0202-087 (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
t
S 1 1 tfJ311U
Date ` ` Signature of Contractor %'�,i �
Lr_ i
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 t
• �N
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.
r(,.j 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.
0,0.1, DKN MOLE 1118, WWPC M4068-03
(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, , '73
Date:-;,,;x:,1'7-!'fs J°Applicant y•i•.�
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. j
Signature (Owner/Agent) a? ?�!• ' Date
BUILDING PERMIT PERMIT #
DATE ; VALUATION LOT -0202_(. % TRACT
50
JOB SITE
ADDRESS
��A L �tt y� x�+yy �r�p�� }T�a
`Y^7 1. A:4.C�{7Ku81i..3'. �� .�.Y,T.vS'til�
LL / n�
GJv�7"iA,J.F/•`t, W)
�ENINEER
OWNER
CONTRACTOR/DESIGNER
C WIMY f.V- i L c imika rin
CENTURY" t.MELL Gf. Mid:f NITTa
1535 k), ma ��t`�_L:C r,; S : 4200
1535 go, T11 RRaTr; +ME, onco
FAQ, 3 �fik°in iZ1 C9 CA 9U08
MT B1ajWARINISTO CA. 9240V
(909)381.6007 CB114 2'120
USE OF. PERMIT
s
�ti3d-YL'.• i:CAhY3dlN/..il PI J.:�a'1.LJ.4C1I V
.
SF,D, - IDT 50, 1k9f: NTICEL1:,4 i P�TY'AGE PLAN 3)3ItWf P1:':3'.t�l1T DOa,'
NOT INCLUDE 13WCK WAaIA r'O0Wi3A OR Of11tr;?'WA,X'' AVF,ROACf3, P1: AN
CEAY-Cr. FEE -RMltW D F.OR MU ,;i'1PLE IS5R1AWC F, OF SAME PLAN TM.
TRACT CONSTRUCTIOW 21211,00 9P'
PO CMIPATIO 29.E=3 SP
OARAWCARPORT 6251" OF
ESTOAA• .CM 6r4AAbt.11 Olt, ti- riJ•4BErfRiiC+ 1011
IX119110 0
C.ONSU ttlC!'rCiNFED 101-00 0-418-000 1M."100
PLAN CHECK.. PEE 101-000.439-318 Wom
101-�6y��giG�"h�i•i11- 0 `a6E1,iS3'i
U;;
�/.T��pfyi�t,�E/Tr(p�{ALY�•TI773S
Lrj. Z S S'L1e.1AL Y' ER 10 i-0604f+tt'"000 $1U.53
1aGUMBINOFEE 101-I00-419--000 $1200
STI"ON0 MOTION M-2- - UrSID 101-000-241-000 $13.29
OR 1717110 Ireg 101-000-423-00 $20.00
"11yy-:qW4rprA�.MCF�ONyAND Vm/c
-A' •�iPLAIN
0
$3,177.93 3,* q.93
$$ B i o
T " MRM, T rEES DUE NO
FEB 14 2002,
S31117,9
n
RECEIPT
DATE % w
[BY %
DATE FINALED
INSPECTO
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab GradeRetum
Air
Steel
Combustion Air
Roof Deck
:t —Z Z ^ 2.
Exhaust Fans
O.K. to Wrap
/ —
F.A.U.
Framing
_ �2— Z _
Compressor
Insulation
—
Vents
Fireplace P.L.
Ar
Grills
Fireplace T.O.
Fans & Controls
Party Wali Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
gg
Drywall - Int. Lath
Final
p2
Final
BLOCKWALL APPROVALS
ol
Steel
POOLS - SPAS
Set Backs
Electric Bond
Footings
�3 —
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
75 —77 pj
Heater Final
Water Piping
Plumbing Top Out
_
7
Plumbing Final
Equipment Enclosure
Shower Pans
A
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final
Utility Notice (Gas) — ??Z 02 1
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 , vo
Utility Notice (Perm)
COMMENTS:
Installation Certificate: Residential CF -611
Site Address PERMIT #
44-661 Liberty Avenue
i 1. BUILDER INFORMATION
i
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 12ACB36 12
12ACB30 10
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 A (�
0 .1A -L DATE:
e
Signature Installing HVAC Contractor
�.•//X..MNi.•�!.•/�nna•/.Iwa^✓..I/rva.w,2S�a✓�('p1.fw4•.r/�w•..✓�'h!n'.b•IJ'iIN.F.'IJ/I:�'NfN!W:Y%7w'1'1'%:I.:?M%YYV%)."Nl/�N%7V/%/N'J.:3'IH.•III//'J6'I�a'.�Oi>W,4iMYi'iv.a.I�v�ir�M'/I!!?%iYl•/JII.IIN'IV:p.:J
L '
d
INSULATION CERTIFICATE
r!
