0310-208 (SFD)�„• 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
?rofessionals Code, and my License is in full force and effect.
License # Lic. Class Exp,
Date
DateSignature of Co tractor
rr"y 1
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 declaration&
( ) 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
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 3'3%#'!'iONALL UNION V Policy No. 71M_�3
(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 ofsection 3700 of the Labor
Code, I sliall forthwith comply with those provisions.
Date:t " i LL.- ? ., Applicar til 4
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 represtentatives of this City to enter upon
the above-mentioned propertyr forjinspection purposes. #
S igna� re �(Owner6Agenb_ � • � �•�-i�-� •., Date • „�,,;.; � *.
BUILDING PERMIT
DATE VALUATION .�qy, LOT
PERMIT #
WiEA
TRACT 30023
JOB SITE I - ADDRESS Qin- � ���'I;���ili�� ;t APN 7 4-270-017
OWNER ,5: CONTRACTOR / DESIGNER / EN INEER
'•itiyi
&W. AHO Fl.a
).,A.,0 N, 1A C''.A 92198.: LA.4,,?U rr,�, CA 9288.3
C,-,09)80303996 czLir (-87 6
USE OF PERMIT
L3MLEYANMIY DYEiRIC
Jnr.., •
WAIS, P001., SF's► OR OR,IV3:'WAY APVRQ,,,kCH
Cl?:tTUM C:(>A6STRUG`^'XON Lp4";'<AA X?
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A!u•Af:J1v.� b:f'h.'lY.•CIR
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160,741 3G
FLTY&f°.W ' i'Hl3'afi • 1ARY
Ci;►NSTRUCIMON Fitly,
101 �0V`0.41 6•000
Nil PO
MAN CHECK "Ik:
-1.01-.000,439-a19
16$5,04-
YWAIA1,?1CAL FEE
101-0t)0.421 TOO
SOMID
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PUZYM N10 WE
1051 .;0t "o -"t1 P-OC10
SIX%
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h�%U�ji�'GNC73�1- �T.'' A R 111
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11Y. R -TOTAL k<<��T..,fsly'I C�"ji�.;,gcX,�1�
aFyNi% .CAlJ•e°'•�.%:9JS1 .C,i'.uCi►1 4dAVx-9
NUV 04 2003
CITY OF LA QUINTA
FINANCE DEPT.
RECEIPT DATEl3Y DATE ED INS
PE�
O
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
Of
Exterior Lath
p
Drywall - Int. Lath
Final
Final
BLOCKWAI
2
APPROVALS
steel
POOLS - SPAS
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
O.K for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
—
Encapsulation
Gas Piping
Gas Test
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:
APR -02-2004 FRI 11 51 AM WESTPAC AIR COND FAX NO. 909 739 9509 P. 13/24
lnytallatioir Certificate: Residential
Site Address
60.259 Prickly fear Lane
1. BUILDER INFORMATION
Stlea Ijollies -Trilogy - T.aQLtlnt3
60311 Trilogy Pkwy
l.it Quinta, CA 92253-7642
INSTALLING CONTIZAC�MR:
2.I-rtME T1NFORMATION
I)TSY'i:lriil'l`1ON
PUf Ult MI-Y'T R-
Flexible. lhrctwurk
Flexible Ductwork
in Attic and
Will have a R -Value.
Iletwt!ell Floors
. of 4.2 or Better
C!+ -6R
PERMIT #
SIJBD1VTSION: Trilogy rt, La Quinta
CITY: La Qahlta
COUNTY: Riv(;rsidc
WEST PAC AIR (Y)N'DITIONINC
1, the undersigned, verify that the cquipnu:,1t listed in the category above my signature is the; actual equipment
intitalled Aird 11lat the cquipmcntmeeis or cxceeds the requirements of the Appliance 13Jficieucy Standards. Yn
addition, Ihavc Vel ifiod that the etluipment is equivalent to or mare efficient than thequipyitent Sp cif lefour ort tl,o
Certiricale of Compliance submilted to demonstrate eoittpbance with the Tinerl,y eY
resideniial Wildinos.
3. 119AT•iNc IN>:c>'1ztvlA'rloN
IiI�,A'f1NCi MANIJFAC"I' ITl'st1TINCYLINIT ACTUAI, L'I�I�. MATING 'Cl'1'Y UQUJI' II LOAD
T?QUCT'. MAKE MOD UL f1 Al U1?
Fern;,ce J,ennox gol:,1104/5X-100 80% 100000
4. (:UOI,iNG TN 110 RMATION
COOLING MANCIFAG"I cOMPRESSOR AC IVAL EFF, COOLWG EQUiP COOLING,
I;QiJIP. MAKE MODEL If SUER C APAC:ITY
Lennon 1,3ACC-060 12 _.
1
['he buildiuC d� si f n heat loss and design heat gain rate have been determined using a method specified in Section
150(11) of tLe l::,tergy WficiMcy Standards, and are two of the criteria used for equipment siring and selection,
�:l'r1�Itn�os'rA'rrr: H�xl�nN:;to�v vAI.Vf,, (TXV):
Ihcrnwsl3lic T"kliansinn Valve (or ComnSisicm approved equivalent) is installed and access is provided for inspection.
Yes t`�(N° I ...� NiA I ..
6. SUDMIT 1 ED 1TY p ,,
a J �
�Q �I Com- — T)ATF,.: L
Signature installing TIVAC: Contractor
e
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INSULATION CERTIFICATE
This is to certify that insulation has been installed in conformance with the current energy
s regulation, California Administrative Code, Title 24, State of California, in the building located at
60-259 PRICKLY PEAR LANE LOT 61, LA QUINTA CA '
CEILINGS: ' : P.
TYPE: BLOW;' `
MAUNFACTURER:.Certainteed THICKNESS: R-38'
WALLS:
' TYPE: BLOW MAUNFACTURER: Certainteed THICKNESS: R-13
GENERAL CONTRACTOR: SHEA HOMES •LICENSE # `
BY: TITLE: I
PARAGON SCHMID' BUILDING PRODUCTS A MASCO Company LICENSE # 221517 s
BY:
• G 'L TITLE: ACCOUNT REPRESENTIVE .DATE: �� e
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