SFD (0202-070)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
7i< )a+
Date " y",y'''Signature of Contractor''s�"•"=�
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).
OI 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
pyertormance 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 1 x3EA1 .01,y
: Policy No. NWW440� -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: « 2Jf*�+) Applicant 1z
r p
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 avid Safety
for a permit subject to - the conditions and restrictions set fortFi on ,'his
application.
1. Each person upon whose behalf this applicatiomis made &each person -a1
whose request and for'whose benefit work is performed under or pursuant tc
any permit issued as a result of this applicaton agrees to,.& shall, indemnify
& hold harmless.th'e City of La Quinta, its officers, agents and employees:
2. Any permit issued as a result of this application becomes null and void`il
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) ~� .�.,�i • Date 12�1,•-+
BUILDING PERMIT PERMIT #
DATE L VALUATION LOT OM 470
� TRACT
JOB SITE APN
ADDRESS %� €�l4.► fA'SIV' ,?fir d3f'�
OWNER
151.4.5 30, Tia =Lmrl MR 01200
;;A1it at„.Lccv"DiV0. CA 92A08
USE OF PERMIT
CONTRACTOR/DESIGNER/ENGINEER
1:.&r1.V - I.rT'R CROWAIL V'JJ.°n IL COMMl. 64,6 IR's
,3'AWS,ERKQ0VX0 'CA. 92408
S.FID 0 .JOT i,, *0 T1C1t LLL k3='f.A 0F, PLAN 4A, VEM1T DOES TiO r
fht'G1.T,►�3�u FSI:J.).��'4`�`,#�1:,1,�;1't"�ts�iSpA� C3�21�T��V'��t:t�.'Y �Pt��43.t�C•Il+��d.�h3
CHIA,= M, l DoJCIM) icC R Mt1VWLE* ISS VaIM, OF VAME PLAN 'f," f11F,
MACTCONSTRUCTION Z09.00If'F'
1rt3#i,MPATIO 62.80 I;F
EIrf—MATED COW OF CO.t+i91RU MON
PLi.�ti bIT FEE 0(u" y
00143TRUCTION , ''
103.000.4.113.000
"113+ 4
PL.AN CHWX IeF%
101-000-4129-318
$165.23
1i41a.0 HANICA1. NRE
101.000.421.000
S656.1.50
1'S�T7�.a��:,ptiqq;AA'; RII,,Cvv.�qq'c1y.�PU
1(01.0Ciy0-��.d2.tn�-(C�lp�'�?�/Gfip
$m--c5aa
l'.1.♦i� F MIN :i i` T.L'a
� l7 �'^k+�\Jr"`P 1 w"' V V f.�
S1410
S?YC3O MQTIGH Fr,2 d't K)
11..0-0004A 1-000
GiAdNHOFEE
101`000"4234100
�!n{P. V7:•
.Vr,1 l.4S'1DPE,R.MPfiC'.+,' PER,
1421901{b'i1i
i71~TE�`iRC;;X"%C)H AN*.0 P1+.1 W C7:TEL ,. $3,249,66
3 ] VSs
FES 1 WiAL FE f F DUR HOW
FINUCEDiik '.
RECEIPT DATE r. +* BY DEP FIN ED INSPECTO
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms 8 Footings
71
Ducts
44
Stab Grade
Return Air
-k.
Steel
_
Combustion Air
Roof Deck
6 _
Exhaust Fans
O.K. to Wrap
y - /sor- t
F.A.U.
Framing
. 2? -z
Compressor
Insulation
- Z
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
- -C>2
Final O
' 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
41
Pool Cover
Sewer ConnectionEncapsulation
Gas Piping
_
Gas Test
Appliances
Final
Final
Utility Notice (Gas) !P� -e-9-
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) 7 --
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:
79-892 Morris Avenue, Lot 5, Monticello -Heritage, La Quinta, California
CEILINGS:
TYPE: BLOW
MANUFACTURER: Certainteed Thickness: R-38
r
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
WN
'Installation Certificate: Residential CF -6R
Site Address PERMIT #
79-892 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, 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% $8000
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
12.ACB36 " 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
V 1LU�lCUI�G.d1.v��+ DATE:
Signature Installing HVAC Contractor
Jan 29 02 11:37a Richard Simpson 661 947-6889
p.4 °
INSTALLATION CERTIFICATE(Page 3. of 8)
CF-611
Site Address -79-1 9 Z M O 2 2 S /a ✓t3N✓ tr?- Permit umber
DUCT LEAKAGE AND. DESIGN DIAGNOSTICS.
DUCT LEAKAGE REDUCTION
1
Tressuriialion Tcst Rcsulls (CFM (u) 23 PA) ,4
'Post Lcakagc (CFM)
Nan I'low _
If FDA Flow is Calovlatod as 400 olmdton x aambcr of tour; oras 21.7 x I loalmg Capaoiiy
in ThouNandA of llfU t•, *plot Caloolatod valUo bot'0
If ran now u. mimsurW . cmttT mmaurul value hinu ('1°
Lookago fraction =Tom Lc 4ngolftasurcd or,C:alculatod Fall flow) n '' ON
' Ya s il'IQakago Irautiou 5 O.lKi F
�( ❑
.
