0403-105 (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
Professionals Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
672285 B 6130105
Date 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 am exempt under Section B&P.C. for this reason
Date Signature of Owner
WORKER'S COMPENSATION DECLARATION
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 NATIONAL UNION Policy No. 7165833
(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 of Section 3700 of the Labor
Code, I shall forthwith comply with those provisions.
Date: 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 perm it, -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.
l certify.that I have read this application and state that the above information is
correct. 1 -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 above-mentioned property for inspection purposes.
Signature (Owner/Agent) Date
BUILDING PERMIT PERMIT#
DATE- VALUATION LOT 0403-105 TRACT
$161,253.20 16 30023
JOB SITE
ADDRESS 60-697 OROURKE CIRCLE
APN
764-270-01.7
OWNER
CONTRACTOR / DESIGNER / EN (NEER
SB EA LA QUINTA LLC
SHEA LA QUIDITA LLC
81260 AVENUE 62
81260 AVE14TJE 62
LAQUINTA CA 92253
LAQUINTA
CA 92253
(760)777.6005
CBL;# TBD
USE OF PERMIT
ST-9GT F FAAE.Y DWELL -n-40
.SFD - LOT 16, PLAN 4520C. PERMIT DOES NOT INCLUDE POOL, SPA,
BLOCK MALLS, OR DRIVEWAY APPROACH.
CUSTOM CONSTRUCTION 1,917.00 SF
PORCHIPATIO 177.00 SF
GARAGE/CARPORT 488.00 SF
ESTIMATED COST OF CONSTRUCTION '
161,253.20
PERA= FEE 911AI 7ARY
CONSTRUCTION FEE 101.000.418-000 $85&50
PLAN CHECK FEE 101-000-439-318 $696.68
MECHANICAL FEE 101.000-421-000 $86,00
ELECTRICAL FEE 101-000-420-000 $I 10.36
PLUMBING FEE 101-000.419.000 $146.75
STRONG MOTION FEE - RESID 101-000-241-000 $16.13
GRADING FEE 101.000-423.000 $15.00
DEVELOPER IMPACT FEE $2,405.00
SUB -TOTAL CONSTRUCTION AND PLAN CHECK
$4,326.42
IMS PRFs -PAID FRES
�D.Qt7
TOTAL PERMIT FEES DUE NOW
$4,326.42
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
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01,
INSULATION CERTIFICATE
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
60.697 OROURKE CIRCLE LOT 1016, LA QUINTA CA r
CEILINGS:
TYPE: BLOW MAUNFACTURER: Certainteed THICKNESS: R-38
5. WALLS:
50 TYPE: BLOW MAUNFACTURER: Certainteed THICKNESS: R-13
f
GENERAL CONTRACTOR: SHEA HOMES LICENSE #
Y
BY: TITLE:
r
PARAGON SCHMID BUILDING PRODUCTS A MASCO Company LICENSE # 221517
5 i
i 5
' BY:
TITLE: ACCOUNT REPRESENTIVE DATE: a6Vl
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Installation Certificate: Residential CF -6R
Site Address PERMIT # 1'
60-697 Orourke Circle
1. BUILDER INFORMATION SUBDIVISION: Trilogy La Quinta
Shea Homes - Trilogy - LaQuinta CITY: La Quinta
60311 Trilogy Pkwy COUNTY: Riverside
La Quinta, CA 92253-7642
INSTALLING CONTRACTOR: WEST PAC AIR CONDITIONING
2. PROJECT INFORMATION
DISTRIBUTION DUCT OR PIPING R -
TYPE VALUE
Flexible Ductwork Flexible Ductwork
in Attic and Will have a R -Value
Between Floors of 4.2 or Better
I, the undersigned, verify that the equipment listed in the category above my signature is the actual equipment
installed and that the equipment_ meets or exceeds the requirements of the Appliance Efficiency Standards. In
addition, Ihave verified that the equipment is equivalent to or more efficient than the equipment specified on the
Certificate of Compliance submitted to demonstrate compliance with the Energy. Efficiency Standards for
residential buildings.
