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0310-216 (SFD)
IF LICENSED CONTRACTOR DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of ihapter 9 (commencing with Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect. L'Icense # 9ey Lic. Claus Exp. Date rte! DatT f r/� e Signature of Contt<actor� t i._..: c 4..: i 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. (,)1 I have and will maintain workers' compensation, insurance, as required by Seefion 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: Carrier3 Qtf.t1.I.7.13+'3i'�A(1 Policy No. 7!b"833 (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 witAthose provisions.• Dater l (�•-iP�., Applicant 1 s. • 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. II -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 Fepresentativest of this City to enter upon the above-mentioned property for inspection purposes. t { `r� Date Signature `(Owner/Agent) �!��• s PERMIT # BUILDING PERMIT 0310-216 DATE VALUATION a LOT 66 TRACT.JOB SITE ADDRESS 8y,..€ 47111RI&M DWINE APN OWNER CONTRACTOR / DESIGNER / EN (NEER 81.260 AVUIVE 62. 8 1 - 260 AMN, 017 #62. - Lilk QLM I'T.A CA. W382,' '1-.& Qu:1k1Th Cha C ML4 6V. 6 � USE OF PERMIT SP -D - 1,0T S15, PL.A.N 41. VA P hR M IT rc'..StryS>.4 NUT I- U41,01J,,, w. --':JC:& f;+lAGLS% 1 004 SPA OR DFUNTv'e'.A,V A Pt1c.7ACH CUST♦iva?)��9�"i3y4�ryI'�'zREli•'•` NXI 1.94010(0 07 �q POal,'1�1'fIPA 71110 i .?�±l �JP C#.A13d+�L;iCFatd�l�e7�:%fTT `�`�.+�D b'F ESUIVV411111D C('1 7r OF I. RonfrZRZJMON 3,64,1159.10, G' NNS Pltid!''TION nT, 10 1 -WO-1. . B-000 ;ABG7,00 ?i L,AN ^:HECK. IEE .100 :-41Lsrl�_318 $704.4 i+ Ait:E"':14ANIC°AP..1',3Ir 00o-421 -00 �E1IM,TRICAYa� �! ga0 ,. i •y:ytlt?rc!'};r�,:(gEjQ iYfir - $ F:dkS11ryFFE , ST7Rf3140W10TIO1d:qF—w R”,"If.) 401-00D- 41-0Y0- i3PU 1*01-1O.P1.R 101 0 0 0 42,«`,/,00 I?BVi?LOPER 11NIPAC•T 19RUNT CH%(X 1,34•K.97 D n LE; 3 l? 7E-P.Al is , $O,©U NOV 0 4 1003. CITY OF LA QUINTA FINANCE DEPT. / RECEIPT DATE / BY DATE5J A•L✓E/ INSP WT9R • �! i i f1i S 1, " INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs YY4 Underground Ducts Forms & Footings Ducts Slab Grade Return Air Steel Combustion Air Roof Deck Exhaust Fans O.K. to Wrap .p 7 F.A.U. Framing 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 BLOCKWALL o XPPROVALS Steel POOLS - SPAS 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 OX for Finish Plaster Sewer Lateral Pool Cover Sewer Connection Encapsulation Gas Piping Gas Test _ �d Appliances Final Final Utility Notice (Gas) ELECTRICAL Temp. Power Pole Underground Conduit Rough Wiring Low Voltage Wiring Furfures Main Service Sub Panels Exterior Receptacles G.F.I. Smoke Detectors Temp. Use of Power Final Utility Notice (Perm) Zf a � APPROVALS -�— COMMENTS: • i >riat:r+r..z:r,.:%'6-%;ryac%nrnno;on/nrnrn/[rr�nF//.0/F/rn/nrflrnrF/rnrn/nrn,'.