0202-180 (SFD)N U)
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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
7141 FS Li t. 1(W.,1 /0
Date 'r!`� .%' Signature of Contractor—,
ontractor -''
OWNER -BUILDER DECLARATION
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
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.
() 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 (301,I)EW RAQ119 IM& Policy No.
i�V`0'449tt04fl3
(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,
1 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: 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
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.
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.
1--;
Signature (Owner/Agent) `' %'~ Date-
BUILDING PERMIT PERMIT#
DATE VALUATION LOT Mr,,160 TRACT
t, :.1 _ . '? $17C`i 428, .110 2f1 741 fr_, -4
JOB SITE
APN
ADDRESS
�+-7 5 DT:C%A"t i,'1K)ffiF Ci:;URT
M4-0?2-.01f?�
OWNER
CONTRACTOR / DESIGNER/ EN (NEER
`3 N'1'rJ1t"� C IROW!sJ. comma' :fid'. s
(%N"9`CIRYl CROW1;:LL C"01vi3a4:t.TtJMES
15.4;4 B01 "130 a :litlx'o 31F. #200
) 535 so. TIP 8'. F;1; a`t'IM t}2109
SAW 13MWARDING OA 92408
M BE'RN•A€di.Q40 CA 994.08
(909)381-60T/ C BUf 7170
USE OF PERMIT
3p17 - LOT alb; 1''L4N 535. 1'F"IT DOZS NCVf INCLUDE kt AXX WAL L�
P004 SPA OR 1_iIiWKWAYAPPROA.0 H, '?$%1111;�i�[rE'.T16 H TO PLAi4 CIiECK'
Y�W,F FOR MULTIPIX ISSUA.NItF. OF SAMA, PLA11 TYPE.
TRACT COM)TRUCTI0I3 :1012.00 �F
PORCIVI)IA.t`IC'► 35.00 Sl+'
ctARAOFXARPORT
.71YST.1iYE1'!1.rED Mb"r oir \GOND~.LJC14+�...i�'O
11761428,10
CONSTRUCTION IFf-VI 101.000.4)8.000 VAN
PLAN CH1`X;x FFIF 101-000-439-318 $I,' l.91
:+AFOW041C.AF..ME : 101-00". 21.000 11r?9.00
ELECTF'ICA1. FFX 101-00"20-000 i3t&'73
PI'l migmFF-E 1011 -01010 -419 -MO $161,25
STRON10 MOTION Dil=l• . REBID 101-000-241-000 $1764
OR AD114 .i FIRE: 101-000.423.000 $20A
f i:;f P:Li3p It IMPACT Flt? $I,99?.f30
-s
3L11`3---rc, ?'AL 6"owm'.l .tYs.n`KYkT ,AN.C31^'1.,1a?J' C'. {ffiCK
1101 :ME- f?'AIC3:F�l I
. TOTIAL PEIM.11YFRES DtXE NOW
'r
Jy� _
RECEIPT
DATE s
By %y ::
DATE FINAL
INSPECTOR
q
INSPECTION RECORD
OPERATION.
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
— —Z
Underground Ducts
Forms & Footings
— lJ — /
Ducts
Slab Grade
— 2—
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
— Z
F.A.U.
Framing
Compressor
Insulation
5
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath2—/Z-
——
Fina!
Final — •o -z 37
BLOCKWALL APPROVALS
Steel
POOLS - SPAS
Set Backs
Electric Bond
Footings
Whin 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
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
—}f — Z
Encapsulation
Gas Piping
Gas Test•
• d 'i
Appliances
Final
Final
Utifrty 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)
Installation Certificate: Residential
Site Address
79-755 Declaration Court
1. BUELDER 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
CF -6R
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
G40UH-48B-090X
80%
88000
G40UH-48B-090X
80%
88000
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
��� �
lLLu ) uadLt.d ., DATE: /Z y
Signature Installing HVAC Contractor
INSULATION CERTIFICATE
This is to certify that insulation -has been installed in conformance with the current energy
regulation, Citiifomis Administram Code, Title 24, State of'Callfornia, in the building located at:
79-766 Declaration Court. Lot 29, Monticello4ioritage, La Quanta, Califomie
CEILINGS:
TYPE: BLOW MANUFACTURER: CERTAINTEED THICKNESS: Rm38
BATTS MANUFACTURER: CERTAINTEED THICKNESS: R-13
GENERAL CONT OR: CENTURY CROWELL COMMUNITIES LICENSE # /
BY: TITLE:
PARAGON SCHMID BUILDING PRODUCTS, A MASCO COMPANY LICENSE # 832072
6 TITLE: ADMINISTRATIVE ASSISTANT DATE:12H212002
Jan 29 IJP 11:37a Richard Simpson 661 947-6889
INSTALLATION CERTIFICATE (Page 3 of 8)
Sift A&Wof toA C,a -jos er
DUCT LEAKAGE AND DESIGN DIAGNOSTICS
DUCT LEAKAGE REDUCTION
(CI%M'(a125 PA)
Tcd I cakagc (CFM)
Fan Flow
If oo blow in Caloalstod dv 400 of Wton x aMber of tons, or ax 21.7 Z 11oWing Capacity
in Thousands of Uf ft. eery 091011100d vA100 horn
If fan now uc measunxl,.anea nwaamd value hero
I.uakagu rtaatiton -Tag l.aalcapd(MWMMd or C"Istod ran flow)
paw if loakapo frantion s 0.06
❑ For AEROSOL TYPE SEALANTS ONLY,- The Mlowing dbigoodle coding w as annpletwh
Doolfan Prummrivntion al -rough in mcasural kakagc (CFM).
CHECK AFTER FINISHING WALL:.
❑ Yox ❑ Nu ❑ l'rrxant pus test or l iouxu prtraacril:ation fact
❑ YCo ❑ No ❑ visual invowon of ixwt Uounmionu
THERMOSTATIC EXPANSION VALVE MM
AYvx ❑ No 1'homloxlatia l:xpam*yon Valv4 (or Cvmmi�ron approved
equivalent) is insialfed and Accen in provided for mupootion
Yo is a paw
❑ DUCT DESIGN
1• ❑ Yae ❑ No ACCA.Msmol D'DcWgn calculations havo bean oowpkftA
Duel Dodp is on the plane and duce imtallalion matches
plane.
2. 0 y*tq ❑ No TXV is bw% led or Fan flow hox boon vafflod. If Sao TXV,
vo ifiud Inn flow imotchax design Jkam (l? -JR.
Mosanrad Nan Flow =
Ywc Cor both 1 amd 2 ur a ffim
p.4
CF -6R
❑ ❑
NXII Tail
Y13
x I'ail
❑ ❑
PUS Fall.
I, the uudvrsigmed, verily ma11I�o:RbovO,diAgttoaatio'tUIR'rPa+R11ea and lho work I pmfo:mud amoeiatod with Ibe tost(s) is in
00 ormanoo With fho AGgOiunarocata Ior oomplisnoo credit.. ('rho bufflur :dutll pmWdo dw 11138.4 provider a cwpp of ibo CF -GR
xigu�) by the builda�r employees or mb.contraolors ocrlifymg 161.1. PM& tasting and iW allown mm the lvgt uvm =& for
compliance tacxlit.i
Tcatn Sigoatutc, l}ato 7 �4"s-*6005"Ictor Ko. Nampa) M
Pcrformcd (i meral Conduetor (Co. Name)
COPY TO: Building "Wt oid
1113CL!3 Provider (if appiiea6le)
Building Owner ut;. Occupancy
January 4, 2001 f
Z
Jan 29 02 11:.37a Richard Simpson 661 947-6889 p.4
INSTALLATION CERTiFICA TE (Page 3 of 8) CF -6R
o
S'CvAddms 7 9- S%-0 t: G L_ .4 vtA Tia �+ Pewmdt
DUCT LEAKAGE AND DESIGN DIAGNOSTICS
--- ___CT LEAKAGE REDUCTION
Pnmuriration Tcml Rcsullm (CIM (A 25 PA)
Test leakage (CFM)
Fan blow
If loan Ylow is Calc kWl ary 4M ofua %n x a9mbor of toas, or ax 21.7 x i bating Cepaoidy
in Thoaxanda'ori#uU onlor oakWatod vnlao horn _
If f to Clow it; uuamml, cmtar nwa n ud value hmv 4200
1,uakapp Yraotm —Too LoakagoMdo rnnod or C"Isted Van i'Iow) ,.
ftm it loakagu rrsothm :s 0.06 ❑
I'I Fan
❑ For AER0901. TYPE SEALANTS ONLY -Its Rbllowfng dlagaosde texdng was completed:
Dual Fan Pm urrralion al tough -in meamutud kahage (CFM)
CHECK AFTER PINWHINC WALL:
❑ Yam ❑ No ❑ irnxe w pa boot or I wasp prvm,&..atioa tow
❑ Yes ❑ No ❑ vinnal Inapeetion of Duet coffiooti sw ❑ ❑
Pas. Fail
THERMOSTATIC EXPANSION VALVE MM
YYwc (JNo Tlu'rnwxlatia lsxpansioa valve (ar Commission approved
equivalmtt) in insta llod and Aumns im provided for mupoatioa Q
Yav is a.pw 5 Fail
❑ UUCT UESIGN
1. ❑ Ycx [] No ACOA Mmanal l) Ikmign aaloulalions havo kxm oiimpiwud,
Dou-t fao dp i'9 on the plant and dad finWlstion matchox
pleas.
2. ❑ Yon Q No TXV is but Ualmr Fan flaw hex boon vurirvA If iao TXv,
vaitied ran Dow matchas dam fi"om (314R.
Mamund lean Mow
❑ ❑
Yes Cor broth I sad 2 a a Para Plass Fail
All, 1. tho :mdmiped, vw* dad thu ebovo diggu9xfie tort Mohs and tlrc wodk I pmformud amociatad with So ted(m) in, in
oonibraVWX'With to rMbumonts l[br oompiiarme arodit. ('biro builder shall proviso tho f Ail S provider a copy or tho ULM
miguctd by the buildar emplgyors or sub.ounhaworm awl irying thus dispomde sussing unil imallation meet iho r"oitunM& for
oomplianac CMXHL j
.��
TcRtra Siigasts% lJnto Iaatelling SaWntraotor (C . amo) OR
Pc6eitua l iiaiaoeal Contractor (co. NW)
COPY Til: ijuild uF DopndnwW
i1l03'Providor (if appbuAlc)
Buildinv Owner ut Occupa»icy
Jlsrtuary 4, 2WI
2-
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:
79-755 DECLARATION COURT
Use Classification:
SINGLE FAMILY DWELLING
Bldg. Permit No.:
0202-180
Occupancy Group:
13-3 Type of Construction:
YN Land Use Zone:
RL
Owner of Building: CENTURY CROWELL COMM.
-7-00"4n
Building Official
Address: 1535 SO. "D" STREET #200
City: SAN BERNARDINO, CA :92408
By: STEVE TRAXEL
Date: 10-14-2002
POST IN A CONSPICUOUS PLACE