0310-213 (SFD)LICENSED CONTRACTOR DECLARATION
I horeby affirm under penalty of perjury that I am licensed under provisions of
(;Mpter 9 (commencing with Section 7000) of Division 3 of the Business and
ProtRssionals Code, and my License is in full force and effect.
License # Lic. Class ;Exp. Date
3r3A /04
Date `" ('" Signature of Contractor
Y , m 4..-r u
l;
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, Businbss & Professionals Code).
( ) I, as owner -of the property, am exclusively contracting with licensed
contractors to construct. -the project (Sec. 7044, Business A 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 andwill maintain a certificate of consent to self -insure for -workers'
compensation, ashprovided for by Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
( S; I have and will maintain workers' compensation insurance, as required by
Sed ion 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 ),4,&Ti01TAL CtI JV,4 Ir Policy No. '71Qk4f:•;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 Calitornia, and -agree that if I should become
subject to the workers' compensationprovis,'oris of Section 3700 of the Labor
Code; I y) halljjforthwith complyf itA those pro rs'ion"s'T
Dated [ tJL" Applicarnt- } 5+
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 applicationjand state that the above information is
correct. I agree to comply with all City `and State laws relating to the building
construction,• and hereby aujhorize reprbsentatives of this City to enter, upon
the above` -mentioned property for inspection purposes. f t'
Y Y
Sianaturre (Owner/Aoentt Date
PERMIT #. .
BUILDING PERMIT
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DATE VALUATION xdr1VJ�`ni0JQ LOT � TRACT ,r�Ztl
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ADDRESS !': i�1w�t ' sYl:. >f �i % �x� JOB
APN o 70-0-17
OWNER
CONTRACTOR/DESIGNER/EN INEER
a`u'>
81-240 AVE NUE,. 62
€k 2elo��P•�•V'�e"t�Ti1F 6),
pt A �
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USE OF PERMIT -
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ccaw���t.����`.��1�Y,�:. 111••+�.�t-aa+�-tae ��s��a
FL.kN CHECK l ;f? 101-00439-31 111. 4 7
MY.i,M A14R':A1..�'.<'?'?i~ e014)0 -421430 , ad:si,�Ff
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K1iSADENO AFF? 3 111-13(`,0,423-00 >
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NOV . 0,. 4 ' 2003 . .
CIFINANCE F LA A
DEPT. .
RECEIPT
DATE/
BY '
DAT A D(✓/
INSPECTOR
INSPECTION RECORD
k ; OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
I
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K to Wrap
A
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wail Firewall
Exterior Lath
,
Drywall - Int. Lath
Final
Final 3 6
BLOCKWALL APPROVALS
steel
POOLS - SPAS
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
f
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 9
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 11:52 AM WESTPAC AIR COND FAX NO. 909 739 9509 P. 18/24
installation (.'er iticale; Residential
Site Addrt,"
60-215 trickly It oar I.atle
1. UUIL1)le, K INI oRMA'il'ION
Shca 11air►es -Trilogy - LaQuinta
60311 Trilogy Pkwy
I.a (,)uinta, CA 92253-7642
TNSTAMIN(3 CONTIUCTOR'.
2. P11103 ECT INbOIRMA`f[ON
nlS'f R,l ftIJ-VON
__
'M111",
Flexible Ductwork
in Atdc and
l3c m,cctt NOON
UUC,[ ORP[L'lNrlt-
-vA1.> it
Flexible Ductwork
Will have a R-Valua
of. 4,2 or Better
CF -6R
PERMIT #
SUBDIVISION: Trilogy (� T,a Quinta
CITY: La Quinta
COUNTY: Riverside
WI•.ST PAC: ATR C0NQiTI0N1NG
1, 111c undcrsigne(1, verify that the equipment listed in the catcgnry above my signature iti the actunl equipment
insu11lctl antl that the equipment meets or c\cceds the requireaneuts orthe Appliance L'ff cicncy Standards. In
addition,Ihavtr verified that the eguiprrlcut i5 equivalent to or more eflicient than the equipment specified on the
('t•rtil<c:;�c of C'omhliancc Subntittrd to de►ttonslrlte cont(�lilrtce with the )Energy EFticiency Standards for
r�s{d�ntial buihlin�s. '
3, II lrA1'ILNG TNI ORMATION .
I11?ATTNO MANUFACT IUTAT1NG UNIT ACTUAL EFF, HEATING EQUIP I 11iATING
L:QUII'; MAKC, MODEL 4 AFUE CAPACITY LOAD
1,11rnuce Lennox G40U11-4813-090X 80 % 88000
80%
4. t,'001,1 NG INFOR1MA•i'ION
C;0C11,1NC1; MANUFACI COMPRESSOR ACTUAL EFF, COOLING EQUIP C: T.O^nG
EQUIP. MAKE MODLL if SUER CAPACITY
A/C i,ennox 13ACC'-048 12
Cltc huiltiinS du -sign n hCat loss and design heat.gain rate havebecn detcrtnincd using a mclltod specified in Section
150(h) of the Foivrgy Efficiency Standards, and are two of the criteria used for equipyuenl sizing and selection.
6.'rule'}Zi1 OS'TATIC 11' MANSION VALVE (TXV):
•11,jelntostatie Expansion Valve (or ComnuSion •approvcd prov
equivalent) is installed and access is ided'for inspection.
Yes �/l No ( I N/A I
DA fE:. 'TZ
�1 vignatur.; Installing I1VAC Contractor
/.'.^..iT%7/91.:t'.:%'l/d%Y//1.::Y/,%/!.'J/,%///LJ/4/.!%l/.S//!l/O/.0//!/.�J,:O//J%J//A/.U////.fOm%J/.:1/.�l//!/lJ.::l/9/:�J/.J/.'J//1/N/.:/.;SY//!'/N/.YO//1.:9/.'J/,J/N/JV.�!/^`'.%✓%!/.9/.1/.'!.:'!.'lw'.:'J//I/.:✓/l,///J.r//Y/lJ/•�J/.lfl///.�:
4-1
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 located at
r-
60-215 PRICKLY PEAR LANE LOT 63, LA QUINTA CA
CEILINGS:
TYPE: BLOW MAUNFACTURER: Certainteed THICKNESS: R-38
6
r WALLS:
TYPE: BLOW MAUNFACTURER: Certainteed THICKNESS: R-13
f GENERAL CONTRACTOR: SHEA HOMES LICENSE #
' BY: TITLE:
PARAGON CHMID BUILDING PRODUCTS A'MASCO Company LICENSE # 221517
l
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BY TITLE: ACCOUNT REPRESENTIVE DATE:
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