0402-202 (SFD)i LICENSED CONTRACTOR DECLARATION
I'leby affirm under penalty of perjury that I am licensed under provisions of
Chg�p'er,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
ver 3 ! i
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 Sianature 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 . Policy No.
NATIONAL UNION 71003
(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,-Jlnd agree,,//IN that if I should become
subject to J he workers' compensatior�provis ons Of�Section 3700 of the Labor
Code;%sh I fort with comply wit those provisions.
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
fora 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 represZntatives of this City to enter upon
the above-mentioned pr perty fo inspect* purposes. I
Signature (Owner/Agent Date
�- BUILDING PERMIT PERMIT#
DATE - -VALUATION - - - LOT G-4()2-2.()2,—TRACT
t24,3A41 63 300:13
JOB SITE
APN
ADDRESS
OWNER
CONTRACTOR/DESIGNER/EN (NEER
;SH A -LA QUWA LLC
S- 4 .1.A Qt3'INT'A VLC
812601a.V NTW 62
8126t3 A.VENt E 62
LA Q:UJ TA CA 92253
'LA QUDT A CA 92251
X760}777•6005 Ck3Li1E 1'I3 :.,
;.
r ,
USE OF PERMIT
-
SI - LOT 63, PL"64=1 PIMMUT DOMS NOT INCLO DE POOL,
SPA, S3.,t)i;K WALIJ9 OR L1FttV•E'GNAX .f1.YPROAC:K
C:UMM COMTRUCTi!7A1 2769.00 SF
PORCH/PATIO 322,00 SP, ;
MARAGWC;A RPOR3 739.00 SP
.[t:^`..@'IMMIA 17:D CM OF GQMM'fl MON
234,0W.10
CONSTRUCTION WE 301-000-418-000 $1,1 moo
PLAN CHECK .P E 101-000-4-39-318 $801.16
M CHANICAL:FEE 101.000-421.000 "I'sto
ELF,CTIUCAL FEE 101-000.420-000 $144.90
[ALL$M1t O"X $.166,00
STRONG MOTION FEE - RESID 1011-000-241-000 $23.43
GRA.DRiG FEE 101-000-423-000 SO -00
DEVELC7M .IRt PACT FEE -- $2,405.00
ART 3'11 PUBLIC PI.A.Cn - R[;3IL 270-00044.5-000
`�`t30-'MTAL. CONS i""'7riTM101 AND PLAAT
�
�c r Y, �/� �Xrg��g;Ep'tq��ky'ay�tlal't:I%.�.,..�:
.d.SYL 17'� 61Gt.�y I�~.1:e IPS DLFdTVW)P
Q � ���AO./4;i�
t4, 2,'fJ.l��l
MAR 0 4 2004
CITY :` U. nf.i:NTA
Ffri:.4:�CE DEPT. .••/
RECEIPT
DATE � � / t,� f
BY, ���
DAT, ALS
INSPE�7��
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
Exhaust Fans
O.K. to Wrap
/ p 6
F.A.U.
Framing
Loo
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
714 ty
Drywall - Int. Lath
S
Final
Final
POOLS - SPAS
BLOCKWALL
APPROVALS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
D
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
Fbdures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
47
Final
Utility Notice (Perm)
v
• 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
81-766 SUN CACTUS LANE LOT 1063, LA 4UINTA 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 DATE: S
Installation Certificate: Residential ` CF-6R, • s;
Site Address PERMIT #
81-766 Sun Castus Lane
1. BUILDER INFORMATION SUBDIVISION: Trilogy @ La Quinta ,
- Shea Homes - Trilogy - LaQuinta CITY: La Quinta,
81260 Ave. 62. 4 COUNTY:Riverside -
L'a Quinta, CA 92253
INSTALLING CONTRACTOR: WEST PAC AIR CONDITIONING '
2. PROJECT INFORMATION
DISTRIBUTION DUCT OR PIPING R-
TYPEVALUE
Flexible Ductwork Flexible Ductwork i
in Attic and Will have a R-Value '
Between Floors 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 HEATING UNIT. ACTUAL EFF. HEATING EQUIP HEATING
EQUIP. MAKE `MODEL # AFUE CAPACITY LOAD
Furnace Lennox . G40UH48B-090X 80% 88000'
G40UH48B-090X 80% t1
4. COOLING INFORMATION
COOLING MANUFACT COMPRESSOR 'ACTUAL EFF.. • COOLING •EQUIP COOLING
EQUIP. MAKE MODEL # SEER CAPACITY ,LOAD
A/C Lennox 13ACC-048 12 x'
13ACC-036 .
., n y
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 '
y l DATE: C w
Sign ture Installing HVAC C ntractor t