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0203-374 (SFD)LICENSED CONTRACTOR DECLARATION. CO �,t. I 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 u l Professionals Code, and my License is in full force and effect. O v � License # Lic. Class Exp. Date LU ti 7141R8 3 o Z ti DateSignature of Contractor �Oti I.- OWNER -BUILDER DECLARATION L) W ~ I hereby affirm under penalty of perjury that I am exempt from the Contractor's CD 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 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). Cl) () I am exempt under Section B&P.C. for this reason LO N Date Signature of Owner O� U Q 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. 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 00WEN R1• )LE INS. Policy No. NWC444068-03 (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 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: r n 4 Applicant- Warning: pplicant 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 who -se benefit work is performed under orpursuant to any permit issued as a result of this applicaton agrees to, & shall, indemnity & hold harmless the City of La. Quints, 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 theabove-mentioned property for inspection purposes. Signature (Owner/Agent) r��J t'L 7` /.` 'f Date~ BUILDING PERMIT PERMIT# DATE VALUATION LOT`�•��' TRACT / - .. ;,:,,7x7?- JOB,SITE APN ADDRESS 'I9-8: 6 11MM .NGS WAYW4.072-0108OWNER CONTRACTOR / DESIGNER / EN INEER 4�ff'[MY tROMI.L Ct714'(MAYNITM13 CY "I'M U&C3�1Ji J=;L GC:.1iht£i:f, �:i.i:;3 15+5 00. T" tc-T ET, 017, 0200 1:35 JU, TO1-MMIT, TJM.4200 :_•.AN 1:il bZNARN1140 CA 92408 &AN Tari RHARC1:J WO t:'A 924M (909)381-6007 c'' jafi "WI120 USE OF PERMIT Gt K{1.' NG ? 7 ANM Y DWELLING SPID • LOT It", PLAN 5XB. ,PFRMIT 1308"S NOT 114CLt►DK Bid Cr WA.I.I.o3, I:OUL, SPA OR DRIV'�FPad►4' APPROACH. '75% Ff, +z1i CFiT IF FE, RI?Dt CTIM11-i FOR MUtNIPLit ISSOA,2dCZ OF SAME PIAN 'ryp TRACT CONSTRUCTION 4021.00 -.3F POR CHIPAB O I t.00 sil gA.R:l+,!?FJCARP'ORT 417.00 SY 3.Si ITHA,;L D CGgJC OF COMIRICjC'I'}rJN IIY10,9.i 0 Y'M1M]I'I' FM ROMM R Y CONSTRUCTION 1;FM 101-000-08-000 8.000 $70600 PLAN 101-000-439-319 $147.17 MECHANICAL FER 101�M-421.000 X0,00 FL&CTIUCAL PUY, 101 -WO -420-000 $1,27.38 Yi.,i M 1,1040 PK'F 101-000-419-000 $10,00 STROM0 MOT1014 IYER . RE,SID '101-000-2 91-0©0 971.8 i OR.,A,D.INU PRE 101.000.423.000 S20,0 DEVZLOPEA IMPACT TIZI1, 00 D�2T -'���.+4y�.iq ��EC 1J l.l�.1 ��41:i.,'.MI.�.�.1.�.1.YLr',4S.t ,:`L. S'/.?�L 1•rJ� LIZZ3ya•�,,•yPRE-yE.+(A�I�.1'.� i+:l�M G.(K) T7 g�7'p�•p` ���� 7' PNS.Ii.Ba�d h' �' )EYN" J.T i 1 O YY q �34 •! r 146 CF �4N E QWjgrrq Ojl;pr RECEIPT DATE , BY DA.TEF.INALED INSPECTOR n OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings Ducts Slab Grade — /-D2 Return Air Steel _ - Combustion Air Roof Deck Exhaust Fans O.K., to Wrap — 3'^C F.A.U. Framing -- -- Compressor Insulation S' o 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 i BLOCKWALL APPROVALS POOLS - SPAS steel 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 Neater Final Water Piping Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral Pool Cover Sewer Connection /!