0403-095 (SFD)�N% LICENSED CONTRACTOR DECLARATION
I, hereby affirm under penalty of perjury that I am licensed under provisions of
, ipter,9 (commencing with Section 7000) of Division 3 of the Business and
1-;P 6ttionMl Uode, and my License Is in full force and effect.
Li1-1
cense
cense Class Exp?Date
285}
.1
Dated } igrnature 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.
( ) I have and will maintain workers' compensation insurance, as required by
Sec tion 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 W.A'TI%I.AL UTllaf.j Policy No. 716§03,.3
(This. section need not be completed if the permit valuation is for $100.00 or less).
() I certify that in the performance of the work for which this permit is issued,
I shall not employ any person in any manner so as�o become subject to the
workers' compensation laws of California and..agy a that if I should become
subject to ehe worker$compensationprovisions f Sectiofi 3700 oftheLabor
Code..hShall fbrthwithl.d6rTmDIv withhh. se Drovisions. ., �Y�''
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 Budding and Safety
for a permit subject to the conditions and, restrictions set forth on his
application. Y
1. Each person upon whose behalf this application'is made & each person at x+
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, avd State laws relating to the 'building
construction, and hereby authorize representatives of this City to: -enter upon {'
the above-mentioned propeity for inspect n;gurpose�s.
Signature (Owner/Agent) /- Date d f
BUILDING PERMIT PERMIT#
~� N
DATF VAI I IATInN I nT TRAr.T
10,01 4 5.20 95 30023
JOB SITE
ADDRESS ; 81,486 SUN CA CJr %4;L IW'
APN
764-270-017
OWNER
CONTRACTOR / DESIGNER / EN (NEER
SI,'E,fi T -A QLD3"iA 1; LIC
SHE- A LA Q 11M LJX
91.260 A�'i?.�TUE 62
81260AVE34MU 62
1..A Q1111YEA CA 92253
LA. Qi;7;dN"TA CA 92253
(760}777.6005 CB".{'ZD
USE OF PERMIT
SFD , ;.OT 93, PIAN r515C: PERMIT DOES NOT INCL. 118 POOL, SPA,
BLOCK WALL& OR DPJVF-W.A:Y APPROACH.
CUSTOM CONSTRUCTION ' 7,4,W.00 OF
;PORCHIII.A,1O 178.00 ap
WR AWCARPORT 473.00 OF
nmwm con of CCDl\Tmg,7G non
201..6. 40
FERTUVOT i'1:+'.'i't' 9[314i1'kAA1
CONSTRUCTION FEE 101-000.918-000 $06.511
PLAN CHECK nl—? 101-000-439.318 $806.72
I, ECHA:1i1'.CAL FEN, 101-000.42.1-000 $86,50
ELECTRICAL ?FAY, 1071-000-42.0-000 $128.39
P.LUMMO FEE 101 «0006419000 sifto0
S TROXCI MOTION FEE - RES113 101-000-241-000 $20.17
O1 TNG PER 101.000-423-01.10 113.00
DZVZIfJPER IMPACT FEE $2,+405.00
AMR4 PUBLIC PLACES - RESIL 270-000-44340(60 $4.1.1
C":1OV.ANDPLAN�37;•.C1,
$4,621.92
LRSS PRR- AWFEM9
"FINANCE
$0,00
�p t1a1.V3rl"F.75ZEN DUR ,l' OW
"��,�21 M
V
,RECEIPT
DATE f
BY
DAT FI ALEEDD
9
INSPECT.QR
6
INSPECTION RECORD
• OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Forms & Footings
Underground Ducts
Ducts
Slab Grade
Return Air
Steel
Roof Deck 517-7Q ��
Combustion Air
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing y A 4.1
Compressor
Insulation ley-
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
BLOCKWALL APPROVALS
POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
FBnal
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out fWjy
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test 2ZM!K 41Z
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures zz
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
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 located
81-886 SUN CACTUS LANE LOT 1095, LA QUINTA CA
CEILINGS:
TYPE: BLOW MAUNFACTURER: Certainteed THICKNESS: R-38
WALLS:
TYPE: BLOW MAUNFACTURER: Certainteed THICKNESS: R-13
GENERAL CONTRACTOR: SHEA HOMES LICENSE #
BY: TITLE:
PARAGON SCHMID BUILDING PRODUCTS A MASCO Company LICE VSE # 221517
BY: TITLE: ACCOUNT REPRESENTIVE , DATE: -71-201494
3
Installation Certificate: Residential CF -6R
Site Address" PERMIT #
81-886 Sun Cactus Lane
1. BUILDER INFORMATION SUBDIVISION: Trilogy @ 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
addition, Ihave verified that the equipment is equivalent to or more efficient than the equipment specified on the
Certificate of Compliances 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 80UHG4/5X-100 80% 100000 .
80
4. COOLING INFORMATION
COOLING MANUFACT COMPRESSOR ACTUAL EFF: COOLING EQUIP. COOLING
EQUIP. MAKE MODEL # SEER CAPACITY . LOAD
A/C Lennox 13ACC-060 12
The building design heat foss 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.
f •
j.
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
��1� YILY l\'Nl
Signature Installing HVAC Contractor
j
DATE: S —26 y.
M