0403-109 (SFD)1 1.,;.eL. affirM.1,tr r.,,r � �vn �.ICTOR DECLARATION
ChdC;*p. 4'-'witrider penalty of perjury that I am licensed under provisions of
yrrdpter 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
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:
Carte 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 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 isnot 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,''ag�ee 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#
0403-109
DATE VALUATION LOT TRACT
$159,947.70 '12 30023
JOB SITE
ADDRESS 60-724 OROUREE CIRCLE
APN
764-270-017
OWNER
CONTRACTOR / DESIGNER / ENGINEER
SHEA LA Q=I A LLC
SHEA LA QU1NTA LLC:
81260 AVENUE 62.
91260 AVE241-TE 62
LAQUINTA CA 92253
LAQUIISTA CA 92253
(760)777.6005 CBL# TBD
USE OF PERMIT
SINGLE FANULY DWELL NG
SFD - LOT 12, PLAN 5505A PERMIIT DOES NOT INCLUDE POOL, SPA,
BLOCK WALLS, OR DRIVEWAY APPROACH,
CUSTOM CONSTRUCTION 1,847.00 SF
PORCH/PATIO 536.00 SF
GARAGE/CARPORT- 456,00 SF
ESTIMATED COST OF CONSTRUCTION
159,947.70
PERmrr FEE summARY
CONSTRUCTION FEE .101.-000.418-000 $249,50
PLAN CHECK FEE 101-000-439-31$ $681.84
MiECHANICAL FEE 101-000-421-000 $66.50
ELECTRICAL FEE 101-000-420-000 $107.27
-PLUMIBINO FEE 101-000-419-000 $124.00
STRONO MiOTION FEE - RESID 101-000=241-000 $15.99
GRADING FEE 101.000.423.000 $15.00
DEVELOPER IMPACT FEE $2,405.00
SUP, -TOTAL CONSTRUCTION AND PLAN CHECK
$4,265.10
LESS PRE -PAID FEES
$0.00
TOTAL PERERAUr FEES DUE NOW
$4,265.10
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
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INSULATION CERTIFICATE
i
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This is to certify that insulation has been installed in conformance with the current energy
istrative Code, Title 24, State of California,.in the building located at
regulation, California Admin
60724 OROURKE CIRCLE LOT 1012, LA QUINTA CA
CEILINGS:
TYPE: BLOW MAUNFACTURER: Certainteed THICKNESS: R-38
t /
WALLS.' Y
r TYPE: BLOW MAUNFACTURER: Certainteed THICKNESS: R-13
GENERAL CONTRACTOR: SHEA HOMES LICENSE #
BY: TITLE: r
%
PARAGON SCHMID BUILDING PRODUCTS A MASCO Company LICENSE #221517
TITLE: ACCOUNT REPRESENTIVE DATE:
r.al/%/.l/J!.=•'ri/Yl/lIA'T?/V/Ill/lIY/1.9./YY/i�'?%7/J%/N/J%�•I7%1M..+Tn'�s/✓i�'%IJVY/.'m,4JYNWNrTYJYIY/'.v//.•IY�W.YY/•AP/�•�.'%7Y/9i➢'?/lis r//!!:H/7.'�%l%..sN/!%7:M./�/J/J•lI./%:�//1 /Y!/f/'/%/I
Installation Certificate: Residential CF -6R'
Site Address PERMIT #
60424 Orourke Circle
1. BUILDER INFORMATION SUBDIVISION: Trilogy @ La Quinta
Shea Homes - Trilogy - LaQuinta CITY: La Quints
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
r 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 80UHG4/5X-100 80% 100000
80% t
4. COOLING INFORMATION ,
COOLING MANUFACT COMPRESSOR ACTUALEFF. COOLING EQUIP COOLING
EQUIP. MAKE MODEL # SEER CAPACITY. LOAD
A/C Lennox 13ACC-060 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
tictr. Eco 12 pct DATE:
Signature Installing HVAC Contractor