0202-181 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
�- Chaptdr 9 (commencing with Section 7000) of Division 3 of the Business and
CV W Professionals. Code, and my License is in full force and effect.
O =5 M License # Lic. Class Exp. Date
W 1%- 714188 14 10/3 1 /0
Z r Date }-.Signature of Contractor
J (-) OWNER -BUILDER DECLARATION
UJ I hereby affirm under penalty of perjury that I am exempt from the Contractor's
CO)CL
License Law for the following reason:
Z ( ) 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&RC. for this reason
LO
N Date Signature of Owner
Ocm
U
Q WORKER'S COMPENSATION DECLARATION
p 1 hereby affirm under penalty of perjury one of the following declarations:
Lo
H 0 O 1 have and will maintain a certificate of consent to self -insure for workers'
X LU L= compensation, as provided for by Section 3700 of the Labor Code, for the
O J Q performance of the�work for which this permit is issued.
m Q ()I have and will maintain workers' compensation insurance, as required by
Q U Q Se
on 3700 of the Labor Code, for the performance of the work for which this
C rn I— permit is issued. My workers' compensation insurance carrier & policy no. are:
,qt Z Carrier
ao 5 001., EN FAME M. Policy No.
t` Q
QJ (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
3 subject to the workers' compensation provisions of Section 3700 of the Labor
Code, I shall forthwith comply with those provisions.
Date: • Applicant
.
77
,-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's
BUILDING PERMIT. PERMIT#
DATE VALUATION LOT 0202-181 TRACT
.1 ID M1 Wi-4
JOB SITE
APN
ADDRESS 1. - 10 D.EVIALHAMON COUTZ"T
F44-072. 72. 00 6
OWNER
CONTRACTOR / DESIGNER / EN (NEER
L'Y1,11MUR Y CR,OWMG C101102Yd.LUM1.':1"i'ii+r3
Cii.CtwFu, lrt �,Sf tt i:Cl f±"
1535 so. °..V z CJICma,'.1T., moo
1535 SIS, S' Di'1.€?N t', VE, ,#200
'sA ' 1?1 1zNA:t TANTO CA 92408
13M MR;h[liV'..t�.,040 CA. 92408
��l!.>ti);7f31-Fyfifri i��T.,� "l,:tt
USE OF PERMIT
MQUIRIMLY MULLM0
SNCL , LOT 30, PLAN 2k3IZ.FV PERMIT @AIRS NOT INCL.tf1JE BE.,CyCK
i'~P: LYA POOL, SRA OR DRIVIEVAY RI1)(3C. 1014 TO PI A14
CHECK "W FOR MULTIPLE is U.XNC9 OF SAME 1? AN TYPE,
TRACT T CONST ttTJt"i'ION 1,000,00 Sty
FORCIMPATIO 49,00 Si?
CtARAOFICARPORT 44,00 9?
11:U'.879�:.Tk'•:�+' ogr OF C0AFN1', ,U(T 0.N
1961Q ,41110
PER- .F.M SUl icy
WNSTRUCTI(YRFM 101.000.418.000 %04,01
.PLAN CHECK: FFN,; 101-000-439-31161 $139.06
WCHANICAL 'F10, 101,000-421--000 SMOO
i?L;r,,C"TPJCA), VEY. 101-000-420-000 $119.Q0
P1.0 M 811110 F .F 101.000.419-W- 0 ;Ix . 00
STC€O did MEC TIG4 FPX - "?SIO 107.OfA-241-000 $10.66
MANN() Wirr1', 101-(9 -473.01.1(? $20.00
DEVELDVER IMPACT FEE t;lr�0"t.11t�
PUB-17_I��1]'�..yArd�7C��r1lYC�JL� � ,� �,
I. .132 SIbiR-PAID 1'EE0
;3,U��iS(l,.f��?
