0310-207 (SFD)a" LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
'-PrOfassionals Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
640934 B
,Dale 5'� i.- 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
( ) 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.
(N) 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 11,V� 1(111 .Ye tl�' d �i r° Policy No. iEi+$�Sf
(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 agAp that if I should become
subject totthe workers' compensation provisions of,Section 3700 of the Labor
Coder•I shall forthwith comply with,h-1hos`e•ptovisio ss-- _�_
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 representatives of this City to enter upon
the abo4 mentioned property for inspection purposes
gail
ture/ (Owne/Agent),»�- �-- Date ° �..4
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BUILDING PERMIT PERMIT#
DATE VALUATION LOT TRACT�J
st �...34,0WO.O3
, . ,r , (r .!�
JOB SITE
APN
ADDRESS �Yw'iC. sY PK%R 1AIVE
OWNER
CONTRACTOR / DESIGNER / EN (NEER
LAQ)tWTA Cv1, 02033
11,A.(j� .W— ,';A CA 9261K_ti
�g091�'� an?3'9Uf/ C €P7G
USE OF PERMIT
RINGfXFPIN'.�fJ.Y DWMIWi
SID • LOT crit PLM 1430C.- PERMIT 1.10&3 i OT jNh" LUDF,.K4)CZ
VX:US, P0014 VA OR "DJW*?iXA ' F+.PPW,'�AACH
CUSTOM COWRRUCTION 4 8F
trCFi2,;;kilPr#`1'?i? S �a.tltl ,Sig
YhrrWATED or (70z461nVar10X
114.f "'Act
3P; UP V Yi"`RT =MPAX.RY
CC►NSTRUCT10N. YEE 101 _0(bZ1'_•: tS-000 e1,112,00 ,
PLAN Cil?,CK FEE 101 ..{)Q :'% u:S4r-3 i R $5931 +'trs
MECHANICAL "a; '21-000
V1,111MBWO 1f.T'S". i 61 9�(Xw? 1164.60
��ii�'�]F(ApKi:�2``40 MOTION FEE R173iD 2 (33: 0('; 2 >l1-G�Ct!il. , $123.0
�),1�.AD R -4l3 1�, T 101 ".`Ei;j,..sy:.4,. � "'i}V�.• � �i',�, v�:�
D fZ1,( YER IMPAC'i, FEE $2y4a"t.ait ,
ART IN P110L;C RACUX , RI,S1i 270.000.445.000 SOZ
SUB-TOTAL L:C,'1N1TTR•CTC'Y110'1J'AWD3r.LA1 ty��:yip
,'1art3.07
10.1113 P��-PJfk ti
so.00
NOV 0:4
.2003
R CEIPT BY DAT LED INSPECT
FINANC PT. 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
OX 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
Final
Final
z a
POOLS - SPAS
BLOCKWALL
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
y
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
Ir
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Vottage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
.Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm) (�
APR -02-2004 FRI 11:49 AM'WESTPAC AIR COND FAX'NO, 909 739 9509 "
Installation Certificate: Residential
Site Address
60-281 Prlekly ]'ear Drive
CF -6R
PERMIT it
l.'IMIi,DVA4 iM"OlZMATION 'SUBDIVISION: BDIVISION: Trilogy Cql La Quinta
Chca Hones - Trilogy - I-4Q11iot3 CITY: I.a Qninta
603 14 Trilogy Pkwy COUNTY: Riverside..
I,a Quint 1,. CA 92.253'-7642
INSTALLING CON'fRAG'TOR: WEST PAC Alit CONDITIONING
2.1'It(1JIr.(:'1' rlvTFt)I2MA7TON
ltllt[JTIoN pIJC`1' QR PIPING R-
1 yl>r VALU1'
Flexible Ductwork hlexihlc Ductwork
in Aitic and Will have a,R-Value
llclrvcea Flonrs of 4.2 or Better
P. 08/24
I, llu vcriry.that Ilie equipment lititcd in the category above my signal ure is the acetal egetipment
iirsi,Jled mid Ihot the equipment meets or exceeds. the requirements of the Appliance L'f�ci4ney Standards. n
the
miditinn, llnv,et vcrificd that tltc equipment is'equivalent to or marc efficient than the equipment sl}cci[icd on
Cerlilleate of Compliance; snbmilted to tle:riinnStTate compliance witli the L-nergy RIT-iciency Stand,rrds Cor
rosiduntial builtlings. • ,
3.IIEVrIiNG INFORMATION
1 i[ "k TING MANUf AC"i HEATING UNIT A(:fUAT., EFF. HEATING EQUIP 1113ATiNG
I;QIJIi'. MAKE MOAFL # AI'UT CAPACITY LOAD
F1,1rmce Lcnpox 6401J114811 -090X W% 58000
G40U1`1-36A-070X 80%
4. ('00LIN(: INFORMATION
COOLING MANUFAC I' CoMpIZESSOtt ACTUAL Br,F. CODLING EQUIP COOLING
1;QIJI1'. MAKE MODEL #1 SFEK CAPACITY i.OAD
A/C Lcuuox 13ACC:-048 12
13ACC-036 .. ... _
` 1a building design float, 10.4s iod design be gain rate have been determined using a method specified in Section
150(Ie) of lhv Energy Ef(icicncy Slandards, and are two of the criteria mcd for equihrnent sizing and seleclion.
6:rIIF14NIOS'CATI(: I,,\PANSION VAi.VF (TXV):
Thortnostatic F,xransion Valve (or Coinmisicrn approved equivalent) is installed and access is provided for inspection.
Yes I No j ..j N/A i l
6. St 11i1Vi 1' ffr"D BY
DATE:
Sigeiatnrc Installing HVAC t :ontractnr
1•_
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INSULATION CERTIFICM ci 3 j
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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
s
60-281• PRICKLY PEAR LANE LOT 60, LA QUINTA CA .
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CEILINGS:
TYPE:, BLOW MAUNFACTURER: Certainteed THICKNESS: R-38
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z
WALLS:
TYPE: BLOW MAUNFACTURER: Certainteed THICKNESS: R-13
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GENERAL CONTRACTOR: SHEA HOMES LICENSE #
BY: TITLE:
PARAGON SCHMID BUILDING PRODUCTS A MASCO Company LICENSE # 221517
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DATE:
BY: 'ACCOUNTEPRESENTIVE 5 v
U Gid TITLE: R
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