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SFD (0202-163)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 Date '� ~'�1�>` -Signature of Contractor L /P OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractor's License Law for the following reason: ( ) 1, 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 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 fat ll,TIEN RAOW INS, Policy No. I,$'g1C-W068.03 (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. Date: 4" ! "`"»+�/P .� Applicant �* `14 114 � 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 tees. 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. a Signature (Owner/Agent) z � ! •` Date-,.: "% ... „.. r r ,L-- BUILDING PERMIT PERMIT" DATE VALUATION LOT TRACT JOB SITE ADDRESS 19- 7w-mommAw aw APN 'f`r'�^41,17.00 a OWNER CONTRACTOR/DESIGNER/INEER C yR vl0 'yakgWWV (,f 1VtigrAVVw., 1�10V1tNAy7FIS 1535 30, 17 Jr TP � .. , ., 0200 1535 1;3©" T, MU"f.'x', SIT, 62100 SAX BERNMWANO CFS 92408 "AR BERNaRi:i3.t+ O CA 92408 (909�3113I.<60M C.PA:,`>t 2120 USE OF PERMIT SWD • I..O`,f' I PLAN 2C, PEMMIT DOI.V%-140T INCLUDE I;.i.,0CK IWAJ .S; I004 SPA OR DRIVEW, Yd1,PPRO.AC.H, dSAlACT COMM'{p,UCT1`,14 r1R1�'J001Vit 611 PORCii/P.Al to 49,00 Silo' 0A. lAWCARPORT 420.00 31`' X-RIU 19D d,>"AW 0r CC,�}:�i•5'�'1"��:i�,"�f',ION .�C1f�16M.7€� [#T�jT�j J{'�Gj '�'.f�^,i (y4',''�j�`�/p} :F'LM.1J.�Y3F..{`IT. E SU.LTBak�.7k�tl!'aY CON r'i RUC PIMI ?B3 101-000-4 1 B-000 $664.00 PI,14 CHEM IREE 101w000'439-318 615$2.24 MECHANICAL FEE r,° 101.000421.000 $60.00 2Lt11'FYtt AL FEE t 10-000,410-000 3 YB go 'l0i P1111MING ING IZD C oco- 41.91,»000 Ali<Lt.W t` ^ t-TRONG MOTION FEEI, RtSID 1'61 -"006-2,11 -000 - ORWItxQ F119. i F�.030 E fOPPR 17 ' 9 t'�ly9t—IlOU FEB 2 WYORAQ 4MI-"i'Cf � .f L C0 3 [ t"t t i' t��7= i,�1 i3� C1 , 3, �►3:> 0 L[ LE.93 $0,00 TMAL i':�;.RY�['I' V%L0 DUE NON � Cyt , ��$4 s60 RECEIPT DATE BY DATE FINALED INSPECT INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings Ducts _ Slab Grade Return Air Steel Combustion Air Roof Deck — ®— Exhaust Fans O.K. to Wrap 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 y —� Drywall - Int. Lath — Final Final - POOLS -SPAS BLOCKWALL APPROVALS Steel Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Underground Plbg. Test Finan Gas Piping PLUMBING APPROVALS Gas Test Electric Final Waste Lines =� Heater Final Water Piping Plumbing Top Out f C, Plumbing Final Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral Pool Cover Sewer Connection Encapsulation Gas Piping Gas Test Appliances Final COMMENTS: Final Utility Notice (Gas) ELECTRICAL APPROVALS Temp. Power Pole Underground Conduit Rough Wiring _ Z_ Low Voltage Wiring Fbdures Main Service Sub Panels Exterior Receptacles G.F.I. Smoke Detectors Temp. Use of Power Final _ —® Utility Notice (Perm) - 7 — 9 >_, i INSULATION CERTIFICATE a aThis is to certify that insulation has been installed in conformance with the current energy a, regulation, California Administrative Code, Title 24, State of California, in the building located at: o 79-780 Morris Avenue, Lot 12 Monticello -Heritage, La Quinta, California g CEILINGS: °a TYPE: BLOW MANUFACTURER: Certainteed. Thickness: R-38 e WALLS: o TYPE: BATTS MANUFACTURER: Certainteed Thickness: R-13 GENERAL CONTRACTOR: CENTURY CROWELL COMMUNITITES LICENSE # g m BY: _ TITLE: PARAGON SCHMID BUILDING PRODUCTS, A MASCO COMPANY LICENSE # 632072 B : TITLE: ADMINISTRATIVE ASSISTANT DATE: 12/12/2002 Installation Certificate: Residential CF -611 Site Address PERMIT #" 79-780 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. . & HEATING INFORMATION HEATING MANUFACT HEATING UNIT ACTUAL EFF. HEATING EQUIP HEATING EQUIP. - MAKE MODEL # AFUE CAPACITY LOAD Furnace 'Lennox 80UHG4/5X-100 80% . 