0202-091 (SFD)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
Br i0P'41/a
Date ` f ' Signature of Contractor ? f�°.� 5
�•
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).
( )1, 1 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.
(y) 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 Policy No.
sIOLDEN LAOL E W. !u-544110-03
(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
I 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
&Dxi�
ate: )
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the costof compensation, damages as provided for in Section 3706
of the Labor Code, interest,and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subjectAo the conditions and restrictions set forth on-'his9
application. .
1. Each person upon whose behalf this application is made & each person at'
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with'all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection purposes. �j }
Signature (Owner/Agent) Date"
BUILDING PERMIT PERMIT#
DATE VALUATION LOTTRACT
r+
_, /J ffwx 3.1010 34 1-1
JOB SITE'
APN
ADDRESS
44—S92 LUARTY AVTNUE�3Q
� iia J$g
OWNER
CONTRACTOR / DESIGNER / EN INFER
CMI RY t: kO'E�'.L U, col►lit 111.1 :8
CENTURY 0ROWELL r_10MVLnVTrX114
1535 so, W.D" uJim-T, sm 02,00
15;35 �� °�►e �#°Y"lt L', &,rL X00
9" DIMIA1=40 CA, 93A08
8AN BERNA" O CA, 924 .09
(909)391.6%-r,? a^: ILIN 2120
USE OF PERMIT ,
SYD - LOT 54. MGNTiCVLD!liU3$A01P, PLAN 213. PAPJAIT DOES 140T
WWI)k.1;> XAX,7,R.* WA :1.3, ,P0010PA Oft
CHECK TU ROW= F3fc.'.�+tV1;f1 1A,Z ISSUANCE OF T AX& PLA. N TWE,
A1S\AC C SAVSTRUC,1],4a`N 1.8.62,+,co LA
P't3$2.C14PT:FITIO 49.00 SP
CANRA.C3L�K`t PORT .420.00 81F
CONOTI$UCTJON FEE 107 -0M41 £I^#1t3t1 .. wm
PLAN CH -ECIC F -EE 101-) -433-3.18 $139.06
MECHANICAL 1•°P,9 101--U00.4µ1.000 $60.00
FUZC9" R,ICAL P811: 1: I�000-td2iJ- �f20 $i t9.4Y�
PLUAtVING FEE 101-000-419-000 5150.00
MOTION FEE, _ RESID 101-000-241-000 $�1}�fi
/.`"iTP4NO
y/y,,��yy�6G6
GRADIM flu 601.00(>425-000 ' $20.00
1EVY.I..CBz ER WPACTFU $1,907.00
is PRE -PAW � ZEW
$0.00
FEB 14 2002 6 11nmr IF A DUR NOW
19,62
CrFY0F 9 A4UJ,11,wA/
> 6i
CEIPT
DAT E/a-1
DAT IED
INSIDE
M
INSPECTION RECORD
OPERATION
A DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
/ _ Z
Underground. Ducts
Forms & Footings
— p _
Ducts
Slab Grade
61 _ Z
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
OX to Wrap
i'I- L
F.A.U.
Framing
—3.
Compressor
Insulation
—.7—
_
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 CP— -
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 -I
I
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
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 . Z
Low Voltage Wiring _
Fixtures
Main Service
Sub Panels
Exterior Receptacles _
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
M
Installation Certificate: Residential CF -611
Site Address - .
44-592 Liberty Avenue
1. BUILDER INFORMATION
Century Homes
1535 South D St. #200
San Bernardino, CA 92408
INSTALLING CONTRACTOR:
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
PERMIT #
SUBDIVISION: Heritage
CITY: La Quinta
COUNTY: Riverside
WEST PAC AIR CONDITIONING
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
150(h) of the Energy Efficiency Standards, and are two of the criteria used for equipment sizing and selection.
5. SUBMITTED BY
Signature Installing HVAC Contractor
DATE: I L( 1 w Z
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 Califomla, in the building located at:
44-592 Liberty Avenue, Lot 64, Monticello -Heritage, La QuInta, Callfornii2
CEILINGS:
TYPE, SLOW MANUFACTURER: CERTAINTEED THICKNESS: R.313 V .
WAI i C2.
