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0309-331 (SFD)LICENSED CONTRACTOR DECLARATION Fpte6yr affirmunder penalty of perjury that I am licensed under provisions of 9 (commencing with Section 7000) of Division 3 of the Business and ofessionals Code, and my License is in full force and effect. License # Lic. Class ;1 Exp. Date e 43 04 ite t; t-," "� "'Signature of Contractor\, 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. (fie) 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: Carrier Policy No. (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 Cone, I Aall„forthwith compl ,WA those prgvisio s DetB: t �a an Applicts t ..t 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. I 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, in & hold harmless the City of La Quinta, its officers, agents and emr es 2. Any permit issued as a result of this application becomes null an 1 work is not commenced within 180 days from date of issuancech permit, or cessation of work for 180 days will subject permit to canc I ti n. 0 1 certify that I have read this application and state that the above inform do is correct. I agree to comply with all City!and State laws relating to the uild g Cl- construction, fconstruction, and hereby,authorize reprresentatives of this City to ent upon the above-mentioned property for inspection purposes. r Signature (Owner/Agehf) �' ' Date r k BUILDING PERMIT PERMIT# DATE VALUATION LOT, f;r()})-;�Tj TRACT / ' %�• .� ''/ �:2tib;`7:$01+ uC)� �t3 JOB SITE APN ADDRESS '�. a-'3•titd ��nafS;.L�k.n�(6�Y 6`s J�,�i^b �il-�� '� OWNER CONTRACTOR/DESIGNER/EN INEER 91-260P'Mi 7L'VZ 8,1.260 AV TUEN ,. LA QUANTA CA 92816 LA Qt)%TA ,. CA (9p2/£,�18 [� 09��.l�i.�sl'.�:d USE OF PERMIT fJ - Y,.0T all; PLA 5'V.00. Pkv RM IT .DOES R'CI ' INC.'J TXX : WALLS, P0?".T1., Yir'w OR MUM, WA irAPPROACH Ci1S'F M C�.)4,5'TR 3C FIOH Z474M SF &'O:-'s1.t31s•`A?'10 3ZT,€tt3 SF ��;9T[i$1!ik2.'71.T9 M;T d32' WIM—MUCUTON oi' Y6,56 71540 7� •�y� pp��+..l �-�v,• ;'p ,/• 8. CONSTRUCTION PTO, 101-_000-A 16.00() 21,014,00 PLAN CHECFa; r AV, 2.OtmObL1 �4��-3IB �aaa.�s MC'KANICAL t 1©.-'i}C�U•:�2: 1-td0�} g3:�D ELECTRICAL 1. S,'.i i?I.}M33T'r30 t?F � 01 o0ct0 t�. ��.Oc,'C $10.0 . 201-EifJ�%-12-f}G(1 $Zn.ti9 OFSJIiE3INO FERZ ' . t l oo ART ill PUB140 i LAO,` 9 • Wltt 210-000445-000 $17,19 9, ]MI Pn-PAr.) 1172M • '7K..V liP,3•r.9.A0.T01,'S.%.�(.C'a �i't'4/Y'*. T 23 2003 rY OF LA QUINTA INANCE- DEPT. RECEIPT DATE BY DAT I LE 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 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 & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath Drywall - Int. Lath cra Final Final POOLS - SPAS BLOCKWAI APPROVALS 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 r- 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 r Q Appliances Final COMMENTS: Final Utility Notice (Gas) ELECTRICAL APPROVALS Temp. Power Pole Underground CondLrit 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# `r'y,�..,.,_.,;././^/:/,r...�•r,.-.::�•nMr•.:.•:.,•.-i•nr.•ri:.•....••,•.,•:.•�.:i.v.•rr:.:i�;-,•,�..•��-,..-r•�iN^i.r':Irv'..••.,:.,•-•.,�..:..•/'•r:rrnrni...•.:.:%•r.•r,.:•.;'.i:'r•.;••...:.::..;..�.�...... • ON CERTIFICATE INSULATI_ .. 