0403-108 (SFD)I LICENSED CONTRACTOR DECLARATION
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
i
Date Signature of Contractor i
fi 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:'
Carrier Policy No.
- NATIONAL ITO ION 716 833
(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 anymanner o as to become subject to the
workers' compensation laws of California, and agree that if I should become
subject to the workers' compensatiioWprovisions of Section 3700 of the Labor
Code. 1=s allsforthw th.comoly with those Drovlslons,
f 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 1
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. 1•9gree 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 (OwnedAgeono-"•f Date-
P et
" ' BUILDING PERMIT ;;;�y PERMIT#
DATE VALUATION LOT f��ul3-t.flg; TRACT
JOB SITE
ADDRESS
APN
OWNER
CONTRACTOR / DESIGNER / ENGINEER
^L
MM LA t 4Li1 .CA LIC
MEA T..A QUWALIX
812%0.AVM4UI: 62
61260AWRTUR CSR
LAQLWrA CK 92253
LAQbMJTA CA. X2253
C7,60)177-,6005 CBL4 'I
USE OF PERMIT
QNrT BFeel DW ..,.111JNG
$1720 . LCr'i 13, PLAN 6305A. PERMI' L'tOO N(;X t' I14CLUDE P00L,,, SPA,
DVoC WALIS, OR, i3RIVEWAV A.KT^r.i C.H.
CUSTOM C:C,tN$°i`ItOdTION 2398.00 3F
P0RCfYPXrI0 376,00 S?
GAR&Cl.UC„ARPORT T53M 3F
PLAN C:I3Eer� f' I: iZ)1.-ilU0�i3'�-ails $815.89
1�,'IM€•I ANICAL'FEE 101-000-421.000 $73.00 .
E4,t;CTRICAi. FEE IM -000-420-000
PLIMAR1140?Rk.-'. 101-000-419-000
SY'R.O'NO H VIOLA ME > RESID 201 -000-24.? -000 g�n.sG
t 311MNIt• O FEE 101 -000-4Z3-000
roZY'.t.,OPL.R rl+9Pl3.CT ME ffii{,40?.OQ
KRT IN PUBLIC PLACES - R&S'(1270-000.445.000 $16,51
C0H0 i..RUC'1'1C1+t Ahi_ PLAN �."�}.:CIC.,U-,640.59 :
�z'OTAL
LESS f IRE4AID 1=3
$0.00
�'ax�.:�:I<.�it�3�s.� r'�:S �31�1=. s�ta�►
X8,84+9(1 �x�
FMAR 4 2004
REC IPT r.iI Y OF
f�rA
BY
DATE FINALED1
JINSPECT9R
INSPECTION RECORD
�. OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
V BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
_
Underground Ducts
Forms & Footings
Q t
Ducts
Stab Grade
7 f
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
p 6.�010_
F.A.U.
Framing
/
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans 8 Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
BLOCKWALL APPROVALS
POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
I I
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping
d
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
3
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
42 y
Gas Test
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fodures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
08/24/2004 10:22. 7603401080 PARAGON SCHMIP 206 PAGE 041'11
�;...:.i%.
;c.,1' ^iirr��arrr,,�•rri;v,rrri•rr.Ric�nrrine.,�nh'vrw....ir�nn,,r�nwasi»nmrrrrixrn^r, rsrr�n.,w�r. v.r.r^irn.✓nr^i rrni�i.^.rri.n•�• i i.; ;•r�1 ..,.ii5r.
s
ATE
INSULATION CERTIFIClo
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 at
;
60-746 OROURKE CIRCLE LOT 1013, LA QUINTA CA
CEILINGS:-.
TYPE:,BLOW MAUNEACTURER: Certainteed THICKNESS: R-38
;
WALLS:
TYPE: BLOW MANUFACTURER: Certainteed THICKNESS: R-13
r
GENERAL, CONTRACTOR: SHEA HOMES LICENSE #
l
BY: TITLE:
PARAGON SCHMID BUILDING PRODUCTS A MASCO Company LICENSE # 221517
'
BY: TITLE: ACCOUNT REPRESENTIVE DATE: V
>:
Y
r Installation Certlfi6te: Residential CF -6R
Site Address PERMIT #
60-746 Orourke Circle
I. BUILDER INFORMATION SUBDIVISION: Trilogy (a, La Quinta
Shea Homes - Trilogy- LaQuinta CITY: La Quinta
6031"1 Trilogy Pkwy COUNTY: Riverside
La Quinta, CA 92253-7642. .
INSTALLING CONTRACTOR: WEST PAC AIR CONDITIONING
Sj '
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 deme strate 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
G40UH48B-090X 80%
4 COOLING INFORMATION
COOLING' MANUFACT COMPRESSOR ACTUAL EFF. COOLING EQUIP COOLING
EQUIP. MAKE MODEL # SEER CAPACITY LOAD
A/C Lennox 13ACC-042 12
13ACC-042
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 0 N/A ❑
6. SUBMITTED BY
Z:�(- f aye C o:Zrr) ikl DATE: 5-2,6— O V
Signature Installing HVAC Contractor