SFD (0202-072)LICENSED CONTRACTOR DECLARATION
I hereby affirm underpenalty 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 "�Y+J rfj'et�
"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.
O, 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 ' Policy No.
(30LDER RMAX111,48,
11,48,
(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:.W �o f�•.+r'a >', Applicant�f'�7
. N r y._
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 Din h'
application.
R�4..'.
1. Each person upon whose behalf this application is made & each person.
whose request and for whose benefit work is performed under or pursuant
any permit issued as a result of this applicaton agrees to, & shall, indemni
& hold harmless the City of La Quinta, its officers, agents and employee
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 suc
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 toenter upon
the above-mentioned property for inspection purposes. d I
Signature'.* (Owner/Agent) ' .f- f ' "' Date" k' p+ `j=%'•!
BUILDING PERMIT FE,RM'TJf
DATE bfVALUATION. LOT ;;';: Sr��'ZaDi IY�'Y TRACT
up)
JOB SITE
APN
ADDRESS.
79-%4 MKYRR".. A"WRUX
604072-0ct
OWNER
CONTRACTOR / DESIGNER / EN INEER
C:1rW MY CROW, M T COMMUNi'%'M
CMIMURY CSC+ OW"ELL COMWEA IES
153 030, °.t"i" _Snkk MU, M, 4200
1535 40. TO 1111111MMp 117, #200
1' 1aERRAIU�t 40 C, A 9?.108
&AN BIMNARDINO OA 92 -IIA
(909)381.6007 I CSLff 2120
USE OF PERMIT
S M, - LOT MONTIcU;r W HEIRI'rAM PLAN aA- NOT
TNC:LUDE BLOCK WA%IA, P00I4PA Oft DRIV-;CWAY APPROACH, Pk41V `
CHECK F91i, I" DEDUCED FOR Nr4'i T.3'f,PL-r,1s3Li.&NCZ OF SA.MLY PLm TYPE
71RAC;f C'ONSTRUC T101.1 LIMA) SF
P RC3" ATICB 49.&II15ti`
GARAMICARPORT 420.00 3F
CGt?I 1 RSIG''3'i S3'0 Ip 614004 « .1 MVtyltl�i 2664,0
Ulil.(:kMKIC,Ai. I''E,E 101.000-421-000 $6f00
E,11 iRIC"?At,,H'M 101.000-420-000 $119.90
,�' �:L�:�r��.1'la�� ��� 1 �41 ••000-�i� �^�)Qi� $�'��•�.�3�1
�
ST&OJO M01301FEErdMM 101-000-2 41-000 MQ}+(66
0!LJIM) YEyyy
•„ ar?1•=C�f30.4! n,�'000 �41!Y HY
�1I
�I F�i•
S
FEB 14 101-T 0.1MWI tIMON AI C
tt��P�s3cs�,ir�y9cy:
4pt7c74
1.JJ;.9ti i�St.d:r'pe'>7A-6)b'.EES
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RECEIPT
DATE / J
BY t
D E FIN ED
INSPECT0
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Z
Underground Ducts
Forms & Footings
/---r-
Ducts
Slab Grade _
l
Return Air
Steel
2
Combustion Air
Roof Deck
Z
Exhaust Fans
O.K. to Wrap
- Z.? _ Z
F.A.U.
Framing
Insulation
�T- Z - Z
-/(, - Z
Compressor
Vents
Fireplace P.L.
�' _ �- Z
Grills
Fireplace T.O.
Plumbing Final
Equipment Enclosure
Fans 8 Controls
Party Wall Insulation
O.K. for Finish Plaster
Condensate Lines
Party Wall Firewall
Gas Piping
_
_ 2 - nZ
Exterior Lath
Gas Test
L'
Drywall - Int. Lath
Z
COMMENTS:
Utility Notice (Gas)
Final I 2F -,12 _ p ::-->
Final
BLOCKWALL APPROVALS
POOLS - SPAS
steel
Set Backs
z
Electric Bond
Footings
Z
Main Drain
Bond Beam
Approval to Cover
Exterior Receptacles
Equipment Location
G.F.I. f"
_
Underground Electric
Temp. Use of Power
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
�' _ �- Z
Heater Final
Water Piping
!
Plumbing Top Out—�
Plumbing Final
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
_
Sewer Lateral
Sewer Connections
Pool Cover
Encapsulation
Gas Piping
_
_ 2 - nZ
Gas Test
L'
COMMENTS:
Utility Notice (Gas)
ELECTRICAL
APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
z
Low Voltage Wiring
Fixtures
Main Service
Sub Panels j
Exterior Receptacles
G.F.I. f"
_
Smoke Detectors
Temp. Use of Power
7�
Notice (Perm) �j
-,.
Certificate
of Occu anc T
_ _ p Y a.
a t-0 f La Quinta
-Buildin qnd'Safety'DepaIrtme'nt 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 compliance with the various ordinances .
of the. City regulating building. construction, or use. For 'the folio wing:
BUILDING'ADDRESS: 79-864 MORALS AVE.
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: -0202-072
Occupancy Group: 133', Type of Construction: VN Land Use Zone: RL
Owner of Building: CENNTURY, CR0INELL COMM: Address- 1535 SO,."D" ,STREET,STE. #' 200
City: SAN BERNARDINO!.CA. 92408
By: GARY SHOWALTER
Date: 08/12/02
a
-,.
