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0310-211 (SFD)LICENSED CONTRACTOR DECLARATION I Hereby affirm under penalty of perjury that I am licensed under provisions of t-'Zapter 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 Jxp. Date .._. 4i � ctor• 1 yr Dae ''; �� Signature of Contra ; d'......w„,�.. OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractor's License Law for the following reason: ( ) 1, 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). ( ) 1, 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 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 $j' ;i'p�r'3h't11�ii °3i F Policy No. 716Py1;I3 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 as to become subject to the workers'. compensation laws of California, and agree that if I should become subject to thetworkers' compensatio6. provisions o#Section 3700 of the Labor Code,'I shall forthwith comply with those provist'4: Date 1 t. I Y 2' Applicant. 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 �^Vip & 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 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 uponq,. the, above mentioned property for inspection purposes. 4 1 .write: ;Signature (Owner/Agent) _ '' Date BUILDING PERMIT PERMIT# DATE VALUATION0 j y4 E� icy } 'j _ . LOT54 TRACT „",.2'"M JOB ADDRESS APN OWNER CONTRACTOR / DESIGNER / EN (NEER GEM HOMEM LA QU.EWrA CA 9%M 1.k QY-TWTA L1& 92M USE OF PERMIT .ae•u , xAst art, K"a..9V1 F-;aw mi & uva:w? adva i 'ld4JX% P001:,11P k Oft V:1RIVIL iA't'APP13Fvtc CH PORCI�VRATIO ��77aiV'h`u �.:.Cd��cM'�csP jRT 114111©f1 UP 221.00 fire 436,0 OF 1W 17W '1 ARfAff C0','q.rj AUCTION 161411010141 6_000 vww cilux- lr elf•; INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Forms & Footings Underground Ducts Ducts Slab Grade Return Air Steel Combustion Air Roof Deck — Exhaust Fans O.K. to Wrap F.A.U. Framing , . p •••e Compressor Insulation 3 v Vents Fireplace P.L. Grills Fireplace T.O. Fans 8 Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath nniwall _ Int I nth Final Final POOLS - SPAS BLOC KWALL A PROVALS Steel Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location Underaround Electric I Final 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 A Encapsulation Gas Piping �/ Gas Test Z i1 raiei COMMENTS: Final Utility Notice (Gas) O 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 Ile Final Utility Notice (Perm) APR -02-2004 FRI 11:50 AM WESTPAC AIR COND FAX NO. 909 739 9509' Installation cer'tifiente: itesideutial CF -61t Sile Address 60-220 Prickly fear bane 1. B1-r1LDVR,iNV0RMA'I'I0N Shea linatcs - Trilogy- LaQ? Iinta 60311 Trilogy Pkm-y I'a Quinta, CA 92253-76-42 iNSTALLING CONI'12AC1'OR 7, PROU07 INFORNIA I1()N PERMIT # SUBDIVISION: Trilogy (,) La (htint:t (TTY: La Quinta COUNTY: Riverside WEST PAC AIR CONDITIONING P. 11/24 �lti;l'kIlt[iTrnrr, , PPCT OR 111PINCT R- '1,Y1'i - VATAM - hlemillbo Ductwork Flexible Dectwork in Altic and WiII have a R -Value 11 tween Floors of 4.2 or Better 1, the utulersipijed, vel-ify that (lie equipment listed in the category'above my signature is the rachial cquihment installed and that the equipment meets orexceeds the tequirements of the Appliance Efficiency Standards. III acl�lltion, 1h4ve verified Iliat the equipment is equivalent to or more efficient than the equipment specified on the eeltificaie of C'opipliance subinitted to dcurunstratc'conipliance Nvith the Energy F,fliciency Standards for ic,idaNial buildinf �.. 3,11FATINt.INFORMATION IiFATING MANIII'ACT 11LArftNCr UNIT' ACTUAL 01F. HEATING EQUiP HEATING li()UiP: MAKL+ MODEL F/ AF11E CAPACITY LOAD Pn'nace Lennox 80UI1G4/5X-100' 80% 100000 80%, 4, COQLiNG I1NVORN4ATION (,'O0LlN0 MANIIFACT COMPRESSOR 'ACTUAL EFF. COOLING EQUi13 COOLING E,Q)UlP. MAK F, MOULL #/ SFFR CAPACITY LOAD A/C Lennox 13AC0-060 l7 Tho buildhip, tlo-Ogii befit loss and design beat gain rate have been determined using a method specified in Section 150(h) of the,Encrl y I?fficiency Standarcls, and are two of the criteria used for equipment sizing and selection. b.TIIF:l2MOSTA'I'iC F,XPAN&ION VALVlr, ('I'XV): '1lierriiostatic Expansion Valve'(or Commision approval equivalent) is installed and access is proviticdrfor inspection. Yes . No L. I N/A L...l 6.81111>v1fi1" 111) RY DATE: Signature Installing fIVAC Contractor i ;.. »<:•s..•acr>us:r.arr„mir::r u�s;vc.z�sc:v,::nrrsariacaiynirr„ric�uiisigi.�sr�ir�rnmins::c:�iviinc�irsiairfrrnacyioi.Amina./c.�s9ioioisi.�iviorrrii✓asii.%ir�rornirr.:oi�ar;rc�i�tca:�iw,:airiisvivimr�ttra�;aiL;z✓icv:;, a INSULATION CERTIFICAI This is to certify that insulation has been installed in,conformance with the current energy °' P regulation, California Administrative Code; Title 24; State of California, in'the building located at, - r 60-220 PRICKLY PEAR LANE LOT 54, LA QUINTA CA CEILINGS: TYPE: BLOW V MAUNFACTURER: Certaintead THICKNESS: R-38 r . G WALLS: TYPE: BLOW MAUNFACTURER: Certainteed' THICKNESS: R-13 d GENERAL CONTRACTOR: SHEA HOMES LICENSE # BY: TITLE: r PARAGON SCHMID B ILDING PRODUCTS A MASCO Company LICENSE # 221517 BY: l TITLE: ACCOUNT REPRESENTIVE DATE: `- i i d I/J1YJ%✓:•`iV.•J/1..7/Y'.,:!%/iYI/•H..f%'.J.:O:/Jry%/%/%/,/.!S%//YHU%1//.%J9;r/1.W%!?.%//d/q(.(Y/1%/IY!%qi//.%1////%J.%//I:IJ/%l%f,/J'/d%/%l///%li0//1/%/./ii///1//J//%/!/%i/////%✓'H%JllfJ!%Y.%d'%!:'I:O/Y//stili'/!•%//I'A:%1�F.1'.I%� , 1 . - . I -