0402-214 (SFD)LICENSED CONTRACTOR DECLARATION
;-I hereby affirm under penalty of perjury that I am licensed under provisions of
f,hnps,-r q (rnmmencing with Section 7000) of Division 3 of the Business and.
'Professionals Code, and my License is in full force -and effect.
License # Lic. Class' Exp. Date
672.•``285 B E` 61101t;
Date "Al, 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.
(V 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.
1�AT1101 fAL 111�if3N 7W233
(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 provisiohs of Section 3700 of the Labor
Code„-I,shall forthwith comply-withlthose provisions,_.,,
Appl ci ant ti
t S'
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 represef�tatives of this City to enter upon
the above-mentioned property�for inspectiorS purposes. 1.` .
t) "�: ( €
S ignature (Owner/Aght) % Date
.' _
BUILDING PERMIT PERMIT#
nATF VALUATION LOT it TRACT
Z/, $157A7340 4Je; .71UU2:3
JOB SITE
ADDRESS
APN
81:�701071 C;,A=,'� L&W
764-270-037
OWNER '
CONTRACTOR/ DESIGNER/ EN INEER
LA QiT[brrALLC
SITITIAI A QT. W'r.A LLC
fel 200 A'4IBMfL, 62
83 260 AVM1`TYE 62
LAS QTTINT. !. CA. 9225'1
z k QT.wm CA 97253
('760)777-61003 CB.L# TBD
USE OF PERMIT
SI?0 . LOT 98., PLAN 5505Ca. PERYNT DOf3 NOT IWf:,`LUDE POOL
SPA, KXXK '#MALLS OR. DRIVEWAY XIVROAC H
CUSTOM CONSTRUCTION 3,843.00 SP
PORCH/PATIO 441.00 S?
OA,RAOZ /CAPPORT 539.00 SF
Esi'.'0l"W) Gd.3ff OF 4 OKYnZt:TC'J,7'0V1
157,073,40
PERbLI ' YWR 9133r$15!dJt RY
CONSTRUCTION IEEE 101-000-418-000 5342,5D
PLAN CHECK FEE, 101.000-4s1-318 $6,771
'MECHANICAL T%E 101.000.421.000 $60.30
LFLECTRICAL FU 1.01-000-420-000 $108,7D
I,LUf1dD W 0 FRE 101-000-419-000 W4100
STR01+ O MOTION FEE • MID 101-000-241-000 $33.71
CRAD1110:FEE 101-000-423-000 $15.00
DEV,RIDPER IMPACT F2
UrJ}3••'iV'rAL COXff1'RT7=0,W A UD .PLAN C:EECK
” i'ERIe�r IMES IDVE NC's'
'O
S-1,25.7.21
MAR4 LUt14 ,
r y-, '.A WNTA
_..
RECEIPT '
DATE ` /
�1
BY
DATE F ALED
INSPEBfi
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs_
Underground Ducts
Forms & Footings
Ducts
Slab Grade WILr D li-
Return Air
Steel
Combustion Air
Roof Deck �j �D ro
O.K. to Wrap --40,
Exhaust Fans
F.A.U.
Framing _ m_p y
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
_
Exterior Lath / z
Drywall - Int. Lath
Final
Final
BLOCKWALL APPROVALS
POOLS -SPAS
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
Equipment Enclosure
Shower Pans
O.K for Finish Plaster
Sewer Lateral C/
Pool Cover
Sewer Connection (
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final
Wlity 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)
COMMENTS:
Im
Installation Certificate: Residential CF -6R
Site Address PERMIT #
81-874 Sun Cactus Lane
1. BUILDER INFORMATION
Shea Homes - Trilogy - LaQuinta
81260 Ave. 62
La Quinta, CA 92253
INSTALLING CONTRACTOR:
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
SUBDIVISION: Trilogy @ La Quinta
CITY: La Quinta
COUNTY: Riverside
WEST PAC AIR CONDITIONING
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 X AFUE CAPACITY LOAD
Furnace Lennox 80UHG4/5X-100 80% 100000
80 %
4. COOLING INFORMATION
COOLING MANUFACT
EQUIP. MAKE
A/C Lennox
COMPRESSOR ACTUAL EFF. COOLING EQUIP COOLING
MODEL # SEER CAPACITY LOAD
13ACC-060 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-1 N/A F1
6. SUBMITTED BY
DATE: O
Signature Installing HVAC Contractor
{
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
81-874 SUN CACTUS LANE LOT 1096, LA QUINTA CA
CEILINGS:
TYPE: BLOW MANUFACTURER: Certainteed THICKNESS: R-38
WALLS: THICKNESS: R-13
TYPE: BLOW MANUFACTURER: Certainteed
GENERAL CONTRACTOR: SHEA HOMES, LICENSE #
BY: TITLE:
PARAGON SCHMID BUILDING PRODUCTS A MASCO Company LICENSE # 221517
BY: TITLE: ACCOUNT
REPRESENTIVE DATE: D