0202-089 (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 Divi§ion 3 of the Business and
Professionals Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
B1191311cr.
Date- '�7 Signature of Contractor
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.
(4 )_f 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.
OOLD? H .E ULF, WS,
id 11 t".. 4+lQi3 ^U 3
(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. -2 11-.4 17 --Applicant
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,G
for a permit subject to the conditions and restrictions set forth ont his
application. } r
1. Each person upon whose behalf this application is made & each person at Y
whose request and for whose benefit work•Js 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) ��>`� Date.
eI
.BUILDING PERMIT PERMIT#
DATE
/I/f,! /{ gVALUATION by.42 II LOT r� (j�yj(ax?Q� TRACT
JOB SITE
APN
ADDRESS
-44-&W 1JTH a'i l� % 6
•-iD i i Q3fi�`3
OWNER
CONTRACTOR / DESIGNER / ENGINEER
a URY CROWML CO M€ILAVIMM
CENN `{Ti' Y CRC} „i.. , CC),WAtYA3MES
1535 30, T* thKI E,`I', UrX 000
3535 *Q, T'MM,Er, FM #.2,60
SAX IARDI 'O CA 92106
3AB' BERNARDI 0 t�,''A. 9Z408
popti-60(17 C -SW 21112
USE OF PERMIT
SPO .. Lar 51 MOldTICELLO HERITAII019 PLAN 48. PLRMIT 1C9OLIS NOT
INCLUDE BLOCK 4AIF LIA, :POWSPA OI212'RWLVA.Y APP'R.Ok41K PIAN
V,HFZK FRE REDUC E&D MR I+1U'VIPLrr, ISSUANCE Of SAME PLXIM TYPE,
TRACT CO NS RMT10N. 2,40.00 SF
AOkMd'A A'IO 62.00 S -If
GARAGWARPO'RT 6".I111 91+
.Wgl.i.M'/.A•aIM CiJU 0.l 'NONSIMU7v AailP.A4
142,910M
PP -R V FUl'' 9CI'WIVI RY
COMMUCTIOX FEE 101-000418-000 S790100
PLAAW CHECK SEE 101.000-4394316 $16$.29
MCCHANICAL M 101400-421-000 $66.331
pall -MO 420-000 smtsl
PLtlMalINO FZZ 101-000-41"00 0.419 00 2142.00
37RONO MOTION ME o MID 101-000-241-000 $14.30
C3RAt?L' O PFIE lOtalftlt3 2' «a Af9 $20.09.
DEVELOPER, IMP,.ACT LPA $1,907.00
f0
Iu hd_
1430 RRE-PJUD MRS,
n
r h �� 14 2002. 'X `. MUM 1.• ES DUE -190W
Cffy0p .QU1?6A
+9a7b[P'Y�e4.W9
'RECEIPT DATE DATE INALE INSPECT
_ Off.
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
- ---- I
Underground Ducts
Forms & Footings
3 —/p _Z
Ducts
Slab Grade
IZ6. - Z
Return Air
Steel
- Q .- y
Combustion Air
Roof Deck
2
Exhaust Fans
O.K. to Wrap
- Z
F.A.U.
_
Framing
_75AC,-Z
Compressor
Insulation.—
._ fjo z
Vents
Fireplace P.L.
Grills
Fireplace T.O.
_
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
-Z
Drywall - Int. Lath
Final
Final
2-
POOLS -SPAS
BLOCKWALL
APPROVALS
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
Heater Final
Water Piping
_
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
0. K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
— -
Appliances
Final
COMMENTS:
Final 0
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)
Installation Certificate: Residential CF -6R
Site Address PERMIT #
44-648 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
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 G40UH-48B-090X 80% 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 12ACB42 12
12ACB36 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
�nJ
Jou'..(JAMA.,� DATE:
Signature Installing HVAC Contractor
r
l
INSULATION CERTIFICATE
This is to certify that insulation has been Installed in cont rmance with the current energy
regulation, California Administrative Code, Tide 24, State of Califomla, in the bullding located at:
44-648 Liberty Avenue, Lot 52, Monticello -Heritage, La Quinta, Callfornia
CEILINGS:
TYPE: BLOW MANUFACTURER: CERTAINTEED THICKNESS: R-36
WALLS:
TYPE: BATTS MANUFACTURER: CERTAINTEED THICKNESS: R-13
GENE CON. CTOR: CENTURY CROWELL COMMUNITIES LICENSE # Z5y/
BY: TITLE: � Saav
PARAGON SCHMID BUILDING PRODUCTS, A MASCO COMPANY LICENSE rY 632072
x,
B ITLE: ADMINISTRATIVE ASSISTANT DATE: 12/12/2002
J
��'d.':�.//S.'J.:T•J,:l'fJ7✓/�!•: :.;.:.ri.`. Jv %4�i/N:O'1(RanLxr.� :.►i/^Y.'J�iiE:f lvi f nr,�.;rnvi.I+�Y.aa.�ni87AO:f.Ai✓.Y/.'n��:�;/,�/Yr;:i:%V.i ids.�:r/Y.+bY,U1.�ei.�v,•r<rx'X�wl��nuAw.�nn
Builder Name:
Project Name:
Builder Field Contact:
HVAC Company Name:
HVAC Installer:
Duct Leakage Measured @ 25 PA
Duct Testing
Certification Form
�&o
S
self -Certifier Results
Tract #
Lot # S Z_
System Z OiL_
(One form per system)
Telephone No.
