0401-401 (SFD)LICENSED CONTRACTOR DECLARATION
I 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.
W License# Lic. Class Exp. Date6 2,285 d /ts
r�
Date'" > > i tr 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•'prope rty -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 NATIONAL JAI1t. N Policy No. 7163333
(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,
.l 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 totthe workers' compensation provisionsrof.Section 3700 of the Labor
Code;:1 shall forthwith comply with those provisions.
.D'ate: ?Applicant.
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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 (OwneAgent) Date
PA
BUILDING PERMIT PERMIT#
i34dd� - i1 -
'DATE "V'' VALUATION - _ LOT -TRACT -
S141„3N. 0 58 300-23
JOB SITE
ADDRESS 8.1-72+6 SUN CA1MUS LIi,.M
APN
764-27C-01.7
OWNER
CONTRACTOR/DESIGNER/EN (NEER
MLEA LP, Q1:1MTALLC
SM, A.LAQUJ-gr,ri.S.LC
812'610 AWNMI 62
91260 AM RM, 62.
LAQtTWA CA .92253
3 Vit, QVINTA CA, 92253
(mor n.600 (IMP, TDD
USE OF PERMIT
iYD - IADT 5E , Pl,%.N 43208. PERMI J' DOPS NOT MCLUDIE P001, SPA,
BLOCK 80'ALI10k OR D IV'MAY AI''PRO.ACK :5% i EDUCTIODI TO PLAN
CHECK. FEE DUE TO MULTIPLE ISSUANCE OF SAME: PL.A;N TYPE
s_:UTOM CONSTRUCTION 1,662,00 8F
FORC10PATI+: 177.00 SP
f; A R AM40 RPOWf 488.00 5F
F.SMA:= C09T OF COMS11MC110H
:144,388.70.
FERMITY, tMMIdAffli
CONSTRUCTION FEE 101-000-4)8-000 $786.50
PLAN CNECK IRE 101-000-439-318 $159.1.9
MECHANICAL Fina 101-000-421-1300 ".511
ELECTRICAL FEE 101 -000--4204= $101.43
PLUMBING F1?Z 101.000-415:`"-000 8122.73
STROT40 MOTION FSE - Rt SID 101-000-W-000 $14.14
O?ZAUMI ME 101.000.4.23.0410 8.15.11.15
rJV%fM,DPj' R IMPACT I79t
n n7lAL .: '07 J I�r°'iZ4�14 MID PL. K��II-+CY
$1,677.51
D !ice USS ME -PAM MS
$0.00
RWf MTS
FEB 11 2004��,TALTIF��
CITY OF LA QUINTA
FINANCE DEPT. /
RECEIPT
DATE
i./!/
BY !
�-��;
DATE ED
itW
INSP T
P1
INSPECTION RECORD
IF
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
1
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel Iwo,
Combustion Air
Roof Deck
o
Exhaust Fans
O.K. to Wrap
p
F.A.U.
Framing
d
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
L
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
Gas Piping
a PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
—v
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
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
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
8j---7 SUN CACTUS'L`ANE LOT 1058, LA QUINTA CA
CEILINGS:
TYPE: BLOW MANUFACTURER: Certainteed THICKNESS: R-38
WALLS:
TYPE: BLOW MANUFACTURER: Certainteed THICKNESS: R-13
GENERAL CONTRACTOR: SHIEA HOMES LICENSE #
BY: TITLE:
r
PARAGON SCHMID BUILDING PRODUCTS A MASCO Company LICENSE # 221517
r
eY; TITLE: ACCOUNT REPRESENTIVE DATE:
L
Installation Certificate: Residential
Site Address
81724 Sun Cactus Lane
1. BUILDER INFORMATION
Shea Homes - Trilogy - LaQuinta
60311 Trilogy Pkwy
La Quinta, CA 92253-7642
INSTALLING CONTRACTOR:
2. PROJECT INFORMATION
CF -6R
PERMIT #
SUBDIVISION: Trilogy @ 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% 88.000
80%
4. COOLING INFORMATION
COOLING MANUFACT
EQUIP. MAKE
COMPRESSOR ACTUAL EFF
MODEL # SEER
COOLING EQUIP
CAPACITY
COOLING
,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 C
6. SUBMITTED BY
`MnOS CC) p&9 DATE:
Signature Installing HVAC Contractor