0202-166 (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
1141.88 f3 1 t?iS 11t}w
Date i a- 4' 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.
(moi) 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:
CartierCCiI�IJ AI,OI,pINNS. Policy No. NWC-54406943
(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:.: , , 7 , 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) / / Date y
BUILDING PERMIT PERMIT#
DATE VALUATION LOT 0202'46C'� TRACT
;% 76,42840 15 2.4191.4
JOB SITE
APN
ADDRESS 29,.757 AQ114l?i;5 A,YY"X.
604-077
OWNER
CONTRACTOR/DESIGNER/ENGINEER
t,'KA 11MY C1ZC'iW>r' .L COWAUt+1'ITIU
ciaw- ruRy C'ROWDIL CM&ALTNUM
1J3S 1901 "D" W. ri 91H, #200
1535 4.0.41)" 917= 3T1,; #t2 ID
SAN FjT.l21<3.AR,i7: NTN CA 92408
S.41.13IM—NARDWO Com, 92409
2120
USE OF PERMIT
CTATOM FA2uiI1..Y ll d.W(J
3W. • wrr JN. P 58. 1%aii:D I't 00-mi'ma' INC.LUDr. 13L.00K Vi`Ai.I.A
P004 SPA OR I3PM.1<WAY APPROACH.
TRACT CONSTRUCTION 3,012.00 3F
PORC1i.1PATIO 25.00 SF
COARAA ICARPOUT 640,00 ST
ES17MATW COST OF CONSIRUCIJON
176,428.10
?J t Edi `"L' : 87.1Mf %QlRly
CONSTRUCTIONFU? 101 -OW-41 B-000 $90,0,€10
PLAN CrIWX FUM 101-000439-318 V31.68
MECHANICAL VVE 101.000.421.-000 MOO
B:LYCTRJ.CAL 1,21M. 101 -WO -42.0-000 1;145.7,2
PLUMBDIC FEE 101 -000 -419 -OW. 1141.1s
STRI iNO t.1OT1014 FYf • I X10 101 -OOD-241 -W0
OWN0 i?3C I !til-I?Q{y-+ i- (lC1 k $20.00
?";:�I:L7P.GrR i�i',lF.�r"1` g�.m - - '• ? . �3,9?°':Ctf3
w'1 3' %Rt3. t �r{� 1 r �?4 �` � -T fi iSft b��1 —
`S4,01 `2.`29
RECEIPT
DATEBY
DATE FINALED
INSPE R
1 P
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
3— Z . 2
Underground Ducts
Forms& Footings
Ducts
Slab Grade
— Z
Return Air
Steel
Shower Pans
Combustion Air
Roof Deck
O.K. for Finish Plaster
Exhaust Fans
0. K. to Wrap
— j —
F.A.U.
Framing
—1j
Compressor
Insulation
—
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wali Firewall
Exterior Lath
Drywall - Int. Lath
mnai ly=/Z — 04 1 Cf
BLOCKWALL APPROVALS
Set Backs
Final
Steel
Electric Bond
Main Drain
Approval to Cover
Equipment Location
Underground Electric
Underaround Plba. Test
POOLS - SPAS
PLUMBING
APPROVALS
Gas Test
Electric Final
Waste Lines Cj
3 - z� • �,
Heater Final
Water Piping
Plumbing
_
Plumbing Final
Top Out
Equipment Enclosure
Shower Pans
_
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Utility Notice (Gas) IZ
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) = =02
Final
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:
79-757 Morris Avenue, Lot 15, 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 COMMUNITIES LICENSE #
BY:
TITLE:
PARAGON SCHMID BUILDING PRODUCTS, A MASCO COMPANY LICENSE # 632072
TITLE: ADMINISTRATIVE ASSISTANT DATE: 12/12/2002
1' Installation Certificate: Residential CF -611
Site Address
79-757 Morris Avenue
1. BUILDER INFORMATION
Century Homes
1535 South D St. #200
San Bernardino, CA 92408
INSTALLING CONTRACTOR:
2. PROJECT INFORMATION .
PERMIT #
SUBDIVISION: Heritage
CITY: La Quinta
COUNTY: Riverside
WEST PAC AIR CONDITIONING
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-48B-090X 80% 88000
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 an&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
Signature Installing HVAC Contractor
DATE: OL
3
Jan 29 02 11:37a Richard Simpson' 661 947-6889 p.4
INSTALLATION CERTIFICATE (Page 3 of 8) CP' -6R :
N';�1757 MORRIS AVCNvE J Permit Number
DUCT LEAKAGE Ah1DDESICN DIAGNOSTICS_
SI DUCT LEAKAGE REDUMION
Prt�ssuriiation Tcst Rcsulls (CFM (d) 25 PA)
'lost Leakage (CFM) .
Fan flow
if Fan I"low is Caloulatod av 4110 dtafton x number ofloav, or m 21.7 x l loaliung C opaoity
in Thousands of Otuft. color caloulatod value here _
If fan flew is mcasurcd, carter mcasurz d value hen; 2 Od
l,cakago Fraction = Tsit I.arkngr!(Mcavunxi or C doulatcd Fan Flow)
Pn.% if lonkogo fraotion s 0.06 ❑
Pass Fail
❑ For AEROSOL TYPE SEALANTS ONLY -The follow Ing diagnostic texting was completed:
Ihrct Fan Prussurivation al rough -in measurud Icakage (CFM)
CHECK AF'T'ER FINISHING WALL:.
