SFD (0202-172)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
Date. "ry ?'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:
( ) 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 0, OLD101 &ACI LY INS, Policy No. NWC-544068-03
(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.
Date: f w -a -+ Applicant
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made &'each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection purposes.
Signature (Owner/Agent) ^�"r'.r !. iP Dater•-
.,
IAM
BUILDING PERMIT PERMITk od
DATE VALUATION LOT ()202-112 TRACT
17. 21 24197.4
JOB SITE
APN
ADDRESS 79.841, 10DURIS A'4XWJF
�tJ ^C1%�-4At?fP
OWNER
CONTRACTOR / DESIGNER / ENGINEER
1535 s0. `D9 grim.1l.11 fant. 4200
15x1.5 So. 1-r mwxr, 3,M, lt',�Co
S Y lM".r'RD21 O CA 92408
SA2+t' 1_ �.1,','X k D:040 C'A 92408
(909)381�60M- (MLO 2120
USE OF PERMIT
MY�10112 I �p�p.v
h /�;'q:��9xxppi Y�/gp�w iy/y y� �ay� �j( /� `'r p' {
S1rD - 1L'0 2) P1.AN 5A, PgR?gl.�.{ �1 OZ$ `tOT ! CLI.$Dlt FTLO'%"'K'7Y1'�"S,
P004 SPA Olt DRIVEWAY APPROACH, IS% 4iMMON °its PIAW 01011K
Y`fZ POP, MULTIPLE ISSUANCE OF I%AM PL.&N TYPE,
'1'UCT C:0141iTRUCT1ON :012100 SF
P0RC'Hf'P.tk't.'1U 23.00 .SF
0ARAGYft AA11011T 640.00 P
ER9t1AKM1.i COQ`. 01?' t;:t31 iTRi' CT11fiH
16,428.10
PERWE r, EE SMUMAlev
CONSTRUCTIM HZIlUl�filafD-A1`�•C}(!:i �3{ ,a9
PIAN CHECK n% 101.000-1139.118
t+ ECHANIC,Al, "Eli MOD
MFCTA1f:A L FEE 101-000-4 20400
PT.,LtM39TelCI F173� 101.000.419.000
STRO1 0 MOTION J�ZZ - RESID 101-000-2412-000 S»7.64
ORADIM0 RE 101 -C100 -4p.,000 $20.110
i'g.� I�,tX3P1'R y7V➢r A.GT 5��, • • ; . ` ° ; k .:: S 1,!tt17. titl
SCJ�3^.�"C+'fi �'tri�3F,"lid'i�1�`4,.a�.`1L•11��1„�tit�i.:��'F.frYw
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RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
y
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
.4/—/p— Z
Underground Ducts
Forms 8 Footings
y —,/) —Z
Ducts
Slab Grade
—1E<—Z
Return Air
Steel
41-17 — Z
Combustion Air
Roof Deck
j — —
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
Compressor
Insulation
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
Final
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
I
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
— =�
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
- Q
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wining
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm) -- ��
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:
r
r,
79-841 Morris Avenue, Lot 21, Monticello -Heritage, La Quinta, California
d
CEILINGS:
P TYPE: BLOW MANUFACTURER: CERTAINTEED THICKNESS: R-38
WALLS:
'TYPE: BATTS MANUFACTURER: CERTAINTEED THICKNESS: R-13
0
GENERAL CONTRACTOR: CENTURY CROWELL COMMUNITIES LICENSE #
BY: TITLE:
PARAGON SCHMID BUILDING PRODUCTS, A MASCO COMPANY LICENSE # 632072
BY: TITLE: ADMINISTRATIVE ASSISTANT DATE: 12/12/2002
i
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Installation Certificate: Residential CF -6R
Site Address PERMIT #
'79-841 Morris Avenue
1. BUILDER INFORMATION
SUBDIVISION: Heritage
Century Homes " CITY: La .Quints
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 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-48B-090X ..80% 88000
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. SUBMITTED BY
�f1.•x_ . ,DATE:..Z- •V Z -
Signature Installing HVAC Contractor
Jan 29 02 11:37a Richard Simpson 661 947-6889 P.4'
INSTALLATION CERTIFICA'T'E (Page-3 of 8) CF-6R
Site. Address
• �- YN/ Moiti2t3 A Permit umber
D UC T i,]EAKAGE ASID DESIGN OIAGNOSTICS
_ DUCT LEAKAGE REDUCTION "
P suriratiun Tcst Rcsults (CPM (d) 25-FA)
1-cs( Leakage (CFM)
Fan Flow T
If Faro Flow is CaloalaW as 40(1 clioo/ton x nu mbcr of Ions, oras 21.7 x I load n? C:apaoity .
