0402-198 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
CNapii; •91(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 C Exp. Date y
f l l ).. � J
,Date""' J r --/''
t ��Signature of Contracto
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 Policy No.
NATIONAL NION 71658"
(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'Tompensation laws of California, and aglfee that if I should become
subject tQ the..1workers' compensation -provisions of Section 3700 of the Labor
Code,•I-all orthwith'comply with those provisions_,,,,„
- Dater'-
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
1 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 authorise representatives of. this City to enter upon
the above-mentioned prope rty-ffor,i spection"purposes.
.Signature (Owner/Agent"�r� Date
BUILDING PERMIT PERMIT#
nATF , / %1AI IIATIMI I OT lP°M1l7JaA.iiJ-. TRAIT T r
1.5',1 X: d 29 30023
JOB SITE
APN
ADDRESS
�,�p
81-785 gum E:s4,CTUS 1�rt. =
CACTUS
7"270-017
OWNER
CONTRA�CTTCOpR / DESIGNpEERRf/ EN INyEYERR
++ � AA y.
taeai:-k- A QV.uv.Ct'1LW
S7MWE A1. AQVfNiAsFL C
81260 .AV'Fr'ly UE tit
61260 A 1RT-E 62
:'-A Qt17WrA CA 92253
(wA QMNTA fats 92253
(76gY777.6005 (71,9 TBD
USE OF PERMIT
lD - LOT 29, PIAN 43208. PERMIT WES NOT fNCLUDE P001I,
SPA BLOCK WALUI OR ill IVEYWAY APPROACH
C:iI;11'OM CONSTRUCTION 1,662,00 8.F
P012Cf YV ATFO 177.0 s
0ARAC,}WARPORT 676,00 87V
E;UTJ 4Y.alAl. .D COSI" OF CO. e7i.d.1.'LJCUMON
143,113M
plim+11:ET..&U, 6U11U!%MY
CON TRUr. JON FEE 101.000-418.000 ffi 3,4fZ
PL -AN CHECK IZE 101-000-439-31.8 X12.21.
MEC<i1 41CA'L 11 Bl 101.000.421.000 Y'73.50
E-1,ECTIY.JCAL F3119 101-000-420-000 $103.19
t'1:UMBI3NO FTE 101X000-419-000 5123115
STRONG MOTION 1 - RY-910 101-000-241-000 214.31
GRADING >:EE 101.000.4,23-000
D0,7BLOPLR IMPACT IEEE $2,405.00
SM -TOTAL C:c�l<Y;�'MIGI'C''i71014 AND PLAN CI T�C.'lo .
$4,169.46
_. _ _ , r US.; PRE -PAW nES
$0.00
3TJ"T PERfAffrKES DUE NOW
HAR 0 4 100
CITV CjF 1. A. QU61NTIA
F.2::::, CF DEPT. ✓✓✓
RECEIPT
DATE
BY
DAT F AL
INSPRCTkV
%SCJ
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
t BUILDING
APPROVALS
MECHANICAL APPROVALS
Sat Backs
Underground Ducts
Forms & Footings
/
Ducts
Slab Grade
�C
Return Air
Steel
Combustion Air
Roof Deck
VXZ
Exhaust Fans
O.K. to Wrap
/
p �'Cd-
F.A.U.
Framing
/ 6
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
O
Final
Final
BLOCKWALL APPROVALS
POOLS - SPAS
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
Z O
Appliances
Final
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
# Inal
Utility Notice (Perm)
COMMENTS:
`Y//�Y..Yir,•/ll: id H. •!./fIYIo/i/'%>%i7•/!.%YI/!C/Y.fi/1%/•%%•l`YF:IYVJ.%/"w>:.!/.•TY/%SG%Ti4!:�Y.'MlT•Nei+GN.•Y1.Y.!F:AYI/�//%1.'M✓.^Y.i%/.%i?!'1.Y!//kidd.%7.•Lf.:l.!FI.ID'A31."I.l:Y!%:%://.•�Y/.•H.'/.:✓f•%�Y.:Y/'/•i!,�//.Y�y .l::•'H�f:FY.%<!,•'�
i
INSULATION CERTIFICATE
w
This is to certify that insulation has been installed in conformance with the current energy 4
regulation, California Administrative Code, Title 24, State of California, in the building at
i t
y 81-785. SUN CACTUS LANE LOT 1029, LA QUINTA CA
CEILINGS:
TYPE: BLOW MANUFACTURER: Certainteed THICKNESS: R-38
r
r,
WALLS:
TYPE: BLOW.MANUFACTURER: Certainteed THICKNESS: �R-13
GENERAL CONTRACTOR: SHEA HOMES LICENSE #
BY: TITLE:
PARAGON SCHMID BUILDING PRODUCTS A MASCO Company LICENSE # 221517
gY: TITLE: ACCOUNT REPRESENTIVE DATE:
1
u
Installation Certificate: Residential CF-6R
Site Address PERMIT #
.7
81-785 Sun Cactus Lane
�J
e�
1. BUILDER INFORMATION SUBDIVISION: Trilogy @ La Quinta
Shea Homes - Trilogy - LaQuinta CITY: La Quinta
81260 Ave. 62 COUNTY: Riverside
La Quinta, CA 92253
INSTALLING CONTRACTOR: WEST PAC'AIR CONDITIONING
2. PROJECT INFORMATION
DISTRIBUTION DUCT OR PIPING R-
-TYPE VALUE
Flexible Ductwork Flexible Ductwork
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
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- N/A
6. SUBMITTED BY
Gi O /"n G �rja< % DATE:. G
Signatur Installing HVAC Contractor
Certificate of.Occupancy
LA TM
G9of Building. & Safety Department
This Certificate is issued pursuant to the requirements of Section 109 of the California Building
%ode, certifying that, at the tine 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: 81-785 Sun Cactus Lane
Use classification: Single Family Dwelling Building Permit No: 0402-198
Occupancy Group:R-3 Type of Construction: VB Land Use Zone: RL
s
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: 08/05/2004
POST IN A CONSPICUOUS PLACE