0202-173 (SFD)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 14 1 U8133 ; 0431 /02
Date '--'Signature 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:
Carrier BCy1.,DEN EAC1.X• IN119. 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,_!. 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 $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 requestand.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 `` d
BUILDING PERMIT PERMIT# it
� � TRACT
DATE VALUATION LOT 0.ma2-1,r)
a�ax s. cie z� 1.11914
JOB SITE
APN
ADDRESS 791-844 1MeC'9..,A1RAn-0K COTMT
OWNER
CONTRACTOR / DESIGNER / ENGINEER
(MINTURY CTOWELL cU U.f`C.I`-MES
CENTURY 1.1RY C. -IM- Wl:'E.:.I., 0()1VjM-U)4rrC�c. �
1 i3g 1 rC.1. Ir ;ir": !'T, um. 0200
153 30. "D" MM, YPR 07010
�cRAW.E?r;d. c .l�l�l��+?0 CA 9240,S
SAN r MIARDINO CA, 924P)c
(909)381.6007 . f' 120
USE OF PERMIT
fC1IX FAMILY WF;LLING
SFD r LOT 21, K.AN 4CkP.V. PERMIT DOFS N -OT INC:LUL. Z BLOCK
WALIA P001i SPA.OR DPUV WAY.A.PPRt?AVH.'14% RiRDttfv'j'ION 3O xf�t+�4i
CHECK FEE FOP, MULTIPLE 15SUd,NCF OF SAME PLAN TYPE
T".G7 CUNSTR.UCTION :404,00 SF
PO#iifHWATIO 62.0 S
0,ARA.0FJCA`RP0 a F 04,00F
k'ST.1lyViL4'J1IM COST OF CONS1VU OZ`d
1?3MM17' FES 9UMURX
;'fJA1 I'f;,i"�t'.FldrllJ&E, 101.000-418.000
PLAN CHkCK FE9 101-000-439-31$ $165.26
MECIi,A)41C.A L FF.F 1. g 1 ' OO�Sa4 � l •C{Lii? Sfib:afl%
F.1.VCTRICAL PEI? 1031-0()0-42,0-000
PiXiy?AWC3FFF101-001}-A19.0(101 _ ; $142,00
9TRfa'biO MOTit7id arEF • kES11). ' 1( -000-24.1 $14.30
C_313a4i)1i'dCjrl 10'1-000423e060
m V E'Lopa R 12"PACTi P i}^ sqp$1,M.00
I4�"
'IJ.�•'".LCTAZ.n�`L�•li�L'iii���'?CLC•`l�1 x�Jl3.F�I..-#�f �f=1L� �
'tv:i,a'.��:1.�i�i
.yV
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
44 —5— Z
Underground Ducts
Forms & Footings
— -- Y
Ducts
Slab Grade
/i—z
Return Air
Steel
—Z
Combustion Air
Roof Deck
— G - 2
Exhaust Fans
O.K. to Wrap
0_ 2
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
Final
Final
BLOCKWALL APPROVALS
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
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Lour Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
(Final S . o v
Utility Notice (Perm)
COMMENTS:
Installation Certificate: Residential CF -6R
Site Address
79-844 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
EQUIP.
Furnace
MANUFACT HEATING UNITACTUAL EFF. HEATING EQUIP HEATING
MAKE MODEL # AFUE CAPACITY LOAD
Lennox G40UH48B-090X 80% 88000
G40UH-36A-070X 80% 66000
4. COOLING INFORMATION
COOLING MANUFACT
EQUIP. MAKE
A/C Lennox
COMPRESSOR ACTUAL EFF. COOLING EQUIP
MODEL # SEER CAPACITY
12ACB42 12
12ACB36 12
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
(&j Q,
/ J U.Q.00 �i 9.— DATE:
Signature Installing.HVAC Contractor
y. v..n'!.�/.»vF,w�.r fAtAf/7' v>1/AII'%YMMWKf1:WI6V.WI�/IN!'1/1�M/�I�VI4WWM/IJMYM�%/��6NIA/YAVN%�'lFns'i!/�f/lfHhMINK'YNd�/N/M�M/��J�'VI/N•'�.•Y+JILS'/!!M
INSULATION CERTIFICATE
i Y
This is to certify that insulation has been Installed in cantormence with the current energy
regulation, Califam4a Adminlstrative Code, 'ribs 24, Slate of Caiibrnia, in the building located at
7'94M4 Dealaradon Court. Lot 221 anticeliomeritage. La Quints, Califomla
CEILIN
TYPE: SLOW.
MANUFACTURER:Certeinteed Thickness: R-38
r
! TTa MANUFAiCTURi:R. Cettainteed Thickness: R 13
GENE L CON CTOR: CENTURY CROWELL COMMUNITFtES LICENSE 0
9Y: TITLE: fs-sc. Scams
PARAGON SCHMID BUILDING PRODUCTS..A MASCO COMPANY LICENSE # 632022.
r
r
By a�z _ TITLE: ADMINISTRATIVE ASSISTANT DATE. 12112/2002
i.
Jan P -b 02 11 t37N '•,'1 : p l .11
INSTALL A' ION CERTIFICA'FE
79-444 Coo a -T
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Building Owner at OtauponaY
Janow742901, /
Jan 29 02 11:378 Richard Simpson 661 847-8888 p.4
INSTALLATION CIE.'t -771"
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,ian 26 OE 111378 Richard Simpson Bel 8.47-6888 p.4
.INSTALI.A'I ION CERT' ICA'I'E(Pagc 3 of 8) CF -6R
79= g�14 Oac�arL�Crd�J C.c��'r
iDUM' LEAKAGE AND DFIIGN OIAGNO I'ICS
OWTLEAKAMEMMMON
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Building ommr at occupancy
. .inn■ary o, 2woDi � .
j
Certificate of Occupancy
C ity 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
ollowing.
BUILDING ADDRESS:
79-844 DECLARATION COURT
f
Use Classification:
SINGLE FAMILY DWELLING
Bldg. Permit No.:
0202-173
Occupancy Group:
R-3 Type of Construction:
VN Land Use Zone:
RL
Owner of Building: CENTURY CROWELL COMM.
Building Official
Address:
1535 SO. "D" STREET #200
City:
SAN BERNARDINO, CA 92408
By:
STEVE TRAXEL
Date:
9-24-02
.POST IN A CONSPICUOUS PLACE