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0203-373 (SFD)LICENSED CONTRACTOR DECLARATION co I hereby affirm under penalty of perjury that I am licensed under provisions of 1- Chapter 9 (commencing with Section 7000) of Division 3 of the Business and N co Professionals Code, and my License is in full force and effect. License # Lic. Class Exp. Date ti LLJ714168 Ole111/0 cZ ti Date.. r� Signature of Contractor - 0 L) OWNER -BUILDER DECLARATION HLU 1 hereby affirm under penalty of perjury that I am exempt from the Contractor's IL !n 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). C'') () I am exempt under Section , B&P.C. for this reason LO N Date Signature of Owner 0 N O) U Q WORKER'S COMPENSATION DECLARATION Cc I hereby affirm under penalty of perjury one of the following declarations: 0 O 1 have and will maintain a certificate of consent to self -insure for workers' { LU compensation, as provided for by Section 3700 .of the Labor Code, for the J Q pefformance of the work for which'this permit is issued. in _J'I have and will maintain workers' compensation insurance, as required by j Q Section 3700 of the Labor Code, for the performance of the work for which this LO L rn permit is issued. My workers' compensation insurance carrier & policy no. are:. IRt Z Carrier 0I3IMM kA.CSI A 11dt3, Policy No. 14W(>644068-03 C) (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 3 subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply With those provisions. Date: Applicant Warning: Failure to secure Workers' Compensation coverage is unlawful and shall subject an employer to criminal penalties and civil fines up to $100,000, in. addition to the cost of compensation, damages as provided for in Section 3706 of the Labor Code, interest and attorney's fees. IMPORTANT Application is hereby made to the Director of'Building and Safety for a permit subject to the conditions and restrictions set forth on his application. 1. Each person upon whose behalf this application is made & each person at whose request and for whose benefit work. is performed under or pursuant to any permit issued as a result of this applicaton agrees to, & shall, indemnity & hold harmless the City of La Quinta, its officers, agents and employees. 2. Any permit issued as a result of this application becomes null and void if work 4s not commenced within 180 days from date, of issuance of such permit, or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that the above information is • correct. I agree to comply with all City,; and State laws relating to the building construction, and hereby authorize representatives of this City to enter upon the above-mentioned property for inspection purposes. T �. Signature (Owner/Agent) J't'" '�- ,Date BUILDING PERMIT PERMIT# tY1.'?iFi--37 DATE VALUATION TRACT U03070,60 Y) 1) 2,419 i-5 JOB SITE APN .ADDRESS ->�1�i.�.l`��it�i WAY 61J�b-n'iP-11F#� OWNER CONTRACTOR / DESIGNER / ENGINEER C leNTURY C'RCW011, CCMMLIN.I.TWES r".1NTU22Y 15351301 017 110117FIr, "TilE, 4200 ? ti35 SO, Tio J7. i'E h711T, l rEl, #200 ;iAId E,F 2AIAi� 111 A �1 Cis 92A.08 SAN f-30:1►fARTANO C.A. 92,108 712o USE OF PERMIT SIrD , WT .17 P1,r° X 3li . PEPAIT DOESNOT IINCLUDF, L3I.taCK 'EVALL.1 Pool, am 0.0- DRI..Vrw&.J,.hPPiJ0ACI.1,-60/6PLAw C><i�.C): ovg RZY.)Urv' ION FOR M111-TIPLZ INSW., NC E OF SAME PI -M4 1"VTE TR. C7 Cc:r1STRUCTION im5so sF PORCIHIPATIC) 9LOtt ur 0AR.AGLYCARPORT 41[$,00 9F J[MTi4A.l XED f.''C.1S'!C OF C'0145°I'R'UCIMON 103,07+0,60 PIMM F'EE SUMMARY CONST 1UC" 101'1 FEE 101 AMOAN-000 PLAN CHECK FFE 101-000-439-:318 2.136.02 MECHANICAL WIN 101 -000-411 .000 $0.00 FLECTWCAL FEE 101-000.120-000 117 414 P11MAM0FF r 101.000419.001 $1X00 STROMt) MOTIUK FES - RIVN I3 101-000.241-i7 O $10.1f 1 10RA15INO W'k? 101-OCKII-423.000 -2010 DEVE--!LOPYR IMPACT G Rli, $1�9Ry.00 693B-TOTAT.CO>;aErrRIATUOzTANO P '(7k1:1:X-X $ 3,034 X> LF,"PS TIRY-PAMFRE2 50,00 Cl_ p TIM, PORMH YKE's nl tt.z .NOW . 2.5,0 44:0" �Y u 1 2002 F Lp►QUIWA aff,0�� R DAT INA INSPECTOR z i N r- [07111 RA 110.2 r , 11 OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings _ Ducts Slab Grade Return Air Steel Combustion Air Roof Deck- , 1---i Exhaust Fans O.K. to Wrap F.A.U. Framing Compressor Insulation . 