0401-405 (SFD)LICENSED CONTRACTOR DECLARATION
1,hereby affirm under penalty of -perjury that I am licensed under provisions of
„Cti&pter 9 (commencing with Section 7000) of Division 3 of the Business and
Professionals Code, and my License is in full force and effect.
License # Lic. Class /+ Exp. Date
WOOS
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.
(4) 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 UNION Policy No. 710033
(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,,Lsliall forthwith comply with those provisions. -
Date': Applicant 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
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 personfat
whose request and for whose benefit work is performed under or pursuantany permit issued as a result of this applicaton agrees to, & shall, indemn& hold harmless the City of La Quinta, its officers, agents and employe2. Any permit issued as a result of this application becomes null and void
work is not commenced within 180 days from date of issuance of su
permit, or cessation of work for 180 days will subject permit to cancellatioI certify that I have read this application and state that the above information
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/Agenti A'. Date
-BUILDING PERMIT PERMIT#
DATE r VALUATION LOT IA`'' - TRACT -
A:1 Uig 3i7iY�fa"
JOB SITE
APN
ADDRESS 81.• 740 SUN CAC'MYS LAW,
OWNER
CONTRACTOR / DESIGNER / ENGINEER
SH ALAQURTCAU-C
01 -MALA C}'[I INT',A.LT.0
€11260 AVL JM 62:
812,60 AVEICJE 62
LA.qJt�+l"TA Cera 92253
Lit. QU ATA CA 922+3
USE OF PERMIT
MWCiI•.L117?ONOL►• •Y DWY-1.u�jG
Sl i a LOT 62, MAN 00.5.0. l+ULMIT 10010- NOT :I%ICt UDLY PUOi., SPA,,
BLOCK WAI.111, OR DM1:1+1 AY APPiiUOACH. 15% I1EDUCTIO134 CO PLOW
CH:?,C K PEE 1:,1117 TO MU 'L TIPLIF ISSUA14CE OF aAME PLAN TY'PA
CUSTFOM COtMAWTION 2,6", Do 3F
PORICIIPATIO 4$8.06 SI'
GARAQ CAR.P£7?R.T 735,00 Sly
I.�"l.Iid.BAITM COYT OF Ci)�'S".E:f�11,7C'T. o
229, .50
+�yz gay. g �,'y�'�59,, '�y�y t, �,
.d: b{.7.CCV. r A7 1w.1X. 61.7.1YltY1 76
CONSTRUCTION FEE 301-000-418-000 S1,044,SO
PLAN C:ki,ECK FOX 1.01-000-439-:318 $221.51
A! IEC1•IANJ.CAt. a ?9 101 -000-4121 -000 59g.Sfa
ALE.G RICAI., ME '101-000-420-000 $142.37
PLUMBING FEE 101-0001.419.000 '8112130
STRONG ;WOTION .FEE ,, MOID 101.000-241.1000 $23,00
f}}U.44.DNO FFIr' 101.000-423-000 $15.00
DIZVE1110PER IMPAZI, FEE S2,405.00
ART IN PUBLIC PLACE a r R ti. 270-000-445-000 S".T %
7, ; _—_..£1�+U3-T°ICY.I:.F`L Ct31��'.�{LTt�'IOW �` IM :�'.l.a.q CTi4? GX
_..
TA,247.1$4
LESS P$'I;�sa a.�,T� ,
$0.00
'1�"
Ij tt/tri (�`M- ,� 1 KES 0' �`.f4 P_Kam DTH1now
2004
54,247.84
CITY OF LA
ipdjifVFA
FORIAiHCE DE
7.
RECEIPT
DATE
BY
DATE IN ED
INSPEC R
INSPECTION RECORD
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 Deck p`
Exhaust Fans
O.K. to Wrap 711
F.A.U.
Framing mss' O "
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
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 ..Q
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 b
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 10
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INSULATION CERTIFICATE
This is to certify that insulation has been installed in conformance with the current energy.
r regulation, California Administrative Code, Title 24, State of California, in the building at
81-748 SUN CACTUS LANE LOT 1062, 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: TITLE: ACCOUNT REPRESENTIVE DATEt 9 %1V
J
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V
Installation Certificate: Residential
Site Address
81748 - Sun Cactus Lane
1. BUILDER INFORMATION
Shea Homes - Trilogy - LaQuinta
60311 Trilogy Pkwy
La Quinta, CA, 92253-7642
CF -6R
PERMIT #
SUBDIVISION: Trilogy @, 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
EQUIP.
MAKE
Furnace
Lennox
4. COOLING
INFORMATION
COOLING
MANUFACT
EQUIP.
MAKE
HEATING UNIT
MODEL #
G40UH48B-090X
G40UH48B-090X
ACTUAL EFF. HEATING EQUIP HEATING
AFUE CAPACITY LOAD
80%
80%
COMPRESSOR ACTUAL EFF
MODEL # SEER
A/C Lennox 13ACC-042 12
13ACC-042
88000
COOLING EQUIP
CAPACITY
COOLING
LOAD
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
O=mraS1`o &41 4 DATE: - - nl-
Signature Installing HVAC Contractor r