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0203-362 (SFD)U) 04 W' C)LO Bch W � C:) Z 0' 0 Hco J W CL U) Z 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 Date �' ` Signature of Contractor «°� •� ,ti'+�..�. 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 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. (w,) 1 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 %i l' f?A,C1i�E INS, Policy No. IMC -544068-43 (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. ✓ S Date:;..-V•w % :s Applicant- Warning: pplicant 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 r 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. f ilCry.. Signature (Owner/Agent) BUILDING PERMIT PERMIT# DATE VALUATION LOT ®'' TRACT 7.x•197.5 JOB SITE ADDRESS 9.-7 :1. T?T.D0.TJyH IC:(.A.U,wS. APN 604-O.Z24= OWNER CONTRACTOR / DESIGNER / EN (NEER f!tyCROWLll,CON )NUm8 .CiELIXORr rWf URY.J131 103 ii.uo,Jzoo J35-30LM,iLj 0M #701D SANMZA1 T3,NTO CA 92408 SAN A,1..,1 NARDI1+O CA 92408 (909)391.60(h CEL4 2120 USE OF PERMIT 3100 � LOT 6 111 AN XREV. PERMIT DOES NOT INCLUDE 131.f,'S( K Wi S UO, P004 10PA OR DRIVEWAYAPPROACH. 7S% PLAW CHIE K R REDUl". rION F011 MUL,ri `u issu €i"IQc& Div S.t'►.ME P3 A14 TYPE .b RlACIT C.'VRVi'ap.UcTior1 1160 101) 9 POItCWP•ATI..t/ V.010 ZIP f.1ARAOV&Ifl ORT 412,00 8F FsTaw= con w, co. 's ucmiq PEM -MU YET 911AMURY CONSTRUC-0,114 FEE 101 4t 0.418.000 S344.9 Pl-,#%N CHECK FEZ 01 -W1.439-3 $124-$6 MUCHANICAL FSH $55deso ELECTMCAL Fg?, 101-000-1420-000 Vfi9.J.><t PL13MIM10 RX 101-000-419-000 0.419-100 $1; 0.00 S`1't1,ONCI MOTION F?%- PiM, 10 101-000-241-000 $149 C1RPij�.1 !0IFBE 101.000-423.000 $20.00 DZVE-LOPERI71r3F`ACT FEE $3,9tY?.Oti y • IJUI3 -� (YrAL, CelQkl'1�1:.�.IX.013013 AND 111A €:,z�3s t"' 1 $2,947.39 p LESS Pl1R- P.AWo if $0,00 D/�\ AL FERWIF IKKES DUE t1,947,79 P,AY u 12002 CITY OF LAQUIWA ; FINANCEDEPT. RECEIPT DATE .�� BY DA E FINA ED /•-o INSPECTOR INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs — — 2 Underground Ducts Forms 8 Footings 2 Ducts Slab Grade g, Return Air Steel — --2 Combustion Air Roof Deck —a2_ Exhaust Fans O.K. to Wrap F.A.U. Framing Compressor Insulation Vents Fireplace P.L. Grills Fireplace T.O. Fans 8 Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath Drywall - Int. Lath —©Z Final Final o ?� BLOCKWALL AF6iROVALS 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 6 Heater Final Water Piping Plumbing Top Out _ L� Plumbing Final Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral Pool Cover Sewer Connection Encapsulation Gas Piping Gas Test o — • v roe X 7 Appliances Final Final Utility Notice (Gas) ELECTRICAL APPROVALS Temp. Power Pole Underground Conduit Rough Wirings /= Low Voltage Wiring Fixtures Main Service Sub Panels Exterior Receptacles G.F.I. Smoke Detectors Temp. Use of Power Final Utility Notice (Perm) 4 Opo Z 57 COMMENTS: ,r E INSULATION CERTIFICATE This is to certify that insulation has been installed in' conformance with the current energy regulation, California Administrative Code,7itle 24, State of California, in the building located at: -79-781 