TYPE; BATTS
MANUFACTURER. CERTAINTEED THICKNESS: R-13
GENE -R,4 CONT CTOR: CENTURY CROWELL COMMUNITIES L.ICENSE# 71 yl
BY; TITLE:
PARAGON SCHMID BUILDING PRODUCTS, A MASCO COMPANY LICENSE #632072
ITLE: ADMINISTRATIVE ASSISTANT DATE: 12/1212002
_Jan 28 02 11:37a Richard Simpson 661 947-6888 p.4
INSTALLATION CERTIFICATE (Page 3 of 8) CF -611
Site Addms i _ S' ), Z J ` Permit Number
``� L ac2T � n/
DUCT LEAIIA& AND DESIGN DIAGNOSTICS
P1 DUCT LEAKAGE REDUCTION
Prc.4suriialion Tcst RCsuI1N (CFM lel 25 PA)
Tcsl f.cakagc (CFM) i
Ilan flow
If Fan Flow is Caloulaicd as 400 olioa/tou s number of tons, or m 21.7 x floating C:apaoity
in 'i'houaanda of 11tu/br. ontvr ealeulatod value 1►ero
if Ilan Row is ou amwd, c:nlc:r measured value hero i uvc
Leakage Fraction —.I" Loallagol(Momured or Calculated Iran flow) n
Pa`s if leak -ago fraction 5 OM ❑
Pass Fail
❑ For AEROSOL TYPE SEALANTS ONLY -The following dlugoostlle testing was completed:
Duel Fan Premuricalion al rough -in mc:axural leakage (CFM)
CHECK AFTER FINISHING WALL:
❑ Yes ❑ No ❑ I mm oro pan IW or I louw prusxu ,ation test
❑ Yes ❑ No ❑ Visual laspcudon 011 )(101. Connuotions ❑ ❑
Pass Fail.
THERMOSTATIC EXPANSION VALVE (TXV)
Y N ❑ No Thermohlatio Edxpaneaion Valve (or Commission approved
oquivalent) is installtA and Acuums is provided for ins cation � []
Yes is a Pan. 1'8•s Fail
❑ oUCT OF -SIGN
1. ❑ Yc, ❑ No ACCA Manual D 1]csign oalaulations baso bocmn oomplolud,
Doul I)asign iia on Ilia plans and dual instsllalion malchos
Plans.
2. ® Yea Ca No TXV is installed or Ftm flow hex been voriliod. If no TXV,
vcriliod fan flow matchovs desigp from CF- 1R.
Mamurod Fan Flow =
❑ ❑
Yee► Ibr both 1 and 2 is a Pans Pass Fall
❑ I, the undersigned, vm y that the above diaguoxric ul romIts and the wozic 1 performed assooialrA with thu tcsl(N) is in
eunibrm aneo with the roquimments fire compliance urmdit. (Tho builder shall provide the I IERSi provider it copy of the CF -OR
sigu%A by tho builder cuzployc a or sub-cwntraclom uurlilying that diagau do losting and installation uwot the rogoiremoiui-4 tier
compliance crudil. J
Tcsls Sipatura, Date Imatalliug Subcaatrwfor (Co. Name) OR
Performed (kneral Contractor (Co. Name)
COPY TO_ Building Department
HIM IWvidor (il'applicahlc)
Building Owner cit Occuvai)cy
January 4, 2001
4.4--sS2- aczTy A.1G1vuG
Tract #
Lot # �y
System 1 of I
(One form per system)
Builder Name:
Project Name:
41
Builder Field Contact: Telephone No.
HVAC Company Name:.
HVAC Installer: Telephone No. ' L7 ` 3� / U�
Self -Certifier Results
Duct Leakage Measured @ 25 PA CFM
Indicate the maximum allowable Duct Leakage and the calculation method used:
❑ 0.7 x Afloor x (0.06) for Climate Zone 8 through 15 CFM
❑ 0.5 x Afloor x (0.06) for Climate Zone 1 through 7 & 16 CFM
400 x (Cooling Capacity in Tons) x (0.06) CFM
0 21.7 x (Heating Capacity in Thousands of output BTU per hour) x (0.06) CFM
��
H�c�� C
Print Name Signature Date
Certificate of -Occupancy
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
Use Classification: SINGLE FAMILY DWELLING
Occupancy Group: R3 Type of Construction: VN
44-592 LIBERTY AVENUE
Owner of Building CENTURY CROWELL COMM.
Building Official
Bldg. Permit No.: 0202-091
Land Use Zone: RL
Address: 1535 SO."D" ,#200
City: SAN BERNARDINO CA. 92408
By: GARY SHOWALTER
Date: 08/22/02
POST IN A CONSPICUOUS PLACE