0401-407 (SFD)I LICENSED CONTRACTOR DECLARATION
I.11-`eby.affirm under penalty of perjury that I am licensed under provisions of
'0,4ter 9 (commencing with Section 7000) of Division 3 of the Business and
Nr6t-ssional-1 Code, and my License Is In full force and ettect.
License # Lic. Class Exp. Date
l2xi 5 I
_6130105
Signature of Contractor-'
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 uncle4 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 NATIONAL UNION Policy No. 7ltFSfS93
(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 to the workers' compensation provisions of Section 3700 of the Labor
Code, ;l shall forthwith comply with those provisions. -
Date: Applicant
—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 for inspection purposes.
Signature (Owne%Agent) - Date r
I —
.,.BUILDING PERMIT PERMIT# fie
,gay
DATF, VAI I IATInNI nT � ? 3 TRAr..T
JOB SITE
APN
ADDRESS 81- 6.1 8014 MCW.Gi TAM.
764-27"1
OWNER
CONTRACTOR / DESIGNER / EN (NEER
SMA LA QUWA.LLC
ME,A ISA Q1JIN:TA
91260 AIM,N1M 62
?1260AY...z�T E 62
i..AQU%-rA Cis. 92253
!AQj.1%FTA CA 92253
(,70)777.6005 CBL4 'IBD
USE OF PERMIT
SAD . 1X)T 3is PLAN 43209. PERMIT DOES NOT INCi:.UM, P004
SPA, BLOCK W'AL S;, OR D12.AMMAY APPROACH, 1.5% REDUCTION TO
PIAN e; HTFI K FIF1; DUE TO Mlt,VIPIX ISSi1ANC1I OF S!sME PLA14 TYPE
CUSTOM. CONSTRUCTION 11662.00 ST?
PORCH/PATIO 171.00 Sty'
CiAVIAC1MARPOV 4n,00 ,
XVMW HD CONN OF COMIMRf7C"It 01?
142,W.70
CON'S" RUCTION FEE 101-000.4.18,000 $786.50
PLAA: CFIW X YM 101-000-439-318 $159. 19
f�iI;C71 .t41C rtil� ME 101-6100.421-000 M.50
ELECTRICAL F}YX 10)-000-420-000 $101.43
PLUMBING Fh;F.. 1011-000-419-000 1122:76
STRONO MDT1C1141IF.?E - e Z!= 101-000-241-00£1 $14-M
GRAD1140 FEE 101.000.423-0 0 $1.5.00
DEWE1,i'3PL'I1,1:+J1/'1>CT FEE
D o 8LY. i ''3,`t3°I`.I I , )I+ S SxdU CV0V1' !`,14J' 1P3aAY4 C z.TC.1r.
$ f,
aI MR-PAWMES, i' ;ES,
g
$0100
FEB 112004
CITY OF LA QuINTA
FINANCE DEPT. /
RECEIPT
DATE- +
J
BY ✓ /
I r
DAT�J
/
INSP
1V 11 ..:�
7 v
rE
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
_
Roof Deck v
Exhaust Fans
_
O.K. to Wrap
F.A.U.
Framing 6
Compressor
Insulation //
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wali 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 — Z
Heater 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
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fbdures :24 444
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
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i
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
1-761-SUN.C4CTUS-L; NE LOT 1031, LA QUINTA CA Y
CEILINGS:
TYPE: BLOW MANUFACTURER: Certainteed THICKNESS: R-38
s
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:
`f 6
Installation Certificate: Residential CF -6R
Site Address PERMIT #
2;81_7.6.1-_":. S u n -. C a c t u s -Lane
1. BUILDER INFORMATION SUBDIVISION: Trilogy P,, La Quinta
Shea Homes - Trilogy - LaQuinta CITY: La Quinta
60311 Trilogy Pkwy ' 'COUNTY: Riverside
La Quinta, CA 92253-7642
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
r�.
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
r HEATING MANUFACT HEATING UNIT ACTUAL EFF. HEATING EQUIP HEATING
i EQUIP. MAKE MODEL # AFUE + CAPACITY LOAD
• J4 •
. Furriace 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.
&THERMOSTATIC EXPANSION VALVE (TXV)t
Thermostatic Expansion Valve (or Commision approved equivalent) is installed and access is, pro vided for inspection.
t❑
- Yes ❑ No ❑ N/A
6. SUBMITTED BY
C�✓�t iSCC� %� , DATE: --/ -
�. ' Signature Installing HVAC Contractor.
,- 0 0Certificate of Occu.pan,cy.
19R
OF Building & Safety Department
This Certificate is issued pursuant to the requirements of Section 109 of the ,California Building
Code, certifying that,: at the time of issuance,' this structure. was in compliance with. the.
provisions of the - Building Code and the various ordinances of the City regulating building
construction and/or use.
BUILDING ADDRESS: 81-761 Sun Cactus Lane
Use classification: Single Family Dwelling Building Permit No: 0401-407
Occupancy Group:R-3 Type of Construction: VIB Land Use -Zone: RL,
..Ownerof Building: Shea La Quinta ILLC...
AIdress: 81260 Avenue 62
City, ST, ZIP: La Quinta, CA 92253
Tom Hartung By: Gary. Hartman
Building Official, Date:. -07/27/2004
POST IN A CONSPICUOUS PLACE