0401-402 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
CWijpter 9 -(commencing with Section 7000) of Division 3 of the,Business-and
Professionals Code, and my License is in full force and effect.
License # y g yLiic. Class Exp,. -bate teg
i.R�
', at 5%
-Date 'I 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:
(' ) 1, 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.
(,)f 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:
Cartier NATIONAL 1,11• IONV Policy No.
(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.l should become
subject t0 the workers' compensation provisions.of-Section 3700 of the Labor
Code, I`shall forthwith comply
thosefprovisions.
Date: f �'` % Applicant s
y .,::-
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
addltlon 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-, 7
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 i
Ir
work is not commenced within 180 days from date of issuance ,of suc
permit, or cessation of work for 180 days will subject permit to cancellatio
I certify that I have read this application and state that the above information s
correct. I agree to comply with all City, and State laws relating to the• buildi
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for irispection�purposes. fI
Signature (Owner/,.A nt) ij r Date 'f ' +�
BUILDING PERMIT PERMIT#
DATE - -VALUATION LOT - TRACT - -
$23_0,�964AO 19 30023
JOB SITE
ADDRESS 81.- SUN CAC1116 LAW,
APN
7"270-e17 I
OWNER
CONTRACTOR / DESIGNER / ENGINEER
SHEA LA Q1.1:11;3' .A ILIC
SM, A LA Qt11.1 f f A. LLC
81260 AV)ai LTE 62
81260 AN'Ii'2RTE 62.
LA.OTAFITA CA 92253
LAQUIRTA CA 92253
(760)7776045 CMJi T8D
USE OF PERMIT
BNOIE FAiATILY P1lJFILING
SFD - L ADT 5D, FlA�Z! 6420C. PERMIT 060, 140T INCLUDE P004 SPA,
BLOCK WAJ. IA OR .1}f3F"WAV.A-PP1COA CH
CUSTOM CONSTRUCTIN4 �,'7:a OP V
PORC:HIP'A.'NO .323.00 SY
GA,atAt3.E C:,Af'..1'ORT 015.00 By,
ENTU"Tf. D CCS Q19 C0149k'� UCV11CSH
230,964AO
27, y� i��2�5; A�ei
CC5MTRUCTION 1i!E 101 -000.418.000 62,040,00
PLA14 C fid' K j°iX 101-0]0"4 39-318 $888.00
f4WHA14ICAL )SEE 101.000-421.000 9'i.StJ
93.TfiTRJCA�L ► EE 101-000-42-0-000
P1UMB1fW 1173 101-000-439-000 .i°Y2.G0
STRQ.40 MOTION WM - R931.i 101---i3iV-241-00 $63.10
GRAUt:fd0 HZE 101>000423-000 ' S15100
DEVE-J.f.V12 Rti. IMPACT Ple:E $4405.00
ART N PUBLIC PLACES - l l�. 270-000-445-000 MAI
�S' UB -TO'T'AL C01W)'IR,DOT),UVAM PIA)C".Y�.WC K
$4,918.24
Ims PRE _PAM Ti' E
$0.00
Q
TOTAL P KURMT-7,08 D (MEN OW
$4,91824
r� 112004
.
CF
�a9AlC Of3ff�Tq
�
®SPT
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Slab Grade
_
_ b
Ducts
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O. K. to Wrap
a
F.A.U.
Framing
Compressor
Insulation
G
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
S/ 20
Drywall - Int. Lath
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
�. — G
Heater Final
Water Piping
_
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
3�
Encapsulation
Gas Piping
r
a�
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)
Installation Certificate: Residential CF -6R
_T
Site Address PERMIT :#
81730 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 (a7 La Quinta
CITY: La Quinta
COUNTY: Riverside
11
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
G40UH36A-070X 80%
4. COOLING INFORMATION
COOLING MANUFACT COMPRESSOR ACTUAL EFF. COOLING EQUIP COOLING
EQUIP. MAKE MODEL # SEER CAPACITY LOAD
A/C Lennox 13ACC-036 12
13ACC-036
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
�f= �SCCLl l�1l DATE: ch y
Signature Installing HVAC Contractor
07/08/2004 09:31, 17607769980 HOLLY PAGE 08
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
81-730 SUN CACTUS LANE LOT 1059, LA QUINTA CA
CEILINGS,
TYPE: BLOW ' 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
U
Y.
B TITLE: ACCOUNT REPRESENTIVE
DATE: