0401-404 (SFD)LICENSED CONTRACTOR DECLARATION
fhe`�eby affirm, under penalty of perjury that I am licensed under provisions of
I- `I^hapter 9 (coliimencing with Section 7000) of Division 3 of the Business and
WProfessionals Code, and my License is in full force and effect.
=).m License # Lic. Class Exp.' Date
LO
W 67 212
Z r— Date y! ' Signature of Contractor
_0.
OWNER -BUILDER DECLARATION
U�
LU I hereby affirm under penalty of perjury that I am exempt from the Contractor's
IL I License Law for the following reason:
Z_ ( ) 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
L
N Date Signature of Owner
N
rT
L 4Q WORKER'S COMPENSATION DECLARATION
t pCcI 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'
D �= compensation, as provided for by Section 3700 of the Labor Code, for the
Qperformance of the work for which this permit is issued.
() (1) 1 have and will maintain workers' compensation insurance, as required by
D 1 Section 3700 of the, Labor Code, for the performance of the work for which this
Zpermit is issued. My workers' compensation insurance carrier & policy no. are:
Carrier o VA:TIOhAL,IJl+ION Policy No. -n
,
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 as -to become subject to the
workers' compensation laws of California, and agree that if I should become
3 subjecfito/the workers' compensation.provisions"of Section 3700 of the Labor
Code,.J;shall forthwith comply with those provisions,.------� —y
mate: tt 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. ; f
Signature (Owner/Agent) s~�` Date,I
BUILDING PERMIT PERMIT#
DATE %1A1 I IATION I nT TRACT
g234M,10 61 F(PUZ3
JOB SITE,
ADDRESS 81-74 2 5UAF CAUJITS Y.V&
APN
, 64 -2'7D -C17
OWNER
CONTRACTOR/DESIGNER/EN 1NEER
M A LA Q MR -PA ILC
*WA LA. QU.CAi'1'A, LLC
81260 AN17NCTE 62.
81260 AVINM 62
IA QTJ.WCA. CA 92253
em. Q[P..ta°�'. , Cry.! 92,{2j 53�p�(�
y �
(760)777-6005 4.9.�3LO SD
USE OF PERMIT
C+I,ERNMILY LiWELLNG
SIMS -1.0?' 6.1., Pd A14 64308, PERMIT DOIEZ NOT T..NCLUDPI POOL, -SPA,
BLOCK. WIA, SIA OR 171RIVEWAY APP1TOACH
CUSTOM CONSTRUCTION 2,769..00 OF
F t3lW.10PA'I IO 322.00 UP
4A}A.AGI?lC.flktl'O12T 719,00 SF
1!,'F.(!`4iIlMBit4��,1€:QU S'JF COOS 'Ed'4T'MTON
134,0V0.10
WIMWARY
CONSTRi.0 1914FEE 101.000-438-000 $1,17.8100
MW.1 CH7�1 K FYI!,' 101-( 0.0-439-318 16
MECHANICAL FER 101.000.4.21.000
ELECTRICAL FZZ 101-460,420-1000 $1449.30
PLUTA13.140 FXX 101-000-419-000 $166.00
STRONG MOTION FEL • RESTO 101-000-..24 1-000 $23.441
�7t�tnt7INO FEE 101-W.0.423.000 $16.00
DEVELOPER ,'11a1PAC:T 1L:E $2,415.0
ART I'M PUBLIC PLACES S - R S•M 270-000W145—M ses.20
R n '•-fig Ifs CC?,l�d �21`Tt`"!`1C31� : i� jL 2 h11 CT;
0
$4,92 6. c1 +'
so,
LESS ERE-3P,T) TSW
Ott
FEB 111004 'rOTAI,YERMn IPM DUE NO
CITY OFIF QU1N1Yq
NANO
E DEPT
V
RECEIPT
DATE i f ,
BY
DATE FINA D
INSPEC•j.��
7
F/J
_2
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
_ _
Forms & Footings G _
Slab Grade/3�
Ducts
Return Air
Steel
Combustion Air
Roof Deck
_l Q
Exhaust Fans
O.K to Wrap
6
F.A.U.
