SFD (0202-168)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-,� 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 wage's 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). t 10.
() 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 -forby Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued. `
Se( ) -1 have and will maintain workers' compensation insurance, as required by
ction 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 WEA 'A(,-] C% DIS, Policy No. NWC:444068• 031
(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 - Applicant -
Warning:
licant 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. f
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. ILI-
1. Each person upon whose behalf this.appl'ication.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. i
Si nature (Owner/A ent) /+- •' • Date,'
PERMIT # '
BUILDING PERMIT.. '
DATE VALUATION ':COT' 3 TRACT
241"1-4
JOB SITE
APN
ADDRESS
+^�OXay
604
OWNER
CONTRACTOR / DESIGNER / EN (NEER
CIN URY MOWELL COhM.: 11:.4
C0100;)a-T-=
Mi 30, I'D" WREST, 113TE 4200
153;30, I'D"3' '1', VIM .92.€90
SA B,'A ih Gr`� c�?�1'Jo .
Al<T Ai 1tAi`�7 C: 9U09
(909,),381.6097 rBL44 212
USE OF
.PERMIT
4/3gqE FAQrE TN.Mr(NC1
, .
''1 ,411:x', N' )0F., SPA OR DFaIVEWAY.filPPROMM "6fi%RMUCT7iON `Cid PL4N ,
CHECK TIE kDR. Mi31„'I P1. I? 1.:50ANCEff, OF SAME PIAN T'S P
POMC~ PATIO 62,00 $F
G3.ARAUHICART'ORT 604.00 tiF
'�,�) C05`�' .OF �tt71`T51RUCCiRM
1,561551&W
•�}•� �g� q -p ye y g [ yp ��••g gV`9'rJUN
Jr'��,CYA'P9J.Yt� :I7Y�C.CLI” Yi.JA+l.ltfAl•0.r.C.7.
.
W1491 T"RUC.T'ION FEB 101-090-418-000 $819,00 ,
PLA14 Ck wxl ru 101-(300-439-318 $1.7�i.ai9
idlEC�f'iNNICAL )'I1': 101.000-421.000 $Gei.St�
EL.C't'ftdcAi,. Y,,z .
P .ilM'OTNO Full 1.01-000-419-000 VIVA
S i'd2C7A s 13bi0 TeC7rtJ F '- k?in Il S ` 101 � 9Q-2 4 -000 _ $13.66
ORADNOPM
DW LI.OPIPUR 1MPAf-C- p ,SII //aa .11 >' .' "r tw 1B9i3 .Ctft
CWNa.TO AL.E,t31 A CiU n �?Jl A1�1•:Q'�� PLOT b`�'W.nt.`7p��
N
RECEIPT
DATE �7 y ' }
1.
BY /
DAT FINALLEED
INSPECT
9 .9 .... • , i.r..t, s• f;
„z rVi
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
- ,2 — Z
Underground Ducts
Forms & Footings
- Z
Ducts
Slab Grade
- L
Return Air
Steel
_ 2,V — Z
Combustion Air
Roof Deck
_ r_7
Exhaust Fans'
O.K. to Wrap
_
F.A.U.
,
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final / 2
BLOCKWALL APPROVALS
steel
POOLS - SPAS
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
I
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
3 -j!- Z
Heater Final
Water Piping
X
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
S$wer Connection
Encapsulation
Gas Piping
Gas Test
S
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)
COMMENTS:
Installation Certificate: Residential CF -611
Lt
Site Address PERMIT #
79-785 Morris Avenue;
1. BUILDER INFORMATION .
SUBDIVISION: Heritage
Century Homes CIT.,Y: 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`Bette;
1, 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-09OX 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 heatd'oss 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
c.,.^ DATE: /1 -
Signature Installing HVAC Contractor
Jan 29 02 11.:37a .Richard Simpson 661 947-6889 p.4
INSTALLATION CERTIFICATE .(Page 3 of 8) CF -6R
Site Addm, A ..7e� 7 8S /ulo +t rt t S l��t�nl vt,ermit' Number
ClIUCi' LEAKAGE AND'DIESIGN, DIACINOSTICS
DUCT LEAKAGE REDUCTION
PreNsprization 1 cat Results (CPM (d1 2.5 PA)
Test I.cakagc (CFM) 5
Nan Flow.
