SFD (0202-071)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
l /
.� �Contractor_t rf.fe4/t�h
Date, 4 rsr � - -Signature of
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 001;-A .4 XACXZ INS, Policy No. 't t?t.".•W068-W
(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: ", J e. /� Applicant—
Warning:
pplicant 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 zon. his•_'
Application.
1. Each person upon whose behalf this application is made & each person it
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 L'a`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. j
Signature (Owner/Agent)
�i ; Date;
BUILDING PERMIT PERMIIT#
DATE �( VALUATION bl �6S7Sll LOT TRACT
!
JOB SITE
)7-970 �f i�rOA1,IR-IS AVENUE
ADDRESSE
APN
tit."Y W A,w GlYii
OWNER i
CONTRACTOR / DESIGNER / EN (NEER
C111-111TIM yMo VILLL L01V. UN. rims
1 -45 , mmxr k S'.k—r-, 0.200
1535 so, WDII ITIrMEL SIR #200
SAN :s^S `RAPD1oa CSA. 92 408
SAN E K" ARM146 CA 32408
(909)381-60r, CRU4. 2120
USE OF PERMIT
w n LOT 0. 4) 't. .RO. LI.B l*111;Kl,1AU6 11LE1X 3U . v. ,aq+1UVU - NOT
INCLUa"?IS B'.,.Ot.':K WALL -0, Pt3t USPA 00, .MUVEWAY.t PPRtc. ACK PLAN .
CI•IFJ-X FEBREDUCED FOR Art0131PL'.I I;r1;'WA14CZ OF SAm' PIAN TYP
TRACT C; Y14i 9,'CXOC ;CICN %�ux sr.
iaC2I2CH/P.ATIO. 29.00 Sri
GARAi1WAR.PORT 621.00 Sr
;ST1MK rE COU OF CON.W.RUCrION
133 9 x,0.20
PKHR 1 FRE SUMMARY
t ONSTIt4IOTaC)N FRE 101.000-:41 &000 SWS100k
PLAN CHECK M9 1.01-C?a—45�'9W3118 $.l6rJ.:E1
f+liMH,d NICA%>~' E 101, 000,421.000
LeLECTIUCAL Ftk 101-000.420-00e �I
Ed Ifti dCl i+ 101-000-419-000 $124.00
Svq:Exq'A�i$�,O77�+•�.NCC99h'�:p��1dt91C�.a'.�TiOR i ER. • RESID 33�b7,p1 �00f0-8241-ft(00 `2 ,Tqo
f290
11, 23,000
DL"VZ1,01 ER, IMPACT FEZ R.1,,�4f1 OQ
j11AAt�y";VyP:tL�� TC-13:1�;1'tj��CIC..
$3,177.93
p`�P01
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tv
W d' f �zA 41r �+'ty M; NOW
A.°1�L X'y&R:,F6.l'rR ,d.� 5 J✓�e E StlOxY
'ti�kle,lk 71%J�n7
FEB 14200 1,
L{.1.
RECEIPT
DATE do-. `e
'BY
D FIN A D
G 2
INSPECT%
,f
V'__
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
I INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
-- Z
Ducts
-
Slab Grade
Return Air
Steel
3 -I - Z
Combustion Air
Roof Deck
41 - , - Z
Exhaust Fans
O.K. to Wrap
-.2
F.A.U.
Framing
-L
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
Final
Final
BLOCKWALL APPROVALS
steel
POOLS -SPAS
Set Backs
Electric Bond
Footings`
Main Drain
Bond Beam
-2z
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines �o
Water Piping
Plumbing Top Out
J -
_
Heater Final
Plumbing Final
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Sewer Connection
'�
Pool Cover
Encapsulation
Gas Piping
Gas Test
Appliances =
Final
Final �z - vz
Utility Notice (Gas) -pz e
ELECTRICAL APPROVALS
Temp. Power Pole .
Underground Conduit
Rough Wiring
Low Voltage Wiring.
Fbdures _
Main Service _
Sub Panels -
Exterior Receptacles �=
G.F.I. .2
Smoke Detectors
Temp. Use of Power
Final - 4
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:
4 f
79-878 Morris Avenue, Lot 6; 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 COMMUNITIES LICENSE #
BY: TITLE:
PARAGON SCHMID BUILDING PRODUCTS, A MASCO COMPANY LICENSE # 632072
BY: TITLE: ADMINISTRATIVE ASSISTANT DATE: 12/12/2002
4 �
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Installation Certificate: Residential CF -611,
Site Address PERMIT #
79-878. 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 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,efficientthan 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=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 sizing and selection.
5. SUBMITTED BY°
UAo qua.. DATE:
Signature Installing HVAC Contractor
'' • { - .{ -+ i..•'r. r. •L Y _. y , r. ,; ..! '�4� -' ��,7 •g. /ulo rLrt:,S` Aver'
{ ' - Duct Testifid
` Certification Foem,
y _ . System OfL
• (one form per, system) [.
.Builder Name:'-
'Project
ame: •Project Narne:
Builder Field Contact: Telephone No.
•xHVAC Company Name:
HVAC Installer
} Telephone No.
Self -Certifier Results.. j• :Y:. �:`' .. ;
' f Duct Leakage Measu eY + ;
g r d @ 25 PA ,. CFM
M -�`•+ 1
Indicate the maximum allowable Duct Leakage and the calculation method used: ri
1:10.T x1.Afloor jxr(0:06)`for Climate Zone 8 through 15 `� 7 4 ' ^ CFM
❑ ' 0.5 x Anoor x (0.06) for Climate Zone 1 through 7 & 16 a CFM . r
400 x (Cooling Capacity in Tons) x (0.06) " �7 2 -CFM
❑ 21'.7 x (Heating Capacity in,Thousands of output BTU per hour) x (0.06) CFM "
• .. r J i _.. 1sI `/�L/// / ,r � it ].
z Print Name • y Signature + Date Y
a•
ft;M.
