0402-199 (SFD)LICENSED CONTRACTOR DECLARATION
4 I Yareby affirm under penalty of perjury that I am licensed under provisions of
1 Ggapter 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 Ekp. Date
13 ~ (1130105
Date Signature of Contractor
/ � Y
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).
( ) 1, 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.
NATIONA►. Ui 10N 7165033
(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' fompensation laws of California,_wcl agree fhat if I should become
subject to the workers' compensation provisions of Section 3700 of the Labor
_l
Cocl , shall fo&jith comply with t�Qprovislons-1
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 f�.ini spection purposes.
Signature (Owner/Agent)' Date I
=, BUILDING PERMIT PERMIT# /
DATE O.LUATION LOT 0,402 i99 TnAOT
28 30023
JOB SITE
ADDRESS
APN
81-797 NUM CAC:'1US f.,A.l E
764-.2.7"V
OWNER
CONTRACTOR /DESIGNER / EN (NEER
SI31F:iiLA C`1UN TAI LC
ST 'S LA QVIMA LIX
81200 AV ENUT-e 6a
8126.0 rrNMRTE 62
LA A CA. 92233
IAQ INTA CA 92253
(760)777-6005 CBL* aw
USE OF PERMIT
SFO = WT 23; PLA14 4210C. PERMIT -DOES NOT rNCIX DB 1?001L„
SPA, 1 LC)CK INA1 U0 OR Dl?.rVE1N'AY APPROACH
C't1S`tOhl CONS'1'11.UCTION 113,10.00 sp
POR.CHIPATIO 214AD SF
0AIt1#GMARPOR`P 474.00 $F
FSEU! 15M C017r OF CU1l;MUMCAN
1194M.80
CONSTRUCTION FEF 10's-000-111118-000
PLAN CHECK PEE 101.000..439-31$ �57�03
Yv 9CFANICALl FgM 101.000421>000 S7 OO
XL ECTIt2CAL PEE 101• -000 -420 -POO $91.21
PLUDAWNG FEE 101.000.419-000 $116."15
ST ROWO MOTION FEE - RESID 1.01-000-X41-000 $11,95
ORADIX1 f.FRE 101.000-423.000 $15100
DEVELOPE.P� IMPACT PEP, '$4405.00
SUD Y`OTAL COMMIYOTION AIM PUN ,r1�•M
$4,002.44
'Cl M�:Rwr FM DUE N4)114.►'
SOWA4
MAR 0 4 20011
C FT(! x L i�;�QrVT'A
RECEIPT
DATE
BY // !!
DATEFIlA/D
INS PE T
L � �
INSPECTION RECORD
a OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
_
Underground Ducts
Forms & Footings
p44
Ducts
Slab Grade
ReturnAir
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
_ _
Compressor
Insulation
_ l E}-
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
pppp..._.����.
3�6�Oy
Neater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K for Finish Plaster
Sewer Lateral_
Pool Cover
Sewer Connection
—y -may
Encapsulation
Gas Piping
Gas Test
4
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)
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
81-797 SUN CACTUS LANE LOT 1028, LA 4UINTA CA
CEILINGS:
TYPE: BLOW MAUNFACTURER: Certainteed THICKNESS: R-38
WALLS:
TYPE: BLOW MAUNFACTURER: Certainteed THICKNESS: R-13
GENERAL CONTRACTOR: SHEA HOMES LICENSE #
BY: TITLE:
PARAGON SCHMID BUILDING PRODUCTS A MASCO Company LICENSE # 221517
adByAit� TITLE: ACCOUNT REPRESENTIVE DATE: G
n
Installation Certificate: Residential CF -6R
Site Address PERMIT #
81-797 Sun Cactus Lane
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 y
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
1 •
HEATING MANUFACT HEATING UNIT ACTUAL EFF. HEATING EQUIP HEATING
EQUIP. MAPLE MODEL # TAFUE CAPACITY LOAD
Furnace Lennox G40UH48B-090X 80% 88000
80%
4. COOLING INFORMATION '
s
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. r
• 6.THERMOSTATIC EXPANSION VALVE (TXV):
Thermostatic Expansion Valve (or Commision approved equivalent) is installed'and access is provided for inspection.
Yes PrNo ❑ N/A ❑
r
6. SUBMITTED BY
DATE: - —O �—
Signatur'elistalling HVAC Contractor
,