0401-396 (SFD)LICENSED CONTRACTOR DECLARATION
�., I''Fe.eby affirm under penalty of perjury that I am licensed under provisions of
H Chapter}0" (commencing with Section 7000) of Division 3 of the Business and
C%4 V) Krofessiorials•Code, and my License is in full force and effect.
O chi • d r License # ` Lic. Class Exp. Date
LU r` _ ei!?.2R:S ?3 ; 1X301135
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Z r- Daie l y f .Signature of Contractor ;r T
CSO 0. ->
rU C:) OWNER -BUILDER DECLARATION
W W r— I hereby affirm under penalty of perjury that I am exempt from the Contractor's
~ U) License Law for the following reason:
Z ( ) 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).
C'') () I am exempt under Section B&P.C. for this reason
LO
C\; 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 NATIONAL UNION Policy No. 716523
(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/@ Section 3700 of the Labor
Code, I s6l'forth6th comply witFi those prove i nsr--
Date: // t.. 4Applicant
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 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
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BUILDING PERMIT 1 PERMIT#
DATC:SM1LU,M1TIOPI LOT 10401-5916 TnAGT
.�• / ,' - / $14.4,180AD :S5 30023
JOB SITE
ADDRESS 8401 W(iTICAW.4USLA, "
APN
764--210-017
OWNER
CONTRACTOR / DESIGNER / EN 1NEER
81260 Ai/1•::NU tit
31260 AVEWUP 62
LAI Q ,TINTA CA 92253
J.,A Q-0WZA CA 922S3
(260)/'17.600:5 CBV.
USE OF PERMIT
: 7 3 FluAm Sfi1E�. 'C
5FT) - LaDT S+, PLAN 432aA PERMIT DOES NOT INCOME P004 SIVA
F1A1S7CK WALLK OR Oi t�Yl?W AY APPROACH. 7SVo REIDUC TION TO k'.�coN
CHECK M� 0119 TO MfJI,TIP1•.,E ISSUANCE Of SAA.A.9E PLAVI TYPE
CUA' OM CONSTRUCTION 1,635.00 VF
PO1:WPATIC I 1 e 1.00 SIO
W)RAC€M.IARPORT 488,00 $F'
1r!°b COS'Q OF Q;C?I`i'�'.I'�''RUC' 100
MAO
C ONSTRUCTJON Imo, 101-000-418-000 $793.30
PLAN CHECK WE 160.X0
MtKCi3"IC;AL FER 101.000x421.000 sr..50
ELE1C'i TICAL F?,X 10)-000-420-000 31OZ24
Pl,timil iNG!=FR 101-000.419.000 3122,
;S TR,01.40 MOTIC 14 Y E . ,,RESI13 11111-000-241-000 V4.32
ORADINO FEE 101.00OA x:1.000 $15.00
DEVE`110PER. IMPACT Il`FE S?,405.03
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S"(. B-T(-}'fAil COXI ;.r2TJC ail VID PT
$3,686.81:
'M*v YRF:P� F �
$ .00
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RECEIPT
DATE
J
BY
DATE F
INSPECT
1A
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Forms & Footings
Slab Grade
_
p, /Q
d'(
Underground Ducts
Ducts
Return Air
Steel
Combustion Air
Roof Deck
j3
Exhaust Fans
O.K.toWrap
F.A.U.
Framing
s-
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wali Insulation
Condensate Lines
Party Wali Firewall
Exterior Lath
g S/
Drywall - Int. Lath
a_V
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
I I
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
Z
Appliances
/
Final
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring 4
144C_
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
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INSULATION CERTIFICATE
This is to certify that insulation has been installed in conformance with the current energy
regulation, Califomia Administrative Code, Title 24, State of California, in the building at
Fy
81-701 SUN CACTUS,LANE LOT 1035, LA QUINTA CA' s
CEILINGS:
TYPE: BLOW MANUFACTURER: Certainteed THICKNESS: R-38
WALLS:
TYPE: BLOW MANUFACTURER: Certainteed THICKNESS: R-13
GENERAL CONTRACTOR: SHEA HOMES• LICENSE #
r BY: TITLE: r
PARAGON SCHMID BUILDING PRODUCTS A MASCO Company LICENSE # 221517
BY: TITLE: ACCOUNT REPRESENTIVE DATE:
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Installation Certificate: Residential CF -6R
Site Address PERMIT #
81701 Sun Cactus Lane
1. BUILDER INFORMATION
Shea Homes - Trilogy - LaQuinta
60311 Trilogy Pkwy
La Quinta, CA 92253-7642
INSTALLING CONTRACTOR:
2. PROJECT INFORMATION
DISTRIBUTION
TYPE
Flexible Ductwork
in Attic and
Between Floors
DUCT OR PIPING R -
VALUE
Flexible Ductwork
Will have a R -Value
of 4.2 or Better
SUBDIVISION: Trilogy @ La Quinta
CITY: La Quinta
COUNTY: Riverside
WEST PAC AIR CONDITIONING
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):
i
Thermostatic Expansion Valve (or Commision approved equivalent) is installed and access is provided for inspection.
Yes ❑ No ❑ N/A ❑
6. SUBMITTED BY
.,Q!s C: J=—.rn.. 6C6 • 0-1 DATE: y —'13 —0- f/
Signature Installing HVAC Contractor