0402-201 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
Chapter 9 (commencinq with Section 7000) of Division 3 of the Business and
Pr6fe9si.9na1s Code, and my License is in full force and effect.
License # Lic. Class " Exp. Pate
r
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 te, 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 ( ) 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 (y) 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.
L7
MATIONAL M0447QCsS$3�
(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' lcompensation laws of California, )and agree that if I should become
subject to the workers' compensation provisions of Section 3700 of the Labor
a . ..'
Code, I shall fo hwith comply with those,.tea proulsYlons.
mate` --'1 '4 Applicant-�, - ~`�0 a•
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 Cityland State laws relating to the building
construction, and hereby authorize representatives of this City to enter iupon
the above-mentioned property forfinspection purposes.
viy � t
Signature (Owner/,Agent) / -'` Date
BUILDING PERMIT PERMIT# 141
DATE !! 1VATION LOT Tn^CT
2133002:1
JOB SITE
ADDRESS
APN
32.-321, SUN Chl a.[=IN1�.
714-27"17 '-
OWNER
CONTRACTOR/DESIGNER/EN INEER
.,HM, ALA QUIMA 11(!
MIE-A LA QTYINTA LLC
81260,0.' NUE,, 62
612f0 AVEWT.6 62
LAQ'rdIarfA C•'A, �12253
LA01"T.tAi°lA CA 92253
V6VP?7-A005 CR'A TBD
USE OF PERMIT
�ir1�r.L•�:�A��Y D°�P�r�r�C3•
SFD •LOT 26, PLAN 4520C. P91:t NT DO"L?8 210T INCLUDE POOL,
SPS, BLOCK W.ALU OR DAN I 'AY APPifOAC14
CUSTOM CO?3u"'IRUCnaN 19940,00 SP
i?ORC,lFATIO 11n,00 SP
(I. R'+GWA1 PORT S'if?.00 8F r
=xrNATRY-) COWr (yI, COMMaUOar
69.70
pzrar"NrTE HUMW Y
CONSTRUCTION FEE 101-000-418-000 $1167,00`
PLAN CH ECK VEJE. 101-000-439-318 � i0G.87
MECHANICAL, FEE 1 LD 1.00ID-421-000
ZLW,TRYC,AL F.99 101-000-420.000 - $112.92
PLJ,7M0JNGFRE 101.000.419-000 r $146.15
STRZVO MOT➢.OM PE -4. RESiD 101-000441-000 $16.118
t3IjA,I')AWOFFA sis.co
T3f."V�Yfii%1;4: ]MP.lt.Gt R'i�L _ ,1.,. �r2,�1Ctr.GO
I3=i'C rt.ITC,UJOITAND PLAW t::l1FF-CF-
C F LESS PRR-PAM Pl
LESS
$0.00
MAR 0 4 200;1.91' P n-!ITY:as����:NOW
"���7
CITY OF LA QUINTA
FINANCE DEPT. /
RECEIPT
DAT r
BY
DATF�✓I L
INS;r R
0.11'
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & FootingsL_
Ducts
Slab Grade �/
Return Air
Steel
Combustion Air
Roof Deck V
Exhaust Fans
O.K. to Wrap J 614,
F.A.U.
Framing
Compressor
Insulation' .f
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 Pibg. Test
Final I
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Wast7a Lines A /( -.a-/
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
OX for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection =�6 p
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
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
81-821 SUN CACTUS LANE ANE LOT 1026, LA QUINtA CA
CEILINGS-. THICKNESS: R-38
TYPE: BLOW MANUFACTURER: Certainteed
WALLS:
TYPE: BLOW MANUFACTURER: Certainteed THICKNESS: R-13
GENERAL CONTRACTOR: SHEA HOMES LICENSE #----
BY:
TITLE:
PARAGON SCHMID BUILDING PRODUCTS A MASCO Company LICENSE # 221517
ATE:
BY: TITLE: ACCOUNT REPRESENTIVE D
Installation Certificate: Residential CF -6R
Site Address PERMIT #
81-821 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: WEST PAC AIR CONDITIONING
2. PROJECT INFORMATION
DISTRIBUTION DUCT OR PIPING R-
TYPEVALUE
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 provided for inspection.
Yes �No ❑ N/A ❑
6. SUBMITTED BY
DATE:
Signature Installing HVAC Contractor