment.1br
compliance credit.]
l'csls Signaturu, Datc / Llstalling Subcwntf for (Co. Nanoc)
Peirrormcd Gcocraj Contractor (Co. Name)
COPY TO: -Building, Depni inevf
1117,118 Provider (il'applicable)
Building Owner ut occupancy
Janna y 4, 2001
Pass
Nail
❑
❑
Pass
Fall
1, the undmignnxl, vwily that tho above: diAgtlofitio tort results and pie work I performed associated -with the: tcxl(s) in in
eoidbrmanc e with the requirements li►r compliance credit- ('rho builder shall pnrvido Wu 1 MRS ptovidai a copy of tho CILOR
AguW by the builder ctnployces or sub -contractors ecrtifying that diagnu do testing anJ ic:%tsL dation meet the require ment.1br
compliance credit.]
l'csls Signaturu, Datc / Llstalling Subcwntf for (Co. Nanoc)
Peirrormcd Gcocraj Contractor (Co. Name)
COPY TO: -Building, Depni inevf
1117,118 Provider (il'applicable)
Building Owner ut occupancy
Janna y 4, 2001
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: 79-752 MORRIS AVENUE
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 0202-165
Occupancy Group: R/3 Type of Construction: V/N Land Use Zone: R/L
Owner of Building: CENTURY CROWELL COMM.
054"t
Building Official
Address: 1535 SO."D" STREET,STE.#200
City: SAN BERNARDINO CA. 92408
By: GARY SHOWALTER
Date: 09/09/02
POST IN A CONSPICUOUS PLACE
N