0202-079 (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
1> P-110/3110;
Date'`Yrr fs?� Signature of Contractor `•=tj _!7k�
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.
Ajgi� 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:
Cartier 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: Lj€ r /1 7 _Applicant
-; --r w
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 otcompensation, 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.
T
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. i
Signature (Owner/Agent) -1 ;? j /! Date 1A
Signature
BUILDING PERMIT PERMIT
OATECP� 1VALUATION LOT GM -079 TRACT
4Z
JOB SITE '
APN
ADDRESS
OWNER
CONTRACTOR/ DESIGNER/ EN INEER
0'MUR.Y CROWE L COMMI.1I°1IES
aR.hT3"uky mowl-au , cow m J +N
1535 30,'D" gf=f, OT -17, $4200
ills 3 5 10, 111Y +DTZ Irr, SS'1? #201
MBEF ARD O CA 92408
61%N BGWARDWO CA 0,29108
m t 212.0
USE OF PERMIT
S£'r, • 1,0T 41IdiCa2r7't'TCLLD t€Itiitii 2"E1fPLAN ice. ,P=RE'F DOESNOT` .
INCLUDE BLOCK WALLS, POOLdSP A: OR 13t1V AY AF'tAROACH. FLAN
CY110r* TME I'DUCE0 MR MULTIPLE, ISSUANCE OF SAMbE PLAN! TYPE
TRACT CG:NSTRUCTION ?.215.00 3F
POR4vHMATIO 29.00 SP
Ci PSS; IC:.ARPORT tiz5,C.0 Sf'
EurMul" COST OF C0N&=TL117Q1rq
11,11910,20
F11i:I T Yn 01 M! 'ARY
C101SISITRIA"M 9N FRY, 101.000.4.18^000 `$W,90
PLAN CHECK FEE 101.OW,-4350m318 $160.11
MMANICA rEER. 101.000-411.000 3602
IMLECTRICdhL FEE lot -0.00-420-000 $139.33
11I:l3MOD10 FRE. 101-000-419--000 Wvtleo
STRONG MOTION n8 • RMID 101-000-241-000 $1:x.29
f1ILPtI2W VFIR ° IM -000.423s000 120,00
0EVEE.i OPER. IMPACT PBX', $1,9co.00
MyFSpPI.AWy CHVW�y:.
a
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14 200 �$:3:i1it7
y dory �y
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FEB NOW
Cif OFLAQUINTA
i leY
F -
RECEIPT
DATE'
BY1 ^ \/
DATE FINALED
INSP T R
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
- -
Underground Ducts
Forms 8 Footings
Ducts
Slab Grade
- Z_
Return Air
Steel
= _ Z
Combustion Air
Roof Deck
- y
Exhaust Fans
O.K. to Wrap
—z—,-
F.A.U.
Framing
3 - Z
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
POOLS - SPAS
steel
Set Backs
Electric Bond
Footings
2-
Main Drain
Bond Beam—
_
,27- —
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines P
_
��
Heater Final
Water Piping
Plumbing Top Out
2
J,/ A J
Plumbing Final
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
Low Voltage Wiring
Fixtures
Main Service _
Sub Panels _
Exterior Receptacles _
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm) l OZ
COMMENTS:
Installation Certificate: Residential CF -611
Site Address PERMIT #
44-605 Franklin 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
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
EQUIP. MAKE MODEL #
A/C Lennox 12ACB36
12ACB30
ACTUAL EFF. COOLING EQUIP COOLING
SEER CAPACITY LOAD
12
10
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
^^ nn �
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Signature Installing HVAC Contractor
DATE: 12-- ( g - bZ
INSULATION CERTIFICATE
This is to certify that insulation has been installed in conformance with the current energy
regulation, California Administrative Code, Title 24, State of California, in the building located at:
44-605 Franklin Court, Lot 42, Monticello -Heritage, La Quinta, California
CEILINGS:
TYPE: BLOW MANUFACTURER: CERTAINTEED THICKNESS: R-38
WALLS:
TYPE: BATTS MANUFACTURER: CERTAINTEED THICKNESS: R-13
GENERAL CONTRACTOR: CENTURY CROWELL COMMUNITIES LICENSE #
BY:
TITLE:
PARAGON SCHMID BUILDING PRODUCTS, A MASCO COMPANY LICENSE # 632072
B TITLE: ADMINISTRATIVE ASSISTANT DATE: 12/12/2002
Builder Name:
Project Name:
Builder Field Contact:
HVAC Company Name:
HVAC Installer:
Duct Leal(age Measured @ 25 PA
Duct Testing
Certification Form
�-V
/c,
Self-4ertifier Results
y q --G a S. Fnx^tvk. I /,.j ca,, m -r
`Tract # V41cl-
Lot # Lt Z
System . I ®f �-
(One form per system)
Telephone No.
