0202-182 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
%t Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
C14 W Professionals Code, and my License is in full force and effect.
O = M License # Lic. Class Exp. Date
r-_ Q In
t- Lu ? 141 Sid
cZ r-- t Date Signature �` Signature of Contractor .3 ,.'•r i JJ
O�
J U 0 1 OWNER -BUILDER DECLARATION
LUa I hereby -affirm under penalty of perjury that I am exempt from the Contractor's
to 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).
cr O I am exempt under Section , B&P.C. for this reason
LO
N Date Signature of Owner
O�
7-Q 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.
(�) 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
(01DEN E,A(W TNS, Policy No. NWC444068_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.
Date: ~APPlicant
L-•-,_. f .
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 r
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.
Signature (Owner/Agent) a �i-" `' Date'`'-
.f
BUILDING PERMIT PERMIT#
DATE VALUATION LOT r1r1 t�i�c TRACT
stn,%0,20 31 24 197 -4
JOB SITE
AP N
ADDRESS 79L W
9LW 1313:t�I.a,4.1�A�T, ON C:E:►i1FC
trk ' i° 34t3�s
OWNER
CONTRACTOR / DESIGNER / EN (NEER
C.1;A11"UR'Y CROW L COMIGMITiiM
Ckw3."3:I'tzy CXkC1wzuco]1I wi laril.s
1535 20. V, !1'1EVI:T'i Fs'r'E. 4200
)535 so, ID, SIT UTI grit, ft00
SAN 1:;LTwNARDINO %A 92A08
WU+1'SRAI .A121'!:R4G CA 92.908
(gov)3*1- tK+i C;'BIX, ! p
USE OF PERMIT
(RI,FAMILY D7WE LWO
31FO - fd'n 31, PLAN 3C".;tFV. PFPUIT DOL''; NOT I1NCLUD, BF�LOC K
WALLS., P004 OPA OR. DIUVWAY APPROACH. REDUCTION TO PLAN
C,1.1PXX F14F FOR P,911U'tit19 ISSUAIXE OF SAME 1'lAN 'CYPF,
TRACT CONSTRUCTION 4216.00 5F
PORCHMATIO a9.00 SF
0ARAOFXARPORT 6Z.0 SF
1N C0,10'01? 4�O �7l.3aV�s�AA0.I!
0.-.o
o2,91.
�y�� y5�}.[l�i.�4TM
CONSTRUL"k'IC N FeM 101-000-418-000
PLAN IL"°IiLC* FEE 101-000-4-39-318
HWH"1CAL ISE' 101-000-4.21-000, $Gt1.41ft
rILECIMC.AL, if'elit 101 -WO -4,20-000 $731i.s3
PLUMBING MIX 101--000.419-tM $124,00
STRO110,i'dOTION 1%W:o RESID 101-000-211-000 $13,29
(11RADING PEE 101.0kh0423-000 520100
11F,V ;Lt3PER. IMPACT .F"EE $i,�i.9 r Arit
'k
?L -�� iAl.c;O1 x 1t�'1`Tt39 P,iJO1c`I..Al� -' }�.C`!(.
1� LE;io
yy
J �RBIrr P ?J 71' .t�io'►w
3d� a 1 iii
RECEIPT
DATE
BY ' .
