SFD (0202-069)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
1141'`1 i 1 AW
'}li_ .
Date 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). C -
( ) 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 cvzrki ruriL, ro. Policy No. NWC-3440684 3
(This section, need not be completed if the permit valuation is for $100.00 or less).
() •1 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: •.c y ,., Applicant
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section. 3706
of the Labor Code; interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to .the conditions and restrictions, set forth on his
application. '
1. Each person upon whose behalf this application is made & eacli person at
whose request and';fo"r.�whose benefit work is performed under or pursuant to'
any permit issued as'a'result of this applicaton agrees to; & shall, indemnify--
& hold harmless' the City of La Quinta, its officers, agents and employees
2. Any permit issued as a result of this application becomes null and .voil
work is not commenced within 180 days from date of issuance of su
permit, or cessation of work for 180 days will subject permit to cancellati ,
I certify that I have read this application and state that the above information is
correct. I•agree to comply with all City, and State laws relating to the buildi g
Construction, and hereby authorize representatives of this City to enter up n
the above-mentioned property for inspection purposes.
Signature'(Owner/Agent) ~��"� �"" ' rDate-`=^/ �` M,,
r, ✓
PERMIT"
BUILDING PERMIT
DATE VALUATION �y LOT TRACT
JOB SITE�sri y�p• p�
ADDRESS 4:" 1,t1ptJ]R.y a$A i
APN
OWNER
CONTRACTOR / DESIGNER / ENGINEER
awftmy C2O'��jj.yy :IJ i"i'�
`y�4'..,►..���0++' ,4p +:;i., ;:,317--.04200
�I��Cryryi'p�7�,rrk�KgptllrT�
1535 so, vv- Iri krt r, arn. � 200 �
5C'1C��3`�'E:ips•���'
,--Cyy*�';;C.I;t CM.ppt��l�/:cct�3ia;�:�i
S 535 SO. Do z:� 3.LM. T.T'.l, a a7 7--. 04200
0AN.S,!��3tiN ARP, I X0 CA 92408
Ct�a':tita.maIamo 'C'A -92408
(909)381.•6007' Cm 2120
USE OF PERMIT
MOLEF CIMIL.Y'DwINIC-4'
9F10 .. LOT4. b10.N'T2C,`1�1.:L0 ffTt<'IU ACE Pi..A 2_FPLV. RRR.b124T X5t,31sS WOT
INC11cY�A awl C1:IWALLS OidSPAOR AWKWAY APMOACH. Pi,.Ml '
CHEXX ME 11EDUC ED 14q01~ WiLtUIPLE 1".�OANCR OF SAVIE PLA14 'Ti0l .
TRACT CCI'k$T�RUCT1;ON 1.80.00 SVP
POfZC`it'iflt1.'!`Yt� 4g,� SSr
,&.�IYIA.�L:itA•A.A'w � osoro ams°ddC7:5%.p.�''�.�f0..A�i.f3,
8i:lvp .tLi
C 0145`g RUC•TION IT, F 101-000,41R-000 064,00
Ct,1��:t{:K FEE 101000-$238.tl5
[F�{I.A14 �439-318
IYi CIM1 f ` i l tA�a i �:e} 101.. y 1 00 421-00 $60FOO .
11ECTi:1CA.1.11-IFIR• k0 = " -420-00 11A.5`0
�1"sl/i,�iQ1
M��yy,T�pi:Nryk'kip'Cp�WFfi/y�y
yp{ {� ��p�+9( g1QQ1•/���49yCw1q:jt9��CbEaO�
STRt✓,IF'L(,tVBMi�'A\�d9'('!�Z.-/1rGiSID 101$ Y�P'V6�"�f'AI-000
Z1AADWO FEE 101.000-4x3-000 520,00
X71!; ILL'OPER IMPACT ME' , �j,90 P.ftO
•„'
& �- �J'�+,L,i":C►�Su°S C1(�l iJk3.F1 of �':1. ,A4 C; I1Si�!
o,£i%(2
•. � .. �a4.,.
NOW
.01YA'JL sL� .�.�. � bk ,Mat.1C+,5V�4-R
't,3,045p�Y+�
FEB 14 2..002
&1C mpY�pOgF�f%4
�pCq��U11p1�NWYi
RECEIPT
DATE !
