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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
'7 14188
Date L `4,4Signature of Contractor
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.
�( 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:
Carter OOLDEN MGM! M& Policy No. '
(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,
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- .ft,. ,.y ;.. Applicant �. �. ' +l r
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall.subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers; agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection purposes.
Signature (Owner/Agent) Date • --'
BUILDING PERMIT PERMIT#
DATE VALUATION LOT til?C1 y `A ri TRACT
2 241' 74
JOB SITE
APN
ADDRESS 7$-797 DT0.'C1alllRAT1Qi'4 {'CJ lTl
60"72—CMY S
OWNER
CONTRACTOR / DESIGNER./ EN (NEER
CWKUR C7R0WF.f_L CUI UNTPMS
CF-MID.RY (M..(YW'b11.L . C:t:.3,ltdfs4C7X'1r1'i IS
1535 ;S0, "D o MF..FX. Vrf-. 4200
1535 so, ".D° vnuxm mu inoo
SM 13TCkNARDTIM-3 CA 92408
SAX BMIAP-1490 CA 92/309
(909- )3R1-6007 (M.I.X 21.7.11
USE OF PERMIT
WNGIL'IrAN&TLY EMLUNG
8M • I n -T 32, b LkN 481tnf. 'PERMIT DOES NOT INCLUDE 51XX,.:11f
WALL;t, P004 VA OR DRIVEWAY APPROACH.M4 4 RPl~ UC I iON O PIA
CI;IF[ K PVE FOR HA1Ji.'r1PLY ISSUANCE DF SANIV, PL.KH TYPY.
TRACT CONSTRUCTION :41400.00 V
Pr Rk,*`1•i1V,AT10 6100 ,`'1P
lea Ra hkllgc4.", OIRT 604,00 L
• EffM A'd'd'.!? M11QT 01r C','C7NSMliC'I:,i0N
142,'933,00
PERAMF U SCIMA1I11 ZY
CONSFRUC91014 ME 101.000.416.000 �er►,6r�
PLA14 CHECK FEE 101-000-43Q.1318
MF,C HANICAL M. 101-00"711.000 $60: SO
ELECTRICAL 1q: 101-000-:420-000 $144.59
PLUM1I INO FEE 101.000-419.000 V42,00
STrONO MOTION FU - RF41D 101-000-241-.000 00 $14,30
G AD1AiC1KIC 101-000.423.00t1 $20.00
DZVE',-,iJIyER I MF.AC 1' i Z1, $1,40o.00
d1k713T'CYI*AL C°C? rAiUC:°1NOX Mm PI.A11T. ("7 CK
$3,ze.ti .ai
USS Y11 -PA -11) M, Fey
F
'",bra, CEJ
1. {� C.
RECEIPT
DATE
BY :
DATE FI LED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms $ Footings
- — Z
Ducts
Slab Grade
g — Z
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O. K. to Wrap
-
F.A.U.
Framing
-
Compressor
Insulation
Z - c2,2
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
-4g - 2 -
Drywall
Drywall - Int. Lath
Final
Final
FOOLS a SPAS
SLOCPr WALL
APPROVALS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. Test
Final
Gas Piping
PLUMSING APPROVALS
Gas Test
Electric Final
Waste Lines
/p -- Z
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
— C _
Encapsulation
Gas Piping
_
Gas Test
Appliances
Final
COMMENTS:
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
Final 72
Utility Notice (Perm) '" Z
INSULATION CERTIFICATE
This is to certify that insulation has been Insta9ed In conformance with the current energy
regulation. California Administrative Code. Title 24, State•of California, in the building located at
79.797 Declaration Court, Lot 32 Mondaelle-Heritage, La Quinta, California
CEILINGS:
TYPE: BLOW MANUFACTURER: Catainfeed Thicknow: A-38
WALL
TYPE: SATTS ' MANUFACTURER: Certainteed Thickness- R-13
e
GENERAL CONTRACTOR: CENTURY'CROWELLCOMMUNITRES LICENSE
TITLE: 6�& .Scj�
j PARAGON SCHMID BUILDING PRODUCTS, A MASCO COMPANY LICENSE # 632072
TITLE: ADMINISTRATIVE ASSISTANT DATE; 12/12/2002
C 7-_
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Installation Certificate: Residential
Site Address
79-797 Declaration Court
1. WELDER 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-36A-070X 80% 66000
4. COOLING INFORMATION
COOLING MANUFACT COMPRESSOR ACTUAL EFF. COOLING EQUIP COOLING
EQUIP. MAKE MODEL # SEER CAPACITY LOAD
ALC 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
(2QaADATE:
Signature Installing HVAC Contractor
Jan 29 OE 11:37a Richard Simpson 66.1 947-6889 p.4
INSTALLATION CERTIFICATE (Pagc 3 of 8) CF -6R
Site Addms 7 9 + -7 c. 14 RAT i d A G.o-jR.To vols er
DUCT LEAKAGE AND DESIGN DIAGNOSTICS
QUCT LEAKAGE REDUCTION
Prosmuri=iation Tart Rcstdis (CFM 61) 25 PA)
Tcd l.cakep (CFM) Z
Fru blow
If Fanflaw in CaloabAW aN 400 of flon:x omber of tons, or ar 21.7 x Ilosiiing Capacity
in 11MWm& of otwv. ones oakwlstod valuo bora
If fan [low in muaamud, tmttt nwanmml valuo hvry
l,askagu 1 halon = T*A I.Askapd(Motend or Cdob:tod Fan. Mow) „
Pamirlonkagu No" Stld16
- ati
J3� 13
Hess Fail
❑ For AEROSOL TYPE SEALANTS ONLY- Ilio Adlowing dlagnoade twding was eomplefbed:
DWI I -on Pmssu radon al rough -in measured kakagc (CFM)
CHECK AFTER FINISHING WALL:
❑ Yom ❑ No ❑ lW mu pan taxa or 1 bmwi pmasxuriiration'ion
❑ Yoe ❑ No ❑ Visual ImWmtion of Dud Conn dionx ❑ ❑
PASS Fail
THENVOSTAI1C EXPANSION VALVE (i(V) -
jg�Y*4 ❑ No '1'henmAsW Ehpm cion Valve (or Canmisaion approved
oquivattmt) is iuslallod and Acum in provided ror mapootion ❑
Yui it a pow este fail
❑ DUCT DEeIGN
1. Q yo [3N* RCCA Manual D lkaign calculations hev0 6wn oomplofudr - T—
Dout Design in on tho pleas and dual imladdation malchox
Pians.
