SFD (0202-162)Y 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
714 388 1IT.-
Date -�= 7 Signature of Contractor-
OWNER-BUILDER
ontractor
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).
( ) 1, 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 GOT,MN € 9 ENS, Policy No. �- � � -
}a" `VIC i4f41 YID
(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. d
Dater, ,[ , a `rte 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.
t
Signature (Owner/Agent) f(+ +�"� Date'''
BUILDING PERMIT PERMT#
DATE VALUATION LOTS• TRACT
11 24.197.4
JOB SITE
ADDRESS 79-7«.4 WIMIS AlffMiT
APN
OWNER
CONTRACTOR / DESIGNER / EN (NEER
15M BID, ate° 3"x:,1 M, VE, moo
15 3 5..30, V , PT, M #200
dY•mlie i�? � 0 CIP", 9 '108
�y
e�"'►, �r.�.��At�1: O CA 92408"
(S*9)381.r: ow 05W 2120
USE OF PERMIT
C3•LL S?AWLY DVM-LbTG-
a11D - IA)T .1 i, PLAN riT�^, `9I',
W'ALIA POOL4 SP TREUCIT1.514 O PLAN
w'•,13.LXX Fna, 170FC'MAfi.'1'dP,; t!SSUA14 OF MME KAN T "Y
T1OXI CO NSTRUC:T'MI'1 w7'
G." sr":[5.AOMARP: RT 604,£20 3F
PLAN CHECK ME � 4 d lL-��{y�titn#�3 $11,7x2.50
y��r513t�
' ,}oi7'�'vlT.f - A4.n�'� L Fr � ,F "'CJ464: 1 "'i3v,.7� $66150
M1tC:'C'WCA41'IT E 101-000'e420.000t,k , _�3 ;1,33
PILSZu8,040RIF,1U1-0.00,419=GOG
S e=IRM10 MO k iafd Fir1'I: i' MID 101-G'0-2 1 n01DO ; > $f 5.64,
c.
r :� 0-42:000,1 $260
t:liLAD-i3t�0�.^1rt'RE.�ny
ft
A
i�t;�V �'L4./f�iiiY. i]briiD7`..fs• t'�1'i w; •. � i f�7.��4`J. 1i��
�.
FEB 27 HIM
U115 -TOTAL CONEMAUClIO1>1' MM RLO,N qt%p�
$3,� ,16.08
$0,00
• r
RECEIPT
DATE
BY
D E INA
INSPECTOR
r-',�,t' e1-) ,� Z-i"��
/
r1i+A di
�f
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
— - 2
Return Air
Steel
g—
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 Wali Firewall
Exterior Lath
Y 'e, —0- —�
Drywall - Int. Lath
Final
Final
POOLS - SPAS
BLOCKWALL
APPROVALS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
5 — — Z
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines _
— ,Z?i—�
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
_
l —U2
Encapsulation
Gas Piping
_
Gas Test
Appliances
—
Final
COMMENTS:
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)
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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:.
79-794 Morris Avenue, Lot 11, 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
B TITLE: ADMINISTRATIVE ASSISTANT DATE: 12/12/2002
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P
,:V Installation Certificate: Residential CF-6R
Site Address PERMIT
79-794 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 equipmentmeets 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-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
12AC836
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
�o,.� ��.�i-r11• -DATE:
Signature Installing HVAC Contractor
Cetific'at6r .of Occupancy - �-
City of La Quints
5
.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 C ty.regu/ating building construction or use. For the following:
BUILDING ADDRESS: .79-794 MORRIS AVE.
.Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 0202-162
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
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