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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
7141 SP/ B IW3IM
Date �'f�/ 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:
() f 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.
1,(/) 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.
. OOLDENEMZE, M3. AM -344062-011
(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: in? J t7 6"Applicant -- :r ^ > • %"y
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 t.
for. a permit subject to the conditions and restrictions set forth on hie,*
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. J � f =
Si nature (Owner/A ent) �A % } +-�'`• r' '��'+ � �• i Date -;�'� �`� '
-BUILDING PERMIT PERMIT#
9
DATE �l VALUATION LOT 02(YJ--CJtt2 TRACT
St42":9I3 /Uig 45
JOB SITE "
ADDRESS
APN
4"581 rkk4XL I (:017RT
OWNER
CONTRACTOR/ DESIGNER /ENN IINEER
rnvdly CTI LCry WY7MRIS
4:1fURyC1hVL CVvaNT0:.3
Y 535 W), "D" ITI + , EI ;1 0.200
133:5 SC. ODD IM�3.,T'a FrX iMOO
SAN LE.3ITAR. XNO CA. 92408
SAN BERN 'R ^, INO C'di. 92408
(909)381-6007 GBLO 2.120
USE OF PERMIT
3F13 • LOT 45. MaN T 10ELLO HZRITAQW, 'K.AN 4B. PERMIT IT DOI S NOT
INCLUDR. 0it ciC .`MALL. POOLVA 011. DIUVENVAY APPROACH, P1.4-13
CHECK PME RMUCED FOP. MULT 1PLZ ISSUANCE OF NAME PLAN YPE
TRACT 4y771RUC ION GN/DO MF
PORCHIPATIO GIG Sy
G«'RAGWCARPORT MIN OF
ESUNI ,7'M COB'S' OF CON91"RUZ�'..i;ION
III -219W.00
'P11.11"a"f.1r PKIE SUNB lis RY
CCsA3STAUCTIM FEE 101.000-418.000 MAP
PLAN C:HEC1C FP.011 101-000-439-318 $165.22
MECHAINiCAL FEE 101.000.42.1*000 N6.50
&WIUC',AL FEF, Z o) _0ii"20-•000 $144,59
Y LvA+lis o ESE 101.000A -151 I $142.00
S;'F'.OX,0 Ev90'1'-4014 PEP, . R1t?.,SID 1014=-M =-M `= $14.30
ClRADMIG AEE 101-000-423-000 120.00
1?WELOVER,1A9PACT IME $1,9K. DD
*•
t
_... ,TJB',Q.TAt, EaOMi'I3.UC110-4, M), :PLAN C,k" `'WK
$3,249,6q�i,'
� II F:a•,; l.d1~r33 PREF-PAID-1 8
$0.00
a
PEW Mp DVENOW
"A t6
FEB 14 7002 •b
C"OI=L.4Q9IMA
RECEIPT
DATEBV
I�
!
DA E FINALED
F-
INSPECTQr
h
r
to 11 . , • 4Z,4 .. _ ti
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
— Z
Return Air
Steel
Combustion Air
Roof Deck
Al —/$—Z 1193,
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
— —dZ
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
-
POOLS - SPAS
BLOCKWALL
APPROVALS
Steel
Set Backs
Electric Bond
Footings
/ — Z
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Li
_
Heater Final
Water Piping
Plumbing Top Out
1/
__j X� - '�
Plumbing Final
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
_
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas) 7- - p 2.
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fbdures
_
Main Service
Sub Panels 17_
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final —�.
Utility Notice (Perm) —7— 7_s- V Z.
Installation Certificate: Residential CF -6R
Site Address
44-658 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
G40UH-48B-090X
80%
88000
G40UH-36A-070X
80%
66000
4. COOLING
INFORMATION
COOLING
MANUFACT
COMPRESSOR
ACTUAL EFF.
COOLING EQUIP
COOLING
EQUIP.
MAKE
MODEL #
SEER
CAPACITY
LOAD
A/C
Lennox
12ACB42
12
12ACB36
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
Qla- A hUAAAAdtj-=
Signature Installing HVAC Contractor
DATE: %,
10/17/2013 01:31 FAX
v KYfv:•..w.ri.'rri:•r.��:pi IIS/MPJ fiiU.'I/v.'//J.'!'/✓r�•/%'ryiV/sV;/: •rJ :sir, rti/I!:r.�.ils'l. ifJPR. HH/YI YI ; %� nLf "L I:`I•',l/f(�ty 7///J �!.'P./IYl/JFI'N/f It/iP.ry /.i/�+•iu: v. ay.VM �. t
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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 Califomia,'in the building located at:
44-658 Franklin Court, Lot 46 Monticello -heritage. La Quinta, California
E IN
TYPE: BLOW MANUFACTURER: Certainteed Thickness: R-38
WALLS:
TYPE: BATTS MANUFACTURER: Certainteed Thickness: R-13
GENERAL CONTRACTOR: CENTURY CROWELL COMMUNrrITES LICENSE P we?
