0403-096 (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
WtY.Nsionals Code, and my U66f a IS In tuii force wid tMeul.
%;i;Nicense # t Lic. Class E p)Date
,Date-�{-' Signature of Contract
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).
( ) 1, as owner of the property; am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals
Code). ' .4
(�) 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.
Se(+r') I have and will maintain workers' compensation insurance, as required by
ction 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 N,A,TION.N., UNION 71.6,524
No. 7}6,52
(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 a4l'to become subject to the
workers; compensation laws of California, and a wee that if I should become
Subject to the workers' compensation provisions„�of Section 3700 of the Labor
Code:_l sfll forthwith comply with�those,provisio,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 ecomes 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, anYState laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property, for inspection purposes. -
Signature (Own er/Agent)l-..i Date a•
BUILDING PERMIT PERMIT#
DATE VALUATION IJ'`1(()c)6 TRACT
sLOT
,?
JOB SITE
ADDRESS 31-910 SUN CAC: LANE
APN
7464.271"17
OWNER
CONTRACTOR / DESIGNER / EN (NEER
fff ;L A. QiJiAI i A ;t LC
X -MA LA QlaTTA U.0
%1260 AVE1 62
81x,60 Ai MW, 62
L,AQTJIA7'1'A C".A. 9225_<
LAQUINTA C.A. 92253
(,`760)777.6005 CS1.9 IMD
USE OF PERMIT
SMOLEFANMY':i?i ELLINO
'
STPD . LOP K PLAN 55-05A. PEMMI f 1"3l.'1ES NOT INCLUDE POOL, SPA,
BLOCK WAUL.% OR DRIVEWAY APPROACH.
CUSTOM C014STRUCTION 4094.0 PF
PORCWPI1TIO 336.00 Sig'
4AIRA131UCARPORY S39N S;' I
ESTU"TED CUST OF C0111SINUC:11011
IFIDAISZO
PAPIVU111zRE 99"R
CONSTRUCTION FEE 101.0.00.418.000
PI,AV CHECK "I; i Cl I -000-439-318 , r 9.59
i4iCILANICAL FEC 101.000-421.000 $03:00
ELECTWCAL IrEP 101-0 00-420-000 $117 57
PLUMBING VIM, 301-000--419-000 S143,00
`7TRICINO MOTION FBI? RIM -11S 101-000-241-000 $10.138
MANN() FEE 101.000.4223-01011
OL'VELO,PER IMPACT -FEE ,405.Oi+
AND PdfE
9.24
11 33 PRL -PAW TlGIsS0,15.I
4 2004 TOTAL. P IMMur FEE S DMr. NOW
MAR 2
CITY OF LA QUINTA /
FIM8NJt CF.D_..PT• ✓
RECEIPT
DATE
BY f
DATEAINALEDI
INSPECTOR
G
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
21
Ducts
Slab Grade
LL
Return Air
Steel
(per
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
D 6
F.A.U.
Framing
Compressor
Insulation
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 Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Water Piping
_
Heater Final
Plumbing Final
Plumbing Top Out
WEquipment
Enclosure
Shower Pans
P17j
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
_
07, y
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)
f
r
J
INSULATION CERTIFICATE,
This is to certify that insulation has been installed in conformance with they current energy
regulation, California Administrative Code, Title 24, State of California, in':he building at
81-910 SUN CACTUS LANE LOT 1094, LA QUINTA CA
CEILINGS:
TYPE: BLOW MANUFACTURER: Certainteed
WALLS:
TYPE: BLOW MANUFACTURER: Certainteed
GENERAL CONTRACTOR: SHEA HOMES
LICENSE #
THICKNESS: R-38
THICKNESS: R-13
BY: TITLE: =
PARAGON SCHMID BUILDING PRODUCTS A MASCO Company 'L.ICENSE # 221517
BY: TITLE: ACCOUNT REPRESENTIVE DATE: 7 �d
Installation Certificate: Residential CF -6R
Site Address PERMIT #
81-910 Sun Cactus Lane
1. BUILDER INFORMATION
Shea Homes - Trilogy - LaQuinta
60311 Trilogy Pkwy
La Quinta, CA 92253-7642
SUBDIVISION: Trilogy @ La Quinta
CITY: La Quinta
COUNTY: Riverside
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 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 80UHG4/5X-100 80% 100000
80%
4. COOLING INFORMATION
COOLING MANUFACT
- EQUIP. MAKE
COMPRESSOR ACTUAL EFF. COOLING EQUIP COOLING
MODEL # SEER CAPACITY LOAD
A/C Lennox 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 ❑ N/A ❑;
6. SUBMITTED BY
cad ��rnwnnto^��-Gei DATE:
Signature Installing HVAC Contractor .