3. HEATING INFORMATION
HEATING MANUFACT HEATING UNIT ACTUAL EFF. HEATING EQUIP HEATING
EQUIP. MAKE MODEL # AFUE CAPACITY LOAD
Furnace Lennox G40UH48B-090X 80% 88000
80%
4. COOLING INFORMATION
COOLING MANUFACT COMPRESSOR ACTUAL EFF. COOLING EQUIP COOLING
EQUIP. MAKE MODEL # SEER CAPACITY LOAD
A/C Lennox 13ACC-048 12
The building design heat loss and design heat gain rate have been determined using a method specified in Section
150(h) of the Energy Efficiency Standards, and are two of the criteria used for equipment sizing and selection.
&THERMOSTATIC EXPANSION VALVE (TXV):
Thermostatic Expansion Valve (or Commision approved equivalent) is installed and access is provided for inspection.
Yes ❑ No ❑ N/A ❑
6. SUBMITTED BY,
�S 2�C'x5r'> /V 7�DATE: O
Signature Installing HVAC Contractor
LICENSED CONTRACTOR DECLARATION
s I ..hereby affirm under penalty of perjury that I am licensed under provisions of
• QX ter 9 (commencing with Section 7000) of Division 3 of the Business and
r
Professionals Code, and my License is in full force and effect. -
License # Lic. Class 6p. Date
11
Date-� Signature of ContractorOWNER-BUILDER DECLARATION
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 econstruct 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( f) 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 NAT1C>:° AL WON Policy No. ;16,58:±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 f to become subject to the
workers' compensation laws of California, and agree that if I should become
subject to the workers' compen sation�rovisionebf Section 3700 of the Labor
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit, subject to the conditions and restrictions set forth on his
application. ,
`1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton'agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I_certify that I have.read this application, and state that the above information is
correct. I agree to comply with all Cityand State laws relating to the building
construction,_and_hereby authorize,' representatives of this City to enter upon
the above-mentioned property for inspe'ctioh purposes.
Signature (Owner/agent) DateLft �E
C
BUILDING PERMIT PERMIT#
DATE VALUATION LOT'$ -Y TRACT
✓`, r .i. /'. . i 0411,, « �. 3trt 30023
JOB SITE
APN -
ADDRESS .-697 0R0V].W UTkCI.nw
76*271
OWNER
CONTRACTOR / DESIGNER / ENGINEER
1MA LA QCJ7Ai1'A LT.C:
91MA 1..A QU7NI'A:C:C,
612.60 ANTNUE 62
81260 AVEMM 62
LA QUIN I'A CA 92253
LA gL)TNTA CSA, 92253
(760)777.6005 Ci;3Ch ISD
USE OF PERMIT
SNOUIFAIv YD11111f li- rig
SrD • LOT 16, PLAN 45200. NER,1 UT DOES NOT INCLUDE POOL, SP.A,
BLOCK W:fii,.i:%OR DRffCiWAYAPPROACH.
CUSTOM CIONIST13.Uf:;TK N 1113117.N, SF
POkIC'1.IPATIO 1 171.00 S.P'
0APACiWAI'C3'O T 498,00 9F
E913 A1'191;3 COST 01T C 019��'11ZU C3H
161,2.; .20
CCj1dS'!RUCTIONFEE` 101-000-418.000 $356,50
P),AAN CH rICK P'EE 101-00".39-318 $606.68
MECHANICAL FEE 101-000-.471-000 580100
rLECTRIC-PJ. FEE 101-000-420-000 5'110,36
PL.UA41 INQ FRE 101-000.419.000 5147
iR.OW 3 MOTION FEF: - R.I°a1D 101.000-2d 11 000 $16.13
GRADING FLEX 10.1.-000.42 3-000 $15,00
A!.►iiLrl O pL'7t WAAC'1 ",Z $2,405.00
r
MAR 2 4 2004
CITY OF Ill QUINTA
• FINANCE DEPT. /
RECEIPT
DATE
BY
DAT I L
INSP VTff
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
p _
Ducts
Slab Grade
Return Air
Steel
/
Combustion Air
Roof Deck
�p/�j/Q ��Exhaust
Fans
O.K. to Wrap
�[[ _
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
7 / o41
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
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
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
7
Encapsulation
Gas Piping
Gas Test
_
Appliances
Final
COMMENTS:
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)