Telephone No.CfoG%
u( CFM
Indicate the maximum allowable Duct Leakage and the calculation method used:
❑ i 0.7 x Aeoor 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) 7 CFM
❑ 21.7 x (Heating Capacity in T'lousands of output BTU per hour) x (0.06) CFM
H'4(n' aAj ihil
Print Name Signature Date
Jan 29 OE 11:37a Richard Simpson 661 947-6889 p.4
INSTALLATION CERTIFICATE (Page 3 of 8) CF -611
'iteAddrrss Ll 9 — (o ala fj`f Q c TMJ IqJ �'' . Permit NiWEer
DUCT LEAKAGE AND DESIGN DIAGNOSTICS
DUCT LEAKAGE REDUCTION
nssuriiulion Ta;sl Rcsulls (CTM (4 125 PA)
'fest Leakage (CTM)
Ilan Flow
If Fan Flow is Caloulatod as 400 ofim/ton x numbor oflou:r, or as 21.7 x Iloalicg Capaoity
in Thbuyand:r of lltuibr, only ealculatat valuo hero _
If fan now is me asumd, unto muasurud valuu haru �U
Luakago Fraction -Toil Loakagol(MeAsumd or C:aloulatcd Fan flow)
Pmm if loakago fraotiuu : 10.06 U L�� ❑
Pass Dail
❑ For AEROSOL TYPE SEALANTS ONLY -The following diaguostle testing was completed:
Dual Tan Pressurization al rough -in measural leakage: (CTM)
CHECK AFTER FINISHING WALL:
❑ Yas ❑ No ❑ 1'ruxtirom pan I" or I to %o pru.�urryation ILI%l
❑ Ycs ❑ No ❑ Visual Intipcution of hoot Connwtions ❑ ❑
Pass Tail
TNERMOSTA7IC EXPANSION VALUE (TXV)
Ya, ❑ No 'l'hWYtltoslatiu Eispa240ft. V21vu (or Commission approved '
Oquivalont) is inalallud and Awcmi it providcxl for ingxtion ❑
Yw 6 it PMN 'a•. Fail
❑ OUCT DESIGN
1' ❑ Yw`5 ❑ Nu ACCA Manual l) llcsign oalaulations havu boon oomplulud,
Duct Da -sign is on tho plans and dual iw1allalion matcho's
plans.
2• ❑ Ym ❑ No TXV is intstallod or i'lm flow hux boon vordiod. If no TXV,
voriliud fan flow niatchm duvign from 01a11L
Mamma Fan Flow =
Yes for both 1 uud 2 is a 11am; Pass Fail
❑ I, Ihu undarsiguul, vw y that Zhu abovo diaguo�ily Wet roavlth aad the work 1 pcdbnnLd asNoc:iatc d with thu teats) is in
I cunformauco with the mquimmunta lire camplianoc orudit. I'lito buihlur shall provido dw 1 UiRti pruvidur a copy of Ihu CF -GR
f Aguotl by the builder' cu►ployocs or web-conlraotorr uortifying that diaituosliu Iosting and ii0allatiun uwL4 Ihu rugairumunk Iia'
I compliance credit.]
APR .2 5 2002
1'C>;Is 'ignatun;,1)atu Inxtalliag Subcontraolor ('o. Namc) OR
Purrurmcd (ones) Contractor (Co. Name)
COPY TO: Building DepartincA
1 I IBRS 11rovidor (if applicablc)
i Building Owner kit OCcuvai.1Cy
r
January 4, 2001
Duct Testing
Certification Form
Tract # 2q1c'?
