0202-177 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
I,Imo—. Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
. M'
cel 111 Professionals Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
E; ti 714186 1 /01
ZO r—d Date -Signature of Contractor
1,�
cP_o H dl--" OWNER -BUILDER DECLARATION
W a I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason:
co ( ) 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
LO
N Date Signature of Owner
ON
C7
d Q WORKER'S COMPENSATION DECLARATION
Q I hereby affirm under penalty of perjury one of the following declarations:
Hp () 1 have and will maintain a certificate of consent to self -insure for workers'
K LU !!- compensation, as provided for by Section 3700 of the Labor Code, for the
J Q performance of the work for which this permit is issued.
n Q U ( ) I have and will maintain workers' compensation insurance, as required by
U Q Section 3700 of the. Labor Code, for the performance of the work for which this
l' Z permit is issued. My workers' compensation insurance carrier & policy no. are:
Cb j Carrier C?C►LPEN VIA -01.131101 Policy No.
r• CY
g (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[,
Warning: Pallors -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:
44 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 Quints, 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.
r� Signature (Owner/Agent) s' Date -
BUILDING PERMIT PERMIT#
DATE VALUATION LOT 4 YZW. ,� A. 7 'P TRACT
$132,9101W 26 ?•3 f 97 -4
JOB SITE
APN
ADDRESS 79-7M 17.TULd►EW11011410-O Wr
1.04-072-006
OWNER
CONTRACTOR/DESIGNER/ENGINEER
C`EW11:1':kX CROW,SU11• GC3;ibZlulCiNl:x'Ci3:J
C.,'KWV 11? y C'.h.ta1.pTO-1. CC72 ib, 'thdl',l7; i
15.35 s0. °1}° UrRLW, Ml 4200
1535 '0,0, 9V'61T& 't', J`lP, -nQO
SAS! 1.135w.F11WD10 CA. 92408
S4AN';y,.I R.1••'fA:?1')1t%T() O.A. V24U8
(9Q9)?)R1_6007 r—I'AL 1 11:7Ott
USE OF PERMIT
aNGLE, Yf WLY TiWEIT.,x.RIG
3FD . LOT 2.6, PLAN 38REV. taRfY1d IT DOJ -?9 NUF II NC:LUDE Sf..00K
WALL% POOL,, SPA OR DRC'IrFW:a5Y APPROACId. %`I Rq,1)CffJI01q TO J'tAN
CHECK YZF T'f.'?11, MUL`[IPLE 102V ANCE OF tiA&IZ PL.A N 9'YPE.
TRACT CONSTRUCTION 3,:[15,09 SF
P+C RCWPATIO 2x100 Sii'
0r`1R FtCIUC'ARPORT 623.00 'IF
1�'�w'f 11V A'11� CC33, T O {°O� SF-k11f."110)4
1.321%01210
C041S'Y,RlJCTION FEE. 1(A -00 043 8 -OW rZ 100
:FLAN CHECK 111% 1014W-41311-:518 $160.11
MECHANICAL, FRE 191-000,421-000 $600
IILN.� TR ICA L PIRE 101-000.4 2tj4*0 $138.53
PLUMB[90 FER 101.000-41 9-000 $1 tQ W
STROND MOTION TTE • 1ILP 101-000-24.. -00C,
ORAJANO F9F 101-�t1ii0-473.000 $40
I31~'VEL0PER. I.fd1PAt'T FEE $1.9119.60
a•
— TIB3-110—TAL C01 rR€T rt0.+J AVD PLAM CREC;1:
A;fS;3S
RECEIPT
DATEBY:
;•.1
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
LAIL>
Underground Ducts
Forms & Footings
-
Ducts
Slab Grade
Return Air -
Steel
Roof Deck
Combustion Air
Exhaust Fans
O.K to Wrap
-1 12- eAL-
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
Drywall - Int. Lath
a -
Final
Final O
BLOCKWALL PP OVALS
POOLS a SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUM&NG 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
Z
Encapsulation
Gas Piping
_
Gas Test
Appliances
Final
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
Utility Notice (Perm) X
COMMENTS:
v:
10/17/2015 02:26 FAX
INSULATION CERTIFICATE
This is to certify thet insulation has been installed in conformance with the current energy
regulation. California Adminlsftfte Code, Title 24, State of California, in the building located at
79-r66 Declembon Court, Lat 26 Monticello-Hedt94e, La Ckulnta, California
CEI E LO
TYPE. W' MANUFACTURER: Certainteed Thickness: R-38
TYPE:BATTg MANUFACTURER Certsinteed Thickness: R-13
Q011
GENERAL CONTRACTOR: CENTURY CROWELL COMMUNITITES LiGENSE $-7�/rLv
BY: TITLE:
PARAGON SCHMID BUILDING PRODUCTS, A MASCO COMPANY 'LICENSE # 632072
TITLE: ADMINISTRATIVE ASSISTANT DATE:12112/2002
Installation Certificate: Residential CF -611
Site Address
79-788 Declaration Court
1. BUILDER INFORMATION
Century Homes
1535 South D St. #200
San Bernardino, CA 92408
INSTALLING CONTRACTOR:
2. PROJECT INFORMATION
DI TRIBUTION
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
EQUIP. MAKE
MODEL #
AFUE
CAPACITY
Furnace Lennox
G40UH-48B-090X
80%
88000
G40UH-36A-070X
80%
66000
4. COOLING INFORMATION
COOLING MANUFACT
COMPRESSOR
ACTUAL EFF.
COOLING EQUIP
EQUIP. MAKE
MODEL #
SEER
CAPACITY
A/C Lennox
12ACB36
12
12ACB30
1.0
HEATING
LOAD
COOLING
LOAD
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
hDATE:.
Signature Installing HVAC Contractor
Jan E6 OE 11#878. Richard Simpson 661 847-6888 p•4
INSTAI.I.ATION CERInFICATT (Page 3 Of 8) CF -6R
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January 4,2"1
Jan 29 OE 111:37a Riahard Simpson 661 847-6809 p.4
INSTALLATION CERTIFICATE 3 of 8) CF -6R
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Building owner. at Occupancy
January 4, 2001.
4 ,
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: 79-78.8 DECLARATION COURT
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 0202-177
Occupancy Group: R-3 Type of Construction: VN Land Use Zone: RL
Owner of Building: CENTURY CROWELL COMM.
J�
Building Official
Address: 1535 S. "D" STREET #200
City: SAN BERNARDINO, CA 92408
By: STEVE TRAXEL
Date: 10-17-2002
POST IN A CONSPICUOUS PLACE