Randolph Court, Lot 6, La Qulnta, California CEILINGS: TYPE: BLOW MANUFACTURER:. CERTAINTEED .. THICKNESS: R-38 WALLS: TYPE: • BATTS MANUFACTURER: CERTAINTEED THICKNESS: R-13 GENERAL CO TRACTOR CENTURYQROWELL COMMUNITIES LIC NSE # BY: TITLE: P RAGON SCHMID BUILDING PRODUCTS, A MASCO COMPANY LICENSE # 632072 B : TITLE: ADMINISTRATIVE ASSISTANT DATE: 11/26/2002 W/V/al%1Nwlavmmm ..'1J/wTY.:+IJ:Y•F':: /.p:4Y/.Y/�Yd./.AY«/P/.P/3::Y.:O/V/.:VwYI.H/.N7/d'✓V.0T/d7://..+1%S'/J•/at+/.Y/.N/.T/�A CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING (Page 1 of 7) CF -4R Joe 90610so0 (`)007%2- 3 150 Builder Contact Telephone Firm: f'DE SE 2T "5 -EP -y I cc= --5 Street Address: r 0. F10 Y, �o� Copies to: Builder, HERS Provider F -5 4-/o 2 Date -F Li Builder ame FLA,d 2C Ian Number G 20 LJ Sample Group Number l.o.T # (�, 74•?RI RaNDoL?H Sample House Number HERS Provider: City/State/Zip: I\A VJP_tlo rl i�A ,tt, HERS RATER COMPLIANCE STATEMENT The house was: . Q"Tested ❑ Approved'as part of sample testing, but was not tested As the HERS rater providing diagnostic testing and field verification, I certify that the houses identified on this form comply ith the dia_nostic tested compliance requirements as checked on this form. FLe The installer has provided a copy of CF -6R (Installation Certificate. C�K,_,/Distribution system is fully ducted (i.e., does not use building cavities as plenums or platform retums in lieu of ducts) l� Where cloth backed, rubber adhesive duct tape is installed, mastic and drawbands are used in combination with cloth backed. rubber adhesive duct tape to seal leaks at duct connections. 9 :-11NIN1UM REQUIREMENTS FOR DUCT LEAKAGE REDUCTION COMPLIANCE CREDIT Duct Diagnostic Leakage Testing Results (Maximum 6% Duct Leakage) Measured Duct Pressurization Test Results (CFM @ 25 Pa) values Test Leakage Flow in CFM ej(o If fan flow is calculated as 400cfm/ton x number of tons enter calculated value here 1(.000 If fan flow is measured enter measured value here Leakage Percentage (100 x Test Leakage/Fan Flow) _ 00 Check Box for Pass or Fail (Pass=6%or less) LJ ❑ Pass Fail L? TH ERMOSTATIC EXPANSION VALVE (TXV) L7 lies ❑ No Thermostatic Expansion Valve is installed and Access is provided for inspection ❑ Yes is a pass Pass Fail ❑ MINIMUM REQUIREMENTS FOR DUCT DESIGN COMPLIANCE CREDIT 1 ❑ Yes ❑ No ACCA Manual D Design requirements have been met (rater has verified that actual installation matches values in CF -I R and design on plan. '-. Yes ❑ No TXV is installed or Fan flow has been verified. If no TXV, verified fan flow matches design from CF - IR. Measured Fan Flow = ❑ ❑ Yes for both I and 2 is a Pass Pass Fail Compliance Forms August 2001 A-16 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: 79-781 RANDOLPH COURT Use Classification: SINGLE FAMILY DWELLING _,.:Bldg. Permit No.: 0203-362 Occupancy Group: R-3 Type of Construction: VN Land Use Zone: RL Owner of Building: CENTURY. CROWELL COMM. Address: A1535 S. "D" STREET #200 City: SAN BERNARDINO, CA 92408 By: STEVE TRAXEL Date: 12-06-2002 Building Official POST IN A CONSPICUOUS PLACE