0202-080 (SFD)U)
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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
Date { r.r ' ,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.
(r`) 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.
(1tJ.[.M SAM IN0, _ VWC-344063.03
(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 subjgct 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 ""`�'t> >
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit, subject to the conditions and restrictions set forth on his`;. .
application. '
1. Each person upon whose behalf this application is made & each person'at'
whose request and for whose benefit work. is'performed under or pursuant to
any permit issued as a result of this applicaton agrees to; & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon:
the above-mentioned property for inspection purposes. r: j
r•
Signature (Owner/Agent) f�y1`f Date;
BUILDING PERMIT PERMIT#
DATE VALUATION LOT, TRACT
43
JOB SITE `
APN
ADDRESS
OWNER
CONTRACTOR / DESIGNER / ENGINEER
C.14;1'rr ,Y" CROW . L COkA'MS tr$
ch—wild'
1535 RO: TN fp c 'T, MIM 0200
'3535,30, 1)' 311 ±,e ME. ftOO
8A1CB1 RWARD190 C14 92408
:#A1+B.SERNAis!)WO CA. 92409
(909)3$1 -(,?07; C � 2120
USE OF PERMIT
0 �3 R"By17ir'�f�L #
WT 43. MC71+ TICELW HERITAGE PLAN 2011KV. PJP.RNIT IVES
NOT 11 CLU,tD 914OCK AIII NOW PA OK DRIV-1WAYAPPRO.ACH. PLAN
Ci'IECK FEE jkl' UCEI) FOR iss;gi.fkNIPLZ 153"SP.9A:NCZ OF !AMZ i'if... N T P E
TRACT C000'k'YeUCTTON 1,300.00 OF
PORC.I' PAT10 49.00'Ir
aARAW( RPS". RT QUO S
:lISMIMIED COW OF CC9Ke'r"MCl'.1 011T
1.06.6 3.70
k,jM rJIVE I3i1AWI"►.#i✓'if
CONE111 RUMON ON FEE 101-000.418 01DO $664.00
KAN CHECK FRE 101-000 439 3 i t3 $133.066
)1t1i< -HAN.1CAL FSE 101-000.421.000 560.00
R .:CTPJC:AL FEE 101-000.4120-000 $119.50
101-Or�Ct)��19-000 $130.0
-
,c��y��.g��s�t,��ryraOME YtK [[��pp..����qq
STR.ONQ MOTIGIN ME °' T4i.+SM `1()'1.L J00-2'41_00?0 $PG,fifi
011ADWO FFE 101-1300423.00 S`151,�50
DEVE ,eGIPER 111 'sib A.CT ME X2,977. t+s7
e Na
,.5, 'r-
`+.��1�
i'31(ai"
1 3 c)P'��A?.�k i
s h c U-513 PRS; -PAM MS
o�
$O q0
FEB 14 2002
L IM? -MT MS D 1400
CffV0FL AQU1t9A
$3,049.62
RECEIPT
DTE
BY 6f
DATE FINALED
INSP
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
- /-
Underground Ducts
Forms & Footings
-
Ducts
Slab Grade
Return Air
Steel
- — Z
Combustion Air
Roof Deck
y - /2 -L
Exhaust Fans
O.K. to Wrap
L -_50-
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
POOLS - SPAS
BLOCKWALL
APPROVALS
steel
Set Backs
Electric Bond
Footings
_
Main Drain
Bond Beam
- _ Z
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
- 2 _ 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
COMMENT�s:
��.//�0.-may
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) -
Installation Certificate: Residential CF -611
Site Address
44-633 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
19 04 1110 11 Wj
SUBDIVISION: Heritage
CITY: La Quints
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.