Framing
Insulation
_
7 A
/a ��!/
Compressor
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
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
—QSI
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Gas Piping
Gas Test
Encapsulation
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)
... /:. r •/ •r. .. ... , ::f: • ter. . r,.r .:.. .r::/,:.- r.v:. f.:. � r:•r:•.. . r. rt r:. /�:.r i�!r:4.`T.'n . �.YfY:.r•:.Y.�r i/::(f:(/.:Ss:V)•1:� :y/:• .. Y.. '.M . If.' ::T .. r:I:l / ✓
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 located
81-742 SUN CACTUS LANE LOT 1061, LA QUINTA CA
CEILINGS:
TYPE: BLOW MAUNFACTURER: Certainteed THICKNESS: R-38
WALLS:
TYPE: BLOW MAUNFACTURER: Certainteed THICKNESS: R-13
GENERAL CONTRACTOR: SHEA HOMES INCENSE #
BY: TITLE:
PARAGON SCHMID BUILDING PRODUCTS A MASCO Company LICENSE # 221517
BY: Q TITLE: ACCOUNT REPRESENTIVE DATE:
. x. ... .. .. .•'i�••.iii. r.....r:::.•r:�r•i.:::....i..�..r.i::/..r:r�. r. iar::riir ,.ia; i. ::.rrir:. ..r:•,r.•r : 'rrnicrii.:.,i�.•:. :. :.. r:: ..
Installation Certificate: Residential CF -6R
Site Address PERMIT #
81742 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 (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 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-048 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): t
Thermostatic Expansion Valve (or Commision approved equivalent) is installed and access is, provided for inspection.
Yes ❑ No ❑ N/A ❑
6. SUBMITTED BY BY,, ,,
'NC'e Fima-cisco DATE:
Signature Installing HVAC Contractor
'r
VZO-d VO/EO'd 919-1
+ , 'ONI ShVl,OOSSd 1N809-POH NdZb:ZO VO-90-AVH
5ET ADHESIVE AND THRECDED ROD:
d. ANCWOR ADWESIVE SWALL BE SIMPSON SET WIGP STRENGTH EPDXY AD"ESIVE MANUFACTURI=D
5Y 51MP50N 5TRONG-TIE'COMPANY INC. PLEASANTON. CA .800-999-5099 (1GB0 "52 9,
LA CITY x'25279) I
B_ ' IN5TALLATION SHALL BE IN ACCORDANCE WITH TWE MANUFACTURER'S RECOMMENDATIONS ANG
IN ACCORDANCE WITH T -II^ ICBG REPORT.
C. THE HOLE 5WALL BE DRILLED WITH A CARBIDE -TIPPED MASONRY DRILL MANUFACTURED IN
ACCORDANCE -WITW AN51 B-94,12. MOLE DEPTH SHALL BE SUFFICIENT TO ALLOW PROPER
EMBEDMENT
D. THE INSTALLATION HOLE 5NALL BE CLEANED OUT WITH A NYLON $RU5W'.AND COMP2E55ED AR
OR BLOWOUT BULB.
E. INSERT THE INJECTOR NOZZLE TO THE BOTTOM Or- THE CLEANED HOLE AND INJECT THE SET
EPDXY TO APPROX. 1/2 OF THE HOLE DEPT4 WWILE SLOWLY WITHDRAWING, THE NOZZLE. INSERT
THE ROD BY NAND TO THE BOTTOM 01= TWE HOLE, USING A SLOW TWISTING MOTION ROTATE THE
THE ROD IN BOT4-I DIRECTION5 TO ENSURE THAT TWE EPDXY ;=LOWS INTO ALL VOIDS AND
F CREVICES.
r-_ THE ANCHOR SHALL NOT, BE DISTURBED FOR 2 HOURS,
G. SPECIAL INSPECTION 15 NOT REQUIRED.
i
C� LACEMEN T
VZO-: b0/q0-d 519-1 +
POST PER PLAN
51MPSON A2A ON EACH
SINE OF P05T W/ 1/2" DIA.
M.S. TPRU P05T AND
I/2" DIA, X 6" EMBED, INTO
CONCRETE ALL -THREAD
ROD. EPDXY INTO PLACE:
5ET EPDXY ADNE51vE.
INSTALLED W/
INJECTOR TOOL
NOTE*'
SPECIAL INSPECTION 15
NOT REQUIRED
1 --ALE: NTS
0 0I -04-W MAI
BAI NO. MIX001A
'ONI S3IVI0OSSV 11809-1108: HdZV:ZO VO-90-Ad111
14'
C� LACEMEN T
VZO-: b0/q0-d 519-1 +
POST PER PLAN
51MPSON A2A ON EACH
SINE OF P05T W/ 1/2" DIA.
M.S. TPRU P05T AND
I/2" DIA, X 6" EMBED, INTO
CONCRETE ALL -THREAD
ROD. EPDXY INTO PLACE:
5ET EPDXY ADNE51vE.
INSTALLED W/
INJECTOR TOOL
NOTE*'
SPECIAL INSPECTION 15
NOT REQUIRED
1 --ALE: NTS
0 0I -04-W MAI
BAI NO. MIX001A
'ONI S3IVI0OSSV 11809-1108: HdZV:ZO VO-90-Ad111