2.. ❑ Ym ❑ No TXV is haaallad orl'au Mrr has bvoa vvtirwd, if as TXV,
vail`wd fan flow matches: 4W* fiem Glt-llZ
Moasumd Fan blow
❑ ❑
Yon for both 1 aad 2 iF a nm POtSS Reil.
1. tho uadargaod, god idol above di g toil r=11W and the work I pmfornuxd awmaieted witb mo tcnt(n) in in
6dbnwam with to tvgoi muents ror comphanoc modit I'lity builder shall pmvido lho MGM GM pmvider a tx►py of fho Cl; -GR
siMW by tho bu!W-r employees or sub-oontraotom codifying drat ding wok tv dq and.acdallation MM tho mgoir<nn fit for
co..plianoc cn-d;t.J
02. .
7 Csfs Sigoatmc,l?alc Iaatalling . r (Co, Naqua)
Pcrrorino d (i�aacenl Contrsct+n (Co. Name)
COPY TO: Buildiur, Depndment
1110W Pmvidor (irappouffi1c)
Building Owner at Occupancy
Jieutuy 4, 2,001 j
Jan Es Oz 11:37a Richard 51,mpson 661 847-6888 p.4
INSTALLATION CERTIFICATE (Page 3 of 8) CF -6R
Site Addta& 9 _ RTiow <.o v n.T• ierm um
DUCT LEAKAGE AND DESIGN DIAGNOSTICS
LEAKAGE. REDUC710H
on TcA,Rc sWLs (CTM fd 25
"roast Leakage (CFM)_
Fan Flow
If Iran Flow is Caloulatod as 400 aAn%n x aumbor of tons, or as 21.7 x I foaling Capsobyy
in Tboutunda of 0ttaV. on1gr oabulntcd value bore
If Can flew in meanaued, anter num a ccl value h=
Loakaago Fraction ='fart IAwkagd(Mc&vnvd or C"Istod Fan flow) r
Paeva if loakbgo fraction 5 0.06
QC
E3
Pass Fail
❑ For ASkOSOL TYPE SEALANTS ONLY - The following dlnpuoxdc testingwas completed: -
Duol Fan Pmourienlion al mugh-in measured leakage (C -FM)
CHECK AFTER FINISHING WALL:
❑Yox E3No 13Prcxanm pa tea[ or I lonso prvaoaaarirnlion toxo
(3 Yon ❑ No ❑ Visual Inspectiem'ef Ihnol Gennualions ❑ ❑
N -W Fail
P-l"Fu 11lOSTATIC EXPANSION VALVE MM
Yaz ❑ No 'Ibniostalic law m,aon Valve (or Commiwiwa approved
oquivalent) is installed and Aa:araa in provided for fiLVwlift ❑
Yes is a pasta 1180
❑ DUCT DESION
I ❑ Yana ❑ No ACOA Manual D Design calculations have bum oouupla>tnd,
Dunt Datip it on the plans and,duct installation malohon
PIN".
2. ❑ Yea (3 No TXV is m:dallod or Fan flow hax`bovn.wjrifted. Ifao TXV,
vinifiiml tan Dow matchw dwagp ftm CF -IL
Mcaamed.Naan.ilow =
❑ ❑
Yen ror both I and 2 be a Pnsaa Pus Fell
1, Wo amdwsigaerl, vwW Oast the abovo diagtuD4o iaat roaultd ad the work I perfon=A aamooiatod with the tang%) is in
ountbrmwo with iho tagger amts for comptisame emdit_ I'Ma buihier shall provido dao l D4it3' pmvWa ra wpy or iho Cl,* -6R
siSaW by tho builder amploymn or amb-contractm antilying that dmp m4k t0aing and iratall+tion sym the nsyuuva=fi4 for
ownpliance aodit.I
'l cats signatum. Data v e Hing WWooalraotor (Co. ) OR
Nwrorma d General Contractor (Co. Name)
COPY TO: llaai dinS,lkpnrhnout
11104 Pcovidw (if applicable)
Building Owner ut~ Occugarcy
January 4, 2001
2
Certificate of Occupancy
City of La Quinta
Building and Safety Department .
This Certificate issued pursuant to the requirements of Section 909 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: 79-797 DECLARATION COURT
Use Classification:
Occupancy Group:
SINGLE FAMILY DWELLING Bldg. Permit No.: 0202-183
R-3 Type of Construction: VN Land Use Zone: RL
Owner of.Building: CENTURY CROWELL COMM.
r&4 -t
Building Official
Address: 1535 SO. "D" STREET #200
City: SAN BERNARDINO, CA 92408
By: STEVE TRAXEL
Date: 10-22-2002
POST IN A CONSPICUOUS PLACE