SFD (0202-067)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
3 i Rf1 f3 1 o/31 i',021
Date^ 2h/• /, � 7 Signature of Contractor
17,K 1 6 l' _ I \r r
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
.. : `- .
( ) I'am exempt under Section B&RC. for this reason t
Date Signature of, Owner
I
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 g0L,`,y2d L koL,&'12�P. Policy No. 2�-6� e` ,p 4400-€f3
(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.
r
Date:P . Applicant
/,.,•, J y�,.
",, I 71111,41
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $1:00,000; in
addition to the cost of compensation, damages as provided for in Section 37.06
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safe
fora permit subject to the conditions and restrictions set forth on
application..
1. Each person upon whose behalf this application is made & each person
whose requestyand for whose benefit work is performed under or pursuant o
any permit issued as a result of this applicaton agrees to, & shall, indemr fy
& hold harmless the City of La Quinta, its officers, agents and employet s.
2. Any permit issued as. a result of this application becomes null and voi • =if --•—
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to caricellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection purposes. f
"r T iDate
Signature (Owner/Agent) A e;•
BUILDING PERMIT PERMITp
��C�•C3€� r
DATE Typ ,VALUATION LOT TRACT
JOB SITE
ADDRESS f s�. M'f�!lErQ^I
OWNER
CONTRACTOR / DESIGNER / EN INFER
L''RIOW911 trE%PY1: UMN.1211
L° ITIU.; Y C.'.ROWaL COM -M 3NUTE,
'035 30, V ICVMEI rl n1..'ro #200
535 i.1401 "Do 151.PRI'�'.TZ, 91,71,
ShV4&b:PX.ARC,1R(.) CK 92A08
SM1yEWR A DWO ' C.A. 92408
(9'0g)3F1.0,007 OBTA 2120
USE OF PERMIT
t'IMI : imn:7C 1?GJ`i. lm
SFD - I'M 2.. Mf,Cfl TICIIi<I.,x. o H.P.R 7'1,i.G4E+',PLa 38P�':IN". PERMIT )"rx7ES NOT
1 Ci�t1 5. ►i�ti'i �lY i ,P00US A&phi?:Dt1[VI WAYAPPRO..A.CK,
T'1
TRACT C:OR"3 TRUCT10il 2215.00 V
P0RCPalPATi0 29.09 8F
6.115-00 5F
Zor=1417-D C0601 OF CONSMUM110N
1314419.29
CUNSTl'VICTiON .FEE 101.000-418.000 �, ��.OP►
PLAN C?fa&0.X� lr'r4 101-600-439.31$ �h `vt1:ACa
MECHAWAI, FEE 101-000-421 m000 960.00
I'PT.fe,C'a RICAL, ME 103-600-420-000 z3 .53
Owmaf1•P£i r , 101 -0004M,M 41N.00
ST;Fi.O1,10 MOTION F`O:,F - 'S10 10.1-000r2v41-000
f;D:+�IR'1aOF�'E'R.IRl;pA. CT Ist �°a,9ttY:iPCa
x
4 2002B
;FEB
1 C13�a I XR1.111AD $=
$0,00
®FLAQUI 7A
RECEIPT
DATE%BY
DAF FINALED V
INS�GTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs 3 — /— �___
Underground Ducts
Forms & Footings — f _ 2 I
Ducts
It -72
Slab Grade
Retum Air
Steel
Combustion Air
Roof Deck ../B —
Exhaust Fans
O.K. to Wrap Z
F.A.U.
