SFD (0202-161)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
'114180 D �y ) oA41. '0
Date:"�'1'"� 7 °''I ,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). 1
() I am exempt under Section B&P.C. for this reason
Date. Signature of Owner
WORKER'S COMPENSATION DECLARATION
o rv-� I hereby affirm under penalty of perjury one of the following declarations:
Lo H p () 1 have and will maintain a certificate of consent to'self-insure for workers'
X LIJ �: compensation, as provided for by Section 3700 of the Labor Code, for the
J Qperformance of the work for which this permit is issued.
Q U () I have and Will maintain workers' compensation insurance, as required by
U' Q Section 3700 of the Labor Code, for the performance of the work for which this
1 rn H permit is issued. My workers' compensation insurance carrier & policy' no. are:.
ob — Carver COMM�� OD�Y t� �X,�j� Policy No.
irl���' 11•�WLf� ��4iD
g (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 -` 7 ' J
`"'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.1 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) i'.n'? ! J Date,1 J�"?'r%1'
BUILDING PERMIT - PERMIT 1l - Y"
TRACT
DATE VALUATION LOT TRACT
�r L � 10 24197A.
.5 . 1•1 i> ,
JOB SITE
APN
ADDRESSas Avim604'^72^M
OWNER
CONTRACTOR / DESIGNER / ENGINEER
=kI'r(J'RY* CRi3VIYML O10MMa . z : -:48
C'T?,IN'iU1131 CRO31rFELL C OMxv1.C1'�t�4."MS
1535 80,16V MRU11;
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
7_215R,_
Underground Ducts
Forms & Footings
Ducts
Slab Grade
(o
Return Air
Steel
— — Z
Combustion Air
Roof Deck ,q .%
— —
Exhaust Fans
O.K to Wrap
2 3
F.A.U.
Framing
—
Compressor
Insulation
Z
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
—2
Drywall - Int. Lath
Z
Final
Final
BLOCKWALL APPROVALS
POOLS - SPAS
Steel
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
�1=� —Z„ S
Heater Final
Water Piping
Plumbing Top Out
Shower Pans
/
Plumbing Final
Equipment Enclosure
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
Final Cia 1
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) p
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:
79-808 Morris Avenue, Lot 10 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 COMMUNITITES LICENSE #
BY: TITLE:
1
PARAGON SCHMID BUILDING PRODUCTS, A MASCO COMPANY LICENSE # 632072
B TITLE: ADMINISTRATIVE ASSISTANT DATE: 12/12/2002
F
s
Installation Certificate: Residential CF -6R
Site Address PERMIT
79-808 • 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 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
12ACB36 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. SUBMITTEDBY _
QCUJ Vii. DATE:
Signature Installing HVAC Contractor
ifi to of.-Occu ancCert ca- �
p y
0 -
City' of La. Quinta.
Building and Safety Department F,yOFti
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:
BUILDING ADDRESS: 79-808 MORRIS AVE.
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit.No.: 0202-161 e
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.'9240.8
By: GARY SHOWALTER
Date: 09/10/02
Building Official
POST IN A CONSPICUOUS PLACE