0203-376 (SFD)LICENSED CONTRACTOR DECLARATION
C 1 hereby affirm under penalty of perjury that I am licensed under provisions of
F- Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
,V UJ Professionals Code, and my License is in full force,and effect.
O.5 M License # Lic. Class Exp. Date
0 LO
I- `� 714166 $ , ! (31� 11 til'
cZ Date ' t' ' Signature of Contractor`'
Cool_
I -'_J 0 CID OWNER -BUILDER DECLARATION
LU LU I hereby affirm.under penalty of perjury that'l am exempt from the Contractor's
rn License Law for the following reason:
Z ( ) I, as owner of the property, or my employees with wages as their sole
compensation, will do the work, and the structure isnot 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).
ce) O Ham exempt under Section , B&P.C. for this reason
NDate Signature of Owner -
m
CJ Q WORKER'S. COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations --
O 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.
06 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 001,0FN EAOL,K YNS"". Policy No. 14WC-S51*4"a--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,
1 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 shad forthwith comply with those provisions'r
J, ,
Date: r, _' Applicant 1
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 3.706
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 inspectioh purposes.
Signature (Owner/Agent).' Date'-' --
BUILDING PERMIT PERMIT# 100;
DATE VALUATION LOT 0,13-376 TRACT
_
�`1.t12.14197•-rp
JOB'SITE
APN
ADDRESS 79478 REMINC4 WAY
6a,1�072_(XXA
OWNER
CONTRACTOR / DESIGNER / EN 1NEER
CIa.'1MR"tl' —MOWF I., 11_'0kA iA+1T`I;"y H
C04i• Cid? Y. CYhO)MALL CUMNIUN1:11-,S
1535 50, "D% S.(:C'�"1', OTL 0200
) 535 PION "D4 NTR1M--1'f M?, FUN
SAR:i3FRNPITA1110 U, 92408Q.4ii..'MAdS:tZO
) CA 924(:r(.:
(S1W1 81�60Ct7 i`—T.L9 7120
USE OF PERMIT
mCxl P: RUAILY VINT , TIM
SPI) - bOT 7C+ PLAW :sflRWk''. PM- NAI'f iiJLS'NOT PiiG3JJ1&P f3i.eC:CK
VIAL14, POC -31, SRA OR T.)11.itlhih►AY"PR0&`H,-A.."K PLAIN cHU,C Fn.
REDIJC'• ION K)R tAAJLT1Pi F tZ'�J•ANC E OFS.NME 1't.,A't1'1`YVE
TRACT C•'t?NSi!'Ri• CTI(h4l 1,-123,00 ap
POOCH/P.ATJO sp
0AR.AC#rUCAI►.T'ORT 41,&00: F
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;I.O�,1�'r'ii:t (1
k"1u'i' 14IRT STTt.6 2y
C+INSTRUCiIOW ".:P: 101 -U00 -08 -NO
PLAN CHWK FP:1? $136.02
MECi1,A1,11CAL M.. 101.0( —11221.000 S600
RISCTRZAL FEE 101-000-420-000 $1 IT 4
Pi,tfMIDID G FFI!'r 101-000.419•000 S11.140;00
STRf'3NO MOTION FEE - RESIV 101-400-211-000 fylv.al
ORADT1,1 1 PEP, 101-000-42.3-000 %110.00
LIEV9*1,.U;f'N'R. IMP,AWT FE, E.
D�: ,.11:1:3= ���'A �Jt:�l TU1?1' Y'��.(.)1��:t..!`+�J• c.'�'F:��:C:fC
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FINA4d�EDEP'r
RECEIPT
DATE
aY r
DATE FINALED
INSPECTOR
Si! I
OPERATION
I DATE
I INSPECTOR
OPERATION
I DATE —TINSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts C
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
F.A:U,
Framing
Compressor
insulation
Y,
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
'Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
57
Final
Final z5-7
BLOCKVVALtAPROVALS
POOLS -SPAS
Steel.
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Undergrounil' bectric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas TestElectric Final
Waste Lines
Heater Final
WaterPipingPlumbing
Final
Plumbing Top,OLd
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
LE �_di
Encapsulation
on
Gas Piping
Gas Test" *
S O -2— 5
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low VottageWiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of -Power
Final
Utility Notice (Perm) 3 7
COMMENTS:
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FOLD REPAIR FOR BROKEN OUTSECTION IN BOTTOM
CHORO WHERE SHOWN. ATTACH A OF 02 2# ADO -M TO
ONE FACE, WITH 1434 NAILS STAGGERED AT Z" OC. DO NOT
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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 of use. For the following:
BUILDING ADDRESS:
Use Classification:
Occupancy Group:
Owner of Building -
79 -778 HEMINGS WAY
SINGLE FAMILY DWELLING
R-3 Type of Construction: VN
CENTURY CROWELL COMM.