This is to certify that insulation has been installed In conformance with the current energy
r regulation, California Administrative Code, Tide 24, State of Califomia, in the building located at:
44-661 Liberty Avenue, Lot 60, Monticello -Heritage, La Quinta, California
;;
CEILINGS:
TYPE: BLOW MANUFACTURER: CERTAINTEED THICKNESS: R-38
d J
i
WALLS -
TYPE: BATTS MANUFACTURER: CERTAINTEED THICKNESS: R-13 .
GENERA CON CTOR: CENTURY CROWELL COMMUNITIES LICENSE #7/1/-/ 4
BY: TITLE:_
PARAGON SCHMID BUILDING PRODUCTS, A MASCO COMPANY LICENSE # 632072
BY. TITLE: ADMINISTRATIVE ASSISTANT DATE: 12/12/2002
Duct Testing
Certification Form
Builder Name:
Tract # Z
Loot # �6
System Z of
(One form per system)
Project Name:
Builder Field Contact: Telephone No.
HVAC Company Name: % LLeL,(6 �C
HVAC Installer: Telephone No.���7��%���O/
Self -Certifier. Results
Duct Leal(age Measured @ 25 PA
0 CFM
Indicate the maximum allowable Duct Leakage and the calculation method used.-
0
sed:❑ 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
❑ 21.7 x (Heating Capacity in T 1. F ousands of output BTU per hour) x (0.06) CFM
Print Name Signature Date
Jan 29 02 11:37a Richard Simpson 661 947-6089 p.4
INSTALLATION CERTIFICATE (Page 3 of 8) CF -611
ONO-
SiteAddrex8 y _ 4 co 1 L. 3 aT� A,,a•n1 c Permitrgmaber
DUCT LEAKAGE AND DESIGN DIAGNOSTICS
_DUCT LEAKAGE REDUCTION
Pressurivalion Tc.4t Rcsulls ((:1'M (u123 PA) 1^
'fest I.cakage (CFM) �—
Ilan Flow
If lrnn Flow is Caloulated as 400 ofwlton x numbor of'tons, or a4 21.7 x !looting Capacity
in Thouqand,: of Otalar, clrlor caloulatod valuo how
If tan Row is mcstsun:d, LmtLT mcasurul value hium
Loakago fraction ='fowl I.oakagu!(Mcavut or Calculatµt Ilan flow)
Pam; if loakago fraction 5 0.06 � � N ❑
Pass Fail
❑ For A EROSOI. TYPE SEALANTS ONLY -The following diagnostic testing was completed:
Duct Fan Pramurimliun at rough -in mcasurial leakage (CFM)
CHECK AFTER FINISHING WALL:
❑ Ya4 ❑ No ❑ Prezuro pad ICS or I lousy proxvurr%lion 10%'1
❑ Yes ❑ No ❑ Visual Inspeotion of Duct Cunnoutions ❑ ❑
Pass Tail
THERMOSTATIC EXPANSION VALVE (TXV)
YM� ❑ Nu 'lh"MonlaGu Expanhron Valve (or Commission approved
equivalent) is inslallcd and Ac=44 is provide d for inVftlion ❑
Yo 6 a pas-. 1'a•. bail
❑ DUCT QESIGN
1. ❑ Y,-% - ❑ No ACOA Manual 1) lksiggn calculations have been eomplulud,
!hurt Design is on Ibo plans and duct installation maluhos
plans.
2. ❑ Yon [a No TXV is hWatlod or Tat flow hIi% bwa vowlvd. If a'o TXV,
vorillud fan flow matuhv:: dewigp front C11 -I IL
Moasurad Fan Flow =
❑ ❑
Yet Ior both 1 uud 2 is a fans Pass Fail
❑ 1, lhu undaraignul, vtuily that tho abovo diagnOstiv tart roMts apd the work I performuf ata ociatul with the tcst(s) is in
eonlbrmadw with tho mqukamants for compliance un:dit. (Tho builder shall provide the 1 I] -RN providur a copy of Ihu Cl, -6R
siguW by tho builder cu►ployces or sub- u►ntracton oortifying that &guumiu tQ%tiug and i wiallmion newt ihu rugairomonis Ibr
compliance crvdit.1 I
did APR 2 5 2002�( i G
Tcoft 'ignatun;, Datu Ltstalling Subco color (Co. Namc) OR
Performed (hetero! Contractor (Co. Namc)
COPY TO: Building Dopnitinont .
