0403-110 (SFD)LICENSED CONTRACTOR DECLARATION
.I hr•Aeby aff; m under penalty of perjury that I am licensed under provisions of
CFiapar.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 EY Date
Date'Signature of Contr ctor, � �
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 p(Operty, 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.
Y)ioI have and will maintain workers' compensation insurance, as required by
S ctn 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 Policy No.
NATIONAL 11N1014 7165333
(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 whiff f this permit is issued,
I shall not employ any person in any manner so as t�{thabecome subject to the
workers' compensation laws of California, and agrg t if I should become
subject to the workers' compensatio provisions�of Section 3700 of the Labor
Code shall forthwith comply wffh those ovisio--
Date: l) 'AvPPlicar --' (►
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 Cotde, 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. I
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 S�felllaws relating to the building
construction, and, hereby authoring represegatives of this City to, enter upon
the above-mentioned pr�,perty,for i spectio' purpose
Signature '(Owner/Agent.Date
d� BUILDING PERMIT PERMIT#
DATE VALUATION LOT TRACT
Vit. 'c" r/ Qt?�� 11Oil2'
JOB SITE
APN
ADDRESS •
60-702 OR-01Ia2KE a4.CLF -
764-270-01.7
OWNER
CONTRACTOR / DESIGNER / ENGINEER
ff-B-PA 1A QUIN'rA LW
$? 260 AV EITUE 62
81260 ANTNUE 62
'L Ai QtYN'i'A .Q& 92253
L&QTJIN--T-4, f2A 92.253
(76tips77-6005 CB14 '.MD
USE OF PERMIT
SOD - LOT11, PI.R W 45208. 1?F_nIIT DOES i%3+.;LUDS P001'
SPA. 'BLOCK t .t,%, ,lift DpwvciwAY APPROAC H,
CUSTOM CONSTRW11ON t,€9%po )qF
P{;/1+.L`t'iPl AT10 _ 7 ' llwo0 SI*
OARAOEICA.RTIORT SUN 3F
WII'S:id.TA110 C09 OF C!f3.RW WC110M
1441%520
:I ;,' f 1x'1 R 30MMAIRY
OYAST RUCTION 1' ER 101 X000-418.000
PLAN CtiCfwK 101-000.439-:318 $644.92
WiW.HKOICAL FE101.000.421.000 03,50
B-LA;I." RWAL tgZE 1011-000-420-000 $104.00
S: RON0 ,101'101'1 FU. • l�. 51D 1012.000-241-000 $14.49
CSIL,ALiiRIG E't% 101-000-423-00%
i?j'r4'?'fifJFbl1?.J7v3P�3CT REE $2,403.00
-1CS LCL) 10N .4M PLAN C=CR
'FR&
$4,1-7 Fi.i
.1x= -PPM fb
$0100
MAR 2 4 2004To,1)ERivi`k1.. S.1),TMIT Ig0W
X4,17&"
CITY OF U. OU;kfTA
FINANCE DEPT
RECEIPT
DAA �,�,
BY I f
DATE77
INSPECTQR
(rA'f
. Mpv
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
Insulation cf
Compressor
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 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 APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans Z
O.K. for Finish Plaster
Sewer Lateral W,10 7
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:
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A r
INSULATION CERTIFICATE:
M
This is to certify that insulation has been installed in conformance with tho current energy
regulation, California Administrative Code, Title 24, State of California, in :he building at y
(J r" -
60-702 OROURKE CIRCLE LOT 1011; LA QUINTI► CA
CEILINGS:
TYPE: BLOW MAUNFACTURER: Certainteed THICKNESS: F.-38
.WALLS:
TYPE: BLOW MANUFACTURER: Certainteed THICKNESS: R-13
GENERAL CONTRACTOR:'SHEA HOMES LICENSE #
BY: TITLE,-
PARAGON
ITLE:PARAGON SCHMID BUILDING PRODUCTS A MASCO Company LICENSE # 221517
BY: �ITLE: ACCOUNT REPRESENTIVE' DATE: "! d
Installation Certificate- iteAdclati�,l C'➢<-6�
Site Address PERM IT it
GU -7U2 Orourlcc Ovelc
1. BUILDER INFORMATIO1VSI.II�I)IV15lUN: "Trilogy (i) LUQuiuta
Shea homes -Trilogy - LaQuJnta Cl. t'Y: 1 Qkliwta
81260 Ave. 62 COUNTY: Riverside+
Uil Quillttl, CA 92253
INSTALLING CONTRACTOR: WI?S'I'_P ACI Alit CON DI'l IONINO
2. PROJLCT'iNFORMATION
DiSTIZI13LJ NON DUCT OR PIPING it -
TYPE VAT -M!
hlexible Ductwork Flexible Ductwork
in /Attic and Will have a It -Value
Betw'cen Floors of 4.2 or 13eUer
y
1, the unhicrsigned, verify That (lie cquiplacnt )ist;:d in talc culcgory abovc,ny Si -nature is thea ACILM1 ceJuipnl(:nt
itistailed and that the equipment meets Or cxCMISt},e I-C(Iuiraneuts oftho'Applicmec Ialirirucy Elan+I;tt'+Iv. h,
addition, Ihave vcrificcl that the equipntcnt is equivalcnt to or mote d1wient thin dtc cyuil)I`kt:ut :,J)C iI1ICd ilii alt,:
Ce,-titicate ol'Compliance submitted to dcnuutsU•atc eumpliunce will, the U.,Jw.rgyM'licie;ttcy slondwiis fur rCSiduntiol
buildings.
4 3. HEATING IKIZORMATION
11LATING MANUFACT III:ATINCY UNIT ACTUAi. F,1 1'. iiliM INCi I'QUJP I I1;A'1'INl-Y
L'QUII'. MAle U MODEL # AFI RT CA PAC ITY LOAD
Furnace Lemieux (AIDUH/1813-090X. 80 % 88*00
80 Mo
4. COOLING INFORMATION
COOLING MiANUMUr COMPRF.MOR ACTUAL 13FF. COMM, EQUIP C:OOLINO
):,.,Quill' MAKE MODU.## SEER CAPACITY 1A MD
AX Lennox 13ACC-048 12
The building design heat loss and design heat gain rate have hccn determined 11:ihlg a 1110th0d t,J10600d'in ;icctic,h
150(lh) of the: 12-ncrgy Ufficiency Standards, and arc: two o.T,lic criicria utieil ror equipment siriti and selection.
6,TIJERMOSTATIC EXPANSION VALVE, (TXV)-.
Thermostatic Expansion Valve (or Commision approved equivalem) is bislallcd and ,,^.Cccm is provlj&d aur iw,Jxu:tiutn.
YC, ta'"; No i I P,IIA .
G. SUBMr1"I`E:u JIM
Signature Installing I1VAC Contractor
10' 'd 6096 6£L 606 'ON XVJ ONOO NIV MIS9M WV £9:LO NOW POH-LZ-M-
Daily Horoscope • • Page 155 of 239
9/24/2004