SFD (0202-167)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
7 141 i1 11011.
Date" F'r,% -Signature of Contractor J t f
+x.
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law'for,4he 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.
( ) I have and will maintain workers'. compensation insurance, as required by
Sec ion 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:.
CarrierPolicy 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 personin 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 3.700 of the Labor
Code; I shall forthwith comply with those provisions.
Date: r 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
additionA 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 he
upon'
the above-mentioned property for inspection purposes. f
Signature (Owner/Agent) ,} f eA Date;,
BUILDING PERMIT PERMIT #'
DATE VALUATION LOT. QJr'�% TRACT
_ r • , 19 9 Fr y> � .r r,t`D �I. a' 24191.4
JOB SITE
ADDRESS ` F\.+` wT i� 7
APN
604,0724W
OWNER
CONTRACTOR/DESIGNER/ENGINEER
C,'�-'.MUR (WROW WIL C101vtMiJ1\I1.7'117IS
CKNI'tiTRY f RO WE T,. COMNYf:1NUS4 S
1555 50. "1 "STM247, M 400
1 535 so, v #2&' o
(9-W)381.600'7 w'F1w 2120'
USE OF PERMIT
SYD W LRT 11% PLAN ZA:TA.W. kyP.,R';,NIT OONS NOT INCL,a11'.1F.. k11~ j=
1.AW% P0014 SPA (7K DR,.E"i' TAY' 's"R.QAr~H;> W_% REDUCTION TO F''i.AN
CHECK It':s1I; FOR MXJ 16`CI'PLF, tSSU,AINC3I; OF Sf111RTv;1-'i..mi T YPK
TRACT CONSTRUCTION 1,800.00 SP
8F
v f num='Pa edoSr av C 0 q STRTJ4:1:C01q,
1116167 ; 70
M.1 1 S.1'RUi:`.!`ION FEE 101.000-418^000 5664,61)
PLAN CHECKr:IIA?o 1#18-aCit�•�i:�� 33�: �133.ea
ME MWICAL KF „ 101.000-4Z.a-OW
MI;,1?C:9'I2iCt3i.FEZ 1 01-000-4:2t9- 000
PUUM13INGPZP g?01�*?t10�4d�a00i? r 63Yt,iQ
wTit.OkdC} VIi3a. Itril4 FEIi. • RE£SI.i'b :101-000-241-000 °— 5 .
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FEB 2 7 2002N'
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DMMO4IM
RECEIPT
DATE
BY
DATE FINALED
INSPECTO
J•.)'.4V
Alar.
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
- Z 5 Z 77
Underground Ducts
Forms & Footings
Z - Z
Ducts
Slab Grade
- - y
Return Air
Steel
Combustion Air
Roof Deck '.
- % —�
Exhaust Fans
O.K. to Wrap%
- Z
F.A.U.
Framing
_ _
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
_ - %-
Final
Final — —v2_ c5
BLOCKWALL APPROVALS
POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings
�- -y_
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
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
Ji
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
—
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring =�_ F
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
AV
Final
Utility Notice (Perm) . ' - 6n
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:
_ e
79-771 Morris Avenue, Lot 16 Monticello -Heritage, La Quinta, California
CEILINGS:
TYPE: BLOW MANUFACTURER: Certainteed Thickness: R-38
WALLS:
TYPE: BATTS ,MANUFACTURER: Certainteed Thickness: R-13
. _ t
0
GENERAL CONTRACTOR: CENTURY CROWELL COMMUNITITES LICENSE #01
01
BY: TITLE: e
e
PARAGON SCHMID BUILDING PRODUCTS, A MASCO COMPANY LICENSE # 632072 e
a
TITLE: ADMINISTRATIVE ASSISTANT DATE: 12/12/2002
e
;Installation Certificate: Residential CF -611
Site Address. PERMIT #
79-771 Morris 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 80UHG4/SX=100 -80% 100000
-80
4. COOLING INFORMATION
COOLING MANUFACT COMPRESSOR ACTUALEFF. 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 thecriteria used for equipment sizing and selection.
5. SUBMIT -TED BY
C!1/ILUL . 'DATE:
Signature Installing HVAC Contractor
Jan 29 02 11:37a Richard S i m•pson 661 9474809 p.4
is
INSTALLATION CERTIFICATE (Page 3 of 8) CF -6R
Site Addl'etls
79_77
Permit Number '
Av Noe,
DUCT LEAKAGE AND DESIGN DIAGNOSTICS
DUCT LEAKAGE REDUCTION ,.
Pru-Nsuruation `fest Rcsuhs (CTM 61125 PA)
• fctiL Leakage (CTM) S,S�
Fan Flow, +
If Fan Flow' is Calonlat:od as 400 cWton x number of tons, oc as 21.7 x I Ioaling Capaoity
in Thouaanda of l;tw%j. ester calculated value bort
If fan tivvv it measumd, cmlia mcasurul value hen—RooO
1n:6dtage Fraction —T% 4 I.a►Itago/(Muavurkxl or (:ulcalatcd Fan Flow)
Pay il,kakogu l'fAotion 50.ttb❑
„ Pass Tail
❑
For AEROSOL TYPE SEALANTS ONLY -The following; diagnostic texting was completed:
I)ucl Fan *Pr( marie.alio'n at rough -in measured kakagc (CFM) ,
CHECK Ali i'ER.FHNI9NING WALL:
® Yes ❑ No ❑ . i re,c sa: pan ukg or I louw pm-eit►rriation to:kt
❑ Yes ❑ No E' Visual Inspection of Mot Connections ❑
THERMOSTATIC MANSION VALVE (TXV)
AY N ® No '17►mt►oxlatio 1sxpattsi0a Valvc (or Commission approved i
oquivalont) is installod and Ac:cc-,v; is provide] for mspvclion
Yw ir. a Pnis 1'a.a Fail-,
0 DUCT DESIGN .
1. ® Yes ®No RCCA Manual D DcAgn calculations have been eompluiud,
Ihnst ikvign is on The plans and duct inslallalion machos
plans.
2• ❑ Yea E No TXV is installed ur Fret flow hex boots vurirwd. If no TXV,
vcrilitud fan flow ntatchw; do•:ign from CT=12 ,
Mcaaurod Fan Flow =
❑ ❑
Yca.lbr butti 1 and 2 ie: a Pam Pass Fall
1, the undmignO, vczily that iho above diagnostic fust mmith apd ilio work I performcd a.-,ociatud with the tcmt(s) in in
conlomtAncC tvitb tho t+cgoiresncntg )i►r oomplianu an dit ('[hes buihlur shall provido Uus HEWS PrbVidor n copy of Iho C 1 !,R
%ignod by the builder eu►ploymn or Hub-cuntraclom ckxtilying that diagno iiu tuAing auJ im.;Iollation ntuv-t the ruquimunonk Air '
complianm cn;dit.)
1'csts Signature, Date; laatalling Subcontraolor 'o. Name) lilt
Pcrlurmcd + - Genoa) Contractor (Co. Name)
COPY TO: IJiiilding Vepnrhncvl ' r
1111113 lWvidor (Xapplicahlc)
Building Owner ut occupancy '-
January 4, 2001
i
r
Certificate of Occupancy
City of La Quinta
Building
and Safety Department
.'
I
R
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:
t1
BUILDING ADDRESS: .79-771 MORRIS AVE.
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: .0202-167
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 Official
Q POST IN A CONSPICUOUS PLACE
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