0310-209 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
Chapter 9 (ommencing with Section 7000) of Division 3 of the Business and
Professionals Code, and my License is in full force and effect.
License # Lic. Class j Exp. Date
640 j ! :3/31/(4
Dae, iU41 nt�lSignature of Con`t,(actor�
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).
O 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.
(V) 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 VAT:1014AL, U141,00 rr; Policy No. 7165&0
(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 ofthe Labor
Code, �I rhallforthwith comply with &&o a provifns,.,,.......>,a,,;�
Da eE (• !� A lic;;ht r
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, 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 reprgsentatives of this City to enter upon
the above mentioned property.for inspection purposes. ,
Signature ('
Q1,
%r/Agent) ¢ j " I" `� Date ? 4 � a
BUILDING PERMIT PERMITN
DATE VALUATION LOT rl TRACT 3002.3
JOB SITE
ADDRESS ({� J'2�`.f.Q.� �'L.•Js�I'I...
APN 14-M%U'CJa�7
OWNER77
CONTRRA�CCT;OgR /rDESIGNER / EN (NEER
yy� ��.. y9
SIM -Al- k1C��L?V.�i�9
a7371Gi,'a..C�� 117SF�.l .
0U0 ,CEJ A ME 62
81-2 60 ANI: 02
USE OF PERMIT
'?FTt -1.OT 36, .P!.,' N 350SC. �i.ERMI T VMS 1400 rNCJ:#JrjF. P;,(t K
WA M% 1,.,1,3PA, OR GRIV I rWAY APIT00ACH
C WTOM 00NX7RUC110N 2.09!%00 317
Fi9lsi:.HPl. TIO 336.00 ate
1ARA4o:I;,�/::.x RP0RT 1110%00 SF
IT
CONSTRUCTION F&P MIN
lyL0 CHMC1+ Re -9
Mi::%Li=. UCAL F ri 7. ill �G(Ni•::12 i ��tri� S!7�.41t)
ITLEC RICfa..FEE
stij��l ,g�,rslc l l�F 1 Y•g;Ir ,;�. 9.�JCIu $J48. Ct
f;aRJ'C.S3v4DTlOWf S - ItKIlD I.fJI-i3f)(1- 1-f1#fr $Fi410S
OR A SING P'R 101 -CH,10-427 3-000
?JJf;fM)P),FR IMPAC!' FI.E.%
SUB-7K)T: ziL CON AND 1>IM CGEiL091
$4, 5y.0 -
D �+ L=�:3h1 PRL7 _PJk �'
NOV
A',
RDEPT..
CITY OF L
FINANC
RECEIPT
DATE #
BY
DATFE AL
INSPECT 5
i
INSPECTION RECORD
OPERATION
DATE
I INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
SW Backs
Underground Ducts
Forms & Footings _
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
OX to Wrap
F.A.U.
Framing ,.
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulaticn
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath i
Final
Final 3ell
BLOCKWALL APPROVALS
POOLS - 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 r
Encapsulation
Gas Piping
Gas Test 3 2
Appliances
Final
Final Q
Utility Notice (Gass
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fbdures
Main Service
Sub Panels
Exterior Receptaces
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Peen)
COMMENTS:
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INSULATION CERTIFICA .. {_. r=
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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
a
60-308 PRICKLY PEAR LANE LOT 56, LA QUINTA CA
CEILINGS:
TYPE: BLOW MAUNFACTURER: Certainteed THICKNESS: R-38
a '
F
r
'o
WALLS:
TYPE: BLOW MAUNFACTURER: Certainteed THICKNESS: R-13.
s
GENERAL CONTRACTOR: SHEA HOMES LICENSE #
x
BY: TITLE:' r
a PARAGON SCHMID BUILDING PRODUCTS A MASCO Company LICENSE # 221517
BY: �, G "r Cyt TITLE: ACCOUNT REPRESENTIVE DATE: S
- 0
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A
APR -02-2004 FRI 11;50 AM WESTPAC AIR COND FAX NO, 909 739 9509
Installation Certificate-, Residenflil (:F -GR
Site Ad4ress
60-308 Prickly Pear Lane
1.111.1-1 I,I)VAt iNVORriIA'1'IO�x
Shwa I Ionws -Trilogy - LaQuinta
60311 Trilogy Pkwy
La Qoillta, CA 92253-7642
INSTALLING CONTRACfUR:
2, PROJECT I' INFORMATION
1�1�'1'f2lliU'1�1C)N -
�l_Y I' l
Flexible Ductwork
in Attic and
Between Floors
UI igr c)R PIPING R-
VALCJr
FLexihlc Ductwork
Wilt have a It -Value
of 4.2 or Better
PERMIT #
SUBDIVISION: Trilogy (a), La Quinta
CITY: La Quinra
COUNTY: Rivmide
WEST 1'AC AIR CONDITIONING
P. 12/24
I, lha undc►sifncil, verify that the equipment listed in the category above my siZ,,ature i; the actual equipment
in!;taped and that Ilic equipment meets or exceeds the requirements of the; Appliance Efficiency Standards. In
'Iddilion, ]have verified that the equipment is equivalent to or more efficiew than the equipment specified on the
C:e•rtiftcaw of Compliance subnutted io demonstrate compliance with the Energy rlfiicieircy Standards for
residential boildings.
3. 11VA'1 ENG INjr0RMA'I'I0N
I1EA'T1NO MANUFACI' 1111ATING UNIT Ac:�rUAL EFF. HEA'D'ING EQUIP IIFATING
F:Qill]'. MAKE MODLLII. AhUF CAPACITY LOAD
hurnace Lennox 80UH00SX-100 80.% 100000
80%
4, COOLING INFORMATION
C:OOI..ING MANI FACT COMPRESSOR AC'T'UAL EFF, COOLING EQUII' COOLING
liQLllP. MAXE MODET.4 SFER CAPACITY LOAD
A/C Lennox 13ACC-060 12 _..
The building design heat loss and dasilln heat gain rate have been determined using a method specified in Section
150(11) or Il►e FRUgy Efficiency Standards, and are two of the criteria used for equipment sizing and selection.
6 l'plERNIOSTATIC EXPANSION VAJLW, (TXV):
1'hermoslatic ItKpansion Valve (or Commision approved equivalent) is installed and access is provided for inspuctio I
Yes[ No l ..J N/A
G. 41111MIl TI) By
_ A:�L--C—)—L
Sj (;nature Instnlling i1yAC Canlractor