0402-208 (SFD)LICENSED CONTRACTOR DECLARATION
F I he eby 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
�:ProfPpsionals Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
kSignature of Contra tob rw �`�• �r^" ^-- ,�
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 UIION 716.33
(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'jcompensation laws of California; and agree'that if I should become
subject =to the workers' compe�atfdn"provisions of.Section 3700 of the Labor
sh
Code-l.all:forthwith comply&th those provisions
Date--* t. -/t Applican—V w
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 Adstatethat the above information'is
correct. I agree to comply with all City, and State laws relating to the building
/ construction, and hereby authOhZe representatives of this City„to enter upon
/ the above-mentioned preperty'for inspeFction•pgqoses.� �`t)
(Owner/Ment' Signature (Owner ✓ / Date
BUILDING PERMIT PERMIT#
nATF VAI IIATIr1N IOT { �.7 {_ TQArT 400,
l
$164J69.70 23 30023
JOB SITE
ADDRESS
APN
81457 5UN CACTUS VANE
7641-270-017
OWNER
CONTRACTOR / DESIGNER / EN (NEER
SF.i1_A, T.A. (QU A, 2:3'..x."'
B1'3�',A LA. Q UNTi'A LLC
81260 AL°LK9M 62
81260 AMM, 62
:LA QTM4TA CA 92253
LA QI:IW17A CA 92253.
(760)777 -kits ma 'TBD.
'
USE OF PERMIT I
SDIIG ~ FAIM-Y 1nY1 MMM
WFE1. LOT 23,.Sai:" 4520.8. PERMIT DOES INOT 114CdAIDE POOL,
SPA, MOCK WALLS OR DRIVE, APPROACH. 73% 119DUCTIIRN,TO
PLAN CHECK NEL' 13UE TO MULTIPLE IS lfA14C`.E OF SAME PLA1I T_YP °
CUS70M CONSTRUCTION 1,940.00 SIS i
CIARA.OIUCA"OR.T 574.00 SF '
r Ir'S:irMATI cosr OF CO2'791R'I3t'i`kON
164,769.70
CONSTRUCTION FEE 101.000_418-000 $367,00
PLA14 CHECK FEL 101-000-439.318
X'HAAIIC'AL FEE 1€11-000.421.000 $30,90
2!<:EC TRICAL FEE 101-000-420-000 112-92
PLUMBINO FIE 101.000.41.9.000 $146.73
STRONG MOTIO3, PKE K RES --ID 101-000-241-000 $16.49
GRADINO FEE 101.000.423-000 WAD
DEVELOPER IMPACT FBI? $2„405.00
MM -TOTAL C;caUSTPl'.I•C71,09AN11) AUS M
�3,819,3i',
1F,09 PRE -PAID R2EV
—00
j�
MAR 0 4 2004
rFIN'A1Vr1=
-
TY OF' LA 01W NTA ./
n�cm4
RECEIPT D'A'TjE BY
DATE I E
I INSPEC OR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
/mac/
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
,
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
V
Compressor
Insulation
1Z y _�g—
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
GasTesElectrFinal
Waste Lines
H ter 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
3
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fbdures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
,, .. .arc; srv%z%•isr.✓�r.:n�:ii✓rr.•;...c:..�_-:.::r :!.F.:�i%;, .:.�•: :;r �..v. ri; �%•� ::..: _,.. ..
�.:.%.�_.y....P.;/.!•i'•r.:Fi, %I+•:.:^v%i•I.^f.:%..1.i4:!'iV.<:.:%I•"l.^/. "✓.!r �.:'v.!/•!."✓n'Y"Y"!.:'lr.:!/.!.:'I.: 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 at
81-857 SUN CACTUS LANE LOT 1023, LA QUINTA CA
CEILINGS:
TYPE: BLOW MANUFACTURER: Certainteed
WALLS:
TYPE: BLOW MANUFACTURER: Certainteed
GENERAL CONTRACTOR: SHEA HOMES
BY:
TITLE:
LICENSE #
THICKNESS: R-38
THICKNESS: R-13
PARAGON SCHMID BUILDING PRODUCTS A MASCO Company LICENSE # 221517
BYTITLE: ACCOUNT REPRESENTIVE DATE:
.vrrNYl/r�F�r�rYFrvrr�rrerlrz�r !'r�YFi:r�<�rY rr�srfiyrv�-•.:<i�:•::%r•rrrr/.rr/��q:r.�.:Y/i/. .r.: i%. �': � •f;
-.. rcrrr•v. i r•-. .r.�zi..-..;�.a•.•ririnei�irs r c�s.�ir-'�a-rrrrrr..
Installation Certificate: Residential CF -6R
Site Address PERMIT #
81-857 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: r 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
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.
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 prov ded for inspection.
Yes No ❑ N/A ❑
6. SUBMITTED BY
DATE: b
Sign tore"Installing HVAC Contractor
t