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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
71,!11 SS B 10131 JC1
Date Z - Signature of Contractor -' J
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:
Carrier Policy No.
g0LDFNV RAGLE INS, N'UN' —N4063.0
(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 fy
shall forthwith comply with those provisi ons,,- 7
e
u
Warning: Failure to secure Workers' Compensation coverage is unlawful and
Shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees._
2. Any permit issued as a result.of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection purposes. =
a
r
Signature (Owner/Agent) %' -r -r . _ Date `_' —f
BUILDING PERMIT PERMIT#
DATE VALUATION LOT (nw-3.84 TRACT
JOB SITE
APN
ADDRESS 7"11 *FXxE'C3,AR A170N ('"01W
160"*??1_tk_*
OWNER
CONTRACTOR/DESIGNER/EN (NEER
CENTURY CROWL=LL c:OMATNIn;ms
C$NTURY CRO•VVJn: L COMM'U".Aifi:il:
) 93 S SO. q >* 0111R IIT, 33T1 ##200
15 3 5 M, !3" 3 R.L.L'" 1', M,, #200
SAN 1. ERLt,7Aiz [1:[€ O CA 92408
SA24 BERNAF'D.1140 CA 92408
(t?j3y I •F�f}iY7 t'I3 #j 2120
USE OF PERMIT
511N'G1%. F#J4f,Y 1 �iflf i SiTC3
SF'D - 1-07' 'fes, PLAN 581LI_V. RISII.bAiT L)DS+S NOT INCLUVEr BLOCKUilk
i.:tA P(X)I, SP -A. OR.L3Wrs"N AY rWPROACF ,1.5% RT4rlUC.TI'OW TC1 PL KA
CHECK PIKE FOR MUL'FJPLL_ ISSUANCE OF SAME PIAN TYPE.
TRACT CaNtTYRUCTION :plT', o 9F
PORC.HMATIO 25,00 SF
(AARd1MYCARPORT 640.00 STS
991 IL!!3A'= C ogr 01y CQU` RUC IT'lo'C
176,428.10
CONSTRUCTION Ir rGJ? 101.00n, 18sQW W910)T
PLAN Ciii`; X D+,tF; 1014=-439-318 W7.42
h/ IF.C'•H.A,7DIC:AL �T_t 101-000-4.21-000 T"119. 00
11?LZC.'t'I21CXl., E'F>•L '101-000-420-000 $16632
PLUpti4MO FrF,R 101.000.4.19.000 $161.25
STRG►HO MDT ON D ER, IdL.SIl: 101 -000 -x^.,41 -WO $17.64
O&ADINt! Flt)?, 101-000-423-000 IaX00
1.)WELOPER IMPACT FRE
;:t •
uIS1�-'.I 111I. Q1>I�it�.t{i;"[`.lOX A1�I31:'":E.'.,k N' (:T•iL[. K
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TATL YOM3 C 3�'.FrE' S DUEJt�f,��i`ii
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5��►�•#�3 m�
RECEIPT
DATE g ,
rr .ti •1. i• 1
BY._•W
4' is
DATE FI�NAALLED
!O, a7,
INSPECTOR
,AN
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
17
MECHANICAL APPROVALS
Set Backs
- g — Z.
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
.-
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
'-p
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans 8 Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
—O '-
Drywall - Int. Lath
Final
Final 0 6 ?i
BLOCKWAILL AP ROVALS
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
PLUMBING 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
Encapsulation
Gas Piping
Gas Test
Appliances
_� �..d-
Final
Final
Utility Notice (Gas)
ELEC1r=A 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 Adft
Utility Notice (Perm)
COMMENTS:
Installation Certificate: Residential CF -6R
Site Address
79-811 .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 theActual equipment
installed and that the equipment meets or exceeds the requirements of the Appliance Efficiency Standards. In
addition, lhave verified that theequipment 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-48B-090X 80% 88000
4. COOLING INFORMATION
COOLING MANUFACT
EQUIP. MAKE
A/C Lennox
COMPRESSOR ACTUAL EFF
MODEL # SEER
12ACB42 12
12ACB36 12
COOLINGEQUIP COOLING
CAPACITY 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 sizingand selection.