Framing
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
'r
Final
BLOCKWALL APPROVALS
Steel
POOLS - SPAS
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam -22—Z
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines — /
Heater Final
Water Piping _
Plumbing Final
Plumbing Top Out r
Equipment Enclosure
Shower Pans
Sewer Lateralcr�
Sewer Connection "
O.K. for Finish Plaster
Pool Cover
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final
Utility Notice (Gas) — e
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring �—
Low Voltage Wiring
Fixtures
Main Service
Sub Panels _Zj
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final 8'7i
Utility Notice (Perm) _ —
COMMENTS:
1. e
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:
s
79-934 Morris Avenue, Lot 2, Monticello -Heritage, La Quinta, California
CEILINGS: + -
- i
TYPE: ' BLOW r MANUFACTURER: CERTAINTEED THICKNESS: R-38
� 1
WALLS:
TYPE: BATTS .MANUFACTURER: CERTAINTEED THICKNESS: R-13 r
e
GENERAL CONTRACTOR: CENTURY CROWELL COMMUNITIES LICENSE #
BY:i
TITLE: `
PARAGON SCHMID BUILDING PRODUCTS, A MASCO COMPANY LICENSE # 632072
e
BY: TITLE: ADMINISTRATIVE ASSISTANT DATE: 12/12/2002
naivivioivivivivivivivivivraivivivirivisiviviviviviv/siviviiivrvivivrviviruivirioivivivisiviviaivivivirrvivivi®ivivuiviaroivivirivivivivr®ivisiviviviaivivivuivioiviaivrviviviviviviviAi"i
s.l
i,
Installation Certificate: Residential CF -6R
Site Address . PERMIT #
79-934 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-48B-090X 80 W 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
,�
DATE:
Signature Installing HVAC Contractor
Jan 29 OE 11:37a Richard Simpson 661.947-6889 p:4
.INSTALLATION CERTIFICA'T'E (Page 3 of 8) . CF -6R
to
$iteAddrerls 79- 9Jy o' If 4vr.-1t&>a' Permit ttmsber
'DUCT LEAkACE AND DESIGN DIAGNOSTICS `
_ DUCT LEAKAGE REDUCTION
- surizalion Test Raw% ((.']-'M (a125 PA)
'fest Leakage (CFM)
Nan Flow
" If Ilan Flow is Calculated as 4W ciimi/ton x number of tons. or as 21.7 x I loalmg Capacity
in ThougandA of lltuft. orator i aloulatod valuo baro
If fan flow is numsum-d, cmlar mcasurud value hcru
Uakago fraction - 'I wit [,cakagc!(M,;arurcd or Caloulatul Fau flow) n .
Pay. if loakagu frautiun S 0.116 ❑
Ya.4a4 Dail
For AEROSOL TYPE SEALANTS ONLY - Tho follow Ing diagnoatle testing was completed:
Duct Fan Pressurrvatiun al rough -in mcaquFal leakage (CFM)
CHECK AFTER FINISHING WALL: ;
❑ Yc,�, '❑ No ❑ Ilwmro pan I" or' llouw pro.isurrration 1e1r1
❑ Yew ❑ No ❑ Visual Inspeution of Duct Cunncwlions ❑. ❑
Pass Tail
THERMOSTATIC EXPANSION VALVE (TXV)
Ya. ❑ No '1'he=oAatio INpaaeion Valve (or Commission approved
oquivalent) is installo i and Ac:vc.-+s is providod for inbImlion ❑
Yc i. a pay ►ac, Fail
O DUCT 0E516N
1 ❑ Yes ❑ No ACOA Manual I) MAgn calculations havu buun c►ompletud,
Iteral Design is on Ilia plans and dual installation maluhox
plans. ,
2. ❑ Yaq ❑ No TXV is installed or Ftm flow ho -c boon voriliod. If no TXV, '
vorihud fan Dow matches diwip from (T -I IL
r Mcasurod Fan Flaw =
❑ ❑
Yos for both 1 and 2 ir; a Par: PttSS Fall
❑ 1, tho undcasignud, vuay that Tho ilbovv diagao:;lio W5t rj4wI 4 and III; work I pc►formud amoc:iatud with the last(s) is in
ounforinAnc e with the wquiromunts tier compliance: orvdit_ IThu builder yball provide dw; l IERN ptuvidur a c:upy'ol' Zhu CF -0R
siguW by tko buildor cu►playa s or sub-uonlraotors uctlilying that diaguu iiu tuAiub anJ iuitallatiun u►uW thu rugairvrnoutti Alf .
complianm crudit.I f
j ,011
Tcsis Signature, Dato In0alling Sabcowractor•(Co. Napo) OR
Pcrlurmud (ionoW Contractor (Co. ,Name) .
COPY TO: Building Depai mollf
1113RS Providor (if applicable)
Buildirig Owner at ACCugo»cv .
January 4, 2001
. :
�7!—1 rs.
Tract #
®uct76sting Lot
Certification Form T. ..