HERS Providor (if applicable)
Building Owner at 0CCutyJlCy
Jaer.ary 4, 2001
i
Builder Name:
Project Name:
Builder Field Contact:
HVAC Company Name:
HVAC Installer:
Duct Testing
Certification Form
Self* Certifier. Results
-Duct Leakage Measured @ 25 PA
L11—L61 i-riat i -Ty AvtF.W
Tract # 2.q %?
Loot # S°
System of-2-
(One
f2(One form per system)
Telephone No.
G
Telephone No. G/
(C/ ( CFM
Indicate the maximum allowable Duct Lealrage and the calculation method used:
0 0.7 x Anoar x (0.06) for Climate Zone 8 through 15 CFM
0 0.5 x Anoor x (0.06) for Climate Zone 1 through 7 & 16 CFM
Y 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
i
Print Name Signature Date
Jan ES 02 11t37a Richard Simpson 661 S47-6868 p.4
INSTALLATION CERTIFICATE (Page 3 of 8) CF -611
$itc Sdril s-14 T (o (� �//3C2 4,1 t N& C '—pErmit Number
DUCT LEAKA2K AND DESIGN DIAGNOSTICS
P,pUCT LEAKAGE REDUCTION
Pressurization Test Rcsulls (CFM (a) 25 PA)
'fes(Lealtage (CFM)
I'm flow
If Fan Flow is Caloulatod av 400 ofin/ton x number of tons, or m 21.7 x I loatimg (.apaoity
in Thouaanda of lifAr. Bator oaloulatod value koro _
If fan flow is mc:asun d, cmio.T mraaurc d value h► ru %
Lookago Fravtion - To -A l.cakage!(Moa+uttxl or Coloulatcd Fan Mow) n
Pa`i if loakago fraction f, 0.06 j�� ❑
C Pass Fail
❑ For A EROSOI, TYPE SEALANTS ONLY -The following dtagnoatle testing was completed:
Duol Fan 13tasmurizalion at rough -in measure! leakage (CFM)
CHECK AFTER FINISHING WALL:
❑ Yos ❑ No ❑ Pros oro pan tot or I louu: prox..u&ftlion te..9
❑ Ycs ❑ No ❑ Visual In.Taction of Duct Connoolions ❑ ❑
Pais fail
THERMOSTA71C EXPANSION VALVE (TXV)
Y�� ❑ No Thumuohlatiu Expansion Valve (or Commission approved
oquivilont) is mstallLd and Ac:utm is provided for invoo ion ❑
YW i. a pa,. 1'as. Fail
❑ DUCT OESIGN
1 • ❑ YT's ❑ No ACOA Manual D flcsign calculations hava bwn complotcd,
Ihrul Design is an tho plans and dud imtslladon mnluho.s
plans.
2. ❑ yom ❑ Nn TXV is mstallod or Fim flow hux boon voriliod. If no TXV,
variliod fan flow matchac: dw ign from CF -I IL
Weasnmd Fan Flow
❑ ❑
Yca for both 1 and 2 in a Par; Pass Foil
❑ 1, tho undersigned, m y (but tho abovo diagnoslio te+t rcyults and the work I perform d associated with the lcd(s) is in
coniorntAnco with tho roquimnwnts li►r compliance orudit. J'llio buildur shall provido Wu 1111,118 provider a copy of Zhu CF -()R
i:iguW by the builder irurplayo a or sub-ountractorr certifying that diagnumio tumiug =J immallation moot thu rogoirolnu u"' li►r
compliancecrvdil.J
kylulo APR 2.5 200 A G
Posts Sipaturc, Date laatalliug Subcontraotor (:o. Name) OR
Pcrformcd (knera) Contractor (Co. Name)
COPY TO: Jluilding ikpartruoul
I MRS Provider (if applicable)
Building Owner ut Occuga»cy
J2nuary 4, 2001
Certificate of Occupancy
City of La Quinta
Building and Safety Department OFnE
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:
Owner of Building CENTURY CROWELL COMM..
44-661 LIBERTY AVENUE
Building Official
Bldg. Permit No.: 0202-087
VN 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