SFD (0202-159)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
.;rofessionals Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
'3141 89 D 10131 Ji?:
Date - ! r
-Signature of Contractor Jh_
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:
( ) 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 OOLI)LON i?Ao j.,E 04S,. Policy No. 3�VG•5�4DG�-b3
(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. `p
Date: - Applicant �• ".r '•! t." I�i
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 ofrissuance 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) 1 t / =1f`t Date. -21, 7 1«
BUILDING PERMIT -PERMIT
DATE VALUATION LOTTRACT
241 Sri -4
JOB SITE
ADDRESS % -m- mot tt?fr' A'Ct17
APN
OWNER
CONTRACTOR / DESIGNER /ENGINEER
y!Cy*YamOW+L C«.VTUUZ
<4111URYL:LY.L•W:OyyVIM
1535 so, %)Wb4aen 200
) 5 3 5 80, !" d1RA, U .Ln 200
1 1 BMWARD1140 CA. 92408
3AM BEEMAE7i3NO tom. 92406
(909)381-600 C1_' y 2120
USE OF PERMIT
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wDF" ; T 1,0 � TLAV �CRIEV. PZRSX IT 00" 72,10T F!1�4CLUDE 4FA�4 CK
WALLA P004 SPA OR DRIVEWAY APPROACK
T1t-ACT CONSTRUCTION 2,400.00 9F
PORP11- PPATIO , 62.00 Sir
OAR A:t3EMA1't'ORT 614, 0 $F
.U9.11'UA1 COST OF %'Go,NMIJS"'i" on
142,983.0 ;
C014S'FRUC1-lON FEE 101-000-418-000 SM10
PLAN CHECK 1!'E» 101-000«439-3 :8
MECHANICAL E 101-000-421.000 $65,30
°II ;7'f;IGJ3l.PT1;C 401.000.420-000 ,$144.Sl
a
PLUNDIN0 FFIR 10V,000-419-000 4142,00
S'TIZO1401V OT1013 PZZ - ATL) 101 -000 2A 1 000 �tA.3G
Oi2�.Uit3e, FFji 101-000a4Z3.4�M t;S20,00
'�� -~-• ? A _ — ' - , , $1!'70'3 U0
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RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
Y) 0
9' — —0 2--
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
_
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Z
ReturnAir
Steel
-y
Combustion Air
Roof Deck N
—
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
_5z4X/_ Z,
Compressor
Insulation
- -z
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
_
Exterior Lath
Drywall - Int. Lath
AO
Final
--
Final AS
BLOCKWALL APPROVALS
steel
POOLS -SPAS
Set Backs
Electric Bond
Footings
21U
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
=�2- 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
Z
Encapsulation
Gas Piping
Gas Test
Appliances
_
Final
Final _
Utility Notice (Gas) �q
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 pyj
Utility Notice (Perm) - - V
COMMENTS:
L--,7-6 8—Zi ii ;-� Tft,.,J j2,
L a T6
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:
79-836 Morris Avenue, Lot 8 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
e
BY: TITLE: ADMINISTRATIVE ASSISTANT. DATE: 12/12/2002 e
m
a,
a
'e.
Installation Certificate: Residential, CF -6R
Site Address PERMIT #
79-836 Morris Avenue
1. BUILDER INFORMATION
Century Homes
1535 South D St. #200
San Bernardino, CA 92408.
INSTALLING CONTRACTOR:
2. PROJECT INFORMATION
DISTRIBUTION DUCT OR PIPING R -
TYPE VALUE
Flexible Ductwork Flexible Ductwork
SUBDIVISION: Heritage
CITY: La Quinta ,
COUNTY: Riverside
WEST PAC AIR CONDITIONING
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% 88006
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 amethod 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
Signature Installing HVAC Contractor
DATE:
WCertificate pf Occupancy
City of La Quinta
t
Building - 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 City regulating. building, construction or use. For the fol%wing:
BUILDING ADDRESS: 79-836 MORRIS AVENUE
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit'No.: 0202-159
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,STEX200
City: SAN BERNARDINO CA. 92408
By: GARY SHOWALTER
Date: 09/09/02
Building Official
POST INA CONSPICUOUS PLACE