SFD (0202-066)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
.10.1
Date `'�`�� Signature of Contractor
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contracto`r'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:
Carver cOL- .N SAME L14a. ,Policy No. t WO -54405&-0
(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.Ili
Date:'") A la /�; 7 • Applicant ,. 7X )J,1412A-")
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, & each person at
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 La 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.
Signature (Owner/Agent) !9 Date ^ fi
BUILDING PERMIT PERMIT#
DATE ✓1 VALUATION LOT TRACT
JOB SITE
ADDRESS e3xiC?tlZ�',.1T)S}-'�-tSiR"�J
APN «�o
OWNER
CONTRACTOR / DESIGNER / EN &NEER
C t'i`UR C3 s Feil <, G'C7dMlJ UAl%�
MTURY CIRO-WELL LL ClOtO+1ADal'M83
7 535 So ; a,.L°iZ, 'xa, 's '. 0200
:I 515 $0. 'R UO T, = 0200
wX amummWo CA, P2408
SAN 2MARDIX0 CA 92408
(909)381CSO '2120
USE OF PERMIT
MOIS FA L Y DFM Lt°A.lG
SFi3 LOT 1; MON '111=1,0 E3914TA X PLAN XiPt?WIMIT DOM! M! NOT
TRACT COIdSTlktbC:' ION U00.00 SIP x
hCHIPA'['Ii3' , '.. 49X0 5Ir
420.0 ax+
PMWk,19 41MAKAKY
ONSIMUCTIat FEE 101 000-418-000 $64.00
PLAN CHMI~" PUZ 101-OCK3439-318 $351224
IBX tANICAI,11F.1,1 101-000.42'1 X000 MA
i�'► :::' ,1 CR t, CPtt 101-060-420-000
l t�1C .2 .101.-?00,-41y9-000
1❑❑1"[yyM.10ppG7��0
3bRJ40 MfE1014 IME,%IIR1pJV 101"00E"243�400 .....
Jyy
'is�.L
CIR-p�rHO'MH 161"000-423*000 ZF .WU' •
DFV- P1L,tSL'KlY,IhVACT FEE.,
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WS .k'RE RaD M's
$0.00
FEB 14 2�a2,F:�:� �'FEESYPEN IAF
tn:
RECEIPT
DATE //99;; / ;3
BY
D�q.7(� FIN LED
INSPEE OR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
I DATE
I INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
- - Z
Underground Ducts
Forms & Footings
_y
Ducts
Slab Grade
Steel
- —Z
Return Air
Combustion Air
Roof Deck
Q—yIRS
Exhaust Fans
O.K. to Wrap
Ay Z
F.A.U.
Framing
—
Compressor
Insulation
- Z - 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 ` d
BLOCKWALL APPROVALS
POOLS - SPAS
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 �j'�
,3 . /. Z
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Shower Pans
-
Equipment Enclosure
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final
Utility Notice (Gas)
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:
-,_•-,---,-,-,----,-,0
INSULATION CERTIFICATE d
This is to certify that insulation has been installed in conformance with the current energy e
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regulation, California Administrative Code, Title 24, State of California, in the building located at -
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79-948 Morris Avenue, Lot 1, Monticello -Heritage, La Quinta, California10 °'e,
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CEILINGS:01
TYPE: BLOW MANUFACTURER: Certairiteed Thickness: R-38
0101
WALLS: a
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TYPE: BATTS MANUFACTURER: Certainteed Thickness: R-13 a
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GENERAL CONTRACTOR: CENTURY CROWELL COMMUNITITES LICENSE # e
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BY: TITLE:01
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PARAGON SCHMID BUILDING PRODUCTS, A MASCO COMPANY LICENSE # 632072
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BY: TITLE: ADMINISTRATIVE ASSISTANT DATE: 12/12/2002 a
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Duct Testing
r Lot '#,
. Certification'Form"
,
system of
.
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s (One form per system)
-. Builder Name
<,
Project Name:: k(ll, .,
Builder Field Contact:
Telephone No. ' t
HVAC Company' Name: 57 G L
,
HVAC Installer:
TelephoneNo. q��-7.7
'
self-Certifier✓Results,
N" Duct Leakage Measured @"25 PA .Y
C_`'CFM` .
-.
-,Indicate, the maximuin allowable Duct Leakage and the calculation method used., `
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°a
.0 0.7 x Afloorrx (0.06) for Climate Zone.8. through 15 -
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; " CFM '
❑ 0.5 x Afloor x (0.06),for.Climate Zone 1 through 7 &'16 :.;
CFM
S 400 x (Cooling Capacity Fin Tons) x (0.06)- . '.
