0310-214 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby, affirm under penalty of perjury that I am licensed under provisions of -
Chap ter 0 (commencing with Section 7000) of Division 3 of the Business. and
Professionals Code, and my License is in full force and effect.
License # Lia Class %) Exp. Date
640934 511W04
Date ' {��"-!�� %' Signature of Contractorr
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 I 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 .l. A-71(,�.P1•,AL J110H F Policy. No. 7101XIi
(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, ANagree that if I should become
subject to ithe workers' compensationrprovi'sion's of Section 3700 of the Labor
Code 'I shall forthwith comply with=those pYrovisions.
Applicant s
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,1'and State laws relating to the building
construction, aInd hereby authorize representatives of this City to enter upon
the aCoVe mentioned property Jor inspection purposes.
SlgnatAe (Ow�dJ'Adent)� ,%w Date
BUILDING PERMIT PERMIT#4���
DATE XZ
r VALUATION �b � %r n� . f LOT 64 TRACT 31. 3
LJ
ADDRESS R P ZJOB SITE
TAX pr AR LAKE
704-270-M.',`
OWNER
CONTRACTOR / DESIGNER / EN (NEER
titE- &h kia IMS
RENA a?6.i dW 1
81-b 60q17MMit
�Q3rE.NTJI�-L
Lk QUIN A 4.A 924;,'123
1�SAIm
CA, 928 91
(909) U33n NKS;-a CY)LA 0976
USE OF PERMIT
HEWMIE FAiLMY 1. �'VE1...tT.M(3
"ir.
"
5 . i.s i ciri, x� sti a� , rc cc�ri► a. tir a Saar : llfa�:t.C, c: ,d.i:« c
WAL1,11, K)01, SPA Eft
Cu'"WA 411() nff?
437.0,31-1
/Py�AJ1i.G'dyI(P(A.T110
.DS!:b.on Yi,Y �
.�M151 ..'#SA."S i rw S.r05 010 N.r4!'NE.d.RUC--1120y17
A-W�M.0
�']6'��•:t�7i lH`'YL'aF: �?';fJ4��aa!'' .
CS3MITRIJCT."Ji't FEE 101..1 -418-000 T"5.0
PLAN f HECK M 1'03....006 439-31 8 4 .0.18
011 .4
MF•C'.HAN,XCAL'ECs, - 1y -.fns`,/0�,3�;+�:A.p?�11-0
�(0�(0� �fp�.96150
P1.1 f1a1B111 t7M1« 1L►1�fi t)�">k =0011 x:11r3.@9
S ,,).O C MOTM)IR FE . ,'st :ASM 1 Eia 0 D-241-000
GRADING FRE 1,01.000,423.000
D,Lr,V1P..00PIGX IM, P.ACT FSE. s�, t:C•�.w
i
►F.[.AI-Its.':C?E "?,
$4,14430
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$4,144.30
V 0 4 1003
CITY OF LA:QUINTA
FINANCE DEPT.
RECEIPT -
DATE r4
F
BY
DATE AL
INSPF�G
�, . �.
a%�
7 0
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
i
Compressor
Insulation
- 0
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
BLOCKWALL PPROVALS
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
-00Encapsulation
Gas Piping
Gas Test
3 O
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacl es
G.F.I.
Smoke Detectors
Temp. Use of Power
Final ic� Z7 4W
Utility Notice (Perm)
COMMENTS: -
APR -02-2004 FRI 11:52 AM WESTPAC AIR COND FAX NO. 909 739 9509
Installation Certii late: Residential
Cly -6R .
rFRMiT 0
Site Address
60-193 Prirldy Fear Lane
1. Itl1IIDER INhQ)%%IATION
SUBDIVISION: Trilogy R I.a Quinta
Sllca I{cun,s-'I'rilnp;y - T..aQuinta
CiTY: La Quinta
COUNTY: Riverside
60311 '[`rilof;Y T1�wy
L,a Qluinta, CA 9225;3-7642
INS'1'AI.L1N(i CONTP.ACTC)R: Wig,%,T PAC AIR CONDITIONING
2, PROJECT INP(➢RMATION
])ItiTRi►11TfIt�N� Ll(1C1_(�RP1PiN(_nR:
YALt F_
Oexible riliCtWilrl' Fjwdble Ductwork
in Attic ,end Will }lave a R -Value
13etw( cn Floors of 4,2 ur Better.
P. 17/24
1, the undersigned, verify tllat tilt; equipntclit listed in the categoryabove my sifmature is the actual equipment
inStalled ailt1 that the CC1lUPTllellt meets ore teceds the regnirements of the Appliance Efficiency Standards. ht
aclditicin, lilaye vc,ri6ed that the equipmenl is equivalent to or more efficient than the equipment specified oil the
Cui tific.lte of Ccintplilrlc: siibtniUcd to detlinnsIrate compliance with the Enerp y 1'sfticirncy Standards for
rc%idcntial buildings.
3. 11111',ATING INp01tMA1110N
MIT A'f'1NCi ATANiII?ACI' IIFATTNGUNIT ACTUAL EFF. IIENrIN CAPACITY
1p HEATING1 OAU
L'Q111P. MAI.1", rAOT)1?LIt AF[JL
Furnace Lennox, (3,40UIi-48R-090X 80 /o
98000
4, cool,ING' IN FORMATION
MAhT3 MI'RLSSOk 1r�UI' COOLING
ACI ALFCOOLINGCOOTfNrMANUFACf MODEL it SAD
IQU11),
A/C L.ciwox 13ACC•048 12
'T'he building design I1cat loss and design hest gain rate
or the criteria ue beet) sed d for equipmentlsi7 ng and gel clo(l specified in uorltion
150(h) of the 1'snergy Efficiency Standards, and are t
6,T11KRM0ti'I'ATIC teXi'ANS10N VALVE,(TXV):
'['hcrnmst ltic 1xpaiision Valve (or Cominision approved equivalent) is installed and access is provided for inspection.
Yes [ No �... I NIA [ .
6.511111 MITfED BY
Signature Mnstullulg [IVAC Contractor
�srn.:r„vso.�rni�r�ri:n�rrnurr�irnrn�;:nivi�rsiiitirvrnrsa¢nviaivinraimviniorninmiaivrvrvirarnrarvivrvii>ioivivmminmivinivivivininrnivinition."°„i✓rare//vivivinrniniviinuirnivmot;ir�n,.a�•n,.rriarri..v,2ssi�.
A INSULATION CERTIFICATE 3.r
This is to certify that insulation has been installed in conformance with the current energy
r
regulation, California Administrative Code, Title 24 State of California, in the building at
r 60-193 PRICKLY PEAR LANE LOT 64, LA QUINTA CA
a CEILINGS: +
G
TYPE: BLOW MAUNFACTURER: Certainteed THICKNESS: R-38
r WALLS:
E � s
TYPE: BLOW MANUFACTURER: Certainteed THICKNESS: R-13 ;
GENERAL CONTRACTOR: SHEA HOMES LICENSE'# 3
e
BY: TITLE: r
PARAGON CHMID BUILDING PRODUCTS A MASCO Company LICENSE #221517.
BY: TITLE: ACCOUNT REPRESENTIVE DATE: i
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