0310-206 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
c°capter 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
640`434 13 6 31.3 3104
6 I fi t...r'
rDate r� t t .Signature of Cont` te; 't
OWNER -BUILDER DECLARATION
Thereby 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.
(\\,,) I have and will maintain workers' compensation insurance, as required by
IS ciion 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:
Carver lBi::TKruA1. !S'� 10 4 F Policy No.: 17665111;�9
(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' compensattiio'n�provisions of Section 3700 of the Labor
Code, I shall forthwith comply with .those provi§Ions.
Dated'S i�. t», APPlicant! ; r.1
ter' 4 •,..; „•may,- :
`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,rand State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above mentioned property for • inspection purposes.
Ign
lure (Owner/AgentDate
1 10-2 6
BUILDING PERMIT PERMITW110-206
DATE VALUATION tKVti►►{y"TA 20 LOT t39 TRACT 30023
/.
JOB SITE
ADDRESS �- �L !.d�t 31 H!
APN '764-1,70-017
OWNER
CONTRACTOR DESIGNER (NEER
:aHIF-1). H01v
!'.rrTEA I Q^61 S
81 -260AVI'MTR 62
LA QTMVTA 0,..k 92883
-LA QFJDJTA ctil 281"
ext9)833.899r, fMU M6
USE OF PERMIT
alit O.L1y
_
V D •' T'Urr 59, st'aYV voYi:t1. :t ►W,Y I.AY..J._�. Ntt ,{ id►w:!-+ }JL b
'd1 AJ,LS, POOL, Si -..A. (-'>a t)rL:t1f'�",irirAY APPROAC`.H
COMM CO.6Ti<`:1ICTIOV zY37.130 Sly
Pok'"KIPILIO 333.00 SF
QAITLAO:3dCMR OFL t 1 ;0011)
' �RAXYZ 0067 or CON9111MCITxON
232,678.20
` .L. h1Z 91 TACN1&IRY
t"0145TRUC'5701" FE 1GZ•GGEI� I '*il00 Slrl{i :Osti
.
`P:{.AN CHECK F*X 101-00&-4139-3'i8 Vnux
MIEC IVIA,1It"1,.[. )ME 141.00(8-421.000 � t5
XLECTRz"W,. FEE l t tf _t�fllb-�s::',0-OtAt) $ Id3.Q�1
PL11iVtBDIO Mex 101-OM419-000 $1 r2.p0
,
3TRONO MOTiOA tom'" s itl ZZ,Ct 101 -pfd -.24I
ORAI)WO FEE; 101-000-4M-000
ART IN PUBLIC z�LACFS - REW51-R. ,170-000-4.45-000.
G*Li,�i.,'� "•9 `,i%F:1'14A �.�,'�.~t.�_i;'lbi�': V 4� i.��'6 :�� iil�f.'y+�Ly`i�.l'•1��y �.iLA.
�F'r,9.J
y��pL�.l
,h�{g j,', • . . .l6Cri�F�i Fd`iS:.�'�4 e�'�le' a�
p�. /.��rf
wV, 4'4+
•:lCL.YrAL Madr F.E:11?N b!l33; NOW
dwrytlmiWe$ Y
NOV 04 2003
CITY OF LA OUJIYTA .
FINAF` R<
RECEIPT
DATE
BY
1.
GATE FJ ED
�7/
INSP T
-d
-
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
OX 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
BLOCKWALL APPROVALS
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
OX for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Q
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)
COMMENTS:
_.
ti
/%f'ii":'!!.!,"!✓d1'GC%il/W:H!/l%1/!irC•l/.'rV/A.:O/A/A/l/////!/.lJ.'AY/!//N/A/A/A////N/A/A/!I/A/A/!//N%1/!J/N/A/NO/A////A//Y.l
r
e
INSULATION CERTIFICATE 3 1-
This is to certify that insulation has been installed in conformance with the Curren energy _
regulation, California Administrative Code, Title 24, State of California, in the building at
{ 60-303 PRICKLY PEAR LANE LOT 59, LA QUINTA CA
Y
E CEILINGS:
TYPE: BLOW MAUNFACTURER: Certainteed THICKNESS: R-38
WALLS:
05 TYPE: BLOW MANUFACTURER: Certainteed THICKNESS: R-13
f
GENERAL CONTRACTOR: SHEA HOMES LICENSE #
BY: TITLE:
PARAGON SCHMID BUILDING PRODUCTS A MASCO Company LICENSE# 221517
BY: ��{�(�. TITLE: ACCOUNT REPRESENTIVE DATE:
;..! X/i%F%1. S'.//./J/!f.'J%J%%T/I'/;'/:'G///S/A'/X�%!//'//'/I'/!/w'///LYC/P'/O/Ci/%J'Yd"J✓:F/.//G.'/J"//+'/l/l%J/I///F/.%!//%p%/YF//%✓'/L%%/'/.f'/A'/J/P%//.. J'%f/.+/.^%J"/'%F'E'/P%: i
APR -02-2004 FRI 11:50 AM WESTPAC AIR COND FAX NO, 909 739 9509
Installation Certificate: Residential CF -6R
Silc Acldretig PERMIT it
60-303 Prickly fear Drive
.lit,'�IT.hP1R1N1+ORIi9A'I'ION
Shea Ifomes - Trilogy". LaQuinta
60311 TiilohyPkwy
La Quinta; ON 922534642
INSTALLING.. CONT14AC1'OR:
2. PRO, X,"I' INFORMA't10N
$L)0DIVISION: Trilogy(cry La Quinta
CITY: La Quinta
COUNTY: Riverside;
WEST PAC AIR CONim'l'ONING
I)1S'UMBUTION
DUCT ORTIPTNG R-
TVIIH
VALUI's
hICA1110 DuctWC3Lk
Nexible Ductwork
in Attic and
Will have a R -Value
Betwom floors
of 4.2 or Better
P. 09/24
1, tho mulcisi2ncd, verify That the quipment listed in the category above my signature is the actual equipment
insl�lled and that the equipment meas or rxcccds the rcgniremenls Of the Appliance Efficiency Standards, In
addition, Ihnve verified that Ilia, equipment is egnivalent to or more efficient than the equipment specified on the
Cerlikate of C ompliancu submitte.d to demonstrate compliance with the Energy Efficiency Standards for
resirlcnlialbuildinLs,, -'
3. HEATING INF ORMATWN
1111ATING MANUI+A(:'I' IIEATING UNIT ACI'UAI, tl;i . IIEWFING LQUJI, HEATING
EQUIP. MAU M()Di?L # A1118 CAPACITY IAAF
Furnace T,ennox 1igOlT1I-4A8-090X 80% 88000
G40U!1-36A-070X 80%
4.,C'001AtNG 1N1'010IATION
COOLING MANUFAC:'T COMPRESSOR ACTUAL EFF. COOLING LQUIP COOLING
I QI)1M.AKI3 MODEL # SFUN CAPACITY TY LOAD
A/C Lctulox l SACC -036 12 _
13ACC-036 _.......
Ilic; bnildirrt.; design heal loss and design heat gaui rate have been determined using a method specified in Section
150(h) of ilhe 1?ncrgy 171'f iciency Standards, and are two of the criteria used for equipment siAng and selection.
6MILRM()STAi'IC EXPANSION VAT,WjXV):
Thermostatic Expansion Valve (or Commision approved egnivalent) is installed and access is provided for inspection,
Yes �. N/A
�. Si,Isnll l"l lsI) BY
uw'rE:;
,Signature Insta ling HVA(. C,nrltrael'or