BY. .ldr%lah TITLE:_4- Sid 4' w_
PARAGON SCHMID BUILDING PRODUCTS, A MASCO COMPANY LICENSE # 632072
TITLE. ADMINISTRATIVE ASSISTANT DATE: 12!12/2002
'w,w!,•v.'.ri n�,�.�.�s.r.-: iiu.�icv.r.+w•v �ri.Ttr.•:YJ.ia.•�.;�riiar TiirnVi<r: riitrK/!.:'✓.r.N.�Y/fil Jliwu:/n ivnryvir...Vw.rser..n:rto.•.+way..v..• i�„: rin �.: vr..�r.v.,r i:viiv�•:'
Builder Name:
Project Name:
Builder Field Contact:
FIVAC Company Name:
HVAC Installer:
Duct Leal(age Measured @ 25 PA
Duct Testing
Certificati®n Form
evi,
Self-�Certifier Results
dss
YY- Fig*NK 1, v CQvw.1
Tract # '? Ll `� 7
Lot #
System 1 ®f
(One form per system)
Telephone No.
Telephone No. 67
laV CFM
Indicate the maximum allowable Duct Leakage and. the calculation method used.
❑ 0.7 x Anoor x (0.06) for Climate Zone 8 through 15 CFM
❑ 0.5 x Anoor x (0.06) for Climate Zone 1 through 7 & 16 CFM
400 x (Cooling Capacity in Tons) x (0.06) CFM
❑ 21.7 x (Heating Capacity in usands of output BTU per hour) x (0.06) CFM
Print Name Signature Date
Builder Name:
Project Name:
Builder Field Contact:
FIVAC Company Name:
HVAC Installer:
Sg N r �J
_ L4 y F,z..a Ic �, c
J
• Tract #
Z)4.1, -7
Duct Testing Lot #�
Certification Form
System 2 0i
(One form per system)
C
Telephone No. .
. Telephone No.
('I e';1 -7 3q�i
Self'Certifier Results
Duct Leaka9 a 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 Afioor x (0.06) for Climate Zone 1 through, 7 & 16 CFM
14.00 x (Cooling Capacity in Tons) x (0.06) CFM
❑ 21.7 x (Heating Capacity in Thousands of output BTU per hour) x (0.06) CFM
M
p4- T-0 2 -
Print Name Signature Date
Jan 29 02 11:37a Richard Simpson 661 947-6889 p.4
INSTALLATION CERTIFICATE P c 3 of 8CF-6R
2
V �i �l C� g"
ite Addressy y _ � s g �n fY � li.t/ CO ..>�� Permit umber
DUCT LEAKAGE AND DESIGN DIAGNOSTICS
)J DUCT LEAKAGE REDUCiiON
Prumuriialion Test Results (CTM (a7 25 PA)
'fest I.cakggc (CFM)
Fan I'low
If I'an Flow is Caloulatod am 400 oiioo/ton s numibcr of sous, or as 21.7.x I loaling C:apaoity
in Thouaanda of Btu/hr. ointvr calculatod valuo baro _
If fan flow is misured, cater mcaaurul value hum
Lockage Fraolion —Toil Loakagc!(Muasured or C:aloulated lean flow) n b •03
Pa.% if loakago fraolion 5 0.1% ❑
Pass Fail
❑ For A FROSOL TYTE SEALANTS ONLY- The fallowing diagnostic testing was completed:
Dual Tan Prussurrrnliun at ruugh•in twasuuxl lcakagc (CFM)
CHECK A14I'ER FINISHING WALL:
❑ Yes ❑ No ❑ Pressure pan I" or 1louso pwssurrralioa toxi
❑ Yes ❑ No ❑ Visual Inspection of Duel Connuotiom ❑ ❑
Pa. FOR.
IN THERMOS-wic EXPANSION VALVE (TXV)
•1'h"morlatiu Expang;on Valv4 (or Commission approved
equivalent
; is installed and Acumm is provided for inspection E,
Yes i.. a pace-. Pass fail
❑ OUCT OEUIGN
1 ❑ Yo-, . ❑ No ACCA Manual 1) Design caluulalions havo bcwn uomp141ud,
Duui Ik;sign is on 16o plans and. dual installation imalchos
plans.
