0202-086 (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
I t F+ B ,-. r"" 1 10131/0111
Date -=` 1' `� �°' Signature of Contractor / I
3 ;
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason: Y
( ) I, as owner of the property, -or my employees with wages._asaheir sole
"compensation, willZlo 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.
4t( ) 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.
GOLDM't ICR.0LE INS. NTW-344068.43
(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.
Date: ,"F hdh' 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
for a permit subject to the conditions and restrictions set forth on his
application. t
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. If ;
Signature (Owner/Agent) � + l�Y7, Date '41"
BUILDING PERMIT PERMIT#
DATE r VALUATION LOT (f',t„02,,0W) TRACT
49
JOB SITE ✓
APN
ADDRESS
1 �nI.fs:7XU A:V
OWNER
CONTRACTOR /DESIGNER / EN (NEER
La2'ruRy 1C. -ROW. . C0b0AC1,QT1U'9
C"ENVIR? CF>L011;&1 .?1 COIAW ,17193
1.535 ate, °D° MCWT,
1535 1,913, 2.i3" M''7fi .t; = #200
SAIN BMW". O C4.-S���c18. _ ._
�a��►�1�1�1�� ai�Q C,� 9NI08
_
(30fT`�3 1-5ir€3i CM3.�0 2120
USE OFPERMIT
S1ryfyyi
1. i.✓ V4F,(wi1J,MSYy"•'J4
S'I'D - W. T 49. MONTIC IZLO:kTla.`P.1TA.C`Iri PL,t'W 2C: P1xRANT DOES NOT
WC;LUD93 DL.00X WA1AA POOMPAC;R DIRI'VEWAY,APPROp.Clg, PLAX
CPI ",Z REDUCED POR MULTIP ILE ISSUANCE OF SAW Planta TYPE,
e
TRACT CONS'i`It'UCTICrN SYS
PO GH1P.tr rI0 +49:00 sp
0A&&0FIC!.ARPORT 420.00 Sly
'ic;917MIMM C4yb'`i' OF C:fi3V5':�.IT UC711fi?H
10151&Z.10
C(IrNS RUCTION FEE 103 -000-41 8p00 } 1664,00
PLAN CHECK PEE 1011,4100-$39-318 0073.06
MECHMICAL FEF, 101.000.421-000 '360100
FILl&C'f`,IUCAL FF.Z 101-000-420-000 3119.90
PLC1M00 '1 101.000.419.000 sI34100
STR,C3NO MOTION FZ4 RESID 101-000-241--000 5..14,66
t2kADINGYER $211.00
DIZVELOPE11.IMPACT FZZ $1,9137:!20
*'p s,
i "d`
em^'iOT-VI CIAND 1 #�3 C? ' ND PLW �X ICAM
t
$3,049.a
77.�..._. i _...._ LES ?VR-PAID',MM
k�P I
$0,00
• ; i;
' '
1lm IMP 11InN 1NVE N07W
93,04962
FEB 14 1007'°
WYOFLAQUIMA
RECEIPT
DATE
SY
DATEFIFI�NAALLEED
INSPECT
INSPECTION RECORD
- OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING.
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts T„ (;_
Slab Grade
-7� -Z -
Return Air
Steel
- Z
Combustion Air
Roof Deck
- Z-
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
. Z -
Compressor
Insulation
-- -
Vents
Fireplace P.L.
Grills -
Fireplace T.O.
—
Fans 8 Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
_ 2 -
Drywall - Int. Lath
Final
Final
— p -vim
POOLS - SPAS
BLOCKWALL
APPROVALS -
,Steel
Set Backs
Electric Bond
Footings
3 -/Z -
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
- �y
Heater Final
Water Piping/
Plumbing Top Out
_
�`
Plumbing Final
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
_
Encapsulation
Gas Piping
_
Gas Test
Appliances
le
Final
COMMENTS:
-
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) , -
ii:" v 1
Installation Certificate: Residential CF -6R
Site Address
44-631 Liberty Avenue
1. BUILDER INFORMATION
Century Homes
1535 South D St. #200
San Bernardino, CA 92408
INSTALLING CONTRACTOR:
2. PROJECT INFORMATION
DISTRIBUTION
TYPE
Flexible Ductwork
in Attic and
Between Floors
DUCT OR PIPING R -
VALUE
Flexible Ductwork
Will have a R -Value
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
EQUIP.
A/C
MANUFACT COMPRESSOR ACTUAL EFF. COOLING EQUIP COOLING
MAKE MODEL # SEER CAPACITY LOAD
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: �4 $��Z
10/17/2013 01:32 FAX 10 012/014
YI::•.�i_,'.:P/J,'i�.VI:PFP.V.'Ir//!/.Pii.'/,'I.I/f.tJ%'/.'lI!/r1..Ilf/llJlrJ%r•rI/I/f///r ilW %J/.%/.•N✓.'/r%vN%.n I.%/fiP:'Prli'/O.'Y/.•%-:/:J.:J:l4-.%iP:'OM'f.%.%/Itrii J:V,(:sv..w:%hy�..nirP: •iri.i
1'
INSULATION CERTIFICAT
This is to cartify that insulatlon has been installed in conformance with the current energy
regulation, California Administrative Code, Title 24,
State of California, in the building located at
.i
? 44-631 Liberty Avenue, Lot 49 Monticello -Heritage. La Oulnta_ C21ifarnfa
BY: TITLE:. %H Swig
PARAGON SCHMID BUILDING PRODUCTS, A MASCO COMPANY LICENSE # 6$2072
TITLE.: ADMINISTRATIVE ASSISTANT DATE: 12/12/2002
CEILINGS6
i.
