0403-104 (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
Prw"Ee. ionals Code, and my License is in full force and effect,
License # Lic. Class Exp. Date
672284 11 'J-`'`�+6,�30105
Date j� ��'Si nature of Contr ct' or.•�
r � g �c
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 Ito .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.
(P)/I have and will maintain workers' compensation insurance, as required by
S action 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 Policy No.
NN, lONAL UNION 7165333
(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 gree that if I should become
subject td. the workers' compensation, provisio` ns of Section 3700 of the Labor
Code,'hshall,forthwith comply vyith those prtovisions�r
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 represtentatives of this City to enter upon
the above-mentioned property (or inspection purposes.
Signature (Owner/Agent) �-'Date1'
BUILDING PERMIT PERMITN
a
DATE VAel IAT!0N LOT 0403-404 TPA T ,
14• .-1/% r,r_.l S002
JOB SITE -- -
APN -
ADDRESS
81.929 .XJX CAC-O'fU*S LARE
764.270-017
OWNER
CONTRACTOR / DESIGNER / EN (NEER
SPS'e l►.LA Q'�J i'ALLC`
aTW,&LAQ1M4T1ALLC
131260 A'VMIE 62
8 1260 Ai1ENM 6.2
JAQI' DrrA CA 92253
LAQUIN A. CA. 52253
(-760)777-6005 CB1.4 'l D
USE OF PERMIT ,.
I CY,, . FAMMY Dwo—UNG
SFD • LOT 17, PLATS 4VOC. PERMIT DOES NOT INCLUDE U.DE POOL, SPA,
BLOCK WAyA OR DMEWAY APPROAGii.
Cf3LMM C0113T UCTICIN LOO' 100 OF
PORCi34'N&TIO 337.09 SF
0ARAO'i?1`C.ARPCRT 9 2,04:x17
ESTDIMTED C09f 01? COMM'Y7G'"1:dON
1515,67;�.10
fes `.v a i04314MARY
COWSTR UCTION FBE 101-000.418.000 SB IS S4
PLAN CHECK FEE; 101-000-4.39-318 $6it2.'i9
MCHANICAL FEE 101--000-4,21-000 $91.00
LLEC;i'€:1CA.L, PEE 101-000-420-000 $107.€1
PLUMF3AN11; ME 101.000.419.000 $142,00
STRONG MOTION FEE- RESID 101-000--241-000 $15.59
ORAD010 .My 101.000.423.000 $15,00
DEVELOPER IMPACT PEE $2,40:5.00
-1,t7 L CO.. 1'I -M4 CRWY,
$4,294,49
D MIS PIR R-PA.ID 1=
MOO
MAR 4 2004.E r, enwffll= »TrF NOW
$4,2.94.4-9
" ti)r-LA QU1NTA
RECEIPT i0
DATE /
BYl / / J
DAT9FI ZED
INSP Tpy
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
_ _
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck 11,011PIA, Ile
Exhaust Fans
O.K. to Wrap 4.4
F.A.U.
Framing Z 41
Compressor
Insulation Zr
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath �X
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 I I
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top OutEquipment
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
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
08/24/2004 10:22 7603401080' PARAGON SCHMID 206 PAGE 06/1.1
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INSULATION CERTIFICATE
INSUL -
This is to certify that insulation has been installed in conformance with the current energy
ode, Title 24, State of California, in the building at
regulation, California Administrative G
' 81-929 SUN CACTUS LANE LOT 1017, LA QUINTA CA
CEILINGS. THICKNESS: R-38
TYPE: BLOW MANUFACTURER: Certainteed
Wei L�S'.
TYPE: BLOW MANUFACTURER: Certainteed THICKNESS: R-13
GENERAL CONTRACTOR: SHEA HOMII~S LICENSE # ;
BY: TITLE:.,`
PARAGON SCHMID BUILDING PRODUCTS A MASCO Company LICENSE # 221517
r 'a
BY:
TITLE: ACCOUNT REPRESENTIVE DATE: e)12'0)0
Y
4 Installation Certificate: Residential CF -611
Site Address y PERMIT #
81-929 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 INFORMA'T'ION
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
r HEATING MANUFACT HEATING UNIT; ACTUAL EFF.. HEATING EQUIP HEATING
EQUIP. MAKE MODEL # AFUE CAPACITY LOAD
Furnace Lennox G40UH48B-090X 80% 88000
80%
4. COOLING INFORMATION
COOLING MANUEACT 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):
ti Thermostatic Expansion. Valve (or Commision approved equivalent) is installed and access 0is provided for inspection.
Yes ❑ No ❑ N/A ❑
6. SUBMITTED BY
r—rn \C'> sm /Q . DATE: -5-2 S
Signature Installing HVAC Contractor a