0403-098 (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)lusiness and
Cude, wid my License Is in tull torCe and effect.
.-icen;e # Lia Class xp. Date
}
.,,.gate~ Y — � '"'~Signature of Contraect'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 property, am exclusively contracting 'with licensed
contractors to construct the project (Sec. 7044;. Business & Professionals
Code): I
() 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
Section 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 L S101't Policy No. 716510,13
(This. section need not be completed if the permit valuation is for $100.00 or less).
( ) [certify that in the performance of the work for which this permit is issued,
I, shall.not employ any person in any manner so a�,s"t'o become subject to the
workerfs' comptensation laws of Cali gorniai and agree that if I should become
subject to the workers' compensation'provlslob Section 3700 of the Labor
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
correct. I agree to comply with all City,
construction, and hereby authorize rep
the above-mentioned property for inspe
Signature
state that the above information is
State laws relating to the building
itatives of this City tenter upon
purposes.
BUILDING PERMIT PERMIT#
nATF W%LUATION = LOT 0x403 056 1 HALT
• f 92 3CG �3
JOB SITE
ADDRESS 81-934 SUN C:AM- 1S LME
APN
764-270--017
OWNER
CONTRACTOR/DESIGNER/EN INEER
i& A L e i.IN, fA LLC
'SHEA LA Qun'A uc''
81260 AV2FM9 62
$31 Z60 A ME 62
7.AQI,TT I -A CA 12253
L,€',QXi%N A CA 92233
(760)777-6,001.5 CB.Ldf\ TSD
USE OF PERMIT
OLF 1.P,Iv9'fisY ADW.E'u-MG
SFD -DOT 92, FLAW 521= PER= DOES NOT INCLUDE POOL,
504 BLOCK WAULA OR DUVEMAs+' APPROACH.
fvYJ3'i'��ldj 4�`fJ�i�'f I3.ilC`1'It?�i �t,I6S,�p aF+
PC7RCHIP,A.TIO $:11.00 Sly
G#A`%'WE.XARPORT 5111,00 rs1F
1��'I'.IYi�WIXIII C09117 OF i" �O�`F��tii�;`a�.ON
flog �.��
y9y�gg� ��qq��ppqq �±•L��.� , ,#
r,i3�niAiUT FRE &WVA.7d7'ddi4f.1
CONSTRUCTION FEE, 101-000-418-000 $926.54
PIS CHECK FLIE 101.000439 319 046.M
Mem"kNICAL FRE 101 MOO
R',L.&CTR1C.AL VEX 101-000-420-000 $119.57
Pi tUMS11-40 FFE 101.000-119.000 $142.40
STRONG MOTION ISP, - V ID 101-000.24 l -000 $13.10
GRADINO F` .E 1,01.000.423.000 SM00
LtZVRLQP8_R i''h9RACT tri
'TT ,-'I.`O'lAL CO . iY Lt�1�p Ar1i] L 3 3 CT
S4,447.82
7 Fi214.1?
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mU.t�O
MAR 2 4 2004 IOTA 1. I?LkZ �.1�7@Ir�+ 13VE 1°i<i4'4'
M:
$�1,�i4i.�
CfTY O, I.A (illfhETd1
FINANCE DEPT
J
RECEIPT
DATE
�'�J��'l
BY
DATE F NALEE ,
i/ a.S
INSPE��C��TO ,
C✓
INSPECTION RECORD
`.OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set3acks
Underground Ducts
Forms & Footings
is
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap p 6'
F.A.U.
Framing
Compressor
Insulation IreVents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final I
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
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 j
Fixtures /
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
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
81-934 SUN CACTUS LANE LOT 1092, LA QUINTA CA
CEILINGS:
TYPE: BLOW MANUFACTURER: Certainteed THICKVESS: R-38
WALLS:
TYPE: BLOW MANUFACTURER: Certainteed THICKNESS: -R-113
GENERAL CONTRACTOR: SHEA HOMES LICENSE #
BY: TITLE:
PARAGON SCHMID BUILDING PRODUCTS A MASCO Company -ICENSE # 221517
BY: U TITLE: ACCOUNT REPRESENTIVE DATE: l C�
oCCi
a
Installation Certificate: Residential CF -6R
Site Address
81-934 Sun Cactus Lane
1. BUILDER INFORMATION
Shea Homes - Trilogy - LaQuinta
60311 Trilogy Pkwy
La Quinta, CA 92253-7642
PERMIT #
SUBDIVISION: Trilogy a, 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
A/C Lennox
COMPRESSOR ACTUAL EFF. COOLING EQUIP COOLING
MODEL # SEER CAPACITY LOAD
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):
Thermostatic Expansion Valve (or Commision approved equivalent) is installed and access is provided for inspection.
Yes ❑ No ❑ N/A ❑
6. SUBMITTED BY
.i
� — I 'Ma C LcCC20�7,(64 DATE: -- 6 --Q
Signature Installing HVAC Contractor