0202-083 (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
1013IIM,
Date `' i`!f1 �S'ignature of Contractor %. Y %� •' .f�M1�
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).
( ) 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
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.
`(5;) 1 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.,
001MV0 EAGLE MS. NWCM4068-0.1
(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, ! t
Date-,,:/ Applicant -
Warning:
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 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. f
17
Signature (Owner/Agent) sit Date
BUILDING PERMIT PERMIT Jt
DATE VALUATION LOT f ' -> o TRACT
46
JOB SITE'
APN
ADDRESS
44 -CIO FR/) MMM MUM
45th-Oil-a,►�i
OWNER
CONTRACTOR / DESIGNER / EN INEER
t T1*1MV CP.0V41L CO)AM' i M. 1-
C $.W 10R'Y C"RC)WML. CrC3M@viEWi`('MS
153 901 9), MEe , M ON
1,535 90. T1114 31mi T, 91M, 0200
(309)3t31 •sw? C"T3L* 2120
USE OF PERMIT
EN ME. 171410 -Al, DWLTZ.10
.51PO - LOT 46..NIONTIC.E-LL0 P rj Rj.T (IZ A3LA14 X. P�.�.�:?,7I'#' DOM ; ICS T
DICIJB,iOR BLOCK �YAY .Z, Pi)OLISPA OR DR AV'.EWAV,APPROAC H, PLAN
CHECK FLOE RI+MUCXD Fplb 'MU1s`T'1PLX ISSUANCE Ole SM4Z PI. NN ME.
TRACT CONSTRUCTION 1,80o.00 SP
PORCHIM10 49.00 SI;
CRARA.0FYCA.e2l'0kT 420.00 8F'
ES MUM ('1105w0r, CONSIRTIUMON
106,
00143 ATiC.`T.ION SSU 101-0-0-418-000 MUD
3''I.AN CHECK MOM 101w000439-318 $138.06
MEMMICAL:rU 101.000.421-000 S6010V
T!`LEC°P'WI C, AL• FEN 101-000-420-000 #119,40
PLUWM F U 101-000.41 IDI V30.00
STltONOiMOTION IFEE- PX- 31D 101-000443-000 210.66
C'TP .A1 ING FFI 101-000-4234000 82.0.04
DEMOPERIAAPACi PF.1" 81,9QrI.00
r
4
:i
1=3 M"' , �PXD .r7h 'l�t�)
SIC e• . TIM? .AC�icL d4SI YS
k,
10�F�J �%�a�.A•
Y�
FEB1 4 2002 �
,,pp��
WY OF LA�3UI81Tf%
RECEIPT
DPAE
B1�yr�
DATE FINA ED
INSPE OR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
— / — r—
Underground Ducts
Forms & Footings
— / — r__
Ducts
_
Slab Grade
z
Return Air
Steel
Combustion Air
Roof Deck
— / Z
Exhaust Fans
O.K. to Wrap_
F.A.U.
Framing
Compressor
Insulation
—2
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
T
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
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
— — 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
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)
COMMENTS:
Installation Certificate: Residential CF -6R
Site Address
44-630 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
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
80UHG4/5X-100
80%
100000
80%
4. COOLING INFORMATION
COOLING MANUFACT
COMPRESSOR
ACTUAL EFF.
COOLING EQUIP
COOLING
EQUIP. MAKE
MODEL #
SEER
CAPACITY
LOAD
A/C Lennox
12ACB60
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
DATE: Z" I �' b I,
Signature Installing HVAC Contractor
Builder Name:
Project Name:
Builder Field Contact:
FIVAC Company Name:
HVAC Installer:
Duct Leakage Measured @ 25 PA
Duct Testing
Certification Form
C
SelfmCertifier Results
1-414-6-30 FRANKI t A/ Lo�wT�
Tract # M10
System 0f 1
(One form per system)
hone No.
