0401-400 (SFD)LICENSED CONTRACTOR DECLARATION
I heroy affirm under penalty of perjury that I am licensed under provisions of
Chapter.9_(commencing with Section 7000) of Division 3 o the Business and
P"'i essiohals Code_, and my License is in full force and effect.
License # Lic. Class Exp' Date
c
Date' P 1, ' f 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.
(k/) 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 IYMON Policy No. `°1OM33
J (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 a�/t,o become subject to the
workers' compensation laws of California, and agree that if I should become
3 subject to the workers' compensation provisions!of Section 3700 of the Labor
Code; shall forthwith comply with those provisions.'��
Date.;^' Applicantf d ' J
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"Statelaws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection purposes. r I
'Signature (Owner/Agent) Date + r
FIA
Y' BUILDING PERMIT PERMIT#
- 0.101-400
DATE - VALUATION - LOT TRACT
U63,2 511 aG x3
JOB SITE
ADDRESS81-71.8°! dU CAC.° ln+s' e1 3� �
APN
7&4-27"17
OWNER "'
CONTRACTOR / DESIGNER / EN &NEER
MWALA. Q1 INJrAI,T.,c^
A 1. A f ili�s.i`A'L 1.0
81264. AV:!!!'NOF 62.
01260 ,1•t~VRMTE 152
;L,A,QUIN 'A. CA 922:53
LiQMWA CA 92253
(760)777-6005 Ct3W MID
USE OF PERMIT
0401Y YI-MMYDtxDMJ: Nry
SFO • I.A)T 57,PIAN N 4520A. PERMIT DO&S 140T MCI UDE POOL, SPA,
134.00K WA1100, OR DR;V'I;•1?W!> Y A.I� POACH
CUST OM CONSTRUCTION 1943.00 5'I:
PORC'AIPATIO 177.00 SIV
t .h,,f3la+fC',AR1IM 433,00 `bid
11MIM&M COST Or COTISMUMIOlgl•
� 4it3; ll3.o a1Z
PLAN CHECK ME 102-000-439-119 $110.1.01
tV ECKANIC.AL, FP'1? 101-000-421-000 T'80.00
'I Ae11` +111C/4..L .Mz 101-013t3d -420-000 $111.27
1'1,i3MLii1`TO F911.1 101.000419.000 $146.73
SI'FtONG MOTION ",9 . R3i?.SID 101-000-241-000 ;16.33
101-000.423-t)00 .SISM
cyy
7�.?a{�r}}c99���..M!!,9
LR+v J:t7./SiL'1?PI�. 1AJfPJ.4V! I:.JSI ��i,'�U�.VQ
d tT) IOTAL t�C>i�1; '�tL3c�'.fiif?9 AND P1.A.1 L"FI�t31CC
$4,339.76
Q,t��W � �.
/��
A\
Imo.-
t�{0, 000
Q
� yg� {P�1�7�7-
-A—T, Y*•••"7.lYiY.d 1�", .1' 1e'iJ��.LTs��7Y
FEB 111 1004
CITY OF LA QUINTA /
FINANCE DEPT. ✓
RECEIPT
DATE
r•
/
BY,
1, �
_
DATE FI LED
INSPECTOR
/ - <�/
70
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
}
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade %Z
Return Air
Steel
Combustion Air
_
Roof Deck
Exhaust Fans
O.K. to Wrap % D
F.A.U.
Framing
Compressor
Insulation p
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath o
Drywall - Int. Lath /a y
-
Final
Final
POOLS -SPAS
BLOCKWALL APPROVALS
steel
Set Backs
Electric Bond
Footings ��O
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 �i
Plumbing Final
_
Plumbing Top Out
Equipment Enclosure
Shower Pans _
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection /
Gas Piping
Encapsulation
Gas Test
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)
07/08/2004 09:31 17607769980 HOLLY PAGE 09
Cl
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
81-718 SUN CACTUS LANE LOT 1057, LA QUINTA CA
CEILINGS:
TYPE: SLOW MANUFACTURER: Certainteed THICKNESS: R-38
WALLS:
TYPE: BLOW MANUFACTURER: Certainteed THICKNESS: R-13
GENERAL CONTRACTOR: SHEA HOMES LICENSE #
BY: TITLE:
PARAGON SCHMID BUILDING PRODUCTS A MASCO Company LICENSE # 221517
BY:TITLE; ACCOUNT REPRESENTIVE DATE:
Installation .Certificate: Residential
Site Address
81718 Sun Cactus Lane
1. BUILDER INFORMATION
Shea Homes - Trilogy - LaQuinta
60311 Trilogy Pkwy
La Quinta, CA 92253-7642
CF -6R
PERMIT ti
SUBDIVISION: Trilogy (a, La Quinta
CITY: La Quinta
COUNTY: Riverside
INSTALLING CONTRACTOR: WEST PAC AIR CONDITIONING
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
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
Z�se- f:�nc iSc o l DATE: 6!v
Signature Installing HVAC Contractor