SFD (0202-068)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
7143 BJZ
Date t Signature of Contractor
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's-
License
ontractor'sLicense 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:
O 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.
Sj 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 CIOLDh`1;3 Policy No. �dWC-M4468-03
(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.
!' �:-
Dateti -2 �1-.;s Applicant _ ... ) r`1v�.
Warning: Failure to secure Workers' Compensation coverage is unlawful and
Mshall 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,
1. Each person upon whose behalf this application is made & each person
whose request and for whose benefit work is performed under or pursuant -t
any permit issued as a result of this applicaton agrees to, & shall, indemnif
& 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 i .
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 enter4. upon
the above-mentioned property for inspection purposes. r�
Signature (Owner/Agent) ...' d�� t•,�, Dates+ `�/'
..,si
BUILDING PERMIT PERMIT#
DATE �'•: VALUATION LOTTRACT
JOB SITE �.
ADDRESS . `P�i�OT Y.W�}JC
APN
tSJ-0' i3ISi!
OWNER
CONTRACTOR / DESIGNER / ENGINEER.
aw3'riRy C'1sdWT_ . L COw�73vT1'1 s
t "1;AI'�T`tRZY C1�.S;�` iL COQ �� UNIMES
1 y35 �Ulm, ;, W, U . 'r, 11M., 0200
1.5-a so, V 8'1*RwrR !nn 42.00
SAN' BrAWPDX90 CA '92408
SA9 33ERMARDINO C".A. 9240h
2120
USE OFPERMIT
M401 1:11, FAMILY 1,J YY.S'+ULI G
$P - *WTF 3. MO1<! F ICEI,;LQ i RRI'1'AUPF P1)"i'J4 4C. F'l f lT DOW- 1 -NO x
'MCLUDE-BLOCKAMIAA POOLf�.'i'A OR DW Si'WA` APPROAC IL
TRACT C014STRUCTION 2,,4013.01D al?
POR.CHIPATIO 62.60 SlY
MR..AGEIC.'APIXIORT 60403F
F
C'OWSTRUCIION Fa 141.000A.18.000 MOD
PLO Ci>OCK F99 IM -000-1429-y1$ $653.12
MES"HAN ICA1. $66,60
MOCTIeCAL FEE 101% -000-420-000 $144,58
1'U31MSPAQF1}E SC11oo O-419-0011 �ib .tyn
'ST1ZC)Nf3 MOVON FRE &16iD 11'61-000-241X000 $14.:30
OWDING SFE b:^= 101-00-423.000, $20,00
DEVELOPER 1,,10-P.AfJ'T :PZ $419 x7.00
�°-�• J -gig � ;
w
FEB 4 201-
t
$0,00
CTTy®rrLAQL%1XTA
x0pi, nem :U'u Now
$3,73750
3
RECEIPT
DA'j + /
BY
D IN D INSPEC R�-
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
/ — Z
Underground Ducts
Forms & Footings
—/-2—
Ducts
Slab Grade
—
Return Air
Steel
Combustion Air
Roof Deck
/ry -Z
Exhaust Fans
O.K. to Wrap
y —/$ - v
F.A.U.
Framing
a
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wali 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
_ Z N
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
_
Waste Lines
Gas Test
Electric Final
Heater Final
Water Piping
f _
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Sewer Connection
_ _ _
_
Pool Cover
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final zT
Utility Notice (Gas) Vz
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) — — -:;,>
COMMENTS:
INSULATION _CERTIFICATE
°'a
This is to certify that insulation has been installed in conformance with the current energy a
regulation, California Administrative Code, Title 24, State of California, in the building located at:
79-920 Morris Avenue, Lot 3, Monticello -Heritage, La Quinta, California e
CEILINGS:
A
TYPE: BLOW MANUFACTURER: Certainteed . Thickness: R-38
WALLS:
'e
TYPE BATTS MANUFACTURER: Certainteed Thickness: R-13
a
a
GENERAL CONTRACTOR: CENTURY CROWELL COMMUNITITES LICENSE # e01
`e
BY: TITLE: 1
PARAGON SCHMID BUILDING PRODUCTS A MASCO COMPANY LICENSE # 632072
6
BY: TITLE: ADMINISTRATIVE ASSISTANT SATE: 12/12/2102
e
e
. r o
k
Installation. Certificate: Residential CF -6R
Site Address PERMIT #
79-920 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 G40UH-4813-090X 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 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
h1.lA4QAA Aen, DATE:
Signature Installing HVAC Contractor
Jan'29 02 11:37a Richard Simpson -661 947-6889 0.4'
INSTALLATION CERTIFICATE (Page 3 of 8) CF -6R
vt
Site Addms 79- ZO M rte 1S ' A v4F v✓ c Permit Number r
DUCT LEAKAGE AND DESIGN. DIAGNOSTICS
DUCT LEAKAGE REDUCTION
ressuriiation Tcst Rcsulls ((.'TM (u125 PA) ;
"font l,cai:age (CFM)
Fad flow
If Ilan Flow is Calouldad a. 400 ofm1ton x number of`tonw or a. 21.7 x l looting Capacity
ill Thousands ofI)tu/br. optg caloulatod value We
[f fan flow iN muasun:d, cmturmuasmx d value huru
L,uakage FrW- ion = T*4 Lcek*((l &-4urcd or Caloulatod Van flow)
at, if cA, go Craotiou 5 0.116 ❑
Pays rail
❑ For AEROSOL TYPE SEALANTS ONLV - Tbc following dingooatic testing ivas completed:
[)no[ Fan 11nmuriialion al rough -in mcasurml leakage (CFM)
CHECK AFTER FINISHING WALL:
❑ Ya. ❑ No ❑ I'n;&%= pan' It`..A or I lou..a piu.x, uri ation lc,%i
❑ Ycs ❑ No ❑ Visual Inypuution of Duct Connuutiow; ❑ ❑
. Paso fail '
. THERMOSTA7IC EXPANSION VALVE (TXV)
❑ No Thuymoraalic I.Npanrioa Valvc (or Commission approved..