If Fan Flow is Calculated ac 400 ofmftan x numboa of tons, or as 21.7 x l looting Capaoity
in Thousands of BtAr, enter calotdatod valuo here
If fan [low i.. measured, eater m'casu" value herr: _
Leakage Fraolion ='I" Loakagol(Mcmumd or l':aloulatotl l an flow)
Pax.. ifleakagu fraoti6n50,06 ❑
Pass I ail
❑ For A F'ROSOL TYPE SEALANTS ONLY -The following diagnostic testing was completed:. ,
Duct Fan Pri,xKuricatiun at rough -in measurml kakagr (CFM);
CHECIK AFTER FINISHING WALL: t
❑ Yes ❑ No ❑ Pre'':sVIV pan 14X or l louse; pn rurreatiun to sl
❑ Ycs ❑ No ❑ Visual Impebtion of Met Cunnuction.. ❑ ❑
Pass ]'nil
THERMOSTAMC EXPANSION VALVE (TXV) '
Y.N ® No fI►extito toric lispan,:ioa Valve (or Corlttnission'approved -- --
oquivalont) is inslallcxl and Act;
vw is providW for mvootiou ❑
yes is a p1b. Pass. fail
❑ DUCT DESIGN
I' ❑ Yes ❑ No ACCA Manual I) Iksign calculations havo been completed, -
I)uct i)asign is on the plans and duct installalion mntoho.s
plans.
2. ® YoA ❑ lVn TXV 6 installed or Fan flow has b vn vutiliod. If Sao TXV,
variflud lion flow niaichtw du'.tiiga from CF' IIL'
Mcaau nd Fan Flow =
Yea Ivr both 1 and 2 in it Pan. Pass Fall
f, lho undcrsigaul, verily that iho'ebovu dittgnoctic tint rtmtrlth and tl►c work I performed associated with the icsl(s) is in
cu brmtmoe witb the rc uimni :nig ibr oom liance credit. 'lire '
9 p ( budder ~half provtdo Uw I I13I18 ptvvidur n copy ul'tho
siguW by the buiWectuployocs or sub-contractom certifying Thal dialmu: to testing and ia.taUation erect lho nsquiretnurtt. I'm
compliant cn dit. J ,
1'csts Signature, Date
�0111ing8ubcontraot4 (Co. Naouc) OR
Pc rformcd (keern) Contractor (Co. Name) '
COPY TO: Building Vepartnteuf
1113118 Provider (iifapplicablc)
Buildiriq Ov nez- ut Occuponcy
32nuary 4, 2001 ;
INSULATION CERTIFICATE d
This is to certify that insulation has been installed in conformance With the current energy o
regulation,.California Administrative Code, Title 24, State of California, in the building located at: 00
79-785 Morris Avenue, Lot 17, Monticello -Heritage, La Quinta, California
CEILINGS:
a
TYPE: BLOW MANUFACTURER: CERTAINTEED - THICKNESS: R-38 e
WALLS:
d
TYPE: BATTS MANUFACTURER: CERTAINTEED THICKNESS: R-13
GENERAL CONTRACTOR:. CENTURY CROWELL COMMUNITIES LICENSE #
BY: TITLE:
r
PARAGON SCHMID BUILDING PRODUCTS, A MASCO COMPANY LICENSE # 632072
BY: TITLE: ADMINISTRATIVE ASSISTANT DATE: 12/12/2002
Certificate -of -Occupancy
Cit'of La Quinta
y
and Safet De artmentBuilding y p
This Certificate issued pursuant to the requirements of Section 109 of the Uniform Bui/ding 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: 79-785 MORRIS AVE
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 0202-168
Occupancy Group: R/3 Type of Construction: V/N 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 '
-�•.. ,L�L.►.�f.9� Date: 09/13/02
Building Official
POST IN A CONSPICUOUS PLACE I
1