100000 a 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 DATE: Signature Installing Installing HVAC Contractor Jan 29 02 11:37a Richard Simpson 661 947-6889 p.'4 INSTALLATION. CERTIFICATE (Page 3;of 8) CF-6R Site Addmmi Permit Nuth r DUCT LEAKAGE AND DES I(CN IAGNOSTICS DUCT LEAKAGE REDUCTION Pressurization Tcst Rcsulls ((7,M 67125 PA) 'I'cti( Leakage (CFM) :5S i- Fnn Flow ` If Fas Flow is Calonlatod as 4W dWtou x iaumbcf oftons, or a.4 21.7x I lcating Capacity - in Thou,and, of BtAr. older caloulmod value here If Can flow ix uumgw :d, cmtdr mcaaurc d value here 0-0070 , I,oaltag'Traction = 'Yesi I.adCngc/(Mcaaurcd of Calculaicd. Fan Flow) Pas,,; ifloakogu Iraotion s(),tffi ❑ ` Pass Fail ❑ For AEROSOL TYPE SEALANTS ONLY -The following din'odgtic testing was completed: [)not Fan Pru-muriraliou al rough-in mcasurw leakage (CFM) CHECK AFTER FINISHING WALL- 11 Yes ❑ No 13 Pres-sur ; pan (cwt or I lousa pmssurivntion lem , ❑ Ycs ❑ No ❑ Visual Inspection of Duct Conrimlions ❑ ❑ Pacs Fa U. D THFftMOSTA nC EXPANSION VALVE (TXV) y YwN 0 No 1' kermo.9aGc Iixpatt,iou Valve (or Comimission approved oquivalont) is installod and Ac uc is iw providcxl for in ipaction ❑ YW ir. a paaa' 1'as, fail 0 DUCT DESIGN , 1. ❑ Yes . - ❑ No . ACCA Manual 1) Dr-Agn oaloulations have burin aomplolud, Duct I)csign is on tho plans and duct installation matches i Plans.. , 2. ® Yav ❑ No "'XV is iutitalled or Fan flow hax boon vorifiled. If no TXV, t' voriilud fan flow matchcv di wip front CF-I it. . McasmedFan Flow= M •Ycs for buth 1 and 2 is a Parr Pass Fall ' 1, the undcrsigno, worry that lho aboyo diagtto:<hc wit mmith aqd the work I pertarmcd assoclatcd with the tcst(t,) is in conibrmtmw with the *uimmcntg fi►r compliance credit. I'I'ho buildur shall pravido ilio 1lls11ti ptuvidor it urpv of Iho CF Ci1L signW.by the builder cluployncs or sub.conlracton; certifying that diagnu% fust ing and nistallatiun ntuvq (ho ruquirutnvaifx Ior compliance cmdil.J oz a C TCsts ,Signatory, Date /h0al&ng Obcoutraotor (to. Name) OR Performed s Goacmj Contractor (Co. Name) COPY TO: • lfuildin0*1rhncut 111:113 Provider (il'applicabic) Building own4x- cit occvvaiiCv. e January4, 2001. J `' XCertificate -of Occu anc . � o� moo. Cit of LaQdin to y V. [.�Off!rfw Budding and Safety Department OF-� 4 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 incompliance with the various ordinances of the City regulating building construction or use.' For the following., - BUILDING ADDRESS: 79-780 MORRIS AVE Use Classification: SINGLE -.,FAMILY DWELLING Bldg. Permit No.: 0202-163 . Occupancy Group: R/3: Type of Construction:. VIN Land Use Zone:' R/L Owner of Building: CENTURY CROWELL COMM. Address: 1535, SO,"D" STREET STE # 200 City: SAN'BERNARDINO . CA 92408 By: ,GARY SHOWALTER (�� a Date: .09/18/02 Building Official POST, IN A CONSPICUOUS PLACE r