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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
1I4188B /F 1013 UW
J ;
Date Signature. of Contractor
yr.Y'
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 & Professional's Code).
( ) 1, 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
hereby affirm under penalty of perjury one of the following -declarations:
( ) 1 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.
(1f)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:
Carver (301,I)SN RAS.'iIX, INS, 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,
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: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to -$1 00,000, 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
t;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.
i
Signature (Owner/Agent) rf= Date_ v'
BUILDING PERMIT PERMIT#
,DATE VALUATION LOTTRACT
� a4irD 241 11.4
JOB SITE ''
APN
ADDRESS 79••sxJ:a.• M-CLA"RRXRON MURT
604-0734Wi
OWNER
CONTRACTOR / DESIGNER r/ ENGINEER
CSN T IPI C1i0W!UA. t: ONWC R1'I:Fi.;S
CrENUITAY (IROIA%E -11 WWA Ui7:i�C`.tF'-
15311 "30, l)-m-nzw, ST& moo
1535 30, ID"'WT111 T-IFIT, �r),.E,1z2b()
Z.AN i; l+:ll.NAARDINO CA 99108
SAN D.Mi `'f.ARiICr O CA 974 (03
(909)381.6007 C'k3ut 2122
USE OF PERMIT
MN OLE YAM.'ILY 3.rN1VLQLUNa
MI) - LOT 25, PIAN 4E0". PER'I},!tIT LION,; NDT .rXC:i.,tfl?E 131.,0CK
WA14.% POCA� SPA OR, "DRrVY.WAY APPROACH. H. %"1r R11: 0C1`110V TO PLA14
CHECK .IEEE FOR. MULTIPLE ISSUdTiP.:,E OF SAM& PJ AN TYPP.
TRACT (,'(ft STR1J(3 T1O).4 2~650,00 S?
PORICIOPATIO 62.01 3F
(tdLR_k(J1YC'AItP0RT 604,00 51�
ERMMI'D C QR'0r1
iTIt114uf ME f1110mma1: Y
CONSTRUCTION PE); 301-000-118-000 S�3a.Otl
FLA %I CHECK FXE 101-000-439-3, 18 $172,59
MBC;H.AN1.(' L 1r}:.I<: 101 -000-421 •000 $66.50
E3l.c£CTRI.CAL F99 101-000-420-000 $113.33
PLUMBING "W 101.000-419.000 $142,04
STRONG MICTION FEE - RMS1D 101-000-2,+31-000 $15.66
ORADINO 199 101.0fXJ-42q-000 3x0,04
DEVEIA)SIER IMPACT )TEZ
- x>:TE,•`.I`(.);C�1'aCO>;I�i7i�;t��"'1NC0]�T.AI��'£'l�h.All":#:l'I:r.F``f;;
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RECEIPT
DATE BY„ .
DT FINALED
INSPECTOR
0C
OPERATION
DATE
I INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Z
Underground Ducts
Forms & Footings
—
Ducts
Slab Grade
Return Air
Steel
— Z
Combustion Air
Roof Deck i
-
Exhaust Fans
O.K to Wrap
— .L Z=
F.A.U.
Framing
Compressor
Insulation
— Z -
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
BLOCKWALL
APPROVALS
Steel
POOLS - SPAS
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBWG
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
Fool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final
Utility Notice (Gas)
ELECT=AL
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
Utility Notice (Perm)
—,�%—U elf
APPROVALS
?/
COMMENTS:
Installation Certificate: Residential CF -6R
Site Address
79402 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 # AFUECAPACITY LOAD
Furnace Lennox G40UH48B-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
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, and are two of the criteria used for equipment sizing and selection.
5. SUBMITTED BY
ee tt --. _
Signature Installing HVAC Contractor
DATE:
INSULATIQN CERTIFICATE
This is to omrtify that insulation has been Installed in contormence with the currant energy
regulation, Califomla Administrative Code, Title 24, Sate o1 California, In the building located at
79802 Dealamillon Court, Lot 25, Monticello -Heritage, La Ouinta, California
CEILING&
TYPE:
BLOW
MANUFACTURER: CERTAINTEED
THICKNES& R-38
ATTS
MANUFACTURER: CERTAINTEED
THICKNESS: R-13
GENE CONT CTOR: CENTURY CROWELL COMMUNITIES LICENSE 0 Oe /
BY. TITLE'
PARAGON SCHMID BUILDING PRODUCTS, A MASCO COMPANY LICENSE 0832072.
By. TITLE: ADMINISTRATIVE ASSISTANT DATE,12/1212002
Jan -28 02 11137a Richard Simpson
881 947-8.888
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8uildias Omwr at Ocetvancy
J m wary 4, XMI
Certificate of Occupancy
City of La Quinta
Building and Safety Department
This Cet ficate 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: 79-802 DECLARATION COURT
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 0202-176
Occupancy Group: R-3 Type of Construction: VN
Land Use Zone: RL
Owner of Building.: CENTURY CROWELL COMM. Address: 1535 S. "D" STREET #200
Building Official
City: SAN BERNARDINO, CA 92408
By: STEVE TRAXEL
Date: 9-26-02
POST IN A CONSPICUOUS PLACE