TOM
4 S rta' :t
DIT. N QVIll
$3,049.62,
WY 46!F '1 T.A�Q.i1!i�•vt14
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
"f.. _71 > i .7
;7 /.j
/& l7, val
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
— Z
Underground Ducts
Fomes & Footings
Ducts
Slab Grade
Z
Return Air
Steel
— Z
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
—v
Compressor
Insulation--
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final o
BLOCKWALL A A OVALS
POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBHWG 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
—ZJs
Encapsulation
Gas Piping
Gas Test
d ?j
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring 17-0 7-
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final O �j
Witty Notice (Perm) "��
COMMENTS:
.W.-4 A•r�y�V Mv.wr vM4N.✓�fh'/.fIVI/�.✓M'rlfilb�•rNrl/tV.'I.•rK.V•N/••/l/.J1f/.!N/Y.I.I+»v.1M!/rNY/N.Y.1/WiVrI�11'�YWIS'J�iYLM/. f�'i/fNYNV.Y.wril/l. NJu:'f•NI.v.'!.•J.•'/.%!/.•rim%'J.N� �':
INSULATION CE6tTIFICATE
This is to certify that insuistion hwbeen'Installed in conformance with the current energy
regulation. California Administrative Code. Title 24, State of California, in the building located at:
T9.759 Declaradon Courts Lot 30 Monticello -Heritage, La Qulnta, California
CEILINGS:
TYPE: BLOW MANUFACTURER: Certainteed Thickness: R-38
TWYPPE BATTS MANUFACTURER: Certainteed Thickness: R-13
f
r
4 GENERAL- CONTRACTOR: CENTURY CROWELL COMMUNITITES LICENSE
PARAGON SCHMID BUILDING PRODUCTS, A MASCO COMPANY LICENSE #°632072
TITLE: ADMINISTRATIVE ASSISTANT DATE: 1211212002
Installation Certificate: Residential CF -611
Site Address
79-769 Declaration Court
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-10.0
80%
100000
80%
4. COOLING
INFORMATION
COOLING
MANUFACT
COMPRESSOR
ACTUAL EFF.
COOLING EQUIP
COOLING
EQUIP.
MAKE
MODEL #
SEER
CAPACITY
LOAD
A/C
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, andare two of the criteria used for equipment sizing and. selection.
5. SUBMITTED BY
0,a.„
Signature Installing HVAC: Contractor
DATE: /)--6-'P'--
Jan 29 02 11237a Richard Simpson
C
79- `7100 fJ a-C.IAII.A710A) Gd d AX
661 347-6889 p.4
gc 3 of 8) CF -6R
DUCT LEAKAGE AND DESIGN DIAGNOSTICS
DUCT LEAKAGE REDUCTION
PFamur nflion Tcd RcsWW ((:FM fO 1i PA)
`feet Leakage (CFM)
I'M stow
If Fan blow in 4alculatod as 4011 cf0fton a muwbcr of tons, ora, 21.7.1 Tenting Capacity
in Thousands of RtulhL apte rr caksulatod vain* bare
if fan flow ix,nmamirudi ceatow ummonmd vatan heau Y
Lcokagu Fraotion —'Yom l aakago/(Myaxrpu�ad or Calaplatodtzar MoW)
Parc,iflookago traction. & 0M �( p
Peas Fail
❑ For ARROSOI. TYPE SEALANTS ONLY -The following dlapuestle o+exd was camphft :
heal Fow PrcauurMation at taugh4n rra:manA leakage (CFIN)
CHECK AF'T'ER. FINISHING WALL:
❑ Yoe ❑ Nu ❑ Prmcum pw(&A or ilomw prvmrriratian tot
❑ Yav ❑ No 0 Viaasl In vaoticm :of Duct Cunawtions ❑ ❑
Pam Fail.
�V THERMMOSTA11C EXPANSION VALVE (TXVj
WY. e ❑ Na 'fhmw iatiC lsxpm don Vatvc (or Commitesion approved
egpivalcnt) in maWle:d and Acum ie pmvkW for mr}Hmtion ❑
Yeae is a pax i' fail
❑ DUCT DEsieN
1• ❑ Yca ❑ No ACCAManual,DIkvMcalculationshavebmm.00mpkWd*
lhm Dcxlp is on Ilio plans and duct instalM en naniaho c
Plans.