Oil
Telephone No. � ���
CFM
Indicate the maximum allowable Duct Leakage and the calculation method used:
❑ 0.7 x Afwr x (0.06) for Climate Zone 8 through 15 CFM
❑ 0.5 x A[,00r x (0.06) for Climate Zone 1 through 7 & 16 CFM
,4, . 400 x (Cooling Capacity in Tons) x (0.06) 1 LO . CFM
❑ 21.7 x (Heating Capacity in Thousands of output BTU per hour) x (0.06) CFM
Print Name Signature Date
Jan 29 02 11:37a Richard Simpson 661.947-6889 p.4
INSTALLATION CERTIFICATE (Page 3 of 8) CF -6R
L/9—(,30 FAimlCItN Go,,n.T_
DUCT LEAKAGE AND DESIGN DIAGNOSTICS
IAJ DUCT LEAKAGE REDUCTION
Pressurrzatiun'rest Rc%UIIN (CTM fel 25 PA)
'fest f.cakagc (CFM) 0
Van Vlow
It Iran Flow is Caloulatatod as 4t1(t ofw/tou x uumbor of tons, or as 21.7 x I loafing Capaoity
in Thournnda of litulhr, ointor caloulatod valuo baro °yU(_)�
if tau ilow is measured, tMiurmcaaurcd value hen
I.eakaga Frea;tivu ='Post l.aa)kagv!(Mk;avutod or l':aloalatad Fau ijlow) - �_�
Pam ifloakago fraotion: t.0.06 ❑ ❑
Pass Tail
❑ For AEROSOL TYPE SEALANTS ONLY -The following diagnontic texting was completed:
Duct Fan Prcmurrialiuu at rough -in uwa%urctl leakage (CFM)
CHECK AFTER FINISHING WALL:
❑ Ycs ❑ No ❑ Prossuro pan 14ka or I louse pre+-4uritiralion wa
❑ Yos ❑ No ❑ Visual Inspection of Duel Connuclions ❑ ❑
Pass Fail,
03 THERMOSTAi1C EXPANSION VALVE (TXV)
Yk-S ❑ No TheYmoAatic Expauhion Valvo (or Commission approved
oquivalont) is installai and Ac=;s 6 providW for msjwtion L3
Yew i.. a pa„ Ya., fail
❑ DUCT UE516N
1. 13Y6"; ❑ Nu RCCA Manual D Dc-Agn oalculations hove beim uomplotud,
Ihrul Dadfru is on tho plans and dual installation malchos
plans.
2. ❑ Yon ❑ No TXV is hwalled or Fim flow huff bkwa vori i od. If no TXV,
variliud fan flow matchers durign from CF-IIZ
Mcasumd Fan Flow =
Yea 1'orboth 1 and 2 is a Parr Plass Fail
❑ 1, (ho undoraignul, vor y dull Zhu aboyc diaguo{'tiG ton ron'Ults and tl►o work 1 pc►fiumui amocialui with the WA(s) iv in
conformanw with the ncquiromants for compliance urudit. ITho builder shall provido tlto I MRS provider a wpy of tho Cl" -GR
riguuJ by the buildar curpic►ya s or su-contraotom certifying that diagnusliu to. twg anJ iu� tallativn 81100111110 rt+quu utnvuh liar
compliance mdit.1 _ AP®
�Oz
tt•�t S�
Tcsts Sigoatun:, Uatc lartalliug Sabcoutraotor ( o. Natnc) t)R
Pcronned (Wacra) Contractor (Co. Name)
COPY '1'O: Building; llaparhuout
1.113115 Provider (irapplieable)
Building Owner at Oc°cvpancy
January 4, 2001
Certificate of Occupancy
City of La Quintal
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:
44-630 FRANKLIN COURT
Use Classification: SINGLE FAMILY DWELLING
Occupancy Group: R3 Type of Construction:
Bldg. Permit No.: 0202-083
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
INSULATIOWCERBEICATE
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:
44.630 Franklin Court, Lot 46, Monticello -Heritage, La Quinta, California
CEILINGS:
TYPE: BLOW MANUFACTURER* CERTAJNTEED THICKNESS: R-38
TYPE: BATTS MANUFACTURER: CERTAJNTEED THICKNESS: R-13
GENERAL GONT�ACTOR: CENTURY CROWELL COMMUNITIES LICENSE
Z -,6*
BY. TITLE:
PARAGON SCHMID BUILDING PRODUCTS, AMASCO COMPANY LICENSE # 632072
TITLE! ADMINISTRATIVE ASSISTANT DATE; 12/12/2002