0401-398 (SFD)4 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
Pr( f6ssionals Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
0228 Ka't f�rJ1)�`riJ
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.
( ) 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 i lG`AIAj, 1JN1014 Policy No. 716:S83114
(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
Code, I shall forthwith comply with thos-e provisions.
Date: ' tJ Applicant t� "
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) "—` Date`
BUILDING PERMIT PERMIT#0401-35A, III
DATE �VALUATION - LOTTRACT
301023
JOB SITE r
ADDRESS 81-737 11W21 CACTUS I ALUK.
APN
7154-270-01.1
OWNER
CONTRACTOR / DESIGNER / EN (NEER
8FiIdA.1 A gt1:CWA. UC
0R" LP, tai nrrA LLC
5126.0 AVEEWT& 62
81260.AVENUB 62
eta;, Q0UN A CA 9121253
LA. QfJDr(A CA 92253
(760)777-6005 C'V0 I,.BI D
USE OF PERMIT
SfIn. - 40T 33, 5515B. PERMIT DOM NOT INC1:U09 P004 ;SRA,
HLOOK _WALLS, OR D RIV Z WA Y APPNC)!LCH
C:lki37'OM CONST2UC'>;'HYN 2,460106 SF
POi1CWPATIO I 1M.00 SF
0A11.A(W_XA 1 ORT 478.00 SF'
ElTr 1 �[A:i.`h�? WSW OF CON911.1��,IMIO:Cd
203,370,20
��jj �A �q,q.yv ��Y;i�33...yra,���� �+
F.Y° VL• r,1 27.8W, i�l�"'S.�AiRRY
CONSTRUCTION FRE 101-000.418•-000 S1,003.g0
PLAN CHWX ME 101-000-41319-318. $610.41
MEC IUNNIC.a. HIM, 101.000--321-000 $64.30
ELECTATC:A.L FEE 101-000-42.0-000 012s.1G
:E'1..iFMBINCI FFIR 101.000-419.000 $150.00
S°lrlY.t; NO MOTION IN- - n- 311D 1 G 1 ••000-u 1-000 $20.3.1
OR ACliNG FAE 101.000.423.000 313100
.lZVLlLOPMR IAAFACT ITEE $3,405.00
Y K PUBLIC FLACES . RESIr 270,0001-445-000'
MS- f0°+A;..f>ON91:CUCTIION ,A�Ti PL&W CHECK
$4,636.65
D fM
TOTAL ET KEESa7DV�.�. HO�.!ri
1TY'y��.+'u�6�a1Pc7
FEB 1 1 2004
•
CITY OF LA QUINTA /
FINANCE DEPT. 1/
RECEIPT
DATE
BY
DATE FI A D
INSP
rA
INSPECTION RECORD'
e^ OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
_
/, (
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof DeckExhaust
Fans
O.K. to Wrap
p y _
F.A.U.
Framing
p
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
_//Z)
/7 TO
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
Gas Test
y
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fbdures
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 06
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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
81-737 SUN CACTUS LANE LOT 1033, 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
BY' �/ 4f'/1%�Q TITLE: ACCOUNT REPRESENTIVE DATE:
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Installation Certificate: Residential
Site Address
81737 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
CF -6R
PERMIT #
,SUBDIVISION: Trilogy a, La Quinta
CITY: La Quinta
COUNTY: Riverside
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 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.
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
DATE: .'� --0 f
Signature Installing HVAC Contractor
cojjociiRzCertificate of Occu ancyo p
G� OF9ti Building & Safety Department
This Certificate is issued pursuant .to the requirements of Section 109 of the California:Building
Cade, certifying- that, at the time of issuance, this structure" was. in compliance with the
provisions of the Building Code and the. various ordinances -of the. City regulating building
construction and/or use.
BUILDING ADDRESS: 81.-737 Sun Cactus Lane
Use classification: Single Family Dwelling Building Permit No.. 0401-398"
Occupancy Group -.R-3 Type of Construction: VB Land .Use Zone: RL
' Owner of Building: Shea La Quinta LLC
Address: 81260 Avenue 62 `
City-, ST, ZIP: La Quinta, CA 92253
Tom Hartung, By: Gary Hartman
Building Official Date: 07/15/2004
POST IN A CONSPICUOUS PLACE