I
5. SUBMITTED BY Y
I—��, DATE:
Signature Installing HVAC Contractor
10/17/2013 01:30 FAX
INSULATION CERTIFICATE
This is to certify that insuiation has been installed in conformance with the current energy
regulation, California Administrative Cade, Title 24, State of California, in the building located at:
44.633 Franklin Court, Lot 43 Monticello -Heritage, La Quints, California
CEILINGS:
TYPE: BLOW MANUFACTURER: Certainteed Thickness: R-38
TYPE: BATTS MANUFACTURER: Certainteed Thickness: R•13
[a 009/014
GENE C N CTOR: CENTURY CROWELL COMMUNITITES LICENSE #�
BY: TITLE;
PARAGON SCHMID BUILDING PRODUCTS, A MASCO COMPANY LICENSE # 632072
TITLE: ADMINISTRATIVE ASSISTANT DATE: 12/12/2002
Jan 29 Oz 1.1:37a Richard Simpson
INSTALLATION CERTIFICATE
661 947-6889 p.4
gc 3 of 8) CF -6R
ryp?�vvvev d . L�- 3 U,(
Site Aadty. .ti t'/ -- Co 33 PX AN L/ nJ C.o .r (l PErmlt umber
DUCT LEAKAGE AND DESIGN DIAGNOSTICS
_ . DUCT LEAKAGE REDUCTION
Pre%surization'I'cal Rcsullti ((TM (x125 PA)
'fest Leakage (CFM)
Fan Flow
If Ilan Mow to Caloulated av 400 ofal/ton x number of tons. Or m 21.7 x 1104titng Capaoity
111 Thousands of lltull>r, Cplt;r Cal4ulafai valUO b4r0
If fan now is nuatyw>.:d, tartur mownrud value ht -70 e
Loakago Fraction —'Post Loa)tagc/(Moarurcd or Cidoulatcd Fau flow)
Paws if loakago ftaotion s 0.116 ,
❑
Pasta Fail
❑ For AEROSOLTYPE 'SEALANTS ONLY - IMefollowInA diagnostic teNtlng;was completed:
Duel Fan Prc;Aawi talion at rough -in mc:a.5urtxl lcakage (CFM)
CHECK AFTER FINISHING WALL:
❑ Yes ❑ No ❑ Ilimmuro pan tinct or I louw pwallriration total
❑ Yov ❑ No ❑ Vianal Inspuutiun of U1101 Conrccclion.4
❑ ❑
Pass Fail.
iHERMOSTAMC EXPANSION VALVE MV)
YEN ❑ No '1•htxmo-dalio Expausion Valvo (or Commission approved
equivalont) in incatallcd and Awsmmi 6 provided for iaapaction❑
Yon is a pans
1'a.n Fail
❑ DUCT! DESIGN.
1 ❑ Ytm ❑ No RCCA Manual D Denim oaloulalions have txxm oumplutuJ,
(heel Davign is on lbc plans and duct installation matches
phin a.
2. ❑ Yes C1 Nn '17CV 6 installed or Fat flow has boon vorilied. If no TXV,
vorilicd fan flow niatchm dewign from C11- l R.
Mcasumd haat Flow
Yes for both 1 and 2 is a Patin
Pass Fall
❑ 1, Iho undaaaignud, vanity that 1ho ebovo diagnoatiu toct ra4vlht agkd the work I pctforluLd amociatud with the tcm(ia) is in
cunibrmwo witb Iho mquironwnts Ibr compliance owdit I'll,o buihlur yball pruvidu Iho I MRS provider n copy of lho CF -OR
niguod by tho buil&r Ftuployocs or mb-cuntractors certifying that diaguu•1io lasting anJ iuxtallatiou twntl tho mquiromuahs 1br
compliance credit.] -APR 2 5 2009
Tcsls Signature, Data 1whilling Subcoatraotor ( o. Namo) OR
Pcrformcd (;mora) Contmctor (Co. Name)
COPY'1'0_ I3uildi4ll0pn1l1uo1ll
III:RS I'rovidor (irappnoalr(c)
Building Owner ut occuxiatlry
January 4, 2001
4N-�33 �r�RNkl�� Go�rti
Tract # N111
Duct Testing Lot # eft
Certification. Farm
System of I
(One form per system)
Builder Name: (��-►r4'U
Project Name:
Builder Field Contact: Telephone No.
HVAC Company Name:
HVAC Installer: Telephone No. uj0qiqCI U/
Self, Certifier. Results
Duct Leal(age Measured @ 25 PA
(� CFM
Indicate the maximum allowable Duct Leakage and the calculation method used:
❑ 0.7 x Apoor x (0.06) for Climate Zone 8 through 15 CFM
❑ 0.5 x AFloor x (0.06) for Climate Zone 1 through 7 & 16 CFM
400 x (Cooling Capacity in Tons) x (0.06) ZD . CFM
❑ 21.7 x (Heating Capacity in Thousands of output BTU per hour) x (0.06) CFM
Print Name Signature
Date
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
44-633 FRANKLIN COURT
Bldg. Permit No.: 0202-080
Occupancy Group: R3 Type of Construction: VN Land Use Zone: RL
Owner of Building
CENTURY CROWELL COMM.
Building Official
Address: 1535 SO."D"STREET,STE #200
City: SAN BERNARDINO CA.92408
By: GARY SHOWALTER
Date: 08/19/02
POST IN A CONSPICUOUS PLACE