5. SUBMITTED BY
(� g a A
Signature Installing. HVAC Contractor
DATE: I Z '/ r' 0 *L
This Is to certify that insulation has been installed in conformance with the current energy
regulation, California Administrative Code, Title 24', State of Call(ornis, In the budding lxated at:
79411 Declaration Court, Lot 33, Monticello -Heritage, La Quints, California
CEILINGS:.
TYPE:
BLOW
MANUFACTURER: CERTAINTEED
THICKNESS: R-38
WALM
TYPE:
BATTS
MANUFACTURER: CERTAINTEED
THICKNESS: R-13
GEN CO RA TOR. CENTURY CROWELL COMMUNITIES LICENSE #?��
BY. r' TITLE: e5:fP? S��
PARAGON SCHMID BUILDING PRODUCTS, A MASCO COMPANY LICENSE # 632072
g TITLE: ADMINISTRATIVE ASSISTANT DATE: 12/1212002
✓.sw:'stire:�.A'/MbAfA�:JY.dIW(�H�mt•,�v7�wwsv�M�mY.wAfotisnwNir.✓•✓v%VhYY1rMI.W'IW/�ti'.V✓*%�AI�Y.vS/:/VMW.7'/4Y7%YN7W+�///,N.�Yn7�"�Swu;i.ns ., +
Jan 29 Oz 11:37a
INSTALIAA"I'I(
'i9..8
Richard Simpson
C
661 947-6889 p.4
uc 3 of'8) CF -6R
Jseaatry
DUCT LEAKAGE AND DESIGN DIAGNOSTICS
LEAKAGE REDUCTION
on Tcsl,Rcsmlw (CFM rd).. 25
- 'red l.cakagc (CFM)
t'nn flow
If k neYlow is Caloulatcd av 400 vWkm x iawnber of touts. or as 21.7 x l Ioating Capacity
in ThamundA of RtNhr, oplo r oakelatod valuo born
If tan Row iK measured, smlcr mcasm A value hum
Lobkago F•raotiou - ToA I.oskagcl(Moaat and or Cdoulatod rate lslow) ,.
P irloagv Cracitiam s a:tw JX� ❑
Pass rail
❑ For ARRO901; TYPE SEALANTS ONLY -The following dhrgnoatle testing was eomplebede
Dual Nan Pronvmiration A rough -in mcmuured k:aUgc (CFM)
CHECK AFTER FINISHING WALL:
❑ Yc" ❑ No ❑ I'rn*nm pan tort or I1ou:so possuriratiun text
❑ Yes ❑ No ❑ vimw in*,don of umt Comoetioos ❑ ❑
Pato Fail
THERMOSTATIC EXPANSION VALVE (TM
Y*4 ❑ No 11"imoAS60 EMpan>aan Valeo (OF CommiUion SPprovr3d
oquivatent) is installed and Acaa.m im prvyided for mupmkuO
,I�'
Yes is paaa 1�ax 1'ad
❑ DUCT UESIGN
1. ❑ Yes ❑ No RCCA Manual 1113cmign calculntiosrs Levu Baca usnmP1U-kA
lhrot I]mign ision the plans and, duct .ia W1m1ion matahch
per+.
