0401-399 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
Chanter 9 (commencing with Section 7000) of Division 3 of the Business and
Rrofes"sionals Code, and my License is in full force and effect. ,f
License,#t Lic. Class Exp`. Date
'Datey } i Signature of Contractor__ tr
S
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 NA'T)CaMAL UNION Policy No. 1165933
(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 WSection 3700 of the Labor
Code,•I,.shaill fortl"ith comply with those provisions.--''
Date: 1` " f Applicant' a'
1
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents:.and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this, City to to enter upon
the above-mentioned property for.' inspection purposes: f'
Signature
ff(Owner/Agent) -' ( Date
BUILDING PERMIT PERMIT#
nATF VAI I IATInN LOT�Z - TRACT
56 30023
JOB SITE
ADDRESS 61-706 qM f,:AC.i"( S LAVE
APN
764-2704117 �.
OWNER
CONTRACTOR / DESIGNER / ENGINEER
MEAT.A.QUIN'1`ALW
iST1M LA QT I W TA LLC
81260 kvWYE 62
81200 MENU, 62
:LAQ1T04TA CA 9225:
LACi'fll, TIVA CA 92253
USE OF PERMIT
63MM ti.FAA1.iLYDWE IMIG
3FD - WT -16,1-ILAN 4.52 B. 'PERMT .DO=- 1400 MC'LUDE P'004
SPA, ElWC'K. WATA.% OR, Y )2WWAY.AKIMACH
CUSTOM CO2d87RUCTION ),664.00.0
PORC".ATIO 177M 5F
CIAK.AOPWARPO RT 4 9.00 SP
WMI4'i71PIZ Corps U,F COAFIRM 1110K
141X8.70
TIFF -W T ME �W6�"AM. WZY
CONSTRUCTION FEE 101-'000-41,3.000 MOM
f UNN CHECK ME 101-000.439-39$ $636.77
WC HA2,11C'AL MI 104.000-421.000 S73,50
X LECTRIC' 'e.l. T?'1?1P, '901 -000 -420 -OW �l0E.G3
P[.i1��F31NC# 1+'f�F.. 1 f11 �Q0C3..r1Y �7v04t1 X121 °�
STF ONO MOTION FER • RF'SID 101-000-2 i -000 $14.14
ORADIN M IC'1-000-423.0001 31:5.00
LihVELO.PER IMPACT IES S?,405.00
'SUE FxXAl+,CC3t1WR,L)'C;liiMIAA! )PLAT;01-MC K
TOTAL PFMdTT MA; DVX NOW
FIFB 11 2u04
FINANCE DEPT.
RECEIPT DA EF
J '
BY
: iJ
DA7 F % LEp
j JC
INSPF g
C//'
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
1
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
014
Underground Ducts
Forms & eootings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
p
Exhaust Fans
O.K. to Wrap
2 v
F.A.U.
Framing
Compressor
Insulation
3
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
o
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
2-
Gas Test
Gas
Appliances
Final
COMMENTS:
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)
INSULATION CERTIFICAT
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
j 81=706 SUN CACTUS -LANE LOT 1056, LA QUINTA CA
CEILINGS: '.
TYPE: BLOW MANUFACTURER: Certainteed THICKNESS: R-38
WALLS: v
TYPE: BLOW MANUFACTURER: Certainteed THICKNESS: R-13
GENERAL CONTRACTOR: SHEA HOMES LICENSE #
BY: TITLE:
r PARAGON SCHMID BUILDING PRODUCTS A MASCO Company LICENSE # 221517
BY: TITLE: ACCOUNT REPRESENTIVE DATE: �� d
f
.,./: ...., ..-;-:.,; ,-<-i•,r:.�i�•�v:.r.arr .f'/I%%//l.:f%t//`%//f//.l ://l/1/l/!/I'/Fl//IS/I% rarf.si%C/f/f/l///Y/F/!//-//Y//Ji!%l/1%YY//rJY!///l.•F'rr;r/T/i/!i//i/1/!/.r//{TF/f7T/� /f'/�: 1: !:T . %r�:•%
Installation. Certificate: Residential CF -6R
Site Address
81706 Sun Cactus Lane
1. BUILDER INFORMATION
Shea Homes - Trilogy - LaQuinta
60311 Trilogy Pkwy
La Quinta, CA 92253-7642
INSTALLING CONTRACTOR:
2. PROJECT INFORMATION
PERMIT #
SUBDIVISION: Trilogy (u, La Quinta
CITY: La Quinta
COUNTY: Riverside
WEST PAC AIR CONDITIONING
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
8&%
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
7yo 5c !y :"t Cd /%/"� • /,C / DATE: !V— 1- —n4
Signature Installing HVAC Contractor