in- Thounnek of Utu/br, color calculnted vnluc hors
If fan flow is mcamtu=l, cater mcaxuryd value hen r yQa
Loakgo Fraction ='format I.p►ltngc/(Measurcxl or coloulated Fan Flow)
Patie il' lcakngo Iraoticm 5 11,116 ❑
' Pass Fail
❑ For AEROSOL TYPE SEALANTS ONLY _ The Mowing dingnoxtic testing was completed:
Ihtcl Fan PRiMMarb..alion al rough-in rex asumd leakage (Cf. M)
CHECK AF'T'ER FINISHING WALL:
❑ Ycs ❑ No- ❑ l'ie c.•om, pan -kms or l louu; pns`uriration test
❑ Ycs ❑ No ❑ Visual Invpeutionol'DuctCunnmions ❑ ❑
• Paso Fail
THERMOSTA71C MANSION VALVE (TXV)
o-Yaa ❑ No . Thuxlnosialic. IAM,:iou Valve (or Commission approved
oquivalent) is inslallud and Au:ex:c L% provided for ingw-olion[�
YLN, is a pass . 1' 'asp • l nil
'❑yuCT umerd
1' ❑ Ycc ❑ No RCCA Manual 1) Design calculations havo bcx.•n complowd, —
Ihwt I)csign is on tbo plans and duct immitillalion mnlch6
plan4.
2. [j yes 0 Nn '1'XV is installed or Fan flow box beets verifiud. If no TXV, {,
vcriliud fan flow matcher: diwign from CF-) IL
Mcmurod Fan Flow=
Yca foe both land 2 is a Parw Pass Fall
1, tho undoraigaud, vcui(y that the obova diad nobs to t mvmlt.� and Clic work I pwflormod ass ociatcd with the tost(s) it; in
cunibmltmco With Tho rctloi menta for campliance cradit.111to builder shall provido tho l MRS provider n Copy of Ibo CF-6R
tuguotl by the builder ctuflloyoc,t or sub-c intractorer cmrtifying thal diagnustio tc:.lutg and m.,taualion ntccl the rugoiratnvatx Ibr
compliance credit.) '
1'cxlr; - Signatory, Date I».�tallmg tiubcontrfio r (Co. Name) QW,
Performed Gkaeral Coetmoter (Co. Name)
COPY TO: Building L)cpartrrrcut ,
HIMS Provider (il'applicablc)
Building Owner ut Occut7ai)CY' `
Ja,tnatry a, 2001
Certificate ot uccupancy
LC� t�Y of
and Safety DepartmentBuilding
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 comp/lance with the various ordinances
of the City regulating building. construction or use. For the following:
BUILDING ADDRESS: 79-841 MORRIS AVENUE
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 0202-172
Occupancy Group: R-3 Type of Construction: VN Land Use Zone: RL
Owner of Building: CENTURY CROWELL COMM. Address: 1535 SO. "D" STREET #200
City: SAN BERNARDINO, CA 92408
By: STEVE TRAXEL
(tea Date: 9-24-02
Building Official
POST IN A CONSPICUOUS PLACE