A., Al (One form per system)
.�r Build�: � •. �' !/ ,.4 f '_� #���' �-� , .'t `, • • • �, 'r� . •,' •
�. CSA
Builder Name: y :
Project Name:
Builder Field Contact:
_ r Telephone No. �.•.t
tHVAC,Conipany Name: -y >• G-.0 .�' G;
3 .. HVAC Installer: Telephone No.
4 `� - � .. e ,, a; '� „ ..i tit•
• r '.S ti.' ' is � _ �; • y ♦ � ty • • 3
_:.�1 -,, � vkt - ' . j 'l� T Y „' `' � - . ' .. _ •t .� .. - t - rte..:
• .S.elf Certifier Results 4
4 Duct Leakage Measured 25 PA?` , ' " ,, /
r: @ w` t `7- :CFM t �,
Indicate the maximum allowable Duct Leakage and the calculation'method used: °M is
` ❑ 0.7 x A '. x -(9:06),for Climate Zone 8;through 15. CFM .
floor.
+ ,
-r'.❑:� 5x An,)., x (0.06) for Climate. Zone 1-through 7 & 16 -, CFM
400 x'{Cooling Capacity in Tons) x (0 06) • '' (Q0
r _ CFM'
r' .❑' 21.7•x (Heating Capacity in-Thousands of output BTU per hour) x (0.06)' CFM' `
L 4-/L-
' "Print Name ..: `- Signature Date j
f' '
, y
' Y �t1� � u '� `' A � �� G Y� t I �[ i .G 'l; Fy� - T+1"•1Y•i ,z �"i *ry.{..+�� • .F-.
y • L � � r-r+ri x
a���te,�•sa • < � .��;,e,�� . . ���sP �,�s ����'�,� ...r����t�6.;�.P���'t�.. din, fif.���?����n�'€t��s. er��>-��� _ }.
L *'
! � _• _ _ ` �,r4 _ ''. , x. , ' f,, • < tract # 'u-�/ •L'
•b 5. L, - �7. 1
_ s DuOt'iestinZ
g ,
R . Cei tificatio-64 Form 5,
t Lot # ' .
•,• ! �,Systelb % Of Z
(one form per'system)
Builder Name: CG�C V t
Project Name: ell
Builder Field Contact:' ' .Telephone No. T
.. HVAC' Company Name: ;Y {
HVAC Installer. Telep
�• ►: hone.No
,^
Self®Certifier.-Results *� �.
Duct Leakage'Measured @
� 25 PA
} CFM
y Indicate the maximum allowable'. Duct Leakage 'rid the calculation method used: ` `
❑ • 0.7 x Anoor x (0.06) for Climate Zone6 through• 1,5 CFM,,,
..
❑ 0.5 x Anoo� x (0:06) for. Climate Zone_ 1 through.? & 16 CFM
400•x (Cooling. Capacity in Tons) x (0:06) 7 °CFM1'
❑ 21.7.x (Heating Capacity in Thousands of output BTU per hour
)'x (0.06). '
CFM
_6 dye
.,4
! P, rint Name s Sig�iafure; Date
' .,rth'Y .tt�•.ss rs r 4"!'{•" r�4 '^"R .t,u• Y,o.
1 O 1 �'' '
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�x�e"M
81
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7'� .; - C d ,` t.r 1 •"sp7 r '.me b=ty� •t�,y e ..r�P3
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Occu a ....rt�ficato of Cea
cityaofla-Quinta.---
fet De artment�Bt ldin �an.d Sa.. y p �� of
This Certificate issued pursuant to the iequirements';of Section- 109-of the. Uniforni Building Code,
certifying. that, at. the time of issuance; this• structure was in with the various- ordinances ,
of the City.regdlating. building constriuctiom oruse. For the fol%win w x
BUILDING ADDRESS: _ 79-934 MORRIS AVENUE
Use Classification: SINGLE FAMILY .DWELLING - , µ' Bldg. Permit No.: 0202=67 '
Occupancy Group: R-3 Type of Construction: VN Land Use Zone: R/L
Owner- of Building: CENTURY CROWELL COMM... Address: 1.535.SO. "D" STREET STE #200-
' City: SAN BERNARDINO CA. 92408
By: GARY SHOWALTER, -
-�a, Date: '08/09/02
Building Official
POST IN A CONSPICUOUS PLACE