0403-075 (BLCK)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.
License # Lic. Class Exp. Difte
40.934 F3 �. �,, ,63,t 112(
Date. gnature of Contracto
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
S4ction 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 UN1014 y Policy No. 710833
(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 Psis 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 tlieworkers' compensattip-provisions of Sect n.37Q of the Labor
Codej,'sshall @rthwitd omply with those pro,1isions.
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. /0
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, andetate laws relating to the building
construction, and hereby author;ize,,�ep ese� atives of this City to enter upon
the above-mentioned property,f r-Inspectlo- purposes. .:
(Owner/Agent) Signature ent) Date. t �' "'o:
g ( g�
BUILDING PERMIT PERMIT#
DATE - VALUATION - LOTTRACT
• '%r� c;; %v4;frlS(i.Si :�3 30023 -
JOB SITE �y
ADDRESS �� w�%r� 4rFh`�Ai+E4i �eatil�
APN
OWNER
CONTRRACTOR/ DESIGNER /EN (NEER
pgEA 1-10W.0
3MpqIV.11
81.260 AW.W. F— 62
81.260 AV3WUF, 62
%AQf,WTA CA 92883
'L&QTJW71A CA 92M
(909)81-3.6996 Cid 6876
USE OF PERMIT
(+MVI RA . BUff ZING
148 I:,,F, b' 0Alti YbI WA8.,4 60 I,. F. T REt.&TNINf3 WAL4 , IiOTH
OkC0 SYSTEM
b FT. WAL U 140,09 LF
4 71', WALL 60.00 LI?
EiTMOIC,1) Coyr OF CONS',RUC`TTON
4�0,L)tD
CONSTRUCTION FZF. 101.000.418.000 572.04
RRE -`r0TAL C0KF. t.TIC°('1DX AND PT AX CliC, CK
$12.00
L&93 PRE' PAID ]FM
MAR 2 4 2004
CITY OF LA t UINTA
FicNAINCE DEPT.
RECEIPT DATE
.Ji • _;N ' -el-717 t"I
DATE FI LED
7i
INSPECTOR .
Iv
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
I INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
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 - IM. Lath
Final
Final
BLOCKWALL APPROVALS
POOLS - SPAS
steel
Set Backs
Electric Bond
Footings p L
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
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
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:
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i
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
81-922 SUN CACTUS LANE LOT 1093, LA QUINTA CA
CEILINGS:
TYPE: BLOW MAUNFACTURER: Certainteed THICKNESS: R-38
WALLS:
TYPE: BLOW MANUFACTURER: Certainteed THICKNESS: IR -13
GENERAL CONTRACTOR: SHEA HOMES LICENSE #
BY: TITLE:
PARAGON SCHMID BUILDING PRODUCTS A MASCO Company _ICENSE # 22151.7
BY: �AJTITLE: ACCOUNT REPRESENTIVE DATE: ✓� Q
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INSULATION CERTIFICATE
This is ertify that insulation• has been installed in conformance with the current gy
regulation, •fomia Administrative Code, Title 24, State of California, in tl' a ding located at
CEILINGS:
TYPE: BLOW MAUNFA RER: Cert eed THICKNESS: R-38
WALLS:
TYPE: BLOW MAUNF URER: Certaintee THICKNESS: R-13
GENERAL CONTRAQT6R: SHEA HOMES
BY:
N
BY:
E#
l TITLE:
SCHMID BUILDING PRODUCTS A MASCO Company LICENSE # 17
TITLE: ACCOUNT REPRESENTIVE DATE:
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Installation Certificate: Residential CF -6R
Site Address PERMIT #
81-922 Sun Cactus Lane
1. BUILDER INFORMATION
Shea Homes - Trilogy - LaQuinta
60311 Trilogy Pkwy
La Quinta, CA 92253-7642
INSTALLING CONTRACTOR:
2. PROJECT INFORMATION
SUBDIVISION: Trilogy o),, La Quinta
CITY: La Quinta
COUNTY: Riverside
WEST PAC AIR CONDITIONING
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 MANI J ACT COMPRESSOR
ACTUAL EFF. COOLING EQUIP COOLING
EQUIP. MAKE' 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.
&THERMOSTATIC EXPANSION VALVE (TXV):
a
Thermostatic Expansion Valve (or Commision approved equivalent) is installed and access is provided for inspection.
Yes ❑ No ❑ N/A ❑
6. SUBMITTED BY
DATE: f5 -96-0y
Signature Installing HVAC Contractor
e