DATE FINALED
INSPECTOR
o�� •0 Z
t_
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
= $S -. S
Underground Ducts
Forms & Footings
4,— — Z
Ducts
Slab Grade
Ix 15, - Z
Return Air
Steel
/- L
Combustion Air
Roof Deck
-
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
6.-
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
Q1/
P®®LS - SPAS
BLOCU'�@> ALL
pPROVALS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
I
Gas Piping
(PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
- - 2
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
-
_
Encapsulation
Gas Piping
Gas Test
ze-
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fbdures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final O O
Utility Notice (Perm)
pp wNiV yNNA•.!♦O'w•/fI�MM..N��..►wrrw+r.Fn:n•x.Miirrlw+..vrrw.►.wwr.ww•...wwM.vw+.SIM+.V+IiYW�NrL✓W:�N'err.w.vrxwr�r�sArA^d.V�lAsilp/ITIYIi�.vvpxx•v.vYN
INSULATIONE
t 'This is to certify that.insuletion has-been installed in conformence with the cunWvt energy
regulation, Ceillarnia Administrative Code. Title 24, State of Calftmia, in the building located at: a
MM DoWwaEon Court, Lot 31, Mont1ceilo-Keritage. La Quints, California
< c
TYPE. BLOW MANUFACTURER: CERTAWTEED THICKNESS: R-38
t
r
TYPE:BATTS MANUFACTURER: CERTAINTEED THICKNESS: R-13
GENERAL CO RACTOR-.CENTURY CROWELL COMMUNITIES LICENSE # %/ /
k
r.
sY: TITLE:
PARAGON 8CHMID BUILDING PRODUCTS, A MASCO COMPANY LICENSE # 832072
A a
BY: TITLE: ADMINISTRATIVE ASSISTANT DATE:1211212002
- ---- ------ _._ _._._...__._.�_._.__._.__.���_.�.�,_...,��,.�.�..� a•.u.�yun..�.,a.v.,.cwue�r�crm�sy+�.:ry«.r.�w.wsfucwon �i?'
Jan 29 02 11:37a Richard Simpson 661 947-6889 p.4
INSTALIATION CERTIFICATE (Pan 3 of 8) CF 6R
79—?jj
10.E :,',7
0'rRArr,0A c,a'j,<T
DUCT LEAKAGE AND DESIGN DIAGNOSTICS
DUCT LEAKAGE'REDUCnON
Pp_ymndr:nlion 7'cd,Rcxu1W (CFM (0.. 25 PA)
'!'oat Leakage (CFM)
Fen view
If loam Flow is (:ado bdcd as 4011 oWfonx iaambof of lona, or as21.71% lies i ag Capsoily
in Thonaenda of 1001 r. COW oakutlated vaipo baro
If tan flow ix rucmuned, cater mca nwied value hcw l� 0.�5
WARP ):raoiion a'r0A 1AWkftgul(Mus.+aned or CadoalMott l'aa flow)
Pawif leakugo ftaulian s 0.06 ❑
4 Feil
❑ For AEROSOI, TYPE SEALANTS ONLY -The fiUowing dhrguesde taxiing was compleftd:
Incl Fan Pncmuriialion at rough -in nwLwW kahagc (CFM)
CHECK AVIrER FINISHING WALL:
17 Yes ❑ No ❑ 1'n,, pan tont or ! 1ouw pnM&.Mion lust
13 Yes 13 No ❑ Visaral Iaspoetiem vtlhtot Ca®cotioax ❑ ❑
Pave Fall
T14ERMOSTAMC EXPANSION VALVE (TXV)
Yc,,c ❑ No ThwooslaticExpaaaion Valve (or Commita:ion approved
equivalent) inihmdalled and Amis* is ptovidcd for iuxpootioa ❑
Yam is a pax 1? fail
(3 DUCT DESIGN
1. ❑ Yc x ❑ No ACOA Mnnnal l) l)mdgn cdculatioas have beim complet 4
Duct.faeign is on the plans.and dutfi ine lleation nutchos
Plans.
2. ❑ Yom (3 No TXV 6 imiallod or Fan Mw haze bwn volirod. If no TXV,
varil'iud lien Dow nawke; dexiga tkont Cdr -1R,
Measured Nan Ilow =
❑ ❑
Yes Ibrbulb 1 and 2'uc a 1'9sw Pass Feil
. 1, tho undmignud. nsify dmf t o aboyo diapo4o N;t roavltx and tho work I pc:fonoud ameoeialod with lho teat(N) is in
oenfotmamw with lho Awimnamts foraemplianca o®dit. ('Rte builder shall ptovidu dw I UMS ptovWar a copy oftho CF -M
aigaW by the WNW aVloyacs or sub-con(raotors ccW ying that dingaoWo wing and m 4*11ation mm the rvgoiat uosnia for
«►mp4anoc candit. J .
