0401-408 (SFD)LICENSED CONTRACTOR DECLARATION
I her&�}y affirm under penalty of perjury that I am licensed under provisions of
Chapter' -§.(commencing with Section 7000) of Division 3 of the Businessand
Professionals Code, and my License is in full force and effect.
License # . Lic. Class Exp. Date
6'i2�5 I3 {JJ'.1t11CS
Date Signature of Contractor ,V
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 bwner 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:
Cartier ?IAT,0,.q.At, UN,()V4 Policy No. 71 3833
(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 those provisions.
Date: ` / ' 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 t
any permit issued as a result of this applicaton agrees to, & shall, indemni D
& hold harmless the City of La Quinta, its officers, agents and employee
2. 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 cancellati n.
I certify that I have read this application and state that the above informatio is
correct. I agree to comply with all City, and State laws relating;;o the buil n
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection purposes.
Signature (Owner/Agent) i'Date
.PUILDING PERMIT PERMIT#
DATE -` VALUATION LOT - W1-4 TRACT -
10
30023
$11.
JOB SITE
ADDRESS 01-11-73 WN C ACTUS LAKE
APN
MA -271"I, 7
OWNER
CONTRACTOR / DESIGNER / EN (NEER
81200 AVRNM 62
81.260 MP.;sNIMT 62
LAQC.rITNi'A CA 92253
LA. QuIff A, CA 52253
('��0�77'7•�i'i05 C1�1.;f'� �'JU
USE OF PERMIT
S.PD . LOQ' 30, PLAI,F 4210A. PLRA11T VOES 1NOT INC LUIX &'CIOI� SPA,
SWCK WA"' OR DRIVEWAY APPROACH, `15% REDUCTION TO KAN
trl°tEcK Fr..F., DUF• '('t01SlSULTIPLE ISS"03KNICS, Otr SAIME 1'i.A.w TYPE
CUSTOM CONSTRUCT= 1,33:1.06,18F
I1011C*11PATIO 214..00 SIe
OA.itAMMARi*OtC'..P474,00 St?
J39.11M.TEDCC+yrWA C0I49.E7 UC:HOW
11.7;691.10
pylq:ik�wC'@ YEAR 9i7� AMARY
CONSTRUCTION F FIE $702.$0
PLAN C1'1WK FEE $143.21
MFICfMNICAL FEL -1 1011-000,421-000 $73,00
ELFXTRICA11 IEEE 101-000-420-000 $90.41
MCiMBINIC) FEZ 101.000-419.000 $1.16.73
579OND Mt: TICA1 FTSE • RESID 101-000-7AI-000 6)1137
GRADING FELL? 161.009-4Z y-QG0 $15160
1]Zi+'ELOPtf1st 104PACT E ¢ d ai3
SUB -TOTAL CO1-19Mi"FC'1'ION AND PLA14 CC2.0 C
M55 PRU-PAID%t1,f 1
$0,00
®
TOTAL PER"WI:1: IT"li`EI513 UX N4' W
S3,5M64
FLEB 111004
CITY OFLA QUINA /
FIR/AIVMCE DEP-
y/
RECEIPT
DATE
BY
DAT I LED
INSPECTOR
Jw
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
=; BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Forms 8 Footings3_
Slab Grade
T���G!Ducts
Underground Ducts
Return Air/
Steel
Combustion Air
Roof Deck
Exhaust Fans
0. K. to Wrap
Framing
_ tq
�p 6
F.A.U.
Compressor
Insulation
Fireplace P.L.
2/2200-y—
Vents
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
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
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 09:91 17607769980 HOLLY PAGE 04
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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
81-773 SUN CACTUS LANE LOT 1030, LA QUINTA CA
CEILINGS:
TYPE: BLOW MANUFACTURER: Certainteed THICKNESS -.'R-38
WALLS:
TYPE: BLOW MANUFACTURER: Certainteed THICKNESS: R-13
GENERAL CONTRACTOR: SHEA HOMES LICENSE #
J
5
BY: TITLE:
PARAGON SCHMID BUILDING PRODUCTS A MASCO Company LICENSE # 221517
BY: all TITLE: ACCOUNT REPRESENTIVE DATE:
J
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Installation Certificate: Residential CF -6R
Site Address PERMIT #
81773 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
MAKE MODEL # AFUE CAPACITY LOAD
EQUIP.
Furnace Lennox G40UH48B-090X 80% 88000
80%
4. COOLING INFORMATION
COOLING
MANUFACT
COMPRESSOR
ACTUAL EFF. COOLING EQUIP COOLING
EQUIP.
MAKE
MODEL #
SEER CAPACITY 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.
&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
Ftc, rrASrb Al DATE:
Signature Installing HVAC Contractor
A
4