Lot # �Z
System of 2
(One form per system)
Builder Name:�(Jy
Project Name:
Builder Field Contact: /- Telephone No.
HVAC Company Name:
HVAC Installer: Telephone No.
Self, Certifier Results
Duct Leakage Measured @ 25 PA
G'
CFM
Indicate the maximum allowable Duct Leakage and the calculation method used:
❑ 0.7 x An= x (0.06) for Climate Zone 8 through 15 CFM
❑ 0.5 x Atioor x (0.06) for Climate Zone 1 through 7 & 16 CFM
j 400 x (Cooling Capacity in Tons) x (0.06) CFM
❑ 21.7 x (Heating Capacity in Th", usands of output BTU per hour) x (0.06) CFM
q-2�S-o
Print Name Signature Date
i
Jan 29 02 11:37a Richard Simpson 661 947-6889
INSTALLATION CERTIFICATE (Page 3 of 8)
Site Ad -Ureas q ,,I _ i,(� ncx�` �� Permit Numbir
DUCT LEAKAGE AND DESIGN DIAGNOSTICS
DUCT LEAKAGE REDUCTION
'fest Results ((:FM (x125 PA)
'fest Leakage (CFM)
p.4
CF -6R
Fan flow
If I -an Flow is Caloulatcd as 400 vim/ton s number of tons, or m 21.7 x l loafing ("apaoity
in Thau.;and.t of Blu/ar, ontor oaloulatod valuo burn
If fan flow is measunxl, enter mtaurud value hum ZU�
Lookago I- action = 'l *0 Loakago/(Moasurod or Culoulatod Fan flow) -
Pam if loakagu ftootion S 0,06 � � � �� ❑
Pass Fail
❑ For AEROSOL TYPE SEALANTS ONLY -The fcdlowIng diagnostic testing was completed:
Duol Fan Pressuriiation at rough -in uwasuFal leakage (CFM)
CHECK AFTER FINISHING WALL:
❑ Yes ❑ No ❑ I'rux+-ulu pan I" or 1lou.-4 pYu.%Nurrreliun 19s1
❑ Ycs ❑ No ❑ Visual Inspcution of Duct Connuclions ❑ ❑
Paas Fadi
THERMAOSTATIC EXPANSION VALVE (TXV)
);rY4y ❑ No ThornloAaiio Expanhton Valvo (or Commission approved
oquiwalont) is installod and Acufmm is providod for m:"lion ❑
Yw i.. a pass I K181.Vail
❑ DUCT DESIGN
1 • ❑ YQ$ ❑ No ACOA Manual D Iksign catculatiuns havo bcm complulud,
Duot iX.rign is on tho plans and duel ii0allation maluho t
plan:;.
2 ❑ Yaq ❑ Nn TXV is instaffod or I'm flow bpi bwa voril'iod, if no TXV,
voriliud fan flow matchas dixign from CTL l IL
Mcssumd Fan Flow =
❑ ❑
Yes for bulb 1 and 2 ii: a Pars Pass Fall
❑ 1, Ibo undmiguud, vurify that Aho abovo diaguostie W.1 ra6"Ila and the work I performud associated with thu tusl(s) is in
cuntomt®nc:u with Ike roquimnwnta for compliant orudit_ ITho buihiur shall providu Wu I MRS pmvidur a copy ullhu CFVR
siguud by Alto buil&r ruiplaya:s or sub -contractors codifying that diagnu:.lio to: ting and iuxtsllatiun aw A thu rugoiromeals Iiir
complianuc. cruifii ( .1 _ APi 2 5 2002
_Rk
'(•CHIN Siirrtaturo, Datu . hwtalling Subcogtraotor (Co. amo) OR
Purfurmed Gouera) Contractor (Co. Name)
COPY TO: lluitdiat; Dcpnrtrnont
1113RS Provider (il'applicablc)
Building Owner at. OCcupaj1CY
January 4, 2001
Certificate of Occupancy
Citydf 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 44-648 LIBERTY AVENUE
Use Classification: SINGLE FAMILY DWELLING
Occupancy Group: R3 Type of Construction: VN
Owner of Building CENTURY CROWELL COMM. .
Building Offic
Bldg. Permit No.: 0202-089
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