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SFD (0202-169)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 Dates; ;;' . 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 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: () ]-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:. Cartier .0OW) 4 RAW. & 1'14 Policy No. XWG �J- 4O60_U3 (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. .7 Date: Applicant --Warning: Failure to secure Workers' Compensation coverage is unlawful and shall subject an employer to criminal penalties and civil fines up to $100,000, in addition to the cost of compensation, damages as provided for in Section 3706 of the Labor Code, interest'and attorney's fees. IMPORTANT Application is hereby made to the Director of Building and Safety for a 'permit subject to the conditions and restrictions set forth on his application. 1. Each person upon whose behalf this application is made & each person at whose request and for whose benefit work is performed under or pursuant to any permit issued as a result of this applicaton agrees to, & shall, indemnity & hold harmless the City of La Quinta, its officers, agents and'employees. 2. Any permit issued as a result of this application becomes null and void if work is not commenced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that the above information is correct. I agree to comply with all City, and State laws relating to the building construction, and hereby authorize representatives of this City to enter upon the above-mentioned property for inspection purposes. Signature (Owner/Agent) z �_/ ,�+t 'a Date.D., BUILDING PERMIT PERMIT# DATE _ VALUATION LOT 02fD2 �69 TRACT tp 18, 24197.4 JOB SITE ` ADDRESS v-,7:N=R s.A-mm APN OWNER CONTRACTOR/ DESIGNER/ EEN61NEER 411$vWgy-OVELL rMCJTkXIS CENT LTR CROW7G4C ONI6MSJES 1535 SID. T" FVRXE -'Y, Ul:, 0200 1:535 Jct, T" 9.1, z • , ; VI`s;, #200 .W, BE1:•tNJST:.:i3WO CA 92408 SAW BEPM�',� ��'.r�O �".tR 92409 t;3t i3�� 16097 LA X11'2( x?` USE OF PERMIT f. ZM- ^ LADT IK P1 A N 3 A0,V. PY MAIT 00M NIt ' 3N4'.I UDE BLOCKWAUS, Pool,, SPA OR PRIVl?WAY APPROACH, '!'dtA4""I` COAIOTAIXT1ti:91•I PORC'HIPATIOn"9.DASP ' td riStSi.1�.4.f1'.dFidY3i! .'A W460F ERTSIXIIED C09r OF C:}P.iMIi;FC'�`. OPI 1321,,910.20 'PERMT FEE SUM ` CONSTli.tlt"1101H FEE 101-000-4118-000 WS.(tL PL41114 CHEM i•' �' MCMNICI.,AL FER 1101-000-421 -000 MW3TRICAL :101-000-4202-000 PLUMBIWO FRE erltolu mt3TIm I„a-=91D 1101-000-241-000 $13,29 cRADYNO W, 110.1 ^000-423-006 12AC6 DEVELOPL''Ct IMPACT FES' � ��� � f $11P0.00 iI �. r E FEB, 2 'DOS YiJT3`' .y,Q�*a�*e"' It it'c: klC% • ,JtJZ9 £, Y �� C 1: ° . r - $3,638,28 :' i f . TOTAL rX MIM IS DITIE NOW • r w V RECEIPT DATE BY D�TyE FINAL.ED INSPECT - INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs 3 - —2_ Underground Ducts Forms & Footings Z Ducts Slab Grade Return Air Steel _2f _ z Combustion Air Roof Deck Exhaust Fans O.K. to Wrap F.A.U. Framing Compressor Insulation J _ Vents Fireplace P.L. Grills Fireplace T.O. Fans 8 Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath Drywall - Int. Lath Final — BLOCKWALL APPROVALS Final steel POOLS - S AS 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 - 2 Heater Final Water Piping _ Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral Pool Cover Sewer Connection aZ _ Encapsulation Gas Piping Gas Test Appliances Final Final Utility Notice (Gas) ELECTRICAL APPROVALS Temp. Power Pole Underground Conduit Rough Wiring _G — Low Voltage