0401-403 (SFD)LICENSED CONTRACTOR DECLARATION
—I he{eby 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.
License # Lic. Class Exp. Date
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:
( ) 1, 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.
SecI have and will maintain workers' compensation insurance, as required by
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 NATIONAL MON Policy No. 716503
(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 provisions of Section 3700 of the Labor
Code; I shall forthwith comply with those provisions.
Date: Applicant—
Warning:
pplicant 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 [atwhose request and for whose benefit work is performed under or pursuant any permit issued as a result of this applicaton agrees to, & shall, indemni& hold harmless the City of La Quinta, its officers, agents and employee2. Any permit issued as a result of this application becomes null and void
work is not commenced within 180 days from date of issuance of supermit, or cessation of work for 180 days will subject permit to cancellatio
I certify that I have read this application and state that the above information
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 inspection purposes. 1
.X
Signature (Owner/Agent) Date
BUILDING PERMIT PERMIT#
DATE VALUATION'- LOT"'- -TRACT e '
/ r' t'. l 29,m -so 60 30023
JOB SITE
APN
ADDRESS 81-7.+•q� STIN CACTUS LANE
'764-270-4A7
OWNER
CONTRACTOR/DESIGNER/ENGINEER
MEA LA QTJ.IIvTTA .Lr 0.A.
a`A C!YJ!MrA LT
81 260 MI1 ITUE 62
$12 AVENUE, 62
LAQUIM CA 52253
LAQIMTrA. CA 922.53
USE OF PERMIT
MOLE I'ltilv3iLY DVIMI 0
SFD a WT 60, PLAN 6505A. PEMIT DO&S, NOT INCLUDE POOL, SPA,
BLOCK WAI.La, OR iI)tj KWAY AP;r RO.11vCH
CUSTOM CONSTRUCTION CTION 2,6",00 SP
POPLK::Ti6;tIATIO 499.00 S1�
0ARA0I?JtM ZPORT r3,Oo Si
Maar . r b' fdj;.ilwWARY
CONSTRUCTION FFIS 101-000,418-000 $1,094,50
PLAN C:I' ECTC. FEE 101-000-439-':118 tt 96.0A
MECHANICAL F7_- t t31-ti0U-r+2I-ti�3l� 3AB .SO
HUtCTRICL L PEP, 101-000.420-000
P1d11'MBI O F'EP 101-000-419.000 $112.00
STRONG MOTION "Z - RESID 101 -000�241 -000 $23.00
GRADING Ft -,.E 101.000-4.23.000 $1510
I1l,VZLOPIOM MPA.CT M, $2,403.00
ART IN PUBLIC PLA,CM . RES1L 270.0004445^000
COMRD (11'r 10-9 AND ITAIIJ, (12MICK
$4,912.37
I X _3 i'' -1"AID k1"?.W
$0.00
FEB 11 2m 'r0TAL 1"A'RWfF S DUE1 A(YW
$4,917,37
CF ®P QUIRfy--A
ANCE
p�PT .
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
. .4
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
TINSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & FootingsDucts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck 116 V
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing S'
Compressor
Insulation S a
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party. Wall Firewall
Exterior Lath
Drywall - Int. Lath S
Final
Final
POOLS - SPAS
BLOCKWALL APPROVALS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground PIN. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines —s'—
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service f 011
Sub Panels
Exterior Receptacles
G.F.I.
Smo4e Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
Installation Certificate: Residential CF -611
Site Address PERMIT #
r 81736 Sun Cactus Lane
1. BUILDER INFORMATION
Shea Homes - Trilogy - LaQuinta
60311 Trilogy Pkwy
La Quinta, CA 92253-7642
INSTALLING CONTRACTOR:
2. PROJECT INFORMATION
DISTRIBUTION
TYPE
Flexible Ductwork
in Attic and
Between Floors
DUCT OR PIPING R -
VALUE
Flexible Ductwork
Will have a R -Value
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 # AFUE CAPACITY LOAD
Furnace Lennox G40UH48B-090X 80% 88000
G40UH4813-090X 80
4. COOLING INFORMATION
COOLING MANUFACT COMPRESSOR ACTUAL EFF. COOLING EQUIP
EQUIP. MAKE MODEL # SEER CAPACITY
A/C Lennox 13ACC-042 12
13ACC-042
COOLING
LOAD
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
--��� r -ca Ecco 0q "jL�-j DATE: :jvs43 -a y
Signature Installing HVAC Contractor
INSULATION CERTIFICATE
This is to c6rtify that insulation has been installed in conformance with the current energy
regulation, California Administrative Code, Title 24, State of California, in the building located
81-736 SUN CACTUS LANE LOT 1060, LA QUINTA CA
_CEILINGS:
TYPE: BLOW MAUNFACTURER: Certainteed THICKNESS: R-38
WALL
TYPE: SLOW MAUNFACTURER: Certainteed THICKNESS: R-13
GENERAL CONTRACTOR: SHEA HOMES LICENSE
BY TITLE -
PARAGON SCHM'10 BUILDING PRODUCTS A MASCO Company LICENSE# 221517
B Y
TITLE: ACCOUNT REPRESENTIVE DATE: