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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
Date - . Signature of Contractor.
r cq
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.
(a 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:
Cartier Policy No.
4'iC:I.f�l;'N E�iC;1,E tN:P, NWC:•,'.e?•1W-0,?
(This section need not be completed itthe 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 sh II forthwith comply with those provisions:
Date: Applicant
4 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.
Signature (Owner/Agent) '' %� '-. Date
BUILDING PERMIT PERMIT#
_
DATE VALUATION LOT TRACT
<jx �Q5,=4:�f3.149 2%• 1.517 a1
JOB SITE
APN
ADDRESS 79—.764) D.FC1.AT1? X110X ('0MrV
45044*)r2-M;t5
OWNER
CONTRACTOR / DESIGNER / EN INEER
P_Effl'+;7ky L"lwl! L CU;t�.".a`•/.tiTldlMS
OR14 F ORY C,RCYW.E-'1 L f_'0MMLiNx. , :S
1535 50.D- 5'TYI T,;TrF. 0200
1535 t1YQ19Y U:Y?M!, ': a.'7f 1;200
:'AA1 Mj.4ARDWO CA 92408
":bq.f3 CA 924
(909)381-6007 CMIAP 2120
USE OF PERMIT
0111190U, _►.t'AMN.T 3)WLU.R4C,
314) • LOT 29 PLAN 5A1tf4?'b'. PERMIT L"5ORS NOT YNCLUDII, .ii.,t7CK
WAL,f,�% P061., SPA O'R :7liiWWAYAi PIWAt;"]-I. 75% REDUCTION TO I'LAW
CH9C K i*1~ F FOP MUILTIPL-E ISSUANCE OF %'.SJ E PLAVT `TPF..
TRACT C ONSTRIJCTION :012.00 Sft
PC?T CHIPATIO 23.Cf0 SN
0A.kI#0FJCA..RP0).RT 2
Y.+sm3T47(yjD cos;6.' of C"s)1Vwt."avri`iCilN
176.x 10
PERKm' Wk 9(JIV,im y
C:OARSTROC'610N FEB )G1.0CK1-41`?4500 ' 13,4100
PIAN CHECK Fr 101-000-339-318 Vri.12
MVVHA N1CA1,'Fh*9 101r000-421-000 S-4,00
ELECTRICAL- FAX S LD1. _000 -420 -ow, $16632
PL>11rlIF,NO IIS' 101 -ON-419-000
91'RONn MOTIGN FEL - P?.ESID 101-000-211-0,00 $27.Gfi
CIRADINCI FRE 101-000-423-000 $20.00
DEV.E-LOPER IMPACT ,R `$i,9t0.0it
e
n
YVXtSId�•At17.7.1.5lG�rl`sWSa NOW
M"TFi, 513
RECEIPT
DATE
;BY
DTEFI ED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
—
Underground Ducts
Forms & Footings
—Z
Ducts
Slab Grade
—/,�r, L
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
Z
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
fZ
Drywall - Int. Lath
— —
Final
Final
BLOCKWALL APPROVALS
Steel
POOLS a SPAS
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBWO APPROVALS
Gas Test
Electric Final
Waste Lines
—Z — Z
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Seaver 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
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
FinalJ(_5_oz----
ldUtility Notice (Perm)
Utility
COMMENTS:
L
10/17/2019 02:27 FAI
INS
ULAL[ON CEWIFICATE
This is to oert6 that insulation has been Instailecl In conlorrnance with the current energy
regulation, Calffomia. Administrative Code, Title 24, Stats of Calffornie, in the bullding located at:
70-760 Declaration Court, Lot 28 Monticello -Heritage, La Quanta, California
ILI :
TYPE: BLOW MANUFACTURER: Certainteed Thickness: R-38
WAL
TYPE: BAITS MANUFACTURER: Cerksinteed Thickness: R-13
012
GENERAL CONTRACTOR: CENTURY CROWELL COMMUNITITES LICENSE # /�ff
BYTITLE:
PARAGON SCHMID BUILDING PRQDUCTS,.A MASCO COMPANY LICENSE #832072
Y ,_ TITLE: ADMINISTRATIVE ASSISTANT DATE:1211212002
Installation Certificate: Residential CF -6R
Site Address PERMIT #
79-760 Declaration Court
1. BUILDER INFORMATION
Century Homes
1535 South D St. #200
San.Bemardino, 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
G40UH48B-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, andaretwo of the criteria used for equipment sizing and selection.
5., SUBMITTED BY . o
Signature Installing HVAC Contractor
DATE: 1 2- - I t- 61
Jan 29 02 11:378 Richard Simpson
661 947-6889 p.4
DUCT LEAKAGE AND DESIGN DIAGNOFFIC:S
REDUCTION
PnmurhWion Teat
'rod:1.cakagc (CFM) _yep
Nan Flow
If Fant Flow is CalouWW e -v 400 oliooltoa x amubm of toast or m 21.7 x I loaling Capacity
in Thmerandm of 10w 1w. o[ntar cakWatW valuo bow _
if tan [low is nwasmod, enter ra msumd vdmu horn
I,valtago t=raction -'Foo Loakagd(A+1m urod or C*vbtod Faa flow) -
PAm+ if hakngo fmotion S 0.116 E3
Paas Fail
❑ For AEROSOL TYPE SEALANTS ONLY -The fellowhyq dinguesde heating was completed:
Dnot Fac Pr ofivation at mugh-in uxmurud kakmgc (CFM)
CHECK AFTER FINISHING WALL::
❑ Yat ❑ No ❑ IWMW pen 14W or I km.,o p umiritratioa too
❑ YcK ❑ No ❑ v-mmd.lavpod m orlhrd coagootivnx ❑ ❑
Nog FAR
THEMOSTAW EXPANSION VALVE MM
JkY.x ❑ No '111Wm Antic lixpaa4011 Vatvo (or Comm -inion approved
cquivalca) is inmailWd and Acmm im providal for inVoction ❑
Y01i it a PON Zm fail
❑ DUCT DEMON
1. ❑ Yea ❑ No AC(IA Mannal D Do ign calculations Lava bom uumplobA
Duct I)mjp is on tho ph= and dud imUllation Imatclhor
plans.
2. ❑ Yar Ca No TXV is inxtaded or Fan Mw hqn bees vatWwd. If two TXV,
vsaifiiW fan now Match" 4m dP fkam Clr-IR.
Mom"MA Nan Flow =
❑ ❑
Yom Ibr Troth 1 and 2 oc a Pam PASS Poll
,& 1, The indmaignod, vmKY Ihattho abovo ding 949 WA molts and the work I porformad.ammaiatcd with tho toat(m).im in
cont'emttalou with to mpimmems lily comptiam'.arudit. I'fho buill ar shall provido dw Ia m pmvidiv a w►py nt'tho CF -OR
:ipW by the bulldur ctnptoyeca or cub-contradora mitifying time dingno ctia testing and' i oftHatiion moot tho ruyaimnxmts for
co mplianm c100.1
Tesla Si at •R � u
!m ma, Date InaMllmg Subaomirao (Co. Ni
Perrormad Gmern) Contractor (Co. Name)
COPY TO: Buildimp UcpminmW
1BM3 Pmvidor (irapplicmblc)
Building Owner ut Occupancy
Jaeaary 4,3001
10
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:
79-760 'DECLARATION COURT
Use Classification; SINGLE FAMILY DWELLING Bldg. Permit No.:
Occupancy Group: R-3 Type of Construction: VN
0202-179
Land Use Zone: RL
Owner of Building: CENTURY CROWELL COMM..' Address: 1535 SO. "D" STREET #200
City: SAN BERNARDINO, CA 92408
By: STEVE TRAXEL
Date: 10-31-2002
Building Official
POST IN A CONSPICUOUS PLACE A