Wiring Fixtures Main Service Sub Panels Exterior Receptacles G.F:I. Smoke Detectors Temp. Use of Power — Final _ �y Utility Notice (Perm) — —®Z COMMENTS: i INSULATION CERTIFICATE t 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 79-799 Morris Avenue, Lot 18 Monticello -Heritage, La Quinta, California e CEILINGS: TYPE: BLOW MANUFACTURER: Certainteed Thickness: R-38 WALLS: d TYPE: BATTS MANUFACTURER: Certainteed Thickness: R-13 GENERAL CONTRACTOR: CENTURY CROWELL COMMUNITITES LICENSE # a BY: TITLE: PARAGON SCHMID BUILDING PRODUCTS, A MASCO COMPANY LICENSE# 632072 0 . a BY: TITLE: ADMINISTRATIVE ASSISTANT DATE: 12/12/2002 a; . e Installation Certificate: Residential 'CF -6R Site. Address PERMIT # . 79-799 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.effcient 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 12ACB36 .12 12ACB30 10 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 .� A ,DATE: /2—(&-0`L_ Signature Installing HVAC Contractor Jan 29 02 11:37a Richard Simpson INSTALLATION CERTIFICATE 4661 947=6889 (Page 3 of 8) �ias:nuuau�n -"7 7q�r M.Q 21t1,s A�trNtl� Permit Number ?g DtICY' LEAitAG9 AND DESIGN DIAGNOSTICS DUCT LEAKAGE REDUCTION• Prx %mriialion'l'" Rcsuhs (CFM (a). 25 PA). Test Lcakage.(CFM) Fan flow If Fan Flow is Caloulatcd ay 40(1 ofw/toit s number of tons, or as 21.7 x I Icali ng Capaoiity • in Thouaandy of 13 Ar. enter caloulntcd vnIUC hart _ r if fan Ilow is mi&sun:d; eadcr mf"tm-A viduc here . `2., D ?� ` l,cakalae 1'raolion ='I" I,adtnggf(Mcarurcd or C:nlodlaled Fan 140,w) Pa..M if leakage ftaotiou S 11.116 ® For AEROSOL TYPE SEALANTS ONLY The following. diagnoxtie twaing was completed: Dant Fm I'mmurication at rough -in mewsurul Icakage (CFM) CHECK AFF ER FINISHING WALL: ❑ Yes ❑ NO ❑ IWxxUrc pan lost or IIOU%c; pro'Nurirration'tcat © Ycs ❑ No • ❑ Visual Intipcution of Duct Connoctions THERMOSTATIC EXPANSION VALVE (TXV) Yw'. ❑ No ' Th xmOr'lalic I?xmgiou Valvc (or Commission' approved oquivalont) is installed and Acve,s4 is provided for m:� —.i m El Pays Dail Pass Hail 13 Yc,' is a pays DUCT DESIGN 1' 13 Yaa ❑ NO RCCA Manual I) I?csign calculations have Fxxn aomplWud, Dui -4 Davign Ly on the plans and data installation mnichos plans. 2.. ❑ Yca : C1 No TXV is m. -49110d ur Fan flow hax baht vorilied. If no TXV, vciilicxl Than Dow mntchcn duwign front CF -IR Measured Fan Flow = Ycs Cor bothA l and 2 iu it Pan.Y Pass Fait I, tho undersignud, verily that tho above diagttastio tl Axl xvnith and tltc work IpertormtW aa4ociatui with the IcHgi;) is in contbrmtmu3 with tha mquirements lot compliance; ciudit. j'lito buiWcr .AWI provido Uto l OWN ptvvidor a copy of Iho CF -OR stsu%W by the builder eu►ployr ca or sub -contractors cortifying that diagno lie lusting aril in..tallmnin utow Iho nigairvinoi k 1br complianc;c cn:dil.j � • ' Tcrcts Signature, Date�Iuctallin Subcontraotcr(CO.Name tilt PLdinmcd 6 ) (kneral Contractoir (Co. Name) COPYTO: Building 130pnrtruout 111111.13 Provider (il'applicablc) Building. Cp mer ut- occut7dncv January 4, 2001 Certificate, of -.Occu k a.n,c.v ,-2 Cit of La',,,,, Quints Building and Safety. Department OF-�� This Certificate issued pursuant to the requirements of Section 109 of the Uniform Building Coale, 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: 79-799 MORRIS AVE. Use .Classification: SINGLE FAMILY DWELLING. Bldg. Permit No.: 0202-169 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 Date: 09/16/02 • Building Official POST IN A CONSPICUOUS PLACE