0403-107 (SFD), LICENSED CONTRACTOR DECLARATION
.I;hereby affirm under penalty of perjury that I am licensed under provisions of
&ap7er 9 (commencing with Section 7000) of Division 3 of the Business and
Professionals Code, and my License is in full force and effect.
Licef-,se #777 ��Lic. Class Exp. Date ryJ
•,�, -.., ,,s jSit .D^''� L..IUi tii
Dat e_<) \ Signature of Contras of r�
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason:
( ) 1, 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:
CarrierPdA` IMIAL 13t1�1+: N Policy No. 710-333
(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, andagree that if I should become
subject°to the workers' compensation provisionof Section 3700 of the Labor
Warning: Failure to secure Workers' domperisation coverage is.unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from ,date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I dertify that I have read this application and state that the above information is
correct. I agree to comply with all City, ard)State laws relating to the building
construction, 'and hereby authorize representatives of this City to enter upon
the above-mentioned property.forI nsp.ectlon purposes.
I Signature
ti
.rt.,
-.." Date
NO
BUILDING PERMIT PERMIT#
DATE VALUATION LOT (I.0-�fi� TRACT
14
JOB SITE
ADDRESS 04411 01AIZOUK'10fi
APN
~i w s iii.
OWNER
CONTRACTOR/DESIGNER/EN (NEER
M.t A1;..Ir.Q1;tTIHA1..LC
MIT -LA, 1A Q?UNTA LLC
81260 Pa .1.� M 62
til 260 2'iMJL7E F, .
'92253
a �R Ll�lt•T71r. CA 92253
1AQUMA CA.
C160)777.6005 Q,BTA' eD
USE OF PERMIT
5Pt) -, LOT .14, PLAW 42101+.. PERMIT DOES NOT R 1.dJ.IDE POOL, SPA,'
13I, OK �,�i'. LVJ, C)R .DRIV17- WAY APl RS)ACK
r
CUSTOM 0UNu1`dRUCTIODd 1,378.00 OF
FOR.GEa;lPATIO 714.00 R
0A3Atr`�'# tARPM 4741,00 Sr
HSTMA.TED COST O C 0,N81':R3.J n0N
119,492WO
L'C+cIXfRVO91ON FEX 101-000-418-000
PLAN CHECK ECK FEE 101-000-4351-31$ $5111.03
V CI.1ANIC.A1., FFA 101-000-431.000 ".00
ELECTIR L.AL PEE 101-,000-420-000 $91.21
PLUMBINO PES $116,75
;,T]tONa MOTION FEty - USED 101-000-24 ] -000
ORADR+ O FizE 101.000,423.000 $15.00
ripAr.1PLOPEF, IMPACT IrLL
SIOD-11;1T:AL CONIS I" UC:'13C31,T AND PT.. CHECK
$4,002.4
Q
SIS13�".� NOW
$�3,W2t, 4
MAR 2 4' 14JI
o V
CITY OF LA QW-14TA
r-H4ANNCE 02 -PT.
RECEI
DATE / /
BY 1
DAT NED
I INSPE TO
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Forms &Footings
�ZJ �j�
Underground Ducts
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
O.K. to Wrap
Q
Exhaust Fans
F.A.U.
Framing�j
/ p
Compressor
Insulation
_
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans 8 Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
r7
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
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
Ak
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)
.90p,
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::- 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
60-741 OROURKE CIRCLE LOT 1014, LA QU,INTA CA
%
s CEILINGS:
's TYPE: BLOW MAU NFACTURER:'Certainteed THICKNESS: R-38WALM
?
r TYPE: BLOW MAUNFACTURER: Certainteed THICKNESS: R-13
r
GENERAL CONTRACTOR: SHEA HOMES LICENSE #
�r
BY: TITLE:
PARAGON SCHMID BUILDING PRODUCTS A MASCO Company LICENSE # 221517
BY TITLE: ACCOUNT REPRESENTIVE DATE: 112261(4
i
?d.q/In•iiq'/7/l/�/+�'�ris s9N.YA%J//�YJ!N•I7.•�a/s/N%J�•:0/lY//►AW9:0%l%J/1N'.O:O•:V%77P.M.DYE✓7/7JTY7%7%Y%J'%7YyHYJ/7/1/YN/y:0/f.NA/a�..ii%Y/d:0'//O?.�r%�/Y/7%/Auo�d'/!//J.�”.%.err/:,.!/.l
Installation Certificate: Residential CF-611
.ems a
Site Address PERMIT #
60-741 Orourke Circle
1. BUILDER INFORMATION SUBDIVISION: Trilogy (a, 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.
6.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
�C�gC�cC�in�i�r�L w1 DATE:
Signature Installing HVAC Contractor