0402-205 (SFD)1
LICENSED CONTRACTOR DECLARATION
I he'rehy affirm under penalty of perjury that I am licensed under provisions of
Chapter; 9, (commencing with Section 7000) of Division 3 of the Business and
XPOtessiorials Lode, and my Licehse is in full force and effect.
License #' Lic. Class Exp. Dat
tttt til ��(j�
_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 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.
(\1 I have and will maintain workers' compensation insurance, as required by
S6ction 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.
WA`I'IO14AL W;1019 7165893
(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 so the workers' compensation�,pro°visioris 6f Section 3700 of the Labor
Cod2,,J?shall forthwith comply wJit�hose pp6isiois`.
Date -
Warning:
` tiApplicant``-r'°
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 withh"all City, and State laws relating to the building
construction, and hereby authorize••represent'atives of this City to enter upon
the above-mentioned pr pert oHn�spection urposes.
Signature (Owner/Agent) Date
BUILDING PERMIT PERMIT#
DATE VAI .I ATInN I OT Ctllr' 2_205 TRArT
.�s 100 :30023
JOB SITE
ADDRESS
APN '
131-$14 SUN CACTUS 1.TlT%
764 :77":17
OWNER
CONTRACTOR / DESIGNER / EN (NEER
SIMA LA Q J_n4T .:e, C
S7fMALAQUWTATLC
81260 .AVENUE 62
812603 AVE13i1E 62
:f;,A'!L DT..VA CA 92.253
;C.,A QXT1RiTA. CA 922$3
(160)177-6005 CD1,9 TLA
USE OF PERMIT
SWO E E.P;AOLY DVJELLDTG
SPO - LOT 29, PLAN 4520.A. PERMIT DOES 14011' ANCL€ DE P'OO4
,SPA, fiLOCK WALLS OR. DR V15,WAYAPPi2.O H
CUSTOM CONSTRUCTION 1,917,00 ;fP
PORCW,d TIO 17!.00 SF
GAftAdg1:9A* k.PDXr 409,00 S
E="373 COQ OF C&Dnb%2uC'i on,
261=.20
PE. UUT 14 8UbTAURY
CONSTRUC;i'It'NF-r )01-00"19.003 $856,50
PLAN CHECK PET 101-000439-318 $696.69
1A RCH_,VI IC.e' L PE 101.000-421.0300 $80.00
ELECTRICAL ME% 101-000.420-000 $111.0.36
FL1.1!1U P NCS TEE, 101-000.419.000 $146,7$
STRONG MOTIONFEE - RESI) 101-000-241-000 $16.19
OILADWO PEP, 101-000.423-000 $15.00
DEVEWPER IMP9.CJ'I''1EG 7y4JS.Qs+
STY .13 RUC, AND PT.AX CHECK
: 0JS PRE --AID FUS
V., 3 26.4 2
$0 00
MAR 0 4 1004 TTL I}EIUM' FEES RITE' .NOW
CITY OF LA QUiNTA
FINANEF DEPT
RECEIPT
DATE
BY
DA ALED
INSPE
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE "
TINSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
S
Exhaust Fans
O.K. to Wrap
Framing
F.A.U.
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
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
'j/ D
Equipment Enclosure
Shower Pans
O.K for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
r
/
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fodures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
Installation Certificate: Residential CF -6R
Site Address PERMIT #
81=814 Sun Cactus Lane
1. BUILDER INFORMATION - '
` SUBDIVISION: Trilogy (u7 La Quinta
Shea -Homes - Trilogy - LaQuinta " CITY: La Quinta
81260 Ave. 62 COUNTY: Riverside
La Quirita,:CA 92253
INSTALLING CONTRACTOR: WEST PAC AIR CONDITIONING
. i
2. PROJECT INFORMATION -
` DISTRIBUTIOT4 DUCT OR PIPINGR-
•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 i
iristalled 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 ori the
Certificate'of Compliance submitted to demonstrate compliance with the Energy Efficiency Standards for
residential buildings` ,
i
3. HEATING INFORMATION
HEATING' MANUFACT HEATING UNIT ACTUALEFF. HEATING EQUIP HEATING .
EQUIP. MAKE:, MODEL # AFUE CAPACITY LOAD
• s
Furnace Lennox G40UH48B-090X 80% 88000 .
fflF24-32TL+D+VI 80-%
4. COOLING INFORMATION
COOLING MANUFACT' COMPRESSOR ACTUAL EFF. .COOLING EQUIP COOLING
EQUIP. MAKE MODEL # SEER CAPACITY LOAD •
A/C Lennox 13ACC-048 12
12HPB24 M ',
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. J
Yes ®' No ❑ N/A ❑
6. SUBMITTED BY
" DATE:
Signature Ins a g HVAC Contractor
1,
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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
81-814 SUN CACTUS LANE LOT 1100, LA QUINTA 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'
TITLE: ACCOUNT REPRESENTIVE DATE: !
BY: ,
8