SFD (0202-171)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
Processionals Code, and my License.is in full force and effect.
License # Lic. Class Exp. Date
714188 B in 1 /01.
Date; , `"'i- -- Signature of Contractor _
- r
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. Sianature of Owner
WORKER'S COMPENSATION DECLARATION
Ihereby 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:
Policy No.
Carrier 00LIIMN &A:C31..t� .Wall. Nwe-544063.`.-
(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: •" / "'7gi`'`n Applicant
w 7 K c-
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.
%. Pr I'll
Signature (Owner/Agent) #'= '�-sof I Dater
19
BUILDING PERMIT PERMIT#
DATE VALUATION LOT OW2W 171. TRACT
SIM623.70 20 24197.4
JOB SITE
APN
ADDRESS 2��:1Y�1.�,11�Ca�.V; A YM111',.
t�' 04-072
OWNER
CONTRACTOR /DESIGNER / EN IIJEER .
Mama C;%owru. a.O1�63.�ci1',J13.!'.0 is
(-*I. grUrZy CaZOMM.L C.OM 9:l N1 m.1.E'rr
153.5 30. YDI Offw: '.�y M W200
1535 1510. Sr .17ME1 r, ITIE 4000
SANSERICIARDWO CA 92408,
SM ,6nNMW.T.N'0 CFS 9A1 O8
210
USE OF PERMIT
SFD u LCAT 20, I LAX ZCR.W. PERMIT 100193 140'f YNCLIXT- ; BLOCK
v"IrT:J�iX T,%'P001i SM OR DJUVE'1�,�YAPI'Rt`3ACH.WvIML1IfG'1 ON' TO.KAI+
CHECK I+PF4 FOI:. Rd. ILTIPLE MSSUA16CF. OF Z.A ML+ PL AN 'i'?P&
TRACT CONSTRUCA101J 1.,VWN 9F
POIiCiR :65'C7O 40.60 S?
0A.RAGVC.ARP0'RT 420400 ST?
ESM"IND COU OF C(MSTRU M,
106,623.70
CONSTRUCTION = 101.000.418-000 HOOD
PLAN CHOCK ME 101-000-13,91,319 $138.06
hIMMANICdAL FI±.R 101-000.421.000 � .64.00
I;.I.,IW'TIZ1C'AL ",'1, .411 90
Ptatii Dnga mix k01wQ��i�41I�-Cii3C► ; •$1�tt.tf4
S'1'ROfidt3MOTION It`ER- RESIV 101--000--Z-41 00
ORAOt'HOFE iQae iCi* a s t1 s r 2. i1
iii?�I:I��I'�Ir
icy FEB 27 7 G`,' ,
4.:6Q B Oi•f! F�P'I�UUFa'1CL': J l
V
SIF6.'.!'€1`P1a.LdOMMUMIMXAND PLAN C54,
.P 4dr1':t L FU4,4Y.6 T 11M't'wt:7 :W lI + .Il Ytl
+Ti7g1F',9..61,
.
I
RECEIPT `
DATE g
BYJ� /)
DATE FINALED
INSPE O _
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Z�,�
Underground Ducts
Forms & Footings
Ducts
Slab Grade
— —
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
2
F.A.U.
