0310-210 (SFD)LICENSED CONTRACTOR DECLARATION
Uf ;Shereby affirm under penalty of perjury that I am licensed under provisions of
H Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
C'4 w r -A Prd essionals Code, and my License is in full force and effect.
O =) Crj License # Lic. Class Exp. Date
t�
Z r-_ Dat' Si nature of Contractor,,
CD O
��O�r ® I f
C) / OWNER -BUILDER DECLARATION
W W I hereby affirm under penalty of perjury that I am exempt from the Contractor's
~ U) License Law for the following reason:
Z_ ( ) 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). •
ce) () I am exempt under Section , B&P.C. for this reason
U')
O N Date , Signature of Owner
rn
Q WORKER'S COMPENSATION DECLARATION
IL
CD Cc I hereby affirm under "penalty-bf-perjury one of the following declarations:
0 () 1 have acid will maintain a certificate of consent to self -insure for workers'
X W compensation, as provided for by Section 3700 of the Labor Code, for the
0Q performance'of the work for which this permit is issued.
100
Q (j) I have and will maintain workers' compensation insurance, as required by
0 U Q Section 3700 of the Labor Code, for the performance of the work for which this
a rn H permit is Issued. My workers' compensation insurance carrier & policy no. are:
? Z Carrier Tx. T1.1.)24AL M4 (Xq 1:: Policy No. 74
w 5
r-0
J (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 a��to become subject to the
workers' compensation laws of California, and agree that if I should become
subject to the workers' compensat on provislons�ofo'Section 3700 of the Labor
Code, l shall forthwith comply'wlth �h�'ose provis
,Date: ti •..a? �'F; l Applicant i
y Warning: Failure to secure Workers' Compensation coverage is unlaWfUlr 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 representatives of this City to enter upo
the abovelmen��tloned property for inspes/oon purposes. }
Sig tiarls (Ovn�erlgent3;# �� 6 ��-^ `' Date, t
PERMIT #
BUILDING PERMIT
DATE j VALUATION S133,.X67.50 LOT 55 TRACT ';0013
JOBSITEADDRESS f 4nF'R(atJ '.:s31
APN
OWNER
CONTRACTOR / DESIGNER / EN (NEER
; ffiAr HOMO
yy)6AArr�ESt�gYty
6
0A 92883
:(..A tl w,"k CA. 's)2W
( Ki +�t333.4 fi i:'r5L-4 15176
USE OF PERMIT
S 'D • La fl9, 044%.e -fi4py.:tlh. -,1 st ,! R' o.ailL�i l L) E INU11. L A%1AJ.0 •3i. .
WALM, P0014 9 PA, ",!IFt OACH
SGC)i��J,C�Tr1',i�fQ,�•Ar/:�i3.T�t't37�`3y'/?.Qfni[�i}F'
-t T" wl .1 T� COX 3 r Or t:°t����1'�'YyC311.011
1331,9 i -501,
PERMIT IMT 90MUMARlY,
COHITRUCTION BI
PLAN CHECK VU Y®r,1 0,56-,4,3 9--11
uii/�,NI�.11�..Tr�a�; l �? i •t'.s4:��.�a;�1 ��i�'U �:,:4tt '
rf,Li".CTRJC;A.LYe8'E lot -.00.0-420-000) - •' 06.63
~�I.,i1T";�I3T310F'�T� TAT^t3of'� 3T�ndQ�7 $±t�.p�';
STRON13 MP2`IM4 F w,-.W8fD 101.0101 4 -CLOS? Y3 1,3F
S2:L`ir'EI.,0P.tRIMPArl"T x!"21'
005-T<YrAL coi r: A1i:t:ia riot jam
$4,110.55
� y'(�}�-'��..]t�ph��Ty'����'�7'HyT�1. r`' CC��
DITE nOW
�Y'71:ti.11�• w�
NOV 0 4 1003
CI7y OF LA QUINTA s'.' _
FIN
RECEIPT ATE Z
BY /
DATE PIVLED,
INSP. 0T
'
.a
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 3
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
BLOCKWALr
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
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'
-
Encapsulation `
-Gas Piping
Gas Test
Appliances
c/ O
Final
Final
Utility Notice (Gas)
ELECTRICAL
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wirinc
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
APPROVALS
COMMENTS:
APR -02-2004 FRI 11;53 AM WESTPAC AIR COND FAX N0, 909 739 9509
ittst:rld:ttidt>t Ce1•tifteate: Residential CIS -6R
Sifc Acltlress PI tuviI I fl
60-286 Prickly rear 1Lnne
1. ]it)i1,DE it INFORMATION
Sbca Ilonics Trilom - I.iQuinta
60111 Trilogy Pkwy
La Quiala, CA 92253-7642
INSTALLING CONTRACTOR:
2, 11,1tOJh,CT INFORMATION
I � f S� Cd:113UTit �N
TYf'1
Flcxiblo Ductwork
inAItic and
Itettive('it floors
i)Z 1CT It 1'1i TNG R -
VALUE,
Flexible Ductwork
Will have a k-Valuo
o£4.2 or Bettor
SUBDIVISION: Trilogy a, Ln Quinta
CiTY: La Quinta
COUNTY: Riverside
Wh:S'1' TAC AIR CnNIffIONING
1, tbo undersigned, verify that tile, equipment listed in Clic category above my signature is the actual equipment
iUStallc d and that the eduipmuut moots or exceeds the requirements of the Appliance Efficiency Standards. In
.A,lition, lhfiv4 veiilird t}int the equipment is ccluivnlent to or more efficient than Ole equipment specified on the
C'erfif cafe of Copiplianco submitted to demonstrate compliance with the Energy Efficiency Standards fur
ruwidrntial buildings -
3. HEATING INFORMATION
P. 20/24
IIf3A'TIN(i
NIANUFACI
HEATING UNIT
AC`T'UAL FFF. IiVATING SQUID 11FATING
I;QUiP.
MAKE,
MOTDT 1, #
AFUE CAPACITY LOAD
rur�utee
l.etvtox
040UTI-4813-09OX
80% 88000
80%
4, CUnl,1NG
INFOUMATION
Ct)OHNO
MANUFAC'T
COM11PX--SSOR
AC'fUAi, ECF. COOLING EQUIP COOLING
TOAD
rQUip.
MAKE
MODE L#
S1ER CAPACITY
A/C
Lennox
13ACC-048
12
T h: building clesibn heat loss and drsirn heat Fain rate have been determined using a method specified in Section
150(h) of lite 1!11crgy 1?fliciency Standards, and are two of the criteria used for equipment sizing and selection.
6.TJ-WP-NTl1ti'r,�TIC EXPANSION VALVE (TXV):
Thernw ,latic 1?xpnnsion'Valve (or Convnision approved equivalent) is installed and access is provided for inspection.
Yes �lirNo I . I N/A
6. S1113MI`I"fRD BY
ff ��-
Sil;nahirc Installing I IVAC Contractor,
f
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 1
60-286 PRICKLY PEAR LANE LOT 55 LA QUINTA CA
CEILINGS:
TYPE: BLOW MAUNFACTURER: Certainteed THICKNESS: R-381 '
WALLS: I
teed THICKNESS: R-13
TYPE: BLOW MANUFACTURER: Certaint
GENERAL CONTRACTOR: SHEA HOMES LICENSE #
i
I f
f
BY: TITLE:
.
PARAGON CHMID BUILDING RODUCTS A MASCO Company LICENSE # 221517 i
j 2
i
BY:
l
TITLE: ACCOUNT REPRESENTIVE DATE:
4V 6