Telephone No. G(q?j 157t7/
&�. CFM
indicate the maximum allowable Duct Leakage and the calculation method used:
110.7 x Afloor x (0.06) for Climate Zone 8 through 15 CFM
❑ 0.5 x Atloor x (0.06) for Climate Zone 1 through 7 & 16 CFM
JX, 400 x (Cooling Capacity in Tons) x (0.06) Z- . CFM
t''<4
❑ 21.7 x (Heating Capacity in Thousands of output BTU per hour) x (0.06) CFM
VIP
Ckvv� ' (AlGRk
Print Name Signature Date
Builder Name:
Project Name:
Builder Field Contact:
HVAC Corn pany Name:
HVAC Installer:
Duct Leakage Measured @ 25 PA
Tract # I -41q-7
DUO Testing Lot # z,
Certification Form
System Z ofz-
(One form per system)
Self'Certifier kesults*
Telephone No.
-7 f
Telephone No. �'d1
� 'L CFM
Indicate the maximum allowable Duct Leakage and the calculation method used.
0 0.7 x, Afl,,, x (0.66) for Climate Zone 8 through 15 CFM
0 0.5 x Afloor x (0.06) for Climate Zone 1 through 7 & 16 CFM
`0- 400 x (Cooling Capacity in7o'ns) x (0.06) o CFM
0 21.7 x (Heating Capacity in Thousands of output BTU per hour) x (0.06) CFM
Wail
Print Name Signature Date
Jan E9 OP 11:37a Richard Simpson 661 947-6889
INSTALLATION CERTIFICATE (Pogo 3 of 8)
(&A: L (eIK 6 Lo7 y L 10 .
_F z
SifeAddms f4t`T tNK l ►nl Cd v Qr PaRat�il 'umber
DUCT LEAFAGE AND DESIGN DIAGNOSTICS
DUCT LEAKAGE REDUCTION
Pressurization Test Rcsulls (CFM 0125
'lost Leakage (CFM) V6
p.4
CT -6R
Fan blow
If Ilan'Flow is Caloulutod m 400 ofin/ton s number of tons. or aV 21.7 x l loafing Capacity
in ThooeandA of ilfVAr. otter caloulatod valuo httro _
If fan flow is numsumd, carter mcammul value hcru f 1 (JQ
Lookage 1'raalion -Toil 1,04ago/(Moa md. or (:aloulatod Fan flow) - _T'
Pass ifloakogu fraotion 50.06 (] j ❑
Pass Fail
❑ For AEROSOLTYPE SEALANTS ONLY -Tho following dhrguoetic testing was completed:
Dual Fan PrWxuriiatiou al rough -in awasuuxl lcakagc (CFM)
CHECK AFTER FINISHING WALL:
❑ yes ❑ No ❑ 1'rovaly pan I" or Itoaw pru:riurrraliun turn
❑ Yas ❑ No ❑ Visual Inspeation of Duct Connuotiony ❑ ❑
Paas Fail.
THERMOSiATic EXPANSION VALVE (TXV)
Y,). ❑ NO ThuttuoA0110 lispavion Vaivo (or Commission approved.
oquivalent) is installed and Aex.-;s is Provided for inv"lion ❑
YW is a pass Paas fail
1 ®
Ys ❑ No RCCA Manual D Dcaign aalaulalions hovo l;Wn oomplutud,
Duet IksiLm is on Ibu plans and dual inslallalion malch0s
Plans.
2. ❑ Yo.4 ❑ No TXV is installed ur I'en flow ha,4 boon voriliod. If no TXV,
vorifiud fan flow ruatchm deign front CF -I R.