(.'.0 Z 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) •O L J COMMENTS: i, 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: 79-806 Hemings Way, Lot 18, Monticeilo-Classics La Qulnta, California CEILINGS: TYPE: BLOW MANUFACTURER: CERTAINTEED THICKNESS: R-38 WALLS: TYPE: BAITS MANUFACTURER: CERTAINTEED THICKNESS: R-13 GENERAL CONTRACTOR: CENTURY CROWELL COMMUNITIES LICENSE_ # • ������ BY:. TITLE: P � .� GON SCHMID BUILDING PRODUCTS, A MASCO COMPANY. LICENSE # 632072 BY: TITLE: ADMINISTRATIVE ASSISTANT DATE: 12/5/2002 CERTIFICATE OF FIELD VERIFICATION AND DIAGNOST:I.0 TESTING (Page 1 of 7) CF -4R Joe Koelaso:ld 158 Builder Contact / ✓ Telephone <uiI N_ hi A 2 n 1"7\w / K 760) S�. 4 ' % O .H'ER at Telephone 64�v ft e -H 14-013L L Cenifying SignatureC Date Finn; �E SE� E k` Ee moi'( �2�TI e -E'5 Street Address: r' D. �:OX 6oZ Copies to: guilder, HERS Provider �,�F5�c� ►�T/off. Date C� jI-Li 2.r I n tv1 ES BuiIderName FLAA 5x13 lan. Number 4 2.o Ll P Sample Group Number z [g'r #t: 113 14•go6 N>Etnt+g14 g Sample House Number HERS Providers L°� I-�.� • E. R. 5 •: City/State/Zip: e -H v f j t (2A 4TSA, '�)2Z7o HERS RATER COMPLIANCE STATEMENT The house was; ❑ Tested L►� 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 thisform comply �k Ith the diagnostic tested compliance requirements as checked on this form. ❑ The installer has provided a copy of CF -6R (Installation Certificate. ❑ Distribution system is fully ducted (i.e., does not use building. cavities as plenums or platform retums in Lieu of ducts) ❑ Where cloth backed, rubberadhesi`ve duct tape is installed, mastic and drawbands are used in combination with cloth backed. rubber adhesive duct tape to seal leaks at duct connections. MIN]MUM REQUIREMENTS FOR DUCT LEAKAGE REDUCTION COMPLIANCE CREDIT Duct Diagnostic Leakage Testing Results (Maximum 61/Q Duct Leakage) Duct Pressurization Test Results (CFM @ 25 Pa) Test. Leakage Flow in CFM If fan flow is calculated as. 400cfm/ton x. number of tons enter calculated value here Measured values If fan flow is measured enter measured value here Leakage Percentage (100 ;x Test Leakage/Fan Flow) = Check Box for Pass or Fail (Pass=6%or less) ❑ ❑ Pass Fail ❑ THERMOSTATIC EXPANSION VALVE (TXV) ❑ Yes ❑ No Thermostatic Expansion Valve is installed and Access is provided for inspection ❑ ❑ Yes is a pass Pass Fail ❑ MINIMUM REQUIREMENTS FOR DUCT DESIGN COMPLIANCE CREDIT t ❑ Yes ❑ No ACOA Manual D Design requirements have. been met (rater has verified that actual installation matches values in CF -111 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 Pass Fail Compliance Forms August 2001 A-16 e Certificate of Occupancy City! of La Quinta, wr 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: 79-806 HEMINGS WAY Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No 0203-374 Occupancy Group: R-3 Type of Construction: VN Land Use Zone: RL Owner of .Building: CENTURY CROWELL COMM. Address: 1535 SO. "D" STREET #200 Building Official City: SAN BERNARDINO, CA 92408 By: STEVE TRAXEL Date: 12-12=2002 POST IN A CONSPICUOUS PLACE