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 / BL®C WALL AP R®VALS P®®LS a SPAS Steel Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Underground Pibg. Test Final Gas Piping PLUMBING APPROVALS Gas Test Electric Final Waste Lines Heater Final Water Piping Plumbing Final Plumbing Top Out '- Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral Pool Cover Sewer Connection .d2 Encapsulation Gas Piping Gas Test Zd 7 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) ILfiQ y WC COMMENTS: INSULATION CERTIFICATE: This is to.certify that insulation has been installed in conformance with the current energy �.Zegulatlo6, California Administrative.Code, Title 24, State of California, In the building located at: 79-820 Herrings Way, Lot 17,:Monticello-Classics, La Quanta, Californla CEILINGS! TYPE: BLOW MANUFACTURER: Certainteed. Thickness: R-38 WALLS: TYPE: BATTS MANUFACTURER: Certainteed Thickness: R-13 GENERAL C NTRACTOR: CE URY CROWELL COMMUNITIES LICENSE #/fid BY: TITLE: V / VRAGON SCHMID BUILDING PRODUCTS, A,MASCO-.COMPANY LICENSE #632072 BY: TITLE: ADMINISTRATIVE ASSISTANT DATE: 12/5/2002 I CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTICTESTING (Page I of 1) CF -4R . V iect Title Firm:`f�E SEfZT Ed E(2- -5 Street Address:P.0. F_I :pX (�L Copies to; Builder, HERS Provider —TFS-T-cp ►��4/oL Dat—re �— � TLj(zYTE`� Buildere FL;4, am3 A Ian Number Sample Group Number Lo T # )7 _N - SZE) Sample House Number HERS Provider: L°�F� ..E • E• R. =�- City/State%Zip: GilIIc_hiy f j,IKA 4t ?A, )SZ7o HERS RATER COMPLI�A/NCE STATEMENT The house cbas: ❑ Tested L"J 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 101 tfie d,iaenostic tested compliance requirements as checked on this form. 13 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 returns in lieu of ducts) ❑ Where cloth backed, rubber adhesive duct tape is installed; mastic and drawbands are .used in combination with cloth backed, rubber adhesive. duct tape to seal leaks at duct connections. ❑ MINIMUM REQUIREMENTS FOR DUCT LEAKAGE REDUCTION COMPLIANCE CREDIT Duct Diagnostic Leakage Testing Results (Maximum 6% Duct'Leakagel Duct Pressurization Test Results (CFM @ 25 Pa) Test Leak -age Flow in CFM I f fan flow is calculated as 4Wcfm/ton x. number of tons enter calculated value here Measured values If fan flow is measured enter measured value here Leakage Percentage (I 00 x Test Leakage/Fan Flow) _ Check Box for Pass or Fail (Pass=6%or less) ❑ Pass Fail, ❑ THERMOSTA'TI'C EXPANSION VALVE (TXV) ❑ Yes ❑ No Thermostatic Expansion Valve is installed and Access is provided for inspection Yes is a pass ❑ MINIMUM REQUIREMENTS'FOR DUCT DESIGN COMPLIANCE CREDIT ❑ Yes ❑ No ACCA Manual D Design requirements have been met (rater has verified that actual installation matches values in CF -'1 R and design on plan. - U Yes ❑ No TXV is installed or Fan flow has been verified. If no TXV, verified fan flow matches design from CF -1 R. Measured Fan Flow = Yes for both, I and ? is a. Pass Compliance Forms August2001 Pass Fail a ❑ Pass Fail A-16 LICENSED CONTRACTOR DECLARATION I' hereby affirm under penalty of perjury that I am licensed under provisions of L 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 714188 B 10/31/0: Date Signature of Contractor OWNER -BUILDER. DECLARATION. I hereby affirm under:penaltyof perjury that I am exempt from the Contractor's License Law for the following reason: ( ) li 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).. ( ) 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. (.) 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 It issued. My workers' compensation insurance carrier & policy no. are: GOLDEN EAGLE INS.. Policy No. NWC-344068-03 (This section need not be completed if the permit valuation is for $100.00 or less). O I certify that in the performanceof 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: Applicant Warning: Failure. to secure Workers' Compensation coverage is unlawful and shall,subjectan 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_ tinder 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 asa result of this application becomes nulland 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. Signature (Owner/Agent) -Date BUILDING PERMIT PERMIT" DATE VALUATION LOT 02 -373 TRACT s103,070AW 47 24197.5 JOs SITE APN ADDRESS 79-820 E90MC3S WAY 604-072408 OWNER CONTRACTOR, / DESIGNER [ENGINEER CENTURY.CROWEI L CONGAUNrrMS CENTURY CROWELL COL D&UNITIFS 1535 30, 'D' MIRE, T, SPE. #200 1535 30: 'ID' STREEP, SIE. #200 SAN BERNARDINO CA 92408 SAN BERMARDI90 CA 92408 (909)381.60.07 CBL# 2120 USE OF PERMIT SINGLE FAMILY DWELLINO SFD • LOT 17 PLAN 3A• P-ERMIT DOES NOT INCLUDE BLOCK WALLS, POOL, SPA OR DRIVEWAY APPROACH, 75% PLAN CHECK FEE REDUCTION FOR MULTIPLE: ISSUANCE OF SAME PLAN TYPE TRACT CONSTRUCTION 1,713,00 SF PORCH/PATIO 91.00 SF OARAGEICARPORT 418.00 SF ESTDAATM COST OF CONSTRUCTION 103,070.60 PERMPT FEE SUbIMARY CONSTRUCTION FEE 101-000-418-000 $633.50 PLAN CHECK FEE 101-000-439-3.18 $136.02 MECHANICAL FEE 101.000-421.-000 $60.00 ELECTRICAL FEE 101-000-420-000. $117.24 PLUMBINO FEE 101-000-419.000 $130.00 STRONG MOTION FEE- REBID 101-000-241-000. $10.31 GRADING FEE 101.0.0.0-423.000 $20;00 DEVELOPER IMPACT FEE $1,907.00 SUB -TOTAL CONSTRUCTION AND PLAN CHECK $3,034.07 IMS PRE-PAID'FEEB $0100 TMAL MOM FEES;DUE NOW $3 +4A7 RECEIPT DATE BY DATE FINALED INSPECTOR I. 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: 79-820 HEMINGS WAY Use Classification: SINGLE FAMILY DWELLING Occupancy Group: R-3 Type of Construction: VN Bldg. Permit No.: 0203-373 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: 12-12-20.02 POST IN A CONSPICUOUS PLACE