%rn/.nr�/rn/nrn/n/nrnrnrF/rr/rornin/nin/a9rn/nrr�rf�rn/rllrzvs/it�;trrn/nr./ccnro/n/nnr�/rlr�M/nrnrnrnrninrsrrF/vrrrr,�r/TU/%n!dan/nn: INSULATION CERTIFICATE 3 )� 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 at. d 81-847 PRISM,DRIVE LOT 66, LA QUINTA CA r CEILINGS: r TYPE: BLOW MAUNFACTURER: Certainteed THICKNESS: R-38 i E WALLS: { TYPE: BLOW MANUFACTURER: Certainteed THICKNESS: R-13 f GENERAL CONTRACTOR: SHEA HOMES LICENSE # A BY: TITLE: r PARAGON SCHMID BUILDING PRODUCTS A MASCO Company LICENSE # 221517 Q - �, BY: CC"Va'44TITLE: ACCOUNT REPRESENTIVE DATE: • I is '/.I'/6%9%!%a'/C/!/i/F/l/F//%l/n%E/A/.f%6%l./�S%!/I/A/I/A/A/J�/6/6/A/A/IS'/E/I./!'/A/A/A/L/B.4/L/A/!/l/A/l/A/6/A/O/A/S/A/A/A/A/A/A/A/A/A/A/!/A/C/A/!/�'/A/P/L/!.•/L/6/A/t'/!/!/I/!/!/l/l/A/!/!/l/�Cf/f%!/1/!%if%J A r , Y APR -02-2004 FRI T1:51.0 WESTPAC•AIR COND FAX NO, 909 739 950.9 111stallation Certificate: Residential CF -6R Site Address 81-847 Prism Drive 1.1sv1 r,1�1<.tz r Ivl� oRn� nrroN S1hc11 lontes - Trilogy - r.aQuinta 603.11 TOON1Y Pkwy La Quinla, CA 92253-7642 1NS'fALL1NCT CCJNTRACI'UR: 2. PiZOJECT 1N'l ORMAT(ON PERMIT #' SUBDIVISION: Trilogy (e)t, La Quinta CITY: Ln Quinta COUNTY: Riverside NVTST PAC AIR CONDITIONING DIST RU11)'1'ION n1JC"1' Olt PiPING R- TYPTs FICXth141)ncty► ork Flexible T)uct\vorlc in Attic and Will Lave a•R-Value 11t;tw&n floors of 4.2 or Better P. 15/24 I, the undejsil;lu:d, verify that the: equipment listed in the category above my signature: is tine actual equipment ifie installed anti that tl►c equipilielit �►ee15 oT exceeds the TequirehicriLs of the Appliance Ff(ieiency St<ecs. In addition, ]l►ays vcriticki that ilia equipment is equivalent to or nmrc efficient than the equipment speciried on the Ceti iFie, toot Con►Plianee submitted to demonstrate complialice with the Energy Bfi7ciency Standards for Tesidrntlll buildin;s. � • 3, 1-t1+ KrING IN1'OiYMA ION MIATINGl MANtJt'A(f MIATINO UNIT ACfUAi, E F. Nr:ATING I QUIP REATING C:QUIP, MATE M41)Gi, # AFUE CAPA:CiTY i.OAD, Fumace_ Lem= G40I,1(1-4813-090X 80% 88000 80% 4, C001,114CY 1NPORMATION ('001-ING MA'NUFAC; c CUMPRI SSOIt ACfUAT„ 4I -F. COOLING EQUIP COOT-ING 1?QUIP. MAKE MODET. /I SEER CAPACITY LOAD A/C: Lennox 13ACC-048 '1'110 buihling &.sip heat loss and design heat gain rate bave been deternuned using a method specified in Section 150(h) of Il►e l;rtcrgy I?fllciency Standards, and arc two of the criteria used for cquipment sizing and selection. 6.7'111�,RMOS't'ATi(' LXPANS10N VALVA; (TXV)t Thennostalie, INpansion Valve (or Cornmision approved equivalent) is installed and access is provide for inspection. Yes No N/A i 6. Sl11IN1111"lt ES) EY llATi:: —1--� Silpnature Tmiallinr HVAC Contractor