BY
DAT FINAL D
�INSPECTO�R-
_n
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
3- / —
Underground Ducts
Forms & Footings
— / _
Ducts
Slab Grade
Return Air
Steel
_
Combustion Air
Roof Deck
--/p — a—
Exhaust Fans
10
O.K. to Wrap
— i g - L
F.A.U.
Framing
3� —
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
_ c9 Z, ,
Final
POOLS - SPAS
BLOCKWALL
_0,2,_
APPROVALS
steel
Set Backs
Electric Bond
Footings
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
! d
Heater Final
Water Piping
Plumbing Top Out
Plumbing Final
Equipment Enclosure
Shower Pansy
O.K. for Finish Plaster
Sewer Lateral
Sewer Connection
_
Pool Cover
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
Final —
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring f=�2
Low Voltage Wiring
Fixtures
/D
Main Service
Sub Panels
Exterior Receptacles
_
G.F.I.
Smoke Detectors
.Temp. Use of Power
Final
Utility Notice (Perm) r
oiora...r..r..r.,.r..i..-iara�.o.�rao�iaiai i mrdooraac+rararaiararaiaiarararaiamraiararaiaraiaiaiaivraiaraaaiararararaiaioigrararaiaiariiiaiaraiarararaioramiarargraiararararaimarir,
0
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:
79-906 Morris Avenue, Lot 4, Monticello -Heritage, La Quints, 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
B TITLE: ADMINISTRATIVE ASSISTANT DATE: 12/12/2002
rririririwvirirrvioiviwriaiwiisisiriiiriririvivirrsrvisiriririririrrrivirrsiririviviiivivirivirroiiiriviwiirviriwrrriaioiviriruiiirivisisiruiririwriririririviriviviriviv,
6
0
Installation Certificate: Residential CF -6R
Site Address PERMIT #
79-906 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_
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
1'50(h) of the Energy Efficiency Standards, and are two of the criteria'used for equipment sizing and -selection.
5. SUBMITTED BY
DATE: I- r3'ot
Signature Installing HVAC Contractor -
' ®uct Testing _ Lot
Certification Form
" ,. ♦ c, ' , (One form per system) j
Builder Name':�!/�
Project Name:
'Builder'Field Contact: Telephone No. 7
t +HVAC Company Name:
HVAC Installer: Telephone No. Cj0 `i -7 ) el tSd/ l
.. + ... �5•_ a .+ t Y. •• } .. +;,orf, + .,a .' ' + — •'
,
' 'Self'Certifier Results
Duct t_eakage Measured. @ 25 PACFM . -
,'
ld lcate'tlie maximum allowable Duct Leakage, and the calculation mithod used:, .•
0 03 x Afloo� x (0.06) for Climate Zone 8 through,15 CFM 4:
IT 0.5'x Afloo' x (0.06) for Climate Zone 1 through 7'&A' 6
CFM7.
.
400 x`(Cooling Capacity in Tons) x (0.06) j ZU :CFM
• ❑ * 21.7 x, (Heating Capacityin Thousands of _output per hour) x (0:06) FM ••
Print Name Signatures ; 2' ±` Date
Y.�y .,k � •- �l: 'O'i"gi i��fS''��'�%'�N' y .-g'
W.0
7."'�r 4t �y 9i yytpF'sC �..
�^,r'* ,� � yaa• � aye'••! . � . ����'OTT`^�l`4y�������f""��3YY%;�fff111 . �' 1 •
S � �, � � � k. �� r'� t M....• r A.fi�f 1-,; �� �y,La"t �rdwo•,r,7�� s h .
'�t 7' t �, , ` : b~ ,,�7�' e +•, n �� S31\4('r%i�,,rtS7iiC , _
'•. .1 -.J n o� a.. .>4 7 5t; 1 1�t `^ _ ,� .q � � S � _ ,.`-�F:7� .�}q�A�Y:�}y� }�y5g�'�54".'}�P� r,.� ( . .
a F � '�{� :7 yv. , J[� q •��R. ..se{]ia�� 1C'i(�.�S�Sy�y � S`j �• r. �.
-
7
' ti?a`.7�`.`4�rt�sas I+?7T." � 'L.` S _ ',, 'i 1' F �1a.. t 5,�'�%�"sA��r(4`�•.`�,'`..�7�:Fi.�y'��'''t..�,,?�x��. .