2. ❑ Yee (3 No TXV is metalloid or lean flow hox buea vwifiod. If no TXV.
vailwd fan,floW malehet, dwipftm CI+ -IL
Meaanrod Fan Flow =
❑ ❑
Yea for both. I and Z be n,ftm Pus Fell
1. Mo undaraigaad, vwWY thMtho abavo dim test mmits and dw wodc I,pmformed amxdatod with Tho teat(") is in
aoatbra moo With tato WyahMnants for oOmpliancu: awdit. Pho builder &A providd dw 11H P -S ptoviderr a cupy of tho C"R
4uW by .tho build v exuplaynca oraub-coninotora cm"ying dant diagm 4k tmaing and ha tallstion amm tho mquietui mik far
ee mpiianoc audit.]
Tcscta Siposatma,J)ato lnatodling S'abctreotor ('" . iJamDc) t1R
Dcrt'ormc d o9nera) Coatraetor, (Co. Name)
COPY TO: liuildiag DeparhnaM .
11103 [Wvidor orappGaablc)
Building awn -or Ut O=MW'ncy
33nuaury 4, 2001
Jan 29 02 1:1:37a
INSTALIAATION
Richard Sampson
ERTIFICATE
TION
661 947-6889 p.4
me 3 of S) CF -6R
DUCT LEAKAGE AND DESIGN DIAGNOSTICS
UCT LEAKAGE REDUCTION
Pmmurimion Tcsl RcsulL4 (CFM (dr 25 PA)
Cowl Leakage (CFM)
Nan !'low
If Fan Flow iw Caloubdod m 400 cWion t number of tons, or ay21.7 x healing Capacity
in Thaarandr of lituft, cogs calculated value hero
[f tau Ilow in mcmunxl, enter mcasmod valuo hart 140cv
Wskago hraWttou Q Too licskaW(Mmsumd or CW6mlated Van flow).,
Paecn irloakago frootion s odl6 0
fts& rail
❑ Por. ABROSOL TYPE SEALANTS ONLY - Tho tidbwing.dkpowdr tawdng was eempleftd:
Duct Fan Pm uriiation at rough -in mcmaned kakagc (CFM)
CHECK AFTER FINISHING WALL:
❑ Yom ❑ No ❑ IW-+ vm pen lost or 1100-0 pm m1&.nlion taxi
❑ Yes ❑ No 13 Visual Iuvaction of i)w com cations ❑ ❑
Page Fail
THERMOSTATIC EXPMSION VALVE MM
Yaa ❑ No 'fhamt A*6o'l.xm4on Valve (or Commission approved
equivalent) is installed and Acomn is pmvidod for iaapomion ❑
YL" 6 a pan it, fail
❑ DUCTDMON
1. ❑ yo ❑ No ACOA Manual D 1)ca+ign aalculatinna Bavn txxm oongiluWd,
I)Wt T)Ddp is an the plans and dud installation malchex
phurn.
2. ❑ ye, (a No TXV is inista0od or. Fan flaw haxx boon vutilxad..If so TXV,
vorifiW Inn flow utateJcou doxigq ftm C11411
Mcumrod ran Inow
Ycs Cor both I and 2 is a Pamj Pas Fall
1, tho undeaiguod, YmWy dud *0 above ditlgnoxtic W rmlis and the work 1 puffionnad ammAsiod wild am tcnt(n) in in
cunr'ofmrmso with the Imimm ms r4W compliance "it. '[ire builder :Thad provide Tho i U044 providar a ropy or the Cl, -GR
signal by the b0ii ar employacw or unb.oantradom cortirying that dimpuAk tad og and iaclaWdion nim the mquirvnmwk for
oompfianea audit. J
Toms. Sigtrataro, trate Im6lwg S'aboo�attaotor (' , atria) OR
Pcrrormcd (idmetal contrmuw (Co. Name)
COPYTO- liuildinp Vourtrpont
1110311cvvideor (if applicable)
Building Ownex- ut occupancy
Jaeosry 4, 2001 f
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
ollowing.
BUILDING ADDRESS:
79-769 DECLARATION COURT
Use Classification: SINGLE FAMILY DWELLING
Occupancy Group:
R-3
Type of Construction: VN
Bldg. Permit No.: 0202-181
Land Use Zone: RL
Owner of Building: CENTURY CROWELL COMM. Address: 1535 S. "D" STREET #200
City: SAN BERNARDINO, CA 92408
By: STEVE TRAXEL
Building Official
Date: 10-17-2002
POST IN A CONSPICUOUS PLACE