SFD (0202-164)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
10/3
4 {re
Date f y •Signature of Contractor ' 1:t } fe
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). r
( ) 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 liy Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
s( t) 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 omiumi+i:kaais)'a Policy No. WC -M4963-03
(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, I shall forthwith comply with those provisions. r -,
Date:_111 1-_ -y 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,lissuance 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)
BUILDING .PERMIT PERMIT# � �f
�F
DATE VALUATION LOT' �'� TRACT
UNA 23170 )13 24 ISKI-4
JOB SITE
APN
ADDRESS 79 ( XQ.RrtTq'.AVEtf(M
6044)n_0%
OWNER
CONTRACTOR / DESIGNER / ENGINEER
1.w 35 30, `D" isa M710200
15951110, "i)' STi EE" , ME. 19200
SAN 1WAR.DIND CA 92409
SAN DNARD11,10 CA 92408
(909)361.6007 C: AA1 2 120
USE OF PERMIT
TOLE 1?J"LYDW19_LNQ
SIM « WT 13 PLAN 2.0RW, PER UT'•i 083 CIT INCLUDE., C K.
WALLA P0014 SPA OsZ.'EyMPWA'Y APPROACH. 15% REDUCTION O PWf
CHWK WE FOR YMlULTIPLF. TSSU A134:,1:' OF RAW.' P1.&N ` YPK
TRACT G:iaNisTRUCTION 1,8100, 00 S'F
PC9ip.GHfpt'i.TIO 40.00 Sir
C3ARA.Gii?1Gls;UORT 420,00 BF
C1tJNQTRUCTION 1a3F..5? 101 -WO -416"000 SrSh�1,1+
PLA' CY- FC11K R9 101-000-489-318 193ia.Ot*
MECFAdlCr'A1, WEE, 11.Cti1#000-421' 000 $60,00
�
1r,1. ECTPIC .All VIM 101,'-060.420-000 � $116700
4'
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33'.R0140I1t:►Til ?d V.046
i R�) ffi3tI VRA4 � i0.1 i-000 4�$'�t��?�
DM1:6.7P1CR IMPACT ME ! `} $ .117th4
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RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
r'"
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
— _ 9-
Underground Ducts
Forms & Footings
Z —
Ducts
Slab Grade
— -
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
:i:g— --3 ..Z
Compressor
Insulation
6 -- —
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
_ d L
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
3- Z _ Z
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Sewer Connection
Pool Cover
Encapsulation
Gas Piping
Gas Test
- NJ
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) —py
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:
79-766 Morris Avenue, Lot 13, 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
BY: TITLE: ADMINISTRATIVE ASSISTANT DATE: 12/12/2002
Jan 29 02 11:37a 'Richard,Simpson
_
INSTALLATION CERTIFICATE
—
561 947-6889
P.
CF_6R
DUCT LEAKAGE AND DESIGN. DIACINOS'I'ICS
DUET LEAKAGE REDUCTION
PrLs,suritation'I'est Results (CIM 61125 PA)
`fest Leakage (CFM) S O
Fan flow - ,
r if Fan Flow is Calculated as 4W ol'tu/ton x number ofIoa o.,or av 21.7 x Ilcaling (:
Installation Certificate: Residential CF-6R
Site Address PERMIT #
79-766 Morris Avenue
1. BUILDER INFORMATION
SUBDIVISION: °Heritage-
Century Homes : CITY: La Quinta .
1.535 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 categoryabove,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 EQUIPHEATING
EQUIP. MAKE MODEL # AFUE CAPACITY LOAD
Furnace Lennox - ' 80UHG4/5X-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 e'
(/aCiuX�u4.- DATE:'-
Signature Installing HVAC Contractor
•':!!�•O{P'%Yo:l.'M'tMn'/1Rp'r%/I'/YN%/✓r'C/-r»II.YYY. A:Y.ylln:nuYIVM.N✓fiY.,ISA+vfi: �hrvfilw�Y•.i/.'.n�•I+VA:`Ir'NAJ//A"Mf'A'YY�O.A'f!H'.w rvwww.w�nn.wwN,M '.NI.:1+•w'AfJ+'.YJV'Nlrl ./+�d:rlaw++r •n •r t-"
/
INSULATION'CERTIFICATE
This Is to certify that insulation has been installed in conformance with the current energy
regulation,- Califomia Administrative Code, Title 24, State of California, in the bullding located at
'
78-766 Morrie Avenue, Lot 13, Monticello-Herltage, La Qulnta, California
r
F
CEILINGS:MANUFACTURER: CERTAlN7EED1 THICKNESS: R-38
TYPE: BLOW
WALLS.
TYPE; BATTS MANUFACTURER: CERTAINTEED .THICKNESS: R-13
'
GENERAL CONTRACTOR. CENTURY CROWELL COMMUNITIES LICENSE # %/y/f, P'
BY. TITLE: •Sv
r
PARAGON SCHMID BUILDING PRODUCTS, A MASCO COMPANY LICENSE # 632072
?
TITLE: ADMINISTRATIVE ASSISTANT DATE: 12112121102'
BY::+'iY�'JAT..tlw'J.'l.:/1'/.'IlI.'I.�/M.M:�
1.�w�Y+V�'A'!:/BNI./!'�JimVvw,/NF%[/�/.IAS%N.LRfYI�W.:R.%9� J/I'J+'I+'IL/JA/.1/!:'II^/A'Y/J//.LF'il.:I/I.i//l.'P/✓+'!Lr'//�'/1.�%/�p/%:Iai/.Jli'WL.G.:Ci•'/.'%
Certificate -of Occupancy,City of La,'.Quinta
Building,and,SafetY pDe artment c MOF
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: 79-766 MORRIS AVE.
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 0202-1$4
Occupancy Group: R3 Type.of Construction:' VN Land Use Zone: RL
Owner of Building: CENTURY.CROWELL COMM. Address: • 1535 SO."D" STREET STYE #200
City: SAN BERNARDINO
By: GARY SHOWALTER
Date: 09/11/02
Building Official
POST IN A CONSPICUOUS PLACE