2. ❑ Yon ONO rXV bs imstaUW ar.Ftm ftvw ha:s boon vcrirwd. irmo TXV,
verified !'an flow matchcuu &wip fi*m CF•IR.
measmad ran Flow
❑ ❑
Yes for both 1 and 2 its a INN PUS Fail
V1, the umdanipud, vuKKY 8mt tho abovo diognOMW WA maltm and tho work I port'om=A amoaiatod with the tcsgs) is in
inrormow with tho jogai mme nts lbr complianm: mudit. ('lie builder shall provide the 111:1 1 provider a w" of* tho CF -6)t
sign W by the buildaranployoes or sub-aoalractarm wdifymg that diegnos�in lc&g and io aallawn eww the mgoimm4tmk for
comrGancc avotlit. J
Tcals Silpaatmo,.Dalo IriahlllfAg Subcouofraoter e. Noma) OR
Pcriurmed GemeW Coutmator (Co. Name)
COPY TO. Building llopo linont
llEM Pravidor (if applicable)
Building Owner ut Oceupo»cy
4,2901 /
�Ae_
Jan 29 Oi' 11:37.a Richard Simpson 661 947-6869 p.4
INSTALLA'T'ION CERTIFICATE (Page 3 of 8) CF -6R
Z_
-19 -W t'(r :A 0=461 A-era-Ti4 nr Cav&7-
DUCT LEAKAGE AND DESIGN DIAGNOSTICS
LEAKAGE
PA)
'rent leakage (CFM) T
Fan Flow
If Iran blow is CnIcubdW &q 400 ~on E nambcr of Iona, or ma 21.7 x I looting C npaok
in ThourrandA of Utuft. onfor coMvlotod. Volvo bore
If fanflow in maasunA, cuLLT mcasotud value hum
Leakage Fra4on -Tod, d, IraaksVAMokwod. or iCodovlstod Ilan flow)
Panw it leaketa rractiun s 0.116
,A406
j Fan
❑ For AEROSOL TYPE; SEALANTS ONLY -The following diagnostic testing was compWed:
Duct Fan Prawariration at rough -in measured Icakagc (CFM)
CHECK AFTER FINISHING WALL:
❑ YeN ❑ No ❑ IWxynr - pen tent or 1lou.93 pr moiriration led
❑ Yes ❑ No ❑ Visoaf InVootion of Duct Connections ❑ ❑
Paan FOR.
n ERMOSTATIC EXPANSION VALVE MM
Yc.,, ❑ No '1'ltcxntoAolk 1?.rcpan4on Valve (or Commiasion apptnved
equivalent) is iuslellod and Aescasu ix pwvidod for fimpoction ❑
YON is a pane 'azsc Fail
❑ DUCT DESIGN
1. ❑ Yon ❑ NV ACOA Manual D Datign calculations have 6asn oongW_—Wk ,.
Duct Dcmign is on.tbo plans and dud inslaliation malchas
PIM.
2. ® yco [3 No TXV in inotallod or Fan flow hmc boon wtrifiW. If np TXV.
verilwd Can flow utotcha. dorigp fiom Cdr -1R.
Measured Fan Plow=
❑ ❑
Yea Cor both 1 and 2 iR a Paras Plass Flair
0 1,160 undmignod, vurily that Ibe abovo dingoes Q %A woplU and tho work I performed associated who thy lost(s) is in
contbrnsane:o with the mpkamenta ror eomplimm- erodit.1'rhe builder shall provide tho 10031 3 providor a copy ollho CF -6R
nipuW by dte bull4wanployocs or nub-canhaators certifying that diad wing OW natafixtion nvmt Ilse Wgairvnmhc Par
compliance cn:dit. J (�_.,
AP
dells Sipratonc,J)ate —T laatalliag !►v r(0o. Memo)
Perrorme-ed O memo) Contractor (Co. Name)
Covy 'ro: Building L%Vnrtmont
11IM4 Providor (rrappbcabdc)
Building garnet- ut occupoocy
January 4, 2001 /
11
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:
Use Classification: SINGLE FAMILY DWELLING
Occupancy Group:
R-3
79-811 DECLARATION COURT
Bldg. Permit No.: 0202-184
Type of Construction: VN Land Use Zone: RL
Owner of Building: CENTURY CROWELL COMM. Address: 1,535 S. "D" STREET #20.0
City:. SAN BERNARDINO, CA 92408
By: STEVE TRAXEL
Date: 10-17-2002
Building Official
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