0401-397 (SFD) (2)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
Chapter 9 (commencinq with Section 7000) of Division 3.of the Business and
Professionals Code, and my License is in full force and effect.
L' icense # Lic. Class Exp. Date
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.
(y )° 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:
Carver WATICRAL UW1O1d Policy No. 71652%
(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
y�u
Code„I shall forthwith comply with those provisions. • 4
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 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) r Date /
-� BUILDING PERMIT / PERMIT#
VO
DATE VALUAIIUIV LU39” TRACT
801779.20 / 34 30023
JOB SITE
APN
ADDRESS 8X-7135i'iJ CACIMS L AM /
764-27"17
17
OWNER /
CONTRACTOR /DESIGNER / EN INFER
SIM% 1A QUINTS,. LLC /{
SHEA 1.,A fli2M'A LL.C;'
81260 MIME 62
812601 AMMUE 62
a.AQU12v`rA C",A. 92253
Y AQteWfA CA 9225.3
Cj6()777.6005 Wif TBD
USE OF PERMIT
MGM FAMMY TYWEIL 10
SFD a i, 0T 34, i<#I:AN 5515C. PZRMIT DOES )aOT )NCIALID ?' P004 SPA,
@l, 0[ WALL4, OR DIMMAY. PPROACH
CWTODA CONST UCT191.l 2.179100 AV
Pta)Zi';HMATIO 1179.00 SIS
MA,G313M6,) RPOta'i'
RSM. ' .IM) CCisr or
310,779.20
1'&MOT FRE 9fMM.; RY
C049`[ RUCTION FF.. 101-000-438-000 "V100
PLAN C1•diPM ME 01-000-439-316 $740-32
MECHANICAL FRY, 101.000-421.000 $66,50
fi:L9: TR1C.A.L 101-000-42&•€ 00 $119.04A
PLUM111' O "M 101-000-419-000 00-419.00) SI:1 IDI
;Ti30N63 MOTION FEE - RESID 101-t 004, •�1 ti000 SR10S
O3t&[312d0 is 101.000-423-000 513.00
1a�R+•}"si.��k:Iti, iiYlAiii~3` ��� $�405.i�0
RUl3-TOTAL C.'014' ..[RUCT1014.�A4" 71'T A f T iC�.Ys
jn2.9I
/1 D LD PRR1 .AID FW3
$01.00
VFE
4
B 1 1 2004
CITY OF LA QUINDEPT. /
FINANCE DEPT.
RECEIPT
DATE"
i/
SY
ILED
/
NSPE C /
9
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
' BUILDING
tAP,P OVALS
MECHANICAL APPROVALS
Set Backs t
Forms & Footings
Underground Ducts
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O. K. to Wrap
F.A.U.
Framing
Compressor
Insulation
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
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
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
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:
.f
07/08/2004 09:31 17607769980 .. HOLLY PAGE 03
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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 at
81-713 SUN CACTUS LANE LOT 1034, LA QUINTA CA
CEILINGS:
TYPE: BLOW MAUNFACTURER: Certainteed THICKNESS: R-38
WALLS:
TYPE: BLOW MANUFACTURER: Certainteed THICKNESS: R-13
GENERAL CONTRACTOR: SHEA, HOMES LICENSE #
BY: TITLE:
PARAGON SCHMID BUILDIN PRODUCTS A MASCO Company LICENSE # 221517
BY: TITLE: ACCOUNT REPRESENTIVE DATE:
1
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ft
Installation Certificate: Residential CF -6R
Site Address PERMIT #
81713 Sun Cactus Lane
1. BUILDER INFORMATION SUBDIVISION: Trilogy @ 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 80UHG4/5X-100 80% 100000
80%
4. COOLING INFORMATION
COOLING MANUFACT COMPRESSOR ACTUAL EFF. 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
j
�► �Cr-- (enc' iS,ca M DATE: '— 3 0
ii
Signature Installing HVAC Contractor