_ 'h. .a ' e. z�i', ! .r'iE fk n!�i.,�,r�S�+� . � . ,e� • st...• 'r �'v _
s 4 f8 - ,!$ the ,'rr•,r �+ ,�-'^ �;.r�-'.` Qfa xZ�,vae..{.: -
i • , p•�F'.n5{" �fy . ♦y^ ,.. f:" ^-r.. T -i^. .,.4 ' .xi4(t' '`� K°ki-"'• r"a afi"-+"'e;'"' visa's ��'' �' _
L{ -. TS "� ''S: ror �ti� �s'iA .:..4?A �;Y.,L '-.. X.hV.f '.'. � ♦
, ..{ +` l i .. • a .• S. '- , r.';� ,... . a•. * , of •' ♦ _ YI -k � '.
Jan 29 02 11:37a Richard Simpson 661 947-6809 p.4.
INSTALLATION CERTIFICATE (Page 3 of 8)CF-;-6R �
GQA r
Site AddnesPermit umber
7 s
1I�go(o /VJoR2ff Ave it/titr- ;
DUCT_ LEAKAGE AND DESWN DIAGNOSTICS . .
ti(IDUCT LEAKAGE REDUCTION
nsuurrialion Tcsl Rcsulls (CTM (al 25 PA)
Tod Lcakagc (CFM)
Fan flows ;
i, '
If Fan Flow is Caloulatod a.44b(1'olua/toi x a*
. aatbor of'toos, or am 21.7 x I Icaling Capacity
in ThouaindA Of MAL oDtCr 61culated valuo hero • Zi)U v L
If fan Row L+ mc:asurW, =' T mvasurcd valnu huro —
l.oakago I. cakago/(Mcarnto or Caloulatod Fan I'low) t]
Paaifleakngofr' tio>iA,006 • ❑','
' "Pae..4 Dail .
❑ For AEROSOL TYPE SEALANTS ONLY -The followingdlagnoatle testing ivas eompleted:. t
Duct Van Prxssxurvaliou at run -in mcasurtxl lcakagc (CFM) '
CHECK ANTER FINISHING WALL: '
❑ Yap ❑ No ❑ 1'r%;muro pan [Qt, of I louw pru.�111rvation tcit
❑ Yes ❑'No ❑ Visual Inspaution of Duct Connuelions ❑ ❑ s
- Cass fail: '
THEPAAOSTATIC EXPANSION VALVE (r") —�— _ _ _ - _ • -- • . ,
.Yeti ❑ No '1h"MoAaGs lsNryauhiou Valvo (or Commission approved
oquivalont) it; mstaflod and Awc.41; L% providW for mrpcxtiou b ❑
YON 6 a.paaw a. Fail
- s
❑ DUCT DESIGN
I,
-11 Y,-% .13 No RCCA Manual D II sign calculations bavu been oumplotud; '
Duct Dceign irk on tho plans and duct installation match 0.41 -
a,
r plans. - r
2. ❑ Yon ❑ No TXV is installed or Ftm flow Mix boon vorilied. If no TXV;
vwiliud tan flow matchk dungy► from CF -I IL
L Moasupcd Fan Flow .=
11 El
+ Yon for bulb 1 and 2 it; it Fonar Pass Fail
❑' 1, the undorsigual, verify that tlw ayova diapoAQ Wst romita and the work I pr rfonnud amociatcA with thu tcnt(s) is in
euntbmtrnc4 with the mquimmunts 14 compliance urudit . )'Ilio builder.-101,pruvido dio HERS provider n copy of Iho CF-Glt
` big uc:c) by 11u; buildor dtuployces or sub-conlraotors eortifying duct &pu.%liu acting anJ installation uwO thu rogairwnuiuk; for
complianoc crc:dil.)
(AA - C A
l'ext,: } Signalura, Date' laatalliug SnbcoWaotor tCo. Naive) O
PGrlurmed (knon) Contractor (Co. Name) '
COPY TO: lfuildinK Department `
111311.14 1'rovidkir (il'appliaablc)
Building Owner at OCCuganCy
rt ificate of OcdupanpyCe t -
0j
Citv of La 0ainta
Ouilding and Safety Department'. of
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: 797906. MORRIS AVENUE
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 0202-69
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