SFD (0202-170)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
714138 R '10.3110
Date, e• 1'1'117ti f) Signature of Contractor "-� �% %' /9
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
Schon 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 GOLDEN KA01,E 1M5, Policy No. N ASC< aQ ,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: �N
Date: - ' ! Applicant Ilu / ��
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.
Signature (Owner/Agent) rQ' { � � I f Date -
k77—_-
BUILDING PERMIT,: PERMIT# r
DATE VALUATION LOT "' � TRACT
JOB SITE
ADDRESS r �. � �.� C� ✓� .-
APN
60"72f10W
OWNER
CONTRACTOR / DESIGNER / ENGINEER
iy`��+3p�4'iJ�iy Y C3��'try3�y��?yE��.+,r:.E. i
i:.KN"C'i3/"�ytY C:"J.�,�Cp���1�r1"�';i.�. r,�v�0hpl�;rNTIM�S
�CyCO��,S/.��p}i�a�y�'CJ
1535 SO. nY, - 3ad�..�'n . , }.Tl.1L'n� M -101J
� i r�� so, TO eaAr`.Gti1:n::. L W'.1� & i0U
SANt NAd?sMYJXO C_%,. 92408
SAN BERNAS "'ISO CeA M08
(909pel-60(v CxKuk 11,x(1
USE OF PERMIT
ST✓I) • ��° �9, �l;:�riib �fi3• k%.°i.�`i L7L'iI�'a`i iJt7'C aPiC,LklilLr �'trOCtC-i'd.AI,I.,Sy
F'0f: 4 SPA, OR I`► fFWAY .f 1,111000, WX R&D 11i0'j,'10;!3. ` 0 T'F.AN (.51i C.
FEE IPC3Fi.. MULTIPLE j + 11ANCE QF SAME PLNH f`YP& ,
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��y�y¢���p�♦.�.�y7{�yap-i�c`��] �y epi pa}a�
't�£84'�.6'A4�R:.4a-CG,iYtvi�Al.] �rt:.Pa6aN fai;,
.P.ER .ir F WAMA39Y
PLAIN t�HMIX i 1�;�0iv-4,39-3.1' '160.1,11
101-00"21-000 ` , �r(yb. i�►
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1. J7.a1:AVi�SlA�eAL I':71.C, •• VLI"!9 dr{."�51t/ .ry Jl r�CinA3
ST ONO MOTION FL ' �� doll) 1.01
caiN T 1 o l4 00'4 }t3t)d3 420.00 '
J)i+�'1YfiLOPE-IZ iM?.hC`f` VZZ
FEB 2 7 290a i,
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WMAMIX. CON; 't UC'.'1•10N AND PLANT 01HErIlt
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RECEIPT
DATE
BY
DATE FINAL D
INSPECTO
�y
f
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
41 -1
Ducts 147
Slab Grade
Return Air _
Steel
_ 2 _
Combustion Air
Roof Deck
-
Exhaust Fans
O.K. to Wrap
-Z
F.A.U.
Framing
6 - p _
Compressor
Insulation
Z3. -
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
-
Drywall - Int. Lath
Final !'L
Final - .r `�
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
- j
Heater Final
Water Piping
_
Plumbing Final
Plumbing Top Out
�r�Z
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
��
Encapsulation
Gas Piping
Gas Test
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 - 6-,Z—
MZUtility Notice (Perm) - p�
Utility
COMMENTS:
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INSULATION CERTIFICATE
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This is.to certify that insulation has been installed in conformance with the current energy
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regulation, California Administrative Code, Title 24, State of California, in the building located at:
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79-813 Morris Avenue, Lot 19, -Monticello -Heritage, La Quinta, California
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CEILINGS:
,TYPE: BLOW MANUFACTURER: CERTAINTEED THICKNESS: R-38''
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WALLS:
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TYPE: BATTS MANUFACTURER; CERTAINTEED ' THICKNESS: R-13
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GENERAL CONTRACTOR: CENTURY CROWELL COMMUNITIES LICENSE #
BY: TITLE:
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PARAGON SCHMID BUILDING PRODUCTS, A MASCO COMPANY LICENSE #632072
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BY: TITLE: ADMINISTRATIVE ASSISTANT DATE: 12/12/2002
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alai'i�-uioivirivisiarsmiirsirisi>iiirivisioisisisi�uisisimoisirisiiisisivioirivisiriomisiois�oreiaioiiia�oiririmsioioivivisiw>ivuioisisioisui:iAmuirui /si /vAivia�si.-isJ
Installation Certificate: Residential CF -611
Site Address PERMIT #
79-813 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
1, the undersigned, verify that the equipment listed in the categoryabove 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 bn'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 sizin' .and selection.