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 81-943 PRISM DRIVE LOT -48, LA QUINTA CA ; CEILINGS: TYPE: BLOW MAUNFACTURER: Certainteed; THICKNESS: R-38 WALLS: - - TYPE: BLOW MANUFACTURER: Certainteed THICKNESS: R-13 GENERAL CONTRACTOR: SHEA HOMES LICENSE # BY: TITLE: PARAGON SCHMID BUILDING PRODUCTS A MASCO Company LICENSE # 221517 BY: TITLE: ACCOUNT REPRESENTIVE DATE: c.•r:.. . -.... :�i�.'y.;��.,.,r....r. � i%vr.•rr., r ..'r.!::•/ri:i:!r::�r. ir.�..;'.,i..:,:r/ iii.i.nrin'ri�rin:.....i.r,.:r.•ririri iririri�•rr:�...� ..:r..... •,.....,:./''..�• i.i •. :. r .. -..-.....>:•>:.:.•::r........;�.e-rr.•:::-:,.%�:.....r...�.yr.;.:rr...'rY.'....,.••.r:.7•.r.;.r......>•r�.v.<•::/>•/a'1:'1.Y:Y.•lr.r/.5'?.7^r:.:.�v..-:,..!%/I.!r%l.<..'r..r.r,'••.:.'r•.I •.4:•�. •...: ♦.r. .. .. .. INSkLATION CERTIFICATE. This is to ertify that insulation has bee stalled in conformance;wth�;th rrent energy regulation,ICalifornia Administrative Co e, Title 24, State of Califo, �n the building located at CEILINGS; ` TYPE: BLOW MAUNFACTUREF�: Certa6teed THICKNESS: R-38 WALLS: TYPE -BOW MAUN.FACTURER: Cer� inteed THICKNESS: R-13 GENERA CONTRAdOR: SHEA HOMES LICENSE # BY: TITLE: PARAGON SCHMID BUILDING PRODUCTS A MASCO Company LICENSE # 221517 BY. TITLE: ACCOUN� REPRESENTIVE DATE: . ...:.......,-....•r..n•rr.-....%•.......err:/:/./,y�rr/:isiii•%•...•::.:.....�....•/•...:.:ri....i�anrr.•ri's,/.i•i:•/'i'�../•/•r•..�.•.:.:..,.......... , . r - . APR-02-2004 FRI 11;45 AM WESTPAC AIR COND:. FAX N0, 909,739 9509 P. 01 el J CO Installation ICertificntc: Residential G'F-6R Site ,Address PERM IT # 81-043 Prism I)ri've I. dU,ihlWR TPJP (112idtA'1'YUN SUBDIVISION: Trilogy (r), La Quinta Soca Ilomes Trilogy - LaQuinta CiTY: La Qllinl;l 60311 Trilogy Pkwy COUN'T'Y: Itivcrsidc La Quinia, CA 92253-76.1) INSTALL] NG CONTRACTOR: VVI s,r PAC: ATR CONT)ITIONING 2. PROJECT 1N1+'ORMATiON Ut 'i'RiiiO3TiC)N DUC1' Olt PIPING R- �'Yl'T VALU L t Flexible Dadwork Flexible Ductwork in Attic and Will have a R-Value 1.tetween Floors of 4,2 or 13cticr 1, t1w undersigned, verify that the equipuleut listed in the category above my signature is the actual equipment intitalled and that 1he eglitpinont meets or exceeds the requirements of the Appliance Efficiency Standards. In a4i(lidon, Iliavc verified that'tlie equipment is egtiivalent to'or mc)rc cfiicient than the equipment specified on the C:;rtificate of Compliance submitted to detilonsirale compliance•wilh the Energy Efficiency Standards for residential buildings. 3. Ii ,A'1'IiNG INVORMA'I'JiON HFATiN(T MANUFAC;T HEATING UNIT ACTUAL L+1-F, 1I2AT)N(T F:QUfP ITFFATING EQUip. MAKE MODEL # AVU1i CAPACITY LOAD FUrnacc Lennox 80UIIG4/5X-100 80% 100000 $00/0 4, COOKING INF011MATION (1001JNQ MANUFAC'.T COMPRFSSOR ACTUAL EFF. COOLING EQUIP COOLING BQU1 P: MAKE. MODEL # SEER CAPACITY LOAD A/CC' Leffiiou l3ACC-0160 12 "[1,c huiIdiug design)eat loss Lt design lie at gain rate have been deIermincd using a method specified in Section 150(h) of the Energy Efficiency Standards, and are two of the eriterii used for equipment sizing and selection. 6. i'IIf+:1t IYI(.1:;'1"ATIC EXPANSION VALVi+: (7:ACV): Thormostalic Fxpansion Valvc (or Commision approved equivalent) is installed and access is provided for inspection. Yes [.-'J" No ..I N/A .I. _. 6, SUBMIT"1'1.17 BV Mb,1116 DATE:11VAC Contractor