Measured Fan Flow =
❑ ❑
Yu{ for both I nud 2 is a 1'am Pasts Fail
❑ 1, tho undmignod, vnrilY thad tho abovo diagUortio tort rozulta aad Iso work I performed associalud with the tcsl(s) is in
cunibmtanco with Iho requinonwnta liar oomp4ance orudiL I'lho builder shall provido dtu I MRS ptovidor a copy ul' Ihu CF -Olt
Kigued by tho buildar cwphryocs or sub-aontraotors cudif' ing that diapm-tio ousting and iustallatiun umA Iiru ruquuomoaiu Ior
complianoc cmdit.i
2 5 2002
APR C/fid
Tcsts Signature, Data lustalliug Subwatraotor (C . Normo) OR
Pcrl'urmcd Goncral Contractor (Co. Nemo)
CONY TO: Jlaildinp Mpnrtntoul
11811.11'rovidor (il'applioahic)
Building Owner art• Occ%vancy
J2nu2ry 4, 2001
Jan 23 OP 11:37a Richard Simpson 661 947-6889 p.4
INSTALLATION CERTIFICATE (Page 3 of 8) CF -6R
44-(00 W4 -(0o
N fr. (I41(rd JK;
.L 2W -z-
DUCT LEAKAGE AND DESIGN DIAGNOSTICS
DUCT LEAKAGE REDUCTION
Pressurization Test Rcsulls ((TM 0125
'fest [,cakage (CFM)
Fan Flow
If lean Flow is Caloulatod as 41X) olWton x numbor of tons. or as 21.7 x I ]waling C:apaoily
in Thoudan& of I0ti/hr. anlcr oaloulatod valuo koro Z l
If fan flow is mcauurud, caller muaxurcd valuu haru
Leakage l'Mlioa —'r#At [,oa1ago/(M0a.4Md or l:nlwlatcd fall flow)
Pans if loakago Itaulion 5 0.06. G G ( ❑
Pass Fail
❑ For AEROSOL TYPE SEALANTS ONLY - Tho following diagnostic testing was completed:
Dual lean Pruiwuriraiion at rough -in mcasurcxf leakage (CFM)
CHECK AFTER FINISHING WALL:
❑ Yov ❑ No ❑ l'(cxti-uru pad 1W or l lou:w proaRvurkation lim
.❑ Yas ❑ No ❑ Visual luspcution ofl)ucl Connuutionv ❑ ❑
Pass Tail
X THERMOSTATIC EXPANSION VALVE (TXV)
Ya. ❑ Nu Th;ymoAatic Expaaaion Valve (or Commission approved
oquivalent) ix installed and Amu= is pruvidccl for inVmliou ❑
Yox L%aPass All bail
❑ DUCT DE51GN
1. ❑ Yag ❑ No ACCA Manual 1) MAgn calculations havo bon oumplutdd,
Dual lksign is on Iho plans and dual installalion matuhus
plans.
2. ® Y" 0 No TXV is installed or Flat flow him boon voMod. If oo TXV,
voriliud lour flow matches: datiign front Cir -1 It.
Measured Fan Flow =
❑ ❑
Yost Ibr bulb 1 and 2 in a PaRl' Pass Feil
❑ 1, Wo undtaaigaud, vw y Ih;d tho abovo diagnofitie Wet r9rpllm and lhq work I performed associated with thu last(s) is in
euutbrmamw with tho i cquiramonts liar campfiance urudit_ IThu buildur shall provide the I IRRS pruvidur a copy ol'Ihu CF-611
Kigucd by tho buildcr ctuployoca or sub-csuntractom certifying that diagnu:diu 1a*168 and iwiallaliuu afoul $he ruquiromenk I<ir
compliance credit]
APR .2 F; 2G�4' �5� C�A16
Tcsts +Signature, Datu hlstallidg Snbcolatraolor ' 'o. Naroo) OR
Performed Goncral Contractor (Co. Name)
COPY TO: Building lhpartmont
111 S Providar (il'applicabic)
Building Owner- tut OCcuoo»Cy
January 4, 2001
'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: 44-605 FRANKLIN COURT
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 0202-079
Occupancy Group: R3 Type of Construction: VN Land Use Zone: RL
Owner of Building: CENTURY CROWELL COMM. . Address: 1535 SO."D"STREET,STE #200
Building Official
City: SAN BERNARDINO CA.92408
By: GARY SHOWALTER
Date: 08/19/02
POST IN A CONSPICUOUS PLACE