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0402-203 (SFD)LICENSED CONTRACTOR DECLARATION 1-hereby.,affirm under penalty of perjury that I am licensed under provisions of Ch-;�pter 9 (commencing with Section 7000) of Division 3 of the Business and c,4 LU PpM6ssiionals Code, and my License is in full force and effect. L i 6e' ns a # Lic. Class 14p. Date LO W o Z r-- /EGe it f Contractor Q- Signature o r,_ OWNER -BUILDER DECLARATION LU LU I hereby affirm under penalty of perjury that I am exempt from the Contractor's U) License Law for the following reason: Z_ ( ) 1, 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). CV) I am exempt under Section —, B&P.C: for this reason LO N Date Signature of Owner 0 C\I 0) dWORKER'S COMPENSATION DECLARATION CL Z C) Cc: I hereby affirm under penalty of perjury one of the following declarations: U-) < �Z 0 1 have and will maintain a certificate of consent to self -insure for workers' X W L= compensation, as provided for by Section 3700 of the Labor Code, for the 0 _J _J < _J performance of the work for which this permit is issued. M < 0 (�)$ I have and will maintain workers' compensation insurance, as required by C) O Section 3700 of the Labor Code, for the performance of the work for which this a: LO F<: permit is issued. My workers' compensation insurance carrier & policy no. are: z Carrier Policy No. ob C) -5 NNrIONAL UNYON 716.U33 < (This. section need not be completed if the permit valuation is for $100.00 or less) _J 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 agr I/ I I California, \ 'ge that i I should become subject to the workers' compensation p ,�.bvisions (if 6pctiorL3700 of the Labor Code 3l� 9114.Ahw'ith comply with th6ese,provisfions ,,Date: lVDApplicant 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 statePhat the above information is correct. I agree to comply with,,f�l! City, and State' laws relating to the building construction, and hereby auth orizel rep rese ritauves of this City to.entbr upon the above-mentioned propertq'f6rlinspection purposes. Signature (Owner/Agent)—''JDate s. BUILDING PERMIT PERMIT# nATF VAI I IA­rintsi I r)T 77bTPArT S1 19114W.10 102 30023 JOB SITE APN ADDRESS 81 - 790 ' SUN CACIVS LANE 764-27"17 OWNER CONTRACTOR/DESIGNER/EN INEER RIMX LA QUINTA UX! M-WALAQUINTALU', $120 AVIDWE 62 81260AVIMLI 02 YAQ11WTA CA 92253 LA QUINTA CA 92253 (760)777-6005 CM0 TBD USE OF PERMIT I 44319GLE IzAlaY SPD - IDT 101, PLAN 4210A PERMIT DOES NNOT INCLUDZ POO1, SPA, BLOM WkLL0 OR DRFVMVAY APP.1.10ACH.'M/6 RMUCTIOW TO PUN CHECK FEE DUE TO MULZIPLE ISSUANCE OF St DAZ PLA14 TYPE CUOTOM. C(NSTRUCTION 1;3`92,00 SF. POR.C1HIPA:1710 214.00 SY 0APLAGIRWARPORT 474,00 8F EMN-MVED C047r OF CONLY11RUC1110-K 3.19.Anzo PEW17AIVIZE SUNMARY CONSITRUCMON VZP_ 101.0[10.418.000 MD -50 RAX &N CHECK FEE 101-000-439--318, $144.51 WCHANICALF&E 101,0©0-421.000 $75.00 ELECTRICAL FEE, 101-1'11) -4120-000 $91.21 PLUMMO FUR 101.000-419.000 S116.75 STRDWO MOTION FEE - RES10 101-000-241-1)077 ORADINO KIM 101-000-4-23-000 §13.00 i3 ltEl.ClPI+3e IAS PACT SUB-TOVT L COM171"RUCTIMI ANDPLAW MEM $3,568.92 xaz 1M3 PRE, -PAID FRES $0.00 JP FE -11 NOW MAR 0 4 2007Ca ,4& 1' 01- LA n kn, i 7A RECEIPT DATE BY 1 INSPE TbR ,�,. f. V INSPECTION RECORD s OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings Ducts Slab GradeReturnAir Steel _ Combustion Air Roof Deck 6 Exhaust Fans O.K. to Wrap ,C p F.A.U. Framing U G Compressor Insulation Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath oe 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 I Gas Piping PLUMBING APPROVALS Gas Test Electric Final Waste Lines Heater Final Water Piping Plumbing Final Qlumbing 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 Fbdures Main Service Ooo- Sub Panels Exterior Receptacles G.F.I. Smoke Detectors Temp. Use of Power Final Utility Notice (Perm) > . t- iisv.%�r./r:.,gra.:�:¢;uausyfiu•oaviv.;a.•:T•w':orr.•.>vs�•�v+�r�tosrivr.�:rs.�toirr.✓J�•r��irrm.�. .c .�:�.�.�.:...vv...Y:v».,>.:..:�-...w>..:�..•....,,..•�.�..,...�..........,•.�.v.-...�.�-...r,..... �.......>-. .f 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 4 81-790 SUN CACTUS LANE LOT 1102, LA QUINTA CA 1 9 CEILINGS: TYPE: BLOW MAUNFACTURER: Certainteed THICKNESS: R-38 a WALLS: i TYPE: BLOW MAUNFACTURER: Certainteed THICKNESS: R-13 t GENERAL CONTRACTOR: SHEA HOMES LICENSE # BY: TITLE: r r PARAGON SCHMID BUILDING PRODUCTS A MASCO Company LICENSE# 221517 f 1 ' BY: / TITLE: ACCOUNT REPRESENTIVE DATE: 1 { 1 '/I%!/F.{a%F.%f/f/i%£//Y//F!f/!/I'/I/1%!N/d/1%/7/"/F/!/d/F?/{iJ%F//%d,/d/.f/f/l/I�7s'.(�/{/F/ly/{/F/F///F/d/F/17!/l/l/iaT/{//ryF/l/7/Fl.//d///F/�/F/l/F///f/✓Yl/O/I/d%//!//N/J/!/l%I/l/i/fT/f%d F/!. Installation Certificate: Residential Site Address 81-790 Sun Cactus Lane 1. BUILDER INFORMATION Shea Homes - Trilogy - LaQuinta 81260 Ave. 62 La Quinta, CA 92253 INSTALLING CONTRACTOR: 2. PROJECT INFORMATION DISTRIBUTION TYPE Flexible Ductwork- in uctworkin Attic and Between Floors DUCT OR PIPING R - VALUE Flexible Ductwork Will have a R -Value of 4.2 or Better CF -6R PERMIT # SUBDIVISION: Trilogy @ La Quinta CITY: La Quinta COUNTY: Riverside WEST PAC AIR CONDITIONING t, 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. 6.THERMOSTATIC EXPANSION VALVE (TXV): Thermostatic Expansion Valve (or Commision approved equivalent) is installed and access is provided for inspection. Yes �`. No F-] N/A ❑ 6. SUBMITTED BY DATE: Signature Installing HVAC Contractor