oquivalou) is instidlc d and Acut-M4 is provided for invpxtion ' ❑
Ycx+ is a pa, 'ass Fail
❑ OUCT DEa1GN
1, ❑ yam 13 -No 4CG1 Manual D l? Agn calculations have [xxm oomplotud,
Duel W%ijgn is on tho plans and dual installation malchhox
plans.
2. ❑ Yea [a No TXV. is installed ur l'lm flow hus btwa vuriltiod. If no TXV,
varihad tun clow maichbn design from Cl.,y1R ,
Mcmurod Tan Flow =
13 11'
s Yes for both 1 and 2 it.; a Pars Pass ' Fail
❑ 1, tho uudmsigavd, vwily that the abuvo diagao:;tio tort m-wita apd the work 1 perfnrmcd as;ocialud with tho tust(s) is in
ounforin neo with.tho rcquirommis Ibr compliance cn:dit_ ('l'hu buihlur shall provido dw I Ifi, pruvidar is copy ul'the C!LOR
a:iguod by the buildvt• cu►ploya:s or sub-cwnivactors codifying that diegnomio taming sad iw tallatiou owat Iho mquiivinuak lilt
compliance: cmilill
Wz.,/ 46t -c
l'c>+ts SiEuraturc, Date lu•talliug Sub .0mractor (Co. I OR
Performed Goneeal Contractor (Co. Name)
COPY TO: 13uildinl UCpnrhnvhtt
1113RS Provider (il'appliicahlc) ,
Building Owner ut OccuVa?.lcy
January 4, 2001 -
f •
zo
i°ract #
Duct`Testing - .hot #
t ' Certification Form
i ,
x. . .•SystelrnofL
r' " (One form per system)
t Builder Name:
• r• i •T , y _ s
Project Name:
- _• Builder Field Contact:' Telephone No. ,� r
HVAC Company Name:, f
HVAC installer: .Telephone No.
r
Self'Certifier Results -
Duct Leakage Measured @ 25 PA CFM
" Indicate the maximum allowable Duct Leakage and the calculation. method used: i
r a - r• o ,
❑ 0.7 x Atloor x (0.06) for Climate Zone 8 through .15 t 'CFM
❑- 0.5x Anoor x (0.06) for Climate Zone 1'through•7-& 16 a t ° s
- � _ a �� CFM ,-
400 x"(Cooling Capacity in Tons) x (0.06) �. CFMt
l „ S-CI
r V
s ❑ , 21.7 x (Heating Capacity in Thousands'of=output BTU per hour) x (0.06) CFM 4
Print Name r Signature Date
" ^�" ' %: r .ri "�1 ' "r. w .1 " i +,%n' , i �s..''s#:k' o`. •+'r'.'s '"'�. _'.. ,_'� r 2V. -Ir We '. $ � � :G' ,t�'{ tea. £•'.4' �a:r_ ,
Jan 29 02 11:37a Richard Simpson '661. 947-6889 0.4
INSTALLATION CEitTiFICATE (Page 3of 8) CF-6R -
Site Addrm s Ii Permit l� comber
79- 97-0a Mo%%u.S A vcyNv e-
DUCT LEAKAGE AND DESIGN DIAGNOSTICS
DUCT LEAKAGE'REDUCTION
Pres,uri�alion �'cst Rcsul6w ((:1�M fu125 PA) - _ � � ,. •
• lilt~(Ixakagc(CFM)
Ilan Flow.