2. ® Yon 0 No TXV is fiWallod or !' an flow has been vuriiiud. If no TXV,
vuriliud fan flow niatchos diwig i front CF -I IL
Mcmurod Fan Flow= .
Yas for both 1 and 2 is a Parc Posts Fail
® I, lho undcrsignod, Yurily atmocialed with the teats) N in
cuniormanco with the mquiroments for compliatrua urudit. (Thu builder shall provido die I MRS providur n copy of Ihu CF -61t
Agusd by th4 builder cluployo s or sub-ountractors cortilying that diagnumie (usting anJ immallatiou uwut oho ruquir4luuatt, liir
compliance: milit. f ADR 1 $ 41109
Tc%ls Sigoalum, Data lustalliug ontraoIor1(Co.Namc)djf
) tl
Performed (kocral Contractor (Co. Name)
COPY TO: Building, Departmoal
I IERS Provider (if applicable)
Building Owner at Occuvancy
.)aauary 4, 2001
Jan 28 02 11:37a Richard Simpson 661 S47-6888 p.4
INSTALLATION CERTIFICATE (Pagc 3 of 8 CF -6R
y y./6Sg FR4,Vk 1?n/ CovmT
DUCT LEAKAGE AND DESIGN DIAGNOSTICS
W DUCT LEAKAGE REDUC710N
I'mmuriralion Test Rcsuhr (CTM fill 25 PA)
'fent l.cakggc (CFM)
Nan Flow
If 170n blow is Calculated as 400 oWfon x number of tons, or as 21.7.x I loafing C:apaoity
in Thouaunda of HfAr. onto caloulatod valuo hero
IC fan flow is mcasured, ant r mcasurul value hen:
Leakage Fraction = TcA Loakaga(Nloadutod or C:aloalatod Fan flow) —
Pa�v ifleakagc fraoliou 50.4M ❑
Pass Fail
❑ For AEROSOL TYPE SEALANTS ONLY -Ile following diagnostic testing was completed:
Dual Fan Pressurization A rough -in measured leakage (CFM)
CHECK ANTER FINISHING WALL:
❑ Ya4 ❑ No ❑ Ilm-;sura pan I(ka or I louw pros-suriration tout
❑ Yas ❑ No ❑ Visual luspuution of Duct Connuotions ❑ ❑
Pass Fad
YNERIVI0STA7IC EXPANSION VALVE (TXV)
Yea ❑ No •l'hormoAafie. Expansion Valve. (or Commission approved
oquivalont) 6 instaliLd and AWf.4Y is pruvidtW for inVoolion 1. ❑
Yew i.. a pass Pass fail
❑ ouCT oEs1GN
I ❑ Y,-1 ❑ Nu RCCA Manual D l�vip► oWaulalions hevo txx n oamplcicd,
lhwt Dasign is on Ihu plans and ducA installation malchor
plana.
2. ❑ Yoa [l No TXV is imstallwl or Ftm flow ho,; boon vuriiiod, If no TXV,
variliud.l'an flow match"N darign from CIS-IlZ
Mcasurod Fan Flow =
Yus l'or both 1 and 2 is a Parr Pass Fail
® 1, tho undorsignul, vuay that the aboyo diopomic te.st roaults apd the work I pct1brmut amocialui with thu tcal(N) is in
conliormanw with the fequiroments ti►r aompliance urudit. (•!'ho buihlur shall provido duo I MRS provider a copy of Iho CF -GR
Aguetl by dto builder eu►ployocm or sub-ountraetors certifying that dialraowlio Io.Ving and iu;%tallation utacl the rogoiromenfs Air
compliance iacdil.f _ A. AR 9 /
14ef� �r C79k
'fouls 8igrraturo, Data installing tiubcontrao (Co. Nanrc) 0-
Nafunned General Contractor (Co. Name)
COPY TO: ffuitdiur, "Hrtrnont
1113118 IWAdor (il'applicaldc)
Building Owner' at. Occuvancy
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:
Use Classification: SINGLE FAMILY DWELLING
Occupancy Group: R3 Type of Construction:
44-658 FRANKLIN COURT
Owner of Building: CENTURY CROWELL COMM.
Building Official
Bldg: Permit No.: 0202-082
Land Use Zone: RL
Address: 1535 SO."D"STREET,STE #200
City: SAN BERNARDINO CA.92408
By: GARY SHOWALTER
Date: 08/19/02
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