0402-206 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby 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
;.R�ofestgionals Code, and my License is in full force and effect. f�
License # • - Lic. Class "� Exp. Date
T
16'?2�8 l> 0 13 f �.l30105
Date Si nature of Contr ctaC or
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:
L p ( ) I have and Will maintain a certificate of consent to self -insure for workers'
3 compensation, as provided for by Section 3700 of the Labor Code, for the
Q performance of the work for which this permit is issued.
� .
C) I have and will maintain workers' compensation insurance, as required by
rSection 3700 of the Labor Code, for the performance of the work for which this Z permit is issued. My workers' compensation insurance carrier & policy no. are:
Cartier Policy No.
NATIONAL MON 71 �✓�:3
Q (This section need not be completed if the permit valuationQsjfor $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 agree%that if I should become
3
subject t6 the wo kers' compensation -provisions of ection 3700 of the Labor
Code h ll ftlbith comply withfthose provisions. /""""",
S Date: i Applicanf•-(
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, damagesasprovided 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 statelthat the above information is
correct. I agree to comply with all City, and State laws relating'to'the building
construction, and hereby a�uth-orizeepreseptatives of this City to enter upon
the above-mentioned property for,inspectio •purposes. tt p
Signature (Owne(/Agent•)' Date lrt
BUILDING PERMIT PERMIT#
DATE .LUATION LOT A4W-209 TnACT 010
;2 ' f e ,414.10 25 3 �D'J' 2.3
JOB SITE
ADDRESS
APN
81.-=.13'V i CACTIUS Lam:
704-27 1.7
OWNER
CONTRACTOR / DESIGNER / EN (NEER
SIM, .I A Q0IWA LW
SHEA LA QtfDr ALLC
61260 VT.2 H, 162
81260,ANT, ,ItiIM 62.
LA QT-W5'A CA 92253
LA.QTJDUA. CA 92253
(76OX177-6005 C£? 4 IM
USE OF PERMIT
ww C,}I ?fi f iYwm Lngr_
SPD . LOT 4, PLAN 4520A. PRIMIT DOM NOTINCLUDE POO1 ,
SPA. BLOCK WALLS OR. UFttitEVAY.� PP:3.a,A►CH
CUSTOM C.C}1yMVIUC,TION 1,630.00 By
POR€:HWA IO ' 177.00 Silo'
iaAkD.mCA..RPoiu 488.00 SF
Hosrrm&nm con, oir Cf)mm7C;"i'dtJn
143,413.10
CONSTRUCTION FSP; 101.000-418.000 $795.50
PLIAN CHFICK FRE 101-000-439-318 $641.50
MEC1• ANIC.A L VEE 101-400.4.21,�= "1 1.50
EL•Et:T.RJCAL VXF 1011-000-420-000 $102.34
PI.tdM$i' 0 PEE 101.000.419.000 $122,75
STROW0 MOTION FES - =-10 101-0 00-241-000 $14.34
C,RADIN fFEE 1.01-000-423.000 $15,00
x8P7il'E1✓OP.i12.1344 Ar -T FEE $4405.00
r TJC':qOLr .AI TD Phi CHC,C.X
TX3D Pits —m.PAM IMM
$4,165.93
$0.00
MAR 0 4 2004 PEOW YMKIS DUES TOW
SKIM03
CITY OF LA QkHNTA
FINANCE 05PT.
RECEIPT
DATE
BY
DATE F A D•
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
0 rzv
Return Air
Steel
Roof Deck s d
O.K. to Wrap 6'
Combustion Air
Exhaust Fans
F.A.U.
Framing
Insulation
Compressor
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
_ _
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
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 at
81-833 SUN CACTUS LANE LOT 1025, 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
BY: TITLE: ACCOUNT REPRESENTIVE DATE:
Installation Certificate: Residential
Site Address
81-833 Sun Cactus Lane
1. BUILDER INFORMATION
Shea Homes - Trilogy - LaQuinta
81260 Ave. 62
La Quinta, CA 92253
CF -6R '
PERMIT #
SUBDIVISION: Trilogy @ La Quinta
CITY: La Quinta
COUNTY: Riverside
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
i
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-1N/A ❑
6. SUBMITTED BY,:�t,,
DATE:
Signature• Installing HVAC Contractor