0310-215 (SFD)LICENSED CONTRACTOR DECLARATION
, I hereby affirm under penalty of perjury that I am licensed under provisions of
' ,;hapter 9 (commencing with Section 7000) of Division 3 of the Business and
P 6fessianals Code, and my License is in full force and effect.
License # Lic. Class ZExp. Date
f ,s
Date t ? ` Signature of Cor�tractor� �•
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.
(tar? 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 & olicy no. are:
Carrier Ala�l')� NA1, U'rl1.t�N 'Et; Policy No. =t�
(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 agreelthat if I should become
subject to the workers' compensation provisions of`Section 3700 of the Labor
Code, I I hall forthwith comply witFi those provisions. •--•�-=�.•»
Date" � - "" ApplicantZ
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 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 Cfate that the above information is
correct. I agree to comply with all City, andiState laws relating to the building
construction, and hereby authoriz@ represeptatives of this City to enter upon
the
tt �
Date �� v
t�
BUILDING PERMIT PERMIT#��
DATE VALUATION VOYJA.'Pii, ka LOT (j;5 TRACT SCjvr:
JOB
APN
ADDRESS�w)y�lP`I°?.?�,F
OWNER
CONTRACTOR / DESIGNER / EN (NEER
1*Mk HOMES
R1 ••260 AN.?",1UE �y2
31.740 AWNUE 62
Lk CZ•UINT.K CIA 9983
I A kg7 fA CA 9298_
..
Y}tl �,J%�'-�'��•SJ7i� (v.S.78.V:' Z::. �O"J
USE OF PERMIT
-y LA A ,,>, X'111.iE' 4 ".VA • : T,"a Qifii,•./W�g41:�ly�V �V V/•:�Yiyu�ip�V A1�yYry�N I./I�,JiWr i1.�,�
k.
qa�rp� t, t� FL
't+Ys" LI A .�'(. 04 31"' �.±i'n Y3:�'r7 �i.�i�in;'.l' . /.�'.r1 c�.f �t E�.Si CD. ".10Y }4+'r.L�t.CTION .i'O [-.L.AN
CI•IHM MY, DU TO .WT'?i "T 1,Y, ISS1.7KM_'_'Z OF Kadi,M7Z Y%`€ AIT TYPE
��i.�'rr�� �it�l'dtiti>"a't14�)Oil s��>'4Q,�i`• iJ��
PO CWPA'1't: {
CONSTRUM110N ME 'j 01a��t3 �' 1 B-000
I�4.14't� Ct-I�rt`:EC �`;� a• {81 ���)•�39-3 7 t3 $?'i�.4`7
ME' WTICATI FEE 1.01.0001,421.000 $00.00
LLRCTP1C 1 .PB;~''. I'r..16
PIXI'MR AIG FU 101400-4.19+ 000 1146.75
STR.OND MOVOW M < .RZS'1D 1.01-000-241-000 1)6.36
ORAS INO FRIE 101 -000-425-000 S15.00
JEWEj.t' RER I1VlEAC as `6d�fl Ot
�.wL'M:r4rxnX
$)Fc'.,•l.-.3 ee.61
*1, +r
1E.',;55.f?�'i.E"� AT I) Y
.0 v':fid
rNOVQ 70�
RECEIPT FINAr _ATEnco , Ma BY
DATE A
INSP R
/
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
OF
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans 8 Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
-
Drywall - Int. Lath
Final
Final �
BLOCKWAL PPROVALS
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 APPROVAL
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
—
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final 7
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixturesol
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
INSULATION CERTIFICATE
G
F This is to certify that insulation - has been installed in conformance with the 60rrent energy !
regulation, California Administrative Code, Title 24, State of California, in the building located at p.
81-859 PRISM DRIVE LOT 65, LA QUINTA C A
CEILINGS:
s
TYPE: BLOW MAUNFACTURER: Cert' inteed THICKNESS: R-38
WALLS: i.
TYPE: BLOW MAUNFACTURER: Certainteed THICKNESS: R-13
b
GENERALCONTRACTOR: SHEA HOMES LICENSE #
J
f BY: TITLE: e
PARAGON SCHMID BUILDING PRODUCTS A MASCO Company LICENSE # 221517
TITLE: : ACCOI
y UNT REPRESENTIVE DATE:.� Q
!'%1.I+r0'/.'%!%J,ylI1:4/n!!/�,E/ryJlq/pq/q/!J/JI'n!'/�%Y/q///•%/.n'IJ/q/q/J/;!///Y/q/q/!/,q%//q/q/q///J/q/J/q/q/q/q/q/q/q/!///1.%%�//n/)�/jry/q/q/nq/q/q//l%!//l;0/q/q/!/-�I%l.%////q//l/////.ql.//JlJY..q!//d%!/INiV
APR -02-2004 FRI 11.52 AM WESTPAC AIR COND FAX NO. 909 739 9509 P. 16/24
1tnSl illatioll Certificate: Residential
Site Address
RI -859 Tris+n IDrive
1,)I11i11,IDl.I�, l i�I•I� OilTy1AT li)iV'
Shea lionws - Trilogy - LaQuinta
60311 Trilogy Pkwy
La Qt inta, CA 92253-7642
INSTALUTN0 CONTRACTOR:
2. PROJE'CTINFORMATION
13T :'i I:113i l'i:1t�N
U'UC:T ok PTP114G R-
yh1_
VAU P
['lcxiblc 1)actwork
Flexible Ductwork
in Ail ic and
Will have a 1: -Value
Between I-loors
of 4.2 or Better
CF -•6R
PIE1tM111' 0
SUBDIVISION; Trilol;y C? T,a Quinti
CITY: La Quinta
COilN'TY: Riverside
WEST PAC: Alit CONDI'T'TC)NING
1, the undersigned, verify That the equipment listed in the category above my signahtro is the actual equipment
in�talled 111(1 that the Cquihulcnt meets or exceeds the tcquiremcnts of the Appliasiee Fliiciency Standards, In
atldijion,1113V ; vcrii'irjl thlt the CLIuipment is equivalent to or more efficient than the equipment specilled on the
Cvdilicatc OfCon►plianee submitted to dk:wonslratu compliance with the Energy Efficiency Standards for
rc.,idential huildin!rs.
3. 11I NUING INFORMATION
IIrKI'1.fG MANUPAC:T HEATING UNIT AC`FUALUTF, IIFATINGEQUIP
TTrA'T'ING
.1
11QUI1'. MAKE MODEL AFlIE CAPACITY LOAD
Pomace Lcnilox G40UIT-4813-090X 80% 88000
90%
4. C001IAN(S' 1NFOtt IATION
COOLING MANUFACT COMPUSSOR ACTUAL FFF. COOI..ING EQUIP COOLING
VLQUUI- MAKP. MOOF1.SEER CAPACITY LOAD
A1C' Lennox 13AC,C-048 12
The buildis�l; design heat loss tlrut design heat glin rate have bean detcmlined using a method specif red in Section
150(h) of the F�nergy I3fticieney Standards, and arc two of the criteria used for equipment siring and selection.
fi:l'11)H;1tMUg't'ATI(; I�XPe�IVSTUN VALVF, (FXV):
'Iherntostatic Expansion V11ve (ot COtnnli5iOn approved equivalent) is installed and access is provi ¢d I'or inspection.
Yes No �_ N/A I 1
6. S'URNtITTu;I) BY
Sil;niturc lustalling I1VAC Contractor