� • .yY ""c.3 Cyt+. r'• �- a #r' c� e. :(' F .'tr`j„`moi ' 4•kJlx .. �Y3}� �vass'aw` �Gti
r•
T-7
-Ave.
"
Tr�aCi
#
Duct Testing-
,., a Lot #
.
Ceiitification dorm
System of
(One
form per system) ^
• • Builder Name:
Project Name: t✓ . G. ` ,_ ..
, .
Builder Field Contact i =� .,t, , r A•
elephone No.
T '
HVAC Company. Name:
y HVAC Installer. r ~ A Telephone No:',.
-7 3
Self -Certifier Results s
^
Duct Leakage Measured;@ 25 PA
CFM
'• • Indicate the maximum allowable Duct Leakage.and.the calculation method used;
' ❑. 0:7 x An -,`x (0.06)`f6r. Climate'Zone 8 through 15 .
CFM
❑ - 0.5 x Aaoor x (0.06) for Climaie:`Zone 1.through 7 & 1'6 ,T
CFM
400 x (Cooling Capacity.in Tons) x (0.06) '
CFM •'
❑. 21.7 x -(Heating Capacityjn Thousands of.output BTU per hour)lx, (0.06) -
CFM
` Print Name . !Signature }
Date
,
�"�ti�.�� _n -.@f f�Ci.�',p�1��?��3h)i���9ri34'3.flu..�!:F€LI.�:1�9�i��v;�`���e�tt�'�'1���•,(���.'��.?���rYi��`faa
G".#r:5•,:i:�.1;rN�it4:�`�i r�. i:. .. .-
1,
Jan 25 OP 11:37a Richard Simpson 661.547-6885 p.4 '
INSTALLATION CERTIFICATE (Page 3 of 8) CF -GR _
'- IV11 L2 J L
Site Address -� S _ 87 iMo A2 L%S A-4tf. Permit Numbtr ,
..DUCT LEAKAGE AND DESIGN DIAGNOSTICS
DUCT LEAKAGE REDUC710N ,
Pressurization'rcit Rcsuk-4 (C'FM (u) 25 PA) Lj U
Test Lcakagc (CFM)
Nan Flow
If Fan Flaw is Caloulat d as 411(1 ofua/lon s number of tons, or ax 21.7.xI loaling Capacity
iu Thomanda of Otothr. cater caloulatod valuo Hero
if tan [low its nusasurul, untur mcasurud value huru "
I,eakagc l-raotion ='real l.cakago/(Muarured or (:aloulatcd Fan flow)
Parma if loakagu fraclivu A 0.06 ❑
Pass I ail
For AEROSOL TYPE SEALANTS ONLY - The following diagnoade testing was completed:
Duct Fan 1'ruvxuriialiou at rough -in mcasurud Lcakagc (CFM) .
CHECK AFTER FINISHING WALL: `.
❑ Yes ❑ No ❑ 1'rv'xvw pan fW or Ilouw p1vW11. .anon 1C,%1
❑ Ycv ❑ No ❑ °Visual In..Tcution of Duct Connuolions ❑ ❑.
pass " Fail.
` THERMOSTATIC EXPANSION VALVE (TXV)
OR YwN ❑ No '1.1►ormoAatic ExpaugionValvo (or Commission approved
equivalent) is installod and Access is providod for mt tioa ❑ `
Yes i.. a pas, f'ass bail
❑ OUCT DESIGN _
I ❑ Yc' ❑ No RCCA Manual 1) Dr -Ag ► calculations have been complotud,
Ihrol I)uvifm is on the plans and dual installation malchos
plans.
2 ❑ ye q ❑ No TXV is mtiTalled or Ftm flow has beau vurilited. If no TXV, ;
vedfiud fan flow awtehm deign from CFL l IL
Mgmurad Fan Flow =
Yes for both 1 and 2 is a Fam Pass Fail
❑ 1, Iho undorsignud, verily that the tlbovo diagnoMio tact fmIN and thr, work I pertonned associated with thu tc d(s) is in
eunionnmw with tho ncquimnwnta ibr compliance urudit. 1'1'ho buildur:ittall provido We I IERS provider it copy of 1ho ULM
sigrrscl by the buildcc cu►picryma or sub -contractors certifying that diagnumio fuming and iu isfiation uwel 1ho ruquirurnoui. Ii►r
compliance crudit.J i
- APR '! 8 2002
Tvsts . ignaturc, !)a—to' Iastalliug Subcolltraoior No. Ni nR
Performed (enera) Contractor (Co. Name)
COPY '1'0: Building Departrnout
IMRS Provider (irappb'cabic)
Building,Owner at OCCuPanCy ^
January 4, 2001
t
Certificate'of O- =r-
� .
�
City of La Quinta,
NQ
.Building and Safety'De'partmebt. OF
This Certificate issuedpursuant 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 following:
BUILDING ADDRESS: 79-878 MORRIS AVE.
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 0202-071
Occupancy Group: R3 Type of Construction: -VN Land Use Zone: RL
Owner of Building:' CENNTURY CROWELL`COMM. Address: 1535 SO."D" STREET,STE. # 200
City: SAN BERNARDINO CA. 92408 "
By: GARY SHOWALTER
f� Date: 08/12/02
Building Official
POST INA CONSPICUOUS PLACE