?
r
TYPE; BLOW
MANUFACTURER; Certairnteed
Thickness: R-38
WALLS:'
_
TYPE: BATTS
MANUFACTURER: Certslnteed
Thickness: R-13
r
GENET CONTRACTOR:
_
CENTURY CROWELL COMM UNITITES
LICENSE #
/ /
BY: TITLE:. %H Swig
PARAGON SCHMID BUILDING PRODUCTS, A MASCO COMPANY LICENSE # 6$2072
TITLE.: ADMINISTRATIVE ASSISTANT DATE: 12/12/2002
Builder Name:
Project Name:
Builder Field Contact:.
HVAC Company Name:
HVAC Installer:
' Duct Testing
Certification Form
/Ll - 6 3lr
tract # Z / 7
Lot #C�
System ®f
(One form per system)
Duct Leal<age Measured @ 25 PA
C.
Self'Certifier Results
Telephone No.
Telephone No. g0C-731 150
10 f CFM
Indicate the maximum allowable Duct Leakage and the calculation method used:
❑ 0.7 x Anoor x (0.06) for Climate Zone 8 through 15 CFM
❑ 0.5 x An,),,, x (0.06) for Climate Zone 1 through 7 & 16 CFM
1 400 x (Cooling Capacity in Tons) x (0.06) CFM
❑ 21.7 x (Heating Capacity in Thousands of output BTU per hour) x (0.06) CFM
Az&
Print Name Signature Date
Jan 28 02 11:37a Richard Simpson 661 347-6888 p.4
INSTALLATION CERTIFICATE (Page 3 of 8) CF -6R
y � /61-� f 7 o F.
iteAddms 4(1-431 L/ 13e+ R Y /)✓e-/lvc Permit INUMbier
DUCT LEAKAGE AND DESIGN DIAGNOSTICS
,DUCT LEAKAGE REDUCnON
P y.•u
rt. ti rnahon I tat RcsullS (CFM (al 25 PA) �
Tod Leakage (CFM) -
Van Flow
If Fait Flow is Caloulatod m 400 ofua/ton x numbor of tons, or as 21.7 x I loading Capacity
In 11ouNanik of 111th). optcr caloulatod valuo hero
' If fan flow iN measured, unturmcannod value hurl:
.
Lookago fraction = 'NM Loakagol(Mcuutod or Caloulatott Van flow)
Pa.c% if loakagu fraction S 0.06 /,
0 - V �
j]
PISS Fail
13 For AEROSOL TYPE SEALANTS ONLY - The fodlowlnR diagnostic teSting was completed:
Duct Fan Prassufuatien al rough -in mcasurcd Icakage (CFM)
CHECK AFTER FINISHING WALL:
❑ Yes ❑ No ❑ Ilts"zUro pan 14ka or l Iduw pros urrralion IL.,4
❑ Yes ❑ No ❑ Visual InVuctiun of Duct Conneeliolm
11
Pass fail
THERMOSTATIC EXPANSION VALVE (TXV)
YwN ❑ No Thlxnwe.•latro llxpa ,+ iou Valvc (or Commission appmed
equivalont) is in%taUod and Acwx= is pmvidccl for in pcotion
[]
YW h; a pais
1), Fail
ass
❑ DUCT DESIGN
1 • ❑ Yl.� ❑ No RCCA Manual D Design calculations have been oumplotud,
Duct Design is on the plana and dual installation matohos
plana.
2. ❑ Yes �I No TXV is urmuallod or Fan flow bus boon vordiod. If no TXV,
voriliud ran flow matches diwign from CT- IIL
Mcacurod Fan Flow =
11
Yvs for both 1 and 2 it;a Pana Pass Fall
13I, tho undarsiguul, Yw y that tlw abovo diagtto:`tio MA roawIN aad 11u; work I performud amociatud with the Icst(s) is in
ounfortuo co with tho mquirpnwnts tirr compliance credit_ I'lZro builder shall provido duo I I1:Rti provider a copy of Iho ULM
nigu%xi by tho buildor clnployocs or sub-ountmolom certifying lint dinguomiu taming and imstallation uww tho mgairvm t. Air
compliance credit.][APR
2.
TcAr. Siiruaturo, )ate lactalliug Subcontrao r (Co. Namo) O
Pcr•lurmcd Gonoral Contractor (Co. Namc)
COPY TO: Building; Depnitruuut
1113RS Providor (irapplicablc)
Building Ownez- ut Occuga»cy
January 4, 2001
n
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:
44-631 LIBERTY AVENUE
Use Classification: SINGLE FAMILY DWELLING
Occupancy Group: R-3 Type of Construction:
Owner of Building: TD.DESERT DEVELOPMENT
Building Official
V_N
Bldg. Permit No.: 0202-086
Land Use Zone: R/L
Address: PO BOX 1716
City: LA QUINTA CA. 92253
By: GARY SHOWALTER
Date: 08/20/02
POST IN A CONSPICUOUS PLACE