If haat Flow is Caloulated m 4M ofm/ton x number of tons, or m 21.7.x Ilouring (apaoity
in Thousands of Btu/br. o for caloulatod valuo baro
If•fan flow is vatmumd, tailor mcaaurud valud hunk
Lockago Fraction ='rte Loakagc!(Momu and or (:bloulatod ran Flow) n
Paws ifleakago fraction 5{l,llb ❑
/Pas:4 Fail
❑ For AEROSOL TYPE SEALANTS ONLY -The following diagnostic testing was completed:
[hart Fan Prumdrrcaliun at rough-ia gw2mrkxl lcakage (CFM)
CHECK AFTER FINISHING WALL:
❑ Yaw ❑ No ❑ ProzV re pan IIsi or I louso pluourrcation taxa
❑ Yaw ❑ No ❑ Visual_ Inspeution of Duct Coamuolioav ❑ ❑
Wass Fail. $
THERMOSTA71C EXPANSION VALVE (TXVI
YMN : ❑ No Tht,Ymor,'latio Isxpan,:ioh Valva (or Commission approved
oquivalont) is installud and Auaws is pruvidkxl for hw":tion ❑
YW is a pn -% Pas. fail
_ ❑ DUCT UESiGN ,
I ' ❑ Yas ❑ No RCCA Manual D DcAgn calculations have boon oomplutud,
Iha;t lksign is on tho plans and dui:( inslslialion maloho s '
plan~.
2. ❑ Yes -0 No 'rXV is in-Aallwl or F lel flow hunt btwa vorilicd. If no TX'V,
vcriliud fun flow match(; diwigp froth C11-I IC
1 Measurod Fan Flow
❑. a .
• Yaw l"or both a and 2 u a Psis.. PASS . Fail
13 1, Iho undursigaud, rarity That tha pbovo diaguortia Wst rC4u11N aqd ti►q work I puiformLd assoniatud with thu tcsl(014 in '
cunformane4 with tho mquinR rants 1irc compliance crud[(_ (Tho buiWur shall provide dw HERS providar a copy of Iho CF-611
uiguoJ by the buildaectuploycen or sub-kwnlraetom curtitying that disgavMiu tuxtiug anJ iuNItA*Iiou uuwt ihu roquiroluond-.4 1W.
complianac cmdil.(
1'chh; Sisnaturu, Datu . Iastolliug Sub ntraolor (Cb. Namo) OR
Pri ormcd (ir nern) Contmctnr (Co. Namc)
COPY TU: lluildiug LVpartivavl t .
HERS Providor (il'appbcablc) .' .
Building .Owner at. Occuga»cy
January 4, 2001
.-®uct Testing Lot #r r
Certification, Fo mn F r ,
System +:2. oft'
L } . i, (one form per system) s
Builder Name:. • _ •• • .:} ,; ` , q ,f ` •. • ' +
Project Nafne--Ile
l ,
s Builder Field Contact: w •s
.Telephone No:
HVAC Company Name:
HVAC Installer: , Telephone No.�"�3y�iso _
• -1 ' • - .•' '• aF .S Yom. _ • } } - - •'
pelf -Certifier Results ;
•r Duct Leakage•Me'asured @ 25 PA - � '�:CFM }
- • `' •. ,. � .. A,
Indicate the maximum allowable Duct Leakage and the calculation,method used.-
0.7
sed:0.7 x Anaor .x (0.06) for Climate Zone'8 through 15 Fr r CFM
❑ 0.5 x A x 0.06^ for Climate Zone 1 through:7. & 16 F CFM
400.x (Cooling Capacity in Tons) x (0.06){,CFM y
y ,
❑ '• 21.7 x (Heating Capacity in Thousands of.�output BTU per, hour)'x"(0:06) . 'CFM' f: "
Print Name . '•7 ��
.Signature Date
�E
• Ali. � t a 4 .. ..� . ; i •y ., E - � 5 �rki * r� ' `� Ey < � a��
• � � T, Y�� a l . �.+r �� ? et; t � ; : F � i >> � � i �ptl �� � spa ; �t'e in 1�s fa;�i���Q�e�� ������ •
i:' tit" ad, rr b�"�i : t ! � �.f� -wk .[r c�a.5 '7•"�, t t S7;
• t���`���v�� :moi. Y°:�:b�� �>_.:„ ,,.$ .� s. ' ,; �.-_'�.rr . -.f t?r.. &+r � .,. fi,�?a .f .;; air . ab. y. ,w.�k: � .. a�dy_�,� ,.,.A�..to�,.4�u�S.iv;:
,. - Y • - 1 i-'.
Cte •of•Occu anc_= eet�fica
city of. La -Quinta
Building 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 comp/lance with -the various ordinances
of the City regulating bui/ding construction 'or use. For the following--
BUILDING
ol%wing:BUILDING ADDRESS: 79-920 MORRIS AVENUE
Use Classification:. SINGLE FAMILY DWELLING Bldg. Permit No.: 0202-68
Occupancy Group: R-3 Type of Construction: VN Land Use Zorie: 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
1.
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