Building Official
Bldg. Permit No.: 0203-376
Land Use Zone: RL
Address: 1535 S. "D" STREET #20.0
City: SAN BERNARDINO, CA 92408
Bys STEVE TRAXEL
Date: 12-16-2002
POST IN A CONSPICUOUS PLACE
INSULATION CERTIFICATE '
This is to certify that insulation has been'Installed in conformance,wlth the current energy
regulation, California Administrative Code, Title 24, State. of California, lni the building located at:
79-778. Herrings Way, Lot 20, Monticello -Classics La Quanta, California
CEILINGS:
TYPE: BLOW MANUFACTURER: CERTAINTEED THICKNESS: R-38
WALLS:
TYPE: BATTS MANUFACTURER: CERTAINTEED THICKNESS: R-13
GENERAL CONTRACTOR: CENTURY CROWELL COMMUNITIES 'L NSE # /
BY: TITLE:
SCHMID BUILDING' PRODUCTS, A MASCO COMPANY LICENSE .# 632072
BY: TITLE: APMINISTRATIVE ASSISTANT DATE: 12/5/2002
4
CERTIFICATE OF FIELD'VERIFICATION AND DIAGNOSTIC TESTING (Page. I of 7) CF -411
.r
ect I isle
Project Address ! ' '
J O e 90610 So ld 0) 772'.
Builder .Contact Teler
H,EIVRaiV / Te ler
0. "hA
ertityi h Signatureate
Fnir: DE SE RT 1_..e J E2. `( 1�2\1 I e -E-5
Street A..dress: c7. ��x:62 1
Copies to: Builder, HERS.Provider
Dat— a -- ---,
�_g T,tJ (L I n V-1 iF-5
B"uilder : ame
l FL;A d -315
e Plan Number
- 2,o Li P .
e Sample Group Number
i:o T # ?10 29 -778 1 6,Wu s� S
Sample House Number
HERS Provider: L°,IIf-�.. E , R.`�•
City/State/Zip: (1A-vf � t t A 44 e °A, `2 Z7c
HERS RATEVested.
OMPLIANCE STATEMENT
The house was:. ❑ Approved as part of sample testing, but was not tested
As the HERS rater providing diagnostic testing and field verification, I certify that the houses identified on this form comply
iWThe
e diagnostic tested compliance requirements as checked on this form_.
installer has provided a copy of CF -6R (Installation Certificate.
LJ Distribution system is fully ducted (i.e., does not use building cavities as plenums or platform returns in lieu of ducts)
dWhere cloth backed; rubber adhesive duct tape'is installed, mastic and draw,bands-are used in combination with cloth
barked, rubber adhesive duct, tape to seal leaks at duct connections.
E NIINI.MU`M REQU;I'REM;ENTS FOR DUCT LEAKAGE REDUCTION COMPLIANCE CREDIT
Duct Diagnostic Leakage Testing Results (Maximum 6%u Duct Leakage)
Measured
Duct Pressurization Test Results (CFM @ 25 Pa) values
Test Leakage Flow in CFM 1 O'5
If fan now is calculated as 400cfm/ton x number of tons enter calculated
value here Z 000
(f fan flow is measured enter measured value here
Leakage Percentage ( l'00 :x Test Leakage/Fan Flow) _ )o
Check Boz for Pass or Fail (Pass=6%o.or less) ET' ❑
Pass Fail
THERMOSTATIC EXPANSION VALVE (TXV)
U Yes ❑ No Thermostatic Expansion Valve is installed. and Access is
provided for inspection
Yes is a pass
❑ MINIMUM REQUIREMENTS FOR DUCT DESIGN COMPLIANCE CREDIT
l ❑ Yes ❑ No ACCA Manual D ,Design requirements have been met (rater has
verified that actual installation matches values in CF -I R and
design on plan.
❑Yes ❑ No TXV is installed or Fan flow has been verified. If no TXV;
verified fan flow matches design from CF- I R
Measured Fan Flow =
Yes for both I and'2 is.a Pass
Compliance- Forms August 2001
U ❑
Pass Fail
❑ ❑
Pass Fail
A-16