❑ Yes ❑ No ❑ Prc-'Nurc pan ttxa or I louse piommilriiation ts:a ,
❑ Yes ❑ No ❑ Visual luspcution srf Duct Connuutions ❑ ❑
Pass Tad.
THERMOSTA'"C EXPANSION VALVE (TXV)
YvN ❑ No Thloym'oslatio F?xpant6on Valve (or Commission approved
equivalent) is installal .and Acrsc^4s is provided for inVt notion ❑
Yew is a pn- 1►a�a 1'nil
❑ DUCT DESIGN
l'❑ Yee ❑ No RCCA Manual I) Design calculations havu l►ten aomplutcd,
Thu t.ikxign is ori lho plans and dud inslAllalion mntohes
plans.
2. ❑ Yew [1 No TXV is mtilalled or Fan flow hax been veriliod. If no TXV,
verilicd tim flow matches design from Cly -1 k
Measured Fan Flow =
.❑ ❑
Ycs for both 1 and 2 is a Fum Pass Fall
I, Iho undarsigncd, roriiy that the above diagnomie test AVRVll s and the worts I perfbrmc: assoiciatal with the 1cst(k) is in
eunlonnance with tho mquimmcnts ibr compliant: erudit. 111to builder shall provide Ute I WMN provider n copy 01'(ho CF -OR
siguod by the builder etrtployocs or sub -contractors certifying that diagnoa110 tostiug and nL-;tallation meth Iho roqoiromojils Ibr
compliance crcdit.l
Feats siguaturc, Date Ltatalling Svl"Ot otor (Co. Nam OR
Performed (;moral Contractor (Co. Name)
COPYTO: O: Building llcparlrnont
1113118 Provider (if applicable)
Building Ownez- at:. 0ccUT>.7ncy
January 4, 2001
Jan 29 02 11:37a Richard Simpson... 661 947-6889 p.4
INSTALLATION CER'T'IFICATE (Page 3 of 8) CF -6R
L2- _ _ _ _.. �.Zz
7 9 -;?s 7
Mont?,; .q VCiravr+ ermit umeber
DUCT LEAKAGE AND DESIGN DIAGNOSTICS
DUCT LEAKAGE REDUCTION
1'ressuriiation Test Rcsul s (CFM 67125 PA)
Tcsl Leakage (CFM) S3'
Pan Flow
If Fna Flow is Calculated wi 4M olioo/ton s number of tons, oras 21.7 x l lcating Capacity
in llouaand.,t of BtAr, enter calculated value here
If fan Ruw Lti mcasurcd, imtrur mLwwr d value hen; l �a
l,00kago Fraotton = ' osl or Calculated Fan Flow)
pass ifloakago lraotrou 5().06
❑
-
® FOr.AEROSOL TYPE SEALANTS ONLY - The following diagnostic tenting eras completed:
Nass Pail
Duct Pan I'krssuriiation at rough -in measurxl leakage (CPM)
CHECK AF'T'ER FINISHING WALL:
❑ yes ❑ No ❑ d'ru uro pan tea or I lou -,a pftxtitiriration test
❑ Ycs ❑ No ® Visual Inspection of Duct Cunnuetions®
0
rase Fail
- THERMOSTATIC EXPANSION VALVE (TXV)
Y,q ❑ No 111'.=0slat;o lixpaagion Valve (or Commission approved
equivalont) is installed and Aztx-.4s is provided for mmpaetion .
[�
Yue is a paaa.
pas. fail
. t. -
0 DUCT DESIGN
1. ® Yes ® No AC CA Manual l) Design calculations boyo bixin completed,
Duct 1)csilrn is on tho plans and duct installation malohos'
plans.
2. ® Yea No TXV is installod or I•'trat flow hex bound vuriliod. if no TXV,
vcrifnA lien flow matches daeiga front CF -I IR
Measured Pan Plow=
❑ , ❑
Yes for both 1 and 2 in a Pam -
Past Fail '
t1, the undersigned, vv*y that tho"aboyo diagtloatic teat rer"Ih; and the work I pertbrmel associated with
thu tcst(s) is in
uronnsmce with the acquirements liir compliance urudit. ITho builder vhall pn►vido dio 1 MRS provider a wpy of Iho CF -OR
siguvd by the builder ctuployoc:s or sub -contractors ecrtifymg that dinguu liu tc,4ing and inslallatiov mee, the requirolnerrtt lbr
compliance credit.]
�
Signature, Date Ltatalling ,,%ubconRr r (Co. Naaoc)
Pulormed (kneeal Contractor (Co. Name)
C01'Y'I,0_ Jiailding Mpnrfrnool
11IMS t'rovidcr (il'applicablc)
Building Owren tat Occupancy
January 4, 2001
e
(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:.
Use Classification: SINGLE FAMILY DWELLING
79-757 MORRIS AVE.
Bldg. Permit No.: 0202-166
Occupancy Group: R3 Type of Construction: V -N Land Use Zone: RL
Owner of Building: CENTURY CROWELL COMM. Address: 1535 SO."D" STREET STE #200
City: SAN BERNARDINO
By:. GARY SHOWALTER
Date: 09/12/02
Building Officia
POST IN A CONSPICUOUS PLACE
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