Framing
2
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 •— z—
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
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
3 -Zg
Heater Final
Water Piping
q
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
1K z
O.K. for Finish Plaster
Sewer. Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final —
Utility Notice (Gas) -Z —
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
COMMENTS:
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:
79-827 Morris Avenue, Lot 20 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:
PARAGON SCHMID BUILDING PRODUCTS, A MASCO COMPANY LICENSE # 632072
BY. TITLE: ADMINISTRATIVE ASSISTANT DATE: 12/12/2002
Installation Certificate: Residential CF -6R
Site Address PERMIT #
79-827 Morris Avenue
1. BUILDER INFORMATION
SUBDIVISION: Heritage
.Century Homes CITY: La Quinta
1535 South 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 80UHG4/5X-100 80% 100000
80
4. COOLING INFORMATION
COOLING MANUFACT COMPRESSOR ACTUAL EFF. COOLING EQUIP COOLING
EQUIP. MAKE MODEL' # SEER CAPACITY LOAD
A/C Lennox 12ACB60 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. SUBMITTED BY
DATE: /Z-ifr' eZ—
Signature Installing HVAC Contractor
Jan 29 l)2 11:37a Richard.Simpson 661'947-6889
p,4 ;
INSTALLATION CERTIFICATE (Page 3 of 8)
CF-6R
Site AdUr(we 7 �- t 2 7' M O 21Z 1$ .A J r N cod' '' e� rmit�! uynber
DUCT LEAKAGE AND DESIGN .DIA'CNOSTICS
DUCT LEAKAGE REDUCTION
1'nssuruation Teal Rcsuks (CTM (al 25 PA)
1'csl Leakage (CFM) 3.3
Van flow
If Van Flow is Calculated as 4M efioa7ton s number of Ions, or av 21.7 x I Icutinp C:apaoity
in Thouwand-4 of Utu14u•, enter calculated value hero
If fan flow is mmsured, anter moaHurud value hum
1.40kage fraction = •l c;A I,csikagq(Me&iuW or (:aloulated 1'an flow)
Ya.� il'lcakagu Itactiou S(l.tib
�( ❑
/Pass
® For ARROSOL TYPE SEALANTS ONLY -The following diagnontle testing was completed:
I�ail
Dent Fan Prusxuriiatiou at rough=in ueen d kahagc (CFM)
x s
CHECK AFFER FINISHING WALL:
L:
❑ Yc ❑ No ❑ Pretmi c pan tk� or I Ioux; prussurrintion iv.l
❑ Yes ❑ No ❑ Visual lnspcction of Duct Conncctionv
❑ ❑ .
Pam Fail
THERMOSTA71C EXPANSION VALVE (TXV)
Y,.N ❑ No I*h;,Ymo.IA60 I?xpanpioa Valvc (oi C6mmission approved ---
— - --
oquivalent) is installed and Accims ix provided for hwImtion
[]
Yes i. a pn`
pass fail"
Q DUCT DESIGN
1' 131c ❑ Nu RCCA Manual I) Design calculations have bwn oomplctud;
Duct Design is on leo plans and duel installalion matches
plans.
2• ® Xaa ❑ No '1'XV is m.StallW! Or I'M flow ha. bosh verilivd, If no TXV,
vcriflud Dnn flow matches design from CF- 12
Measured Fan Flow =
❑ ❑
Ycs for both i and 2 it; a lass
Pass Fail
- 1, tho nnd"Migncd, vwi y thattho above dlagllostiV arit rcohz: and Mr, work I perfgnm:d amociated with Chulcfd(s) IN In
Contbitnance with the requironum s ti►r compliance credit. I'Mo buildur shall providy Iles f114Kti pn►vidcr a copy
o1• the Cl' tilt
sigucd by the builder curployccs or sub-contractors codifying that &gnuvdc v thig and ilLmallation ntvut (hu
zvgoi vtnuaof. Dor
compliance crrdil.I
�02-
TCKtx Signatun, Datc
Itlatalling SAi1W actor CO. N=6-011
Pcribrmcd General Contmetor (Co. Name)
COPY TO: Building Department
1113115 Provider (if applicable)
Building Ovinez-" at occupa»Cy
January 4, 2001 %
Certificate of Occupancy
City of La Ouinta
.Buildin Tand Safety Department OFti
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 comp/lance with the various ordinances
of the City regulating building construction or use., For the fol%wing:
BUILDING ADDRESS: 79-827 MORRIS.AVE.
Use -Classification: SINGLE FAMILY DWELLING Bldg. Permit No.:.. 0202-171
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
F
Date: 09/1.7/02
Building Official
POST IN A CONSPICUOUS, PLACE