0403-102 (SFD)LICENSED'CONTRACTOR DECLARATION
I,hereby 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
;,Professionals Code, and my License is in full force and effect/1
Licen e # Lic. Class Exp. Date
"ice 5 J B 6/30105
Date Signature of Contracto, 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 prdperty, 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
Setl n 3700 of the Labor Code; fo" the performance of the work for which this
pe mit is issued. My workers' compensation insurance carrier & policy no. are:
CarrierNATIONAL LI'N1O14 Policy No. 9155�a3
(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 Californias annd�agree that if I should become
subject}to k he workers' compensattiionrprovislons of Sect oc� 3,70„0 oaf the Labor
Code;'=1`shall forthwKt omply with those se provisions
Date:~ � �'Applica(It _
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°,nspection purposes. 4i
Signature (Owner Age tn) : Date
Z' F. BUILDING PERMIT PERMIT#
DATE VALUATION LOT Q�'1c�13-1`�� TRACT
,f , ' f% . j T134,849,20 30023
JOB SITE
ADDRESS 81-9w SUN ("A,Cl'dis L:AKF.
APN
164-270-017
OWNER
CONTRACTOR/DESIGNER/EN (NEER
SHEA LA QUT LA. LLC
4SHEA -LA Q11:ti fA X L(I
81 Z 6 0 ffi WYE 62
61260 A4_n,1U0,? rat
LA QtMTi`A. CA 9225:3
L.A. QUA -71A Cis. 92253
(760) 77'6005 CBLO 'rBD
USE OF PERMIT
B'7 gGL.E Ffia� 1 _i DwIl3Yie
SFD - 1..;1"JT 19, PLAN 45108; PERMIT DOLTS NOT 04CLt.IDE POOL,
3PP, DUO-= WALI..S,'OR DRIVEWAY APPROACH,
CUSTOM M CO?dS'rI'dUC•!'ION' iIZ3100 3F
F+OTt60ATZO 437.00 SF
4W.010 SF+
SdAi.GLt:T.i,.I:..V O+os or, c1�td`IA)Xa'liPir.i..Y.o
- 13 4,849.20
.20
S-^•"�.J�'!:l.S 1!!PL.L' lY EJSY3iYA7� .
Ct)NSTR.xJCT1ON PER 101.000-418-000
P1,AN CHECI: FEE 101-000-439-318 �619.ge!
MECHANICAL FEE 101-000-421-000 �Sd4.SE�
W,CTRICAL PCE 101-0001-420-000
PL,11MrialCly .F71y, 101.000-419.000
a T RONLI MOTION Me • R2,331I3 101-000-241-000
GRAD114Q FEE 101-0004113-000 stsm
.1 EV E L0P,1~R IMPAS_ T ",Z $2,405.00
u10B-:f(YrAL C0NS'?`11Ur r1QW ,A&i11! i PLAW CHECK
W,11:5,24
7. &Ss PRE -PATO RJUS
A00
11M1%0,T
S4,A1a24
.a. T.S DUE J40W
EMAR44 2004
J
CITY OF LA OI.1NTA ✓
- FO�ek�NCf= DEPT.
RECEIPT
DATE } I
BY
DATEIN qED n
INSP CTO
4—
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
I
Return Air
Steel
Combustion Air
Roof Deck
6
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
v
Compressor
Insulation
44
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
2 D
Drywall - Int. Lath
d (,
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 Fina!
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Q Q
Gas Test -
Appliances
Final
Final
Utility 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:
08/24/2004 10:22
7603401080
PARAGON SCHMID 206
INSULATION CERTIFICATE
This is to certify that insulation has been installed in conformance with the current energ
regulation, California Administrative Code, Title 24, State of California, in the building at
81-905 SUN CACTUS LANE LOT 1019, 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
PAGE 071411
PARAGON SCHMID BUILDING PRODUCTS A MASCO Company LICENSE # 221517
BY:
TITLE: ACCOUNT REPRESENTIVE DATE:
r
Installation Certificate: Residential
Site Address
.81-905 Sun Cactus Lane
1. BUILDER INFORMATION
Shea Homes - Trilogy - LaQuinta
60311 Trilogy Pkwy
La Quinta, CA 92253-7642
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
CF -6R
PERMIT #
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 # AFUE CAPACITY LOAD
Furnace Lennox G40UH48B-090X 80% 88000
8_0%
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):
Thermostatic Expansion Valve. (or Commision approved equivalent) is installed and access is provided for inspection.
Yes ❑ No ❑ N/A ❑
6. SUBMITTED BY
DATE: �5--;?,60
Signature Installing HVAC Contractor