Pass_ Fail
❑ For AEROSOL TYPE SEALANTS ONLY - Tho following diagnostic testing was completed: .
[)not ran ftcmuriiatiun at rough-in mcasural leakage (CFM)
CHECK AFTER FINISHING WALL:
❑ Yes ❑ No ❑ Prommm pan IW or I louse prowilrization test
❑ Yov ❑ No ❑ Visual lnsiu:ution of Uuet Cunnw:tiop
, ❑ ❑
'
Pass . •bail.
I�1 THERN16STATIC EXPANSION VALVE (TXV)
'
V, Y" ❑'No ThetnoAafio Expansion Valve (or Commission approved'
' oquivalont) is installod and Aauass is providW for hmpeotion .'
❑
' YW is a pas,
Pass, fail
❑ DUCT oESIGN ..
1 • ❑ Yo,; ❑ No ACOA Manual D Dmipr calculations havo been complulod, '
Dual Design is on the plans and duel installation malches
plans.
2. ❑ Yv, 0 No TXV w bwtallod or Fml flow box bcou vorillvd. If no TXV,
verified lin flow matches dewign from (71-11L
r Mcasurod .F an Flow =.
Yas lbr both 1 and 2 it;a Yarn
PASS Fei(
® 1, Iho undmiFpod, vivify that the above diaguo,4j#; lost r4mW aµd the work 1 performed amociza6d with tbu lust(s) is in
conlnmtauce with the w4ullwnunlx lbr anmpliance ulodit. ('lio buildur shall provide dw I MRS provider a copy of Iho CFSR
sigusd by tho builder• ctuplayo" or sub-ountraelons certifying that diagnu:•1io W.-Aing and iu.%tallatiou moot oho mquironiouiti lin'
complianu: crudii.]
oo:
OJT4APR
ApM4,I , Datu Installing Subcontrac r (Co. Namc) dR
Porn rmcd (irWacra) Contractor (Co. Namc)
t
COPY '1'O_ Building lkpartnoul '
HEMS Provider (il'applicahic)
Building Owner, tit OCCuga11cy
January 4, 2001
'Tract # q-
Testing- ..
tot;# 5
-
j Xertification . dorm _ •
r
System of
(One form.per system)
Builder Name: e
\
Project Name:
Builder Field Contact: Y i. Telephone No.
HVAC Company Name:.
r
HVAC Installer:. Telephone°No:
. Self -Certifier Results
Duct Leakage Measured Y25 PA
CS CFM
• @
-
Indicate the maximum allowable Duct Leakage and the calculation method used: ' '• t - '
„
0 0.7.x An.,,, x•(0.06),for Climate Zone 8 through 15
4 CFM fi f
D 0.5 x.Afloox,(0.06) for Climate Zond 1 through 7. &'16
r
CFM
r
400 x.(Cooling Capacity. in Tons)'x (0.06) ,
.CFM r.
.
❑. 21.7 x (Heating Capacity in Thousands of output BTU per hour) x'(0.06)
CFM,
`
lVI
' Print Name Signature .
- �_ Date
' SF7` 7 = '�J -4' cR.r,:r' Qi rax r-•
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'Certification For
y.
(One form per system)
G.'
Builder,Name: r 'f vv�
Project Name:
r, Builder Field Contact: r Tele one No, { $
'`�Ll a
,HVAC,Company.Name: b
r ^: L
*..HVAC Installer: .r -,.,-..Tele hone
,TTelephone No: ••
1. . . a G . ' •
Self -Certifier Results ,
} Duct Leakage Measured :@ 25 PA CFM
indicate the maximum allowable Duct Leakage and the calculation:mefhod used:
0.7'x Aeoor X'(0.66) for•Climate Zone 8 through,1.5 CFM
❑ 0:5 x,Afloor x (0.06) forClimate Zone 1 through 7A 16 ,.; ,' -'CFM .
G
.
400.X (Cooling Capacity in Tons) x (0.0.6) '• `° t ' �! CFM
:.21.7 x` (Heating Capacity,In Thousands of output BTU per hour. x 0.06 'CFM,
Print Name • Signature .G Date
f ,
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�� ;. , ���r�..r�.�a � l��p�i�t� -�a ���:„ �: ,:a � _���: ��•b�� . � I��M✓�>.J��}. • _
'1 r.
Certificate of Occupancy
City of La Quinta
Building and 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 following:
BUILDING ADDRESS:
Use Classification: SINGLE FAMILY DWELLING
79-892 MORRIS AVENUE
Bldg. Permit No.: 0202-70
Occupancy Group: R-3 Type of Construction:. VN 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
Date: 08/09/02
Building Official
POST IN A CONSPICUOUS PLACE