& SUBMITTED BY
ot.-.JC (.�-As�l.4►�t�+; DATE:
Signature Installing HVAC Contractor
Jan-FS UP 11:37a Richard Simpson 661 947-6889 r p,4
INSTALLATION CERTIIFICATE. (Page 3 of 8) CF 6R
�?"J/l/ ULY A�LGP� i2/ /i
Site Ad,,dl 9 �� M 0 R RtS Avt�•Nv� P ik i t�mi�i r,
DUCT UAICACE AND (DESIGN DIACNOSTI'
DUCT LEAKAGE REDUCTION '
1'nwsurrrat►on I est Rcs,ull.s (CFM til 25 PA)
'fest 1,cakagc (CFM)
Fan Flow
If Fan Flow is Calculatod as 4()t) cfaion a nwnbcr of tour, or as 21.7 x 1lcatimp, Capacity
in Thouyand�t of I3tu/br. enter calculates value here
tf fan tlow u mcasurcd, c,•ntcsr mgaxurcd value hurt O O O
Lcakag,; Fraction I,mkago/(MCa," 4 or.Coloulated Fan Flow) ,
Prue if lockage fteotic►n s 0.(w ❑
Fail
❑ For AEROSOL TYPE SEALANTS ONLY - The following diagnostic tearing was completed:
Doul Fan l'rcxtiuriiatiou al rough-in me a'sured Icakagc,(CFM) '
CHECK ANTER FINISHING WALL:
❑ Yes ❑ No ❑ 1'rk c+nru pan I" or I)ouse; plt►ssurkeation torn
❑ Yes ❑ No ❑ Visual Inspection of Duet Councolions ❑ ❑
l'asS .
Fad.
�iM@R1IAOSTA7IC MANSION VALVE (TXV)
Y�� ® No '111arnio.1860 I'sxpau?:ion Valvc (or Corttniiission approved--
oquivalent) is installed and Act;==; is provided for insImlion • . �]
Yule ie a•paa� Dail
❑ DUCT DESIGN
I ❑ Yos ❑ N' RCCA Manual I) Dr-Migm calculations have boon 6omplolcd,
OU01 IX-Agn is on the plane and duel in%Iall.9lion mntcb_ Ca
plans.
. f
2. ® Wfl . ] No I'3CV i� intAallcd tir Fwflow hoz been vurikiW, If no TXv, - r
eril➢cd lith flow matahun davgn from CF-IIL
Measured Fan Flow =
0 ❑
Yces Ibr both 1 and 2 it; a Par:( • Pass Fail
I, Ibc undcrsigavd, vw y that the above; di49il9stic War romulk and the work i pertbrmod associatod with the ieat(K) is in .
Coatbrmana: Wit the requirements lire compliance: credit. ('l'ho builder shall provido the 1 MRtipcuviJar n wpy'ol' Iho CILOR
sign.:J by tho buildor colployoca or rub-contractois ccrWl ing that diapu mio tc.%ting nni nretallation nun►t Ihu ruquirvtuval Ibr '
compliance: crcdil. J
Icstx Signatruo,l� c
Installing ,%'ubco for (Co. Name)
Pc rl'urmcd Ge. acral Contractor (Co. Name)
COPY '1'O: 13uilding llepattmcnl
1113RS Providinr (if appiicablc)
Building ovmer ut oCCuth,)nCy
January a, 28111
r
Certificate -of Occupancy
City of L Quinta
Building and Safety.D6pa,rtmeht
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 tegu/ating building construction -or use. For the following:
BUILDING ADDRESS: 79-813 MORRIS AVE.
Use Classification:" 'SINGLE FAMILY DWELLING 'Bldg. Permit No.: 0202-170
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