Certificate
of Occu anc T
_ _ p Y a.
a t-0 f La Quinta
-Buildin qnd'Safety'DepaIrtme'nt 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 compliance with the various ordinances .
of the. City regulating building. construction, or use. For 'the folio wing:
BUILDING'ADDRESS: 79-864 MORALS AVE.
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: -0202-072
Occupancy Group: 133', Type of Construction: VN Land Use Zone: RL
Owner of Building: CENNTURY, CR0INELL COMM: Address- 1535 SO,."D" ,STREET,STE. #' 200
City: SAN BERNARDINO!.CA. 92408
By: GARY SHOWALTER
Date: 08/12/02
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:
79-864 Morris Avenue, Lot 7, 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
TITLE: ADMINISTRATIVE ASSISTANT DATE: 12/12/2002
Installation Certificate: Residential CF -6R
Site Address PERMIT #
79-864 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 V
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
n
DATE':ybt
Signature Installing HVAC Contractor.
t j j Tract # ZLl �Gl
duct Testing ' V' Lot #
Certification Forlrn`
SyStlYl' l .. of /a
(One form per system)
Builder Name:
Project Name:
Builder Field`Contact: I Telephon6'NO. •. }
"'HVAC`CompanyV Name:
7 L ,
HVAC Installer: .Tel'ephone No: c1dq-73y�S0�
' Self,Certifieir Res iuIts
.,Duct Leakage Measured @ 25 PA', '°' s , -� > C� CFM
Indicate the'maximum allowable Duct Leakage and thefcalculation method used.;
t , ❑ .0.7 x Anoor x {0:06)' for Climate Zone 8 through 15 �+ ' CFM
0 0.5x Aflor x.(0.06)for Climate Zone.1.through 7 & .16'. ; CFM
o
400 x (Cooling Capacity -in Tons) x (0.06)' _
CFM -•
❑ 21.7 xl(Heating Capacity in Thousarnds of output BTU per hour) x (0.06) CFM r
Print Name ' "'Signature .' Date
'• V� t t -��. � f - L "nr.- "^.r�rd^I^{r.s -F ./,IXf� i 4i'e;'4" 1 �qC� �.IF ..YF9 � ) =r y5, .;� {} P�P,i ,'1
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t
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Jan 29 02 11:37a Richard'Simpson 661 947-6889
T p.4
INSTALLATION CERTIFICATE (Page 3 of 8)
CF -611
Site Addy&s 7 Cl _ F 6 y -IJM o =.f A44 hermit Number
DUCT LEAFAGE AND DESIGN DIAGNOSTICS
DUCT LEAKAGE REDUCTION
Pre ti' •surnation Text Resui4ti (CTM (u) 25 PA)
'fent
Lcakagc (CFM).
Nan flow
If Iran F16w is Caloulatod as 400 ofmliou x number of tons, or m 21.7 x I loafing Capaoity ` i)
'� Ute
in Thousand i of 11tu/11t. olrtOr Caloulet�xf valuo hueo
If ran flow is mcasun:d, cntimmaasurul valuu hum
Lackago Vmtionr= 'FcA [.aakagol(Mumiurod or C:aloalatod Van flow) n O.O LT
Paw it loakngu Irautiun 5 U.1)6 ,
Eli®
Pass I ail
❑ For AEROSOL TYPE SEALANTS ONLY -The folloiving diagnostic testing vras completed:
[)not Tan Waaariialiun al rough -in measurLd leakage (CTM)
CHECK AFTER FINISHING WALL:
❑ Yes ❑ No ❑ 1196k uni pan (W or I Iowa) pn:.,urvation turn
❑ Yes ❑ No ❑ Visual In..puution of Daet Connuuliowl
❑ ❑
Pass Tail.
[ [ THEIRAOSTAMC EXPANSION VALVE ('TXV)
M y N []NO' Th,,rntoriafiu lixpan4on V21ve (or Commission approved
Oquivalont) is installul and A"-,--;4 is pmvidal for mby tion
❑
Yw i.. a pais
Pa%S fail
❑ DUCT OE51ON y
. ' 1 ❑ Y" ❑ No RCCA Manual D Ikvign odaulations hovu bixin complutud,
Drrol Msign iron Ihophurs and duul installation niatchus
plans.
2 [3Yav 0 No TXV is inslallud or Fan flow box boon vut;ilitud. If no TXV,
vmiliud lien flow nlatchus divign frons C11a1R.
Mcasumd Fan Flow =
Yar Ibr butte 1 uud 2 is a fans
Pws•• Fall
®1, tho undorsigoul, vwWy that tho abovo diaguoitiV tPA rasal>4 and the work I performcd as ociatud with thu tcsl(n) is in
confor1 fanC4 with the Mquiramon[a Ibr onmpliance urudit. (Tho buihlur shall pruvidu Uro I IERti providur a copy ul' Ihu CF -61t
niguW by tho buiWr carplcya:s or Hub uoutraotom uortHl mg that disgnuslio fuming and in:iIallalion uwot Ihu mquiroluenh, lirr
complianm cruditl
1�
A°R 1 2002
Tcrls Sigaatun , llato Installing Subcomtraotor (( Name) OR
Purionncd GooPral Contractor (Co. Name)
COPY TO: 13uildint; Depndiuonl
IMRS Pmvidor (il'applicablc)
Building Owner in ,0CCuV07.1Cy
January 4, 2°001