Teals signature, Into ImMliniSubcontreolor (Co. Namo)
Pcrforinm] ameral'Coutraotor (CO. Name)
COPY TO: Buddiur.Dgmrtruont
11118.1 Pwvidor'(ifappliaablc)
Building Owrtex- at Occutraelcy
January 4, 2001 f
Jan 29 02 11:37a
INSTAIJ A
Richard Simpson
ERTiFICATE
9.783 �c c�ARATIo�I Co
661 947-6889 p.4
Lre-3 of 8) CF -6R
DUCT LEAKAGE AND DESIGN DIAGNOSTICS
PrumuWation TcstAcsults (CFM "25 PA)
'Gest I.cakagc (CFM)
Fan Flow
If Fan Flow in Calcubdod as 400 orMou x numberof1ow% or as 21.7 x dealing C:apsoity
in ThonaandA of Wulht: oofor calooletol valuo bozo
if ran naw im mcaaural, cater mcamrad value hau f b o0
lAnkago Radion -'ry t lAakapdWearmod or Cakalbtod ran flow) R
Pan ifleakago fraction S 0.06 19 ❑
Pass Fail
❑ For AEROSOI. TYPE SEALANTS ONLY -The following dinpnos le testing was eompleied:
fact Fan PhM urizAbon aLrough-in mcaxurod kakagc (CFM)
CHECK AffER FINISHING WALL:
❑ yes ❑ Na ❑ 1'n amw pa tart or iloo ao pv mrivatioa ma
❑ Yen ON, ❑ Visna Invoution of lhmt Comroatiumt ❑ ❑
Paan Fad
14 THERMOSTATIC EXPANSION VALVE �V
JKY�: ❑ No 11wm Antic l:xPm6on Valve (or Commission approved
oquivalwt) is matched and ncmw is provided for iuVmion ❑
Yc�a ec a pas: rw Fail
❑ DUCT DESIGN
1. ❑ Yaa ❑ No RCCA Manual l7 ]kzrign•aeloulatians havoonngihtWd,
1)W1 T)Wign is an the pleas and dura initalheion mntohom
plana.
2. ❑ Yca Q No TXV is.hWallod or Fan flow heK.buon vwWwd. if n*'1'XV,
vaifiad Pan flow awchm di ign Thom CF -11t.
mmaarod Fan How = _
❑ ❑
Yea Cor bath 1 and 2 is a Parc+ Paws Fell
® 1, tho rmdataigmid, vu:* dud the abrin diagno4o WA rmla and tho work.1 porformud amociatod withAc tcat(n) is in
oantoimftoo With the Mgaitamo tt2 row compliamm crodit. (Tho buiblor shall provido 1ho.I1104 pmvidoe a copy of iho CF -GR
signed by ibe bud&e cugrloyms or sub-conhwwrs codifying that diapuAio toting and ireAallr4ion swot tho ruquiwtm000k Por
compliance avdil.)
B .
Teals Signattev, Date lu Wling ft r (Co. Nampo)
PcrfonuLd (:choral Contrsotor (Co. Name)
Ct)PY To- 1luildin¢,1)opnrtmoa1
1113R.9 lWvidor (irapplioabk)
Building Owner wt occaga.icy
Jsanary 4, 2001
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:
79-783 DECLARATION COURT
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.:
Occupancy Group: R-3 Type of Construction: VN Land Use Zone:
Owner of Building: CENTURY CROWELL COMM.
-7--&04n
.7--&04n
Building Official
0202-182
RL
Address: 1535 S. "Dn STREET #200
City: SAN BERNARDINO, CA 92408
By: STEVE TRAXEL
Date: 10-17-2002
POST IN A CONSPICUOUS PLACE