CFM
❑ 21:7 x (Heating Capacity in -Thousands of output BTU perhour) x (0.06) y CFM' ,
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Print" Name Signature
Date
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y�+" t _ •1 � � �ty � � ,' ` �5 {.'�e�r � �Y' �'�'
Wit. �. de •,r�.y..- i-..�r� t c'� .a
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Installation Certificate: Residential.. CF -6R
Site Address PERMIT #
79-948 Morris Avenue
1. BUILDER INFORMATION
SUBDIVISION': Heritage-
Century
eritageCentury 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 thafthe 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 80UH64/5X-100 80% 100000
80 a/o
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 `
150(h) of the Energy Efficiency Standards, and,are two of the criteria used for equipment sizing and selection.
.5. SUBMITTED, BY
iAA4 4A>a. DATE. =f1 01L.
SignatureInstalling HVAC Contractor
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Jan 29`02 11:37a Richard Simpson 661'947-6889 p.4,,
INSTALLATION CERTIFICATE (Page 3, of 8) CF -6R
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ite Address 7q� 9 y MOR iJ A ✓e? Nva' Permit Number.
DUCT LEAKAGE AND DESIGN DIACNOST.ICS
�. DUCT LEAKAGE REDUCTION
Pressurization "rest Rcsulis (CFM (ql. 25 PA)
'feat l.cakage (CFM) C
Nan I'low
1t' Fara Flow is Caloulatod av 400 olm/ton x numbor of tons. or as 21.7 x gloating. Capacity.
in Thoudanda of lituft. enter calculated value hero
[C tan now is m�sun d, ealcr mcasurud valuu hero
Loakago Fraction Q 'ro I.ca}sagc!(Mcalautcd or (:aloulatcll Fan How)7 Lt -
Pam if loakagu I'raotion S 0.06 � ' ❑
Pass Fail
❑ For AEROSOL TYPE SEALANTS ONLY -The following{ diagnostic testing was completed:
Auet Pan Pressurization at rough -in iWasurxl Icakage (CI -*M)
CHECK AFTER FINISHING WALL:
❑ Yus ❑ No ❑ PIV&% ttu pan 1"-4 or I Iouw prussurrzation lost
❑ Ycs" ❑ No ❑ Visual Inspuution of Ducl Connuoliotw . ❑ . ❑
Pass fall .
❑ .THERMOSTATIC EXPANSION VALVE (TXVj -_ .._.. -.. .:- —.- • --•__
Yw� �Io `fhtaffioA060 INPa eiou Valve (or Commission approved `
oquivalent) is installul and Acca m is Provided for inVm ion
Yu~ 6 a pa.+, }_asn fail
.N -
❑ DUCT UESIGN
1 ❑ Yk ❑ No RCCA Manual D Drusig n calculations Levo boun uomplutud, �.
Duot Dasign is on tho plans and dual installation mMohos
plans.
2. ❑ yes ' 0 No TXV is mstAW ar'Fan flow hos boon vorifiod. If no TXV,
vorifiud fara flow matchae dev ign from C11 -IR.
: Mamumd Fan Flow =
t Yes rur both I and 2 it; a Pass Pass Fall.
❑ 1, the und' mig aul, ruvifg that the abovo diagnostic test rmlLv and the work I perIormed associalcd with the Ies4s) is in
conibnupAco with the l+Cquimments Ibr compliance urudit. ITho buihlur shall provide dlo I II RS providur a copy of oho CF -611
siguW by the builder ctuployoLs or subiwntraclor:rccrtil'ying that ding RU 4k iuuiug and iuNtallation meet Ike rugau'ameaat+ Air ,..
compliant cn-Al.} ,
10
'festa Signature, Date ' Iactallimg .Subcautraotor (Co. Name) OR
Pcrlormed General Contractor (Co. Name) '
COPY TO. Building lxpartmont
11I3RS Provider (il'applicablc) '
Building ownez- ut OccvVa»cY
January 4,201
f Occu ya Certificate oa
p
City, of La Quinta..
Buildin and Safety Department'
FM 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 fol%wing:
r
BUILDING ADDRESS: 79/948 MORRIS AVENUE
Use Classification: SINGLE. FAMILY DWELLING Bldg. Permit No..: 0202-.066
Occupancy Group: R-3 Type of Construction: VN Land Use Zone: RL
Owner.of- Building: CENTURY CROWELL _COMM. Address: 1535 SO."D"STREET STE. #200
City: SAN BERNARDINO CA. 92408
By: GARY SHOWALTER
--a' Date: '08/09/02
Buildirg
i Officia
POST IN A CONSPICUOUS PLACE:
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