0403-103 (SFD)( ,LICENSED CONTRACTOR DECLARATION
kireby affirm under penalty of perjury that I am licensed under provisions of
pter 9 .(commencing with Section 7000) of Division 3 of the Businpss and
Professionals Code, and my License is in full force and effect. r
!*icen'se # Lic. Class Exp. Date
25
�;..
Date . . r_t ` (S gnature 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:
( ) 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
Section 3700 of the Labor Code, for the performance of the work for which this
p4rmit is issued. My workers' compensation insurance carrier & policy no. are:
Carrier NA,{ IONALP UNION Policy No. 7165933
(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 s/as to become subject to the
workers ''compensation laws of Caffornia,�and agree that if I should become
subjec�to-t a wolkers' compensation provisions of Section 3700 of the Labor
Code, 1'9,111 fort1'ikt comply4ith thoseNprovisions.
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 okcompensation, 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 th
correct. I agree to comply with all City, and State la
construction, and hereby authorize representatives
the above-mentioned property for --inspection purpoJs
ifir.,,
11 Signature (OwCdr,/,_ge(i)
at the above information is
ws relating to the building
of this City to enter upon
es.
Date
BUILDING PERMIT PERMIT#
DATE VALUATION LOT 0403--103 TRACT' .
a, . , j 1 ►4i37 ►. f1 1 13002's
JOB SITE
APN
ADDRESS 81-9,17 SUM r -AC,"! IS LAMP
M-270.017
,OWNER "'
CONTRACTOR/DESIGNER/ENGINEER
81UKA1AQtTfi TAIL;
MUALAQ%r.N AL
81260 AVIMTE 62
83 2601�.'V7 STU--f'?. 62
j AQX]aTA CA ' '32.'253
LA CA 92251
(760Y777-6005 C1,11%6 THD
USE OF PERMIT
�.�c�• T'Aiv�.I" �t���7�t�
S,f D1 WYV 19, Pi -W4 4310A. PERMIT OO9-S NOT YNCL UDE P001, SPA,
KAXK;. "MAIL" OR DRIVEWAY APPROACH.
i
CUSTOM CONSTRUCTION 1199S.OD SIP
PORCI-11PA'I TO 437.00 SF
C7APLAGWC,AitFORT 520,00 81?
LrvnsdAT :D C ofu ac ci5:t�.t98Ru 8,fi.o
1-11MV1'.0 1 gri1FiJWAIM
Cbl-43TRUCTIOII F'E'E 101'000.4.18-000 $839,100
}ALAN CHECK VEE 101-000-439-318MECHANICAL
FEE 101-000-421-000
MIX-C'P1u1CALFEE 101-0O0-420-000 ffiI t7.fli1
PLLih9111130 Frill; 101.000-419.000 Bial,00
STItC91 0 MOTION FEE a R.E310 101-000-241-000 $13.69
63i;ADING FRE 101.000.423.000 115.00
DEVELOPS. ; IMPACT ME, 3i�Q03.00r
� 172E;C`7It�2s A�i5 T�T,,Al+i G1l�i'T�
u,"02,18
MSS PT4R.�P AiS'.1.F
$"v100
�34P9JSe03.V
� ''�RYP:a�T.ti:n�7 .1A 6•.:a .S�iJ yq'
"INANCE
RECEIPT
DATE f
BY
D F ALE
INSP O
L
INSPECTION RECORD
O ! OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs _
Forms & Footings _ `_ _ _ _
Slab Grade v D
Underground Ducts
Ducts
Return Air
Steel
Combustion Air
Roof Deck
91.,I -q
Exhaust Fans
O.K to Wrap
7�
F.A.U.
Framing
A v
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
/ f9
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 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
Sub Panels
Exterior Receptacles
G. F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
......N •v✓.!r:vl/.•ertovY:N�!/Jr.o.%:V:N:9!:,r r:(/W'N:iR:ly:f/:�.`7,w,:/7: 'V:0%%3r �r:N':NfY.r%L :l !N:(I.:7.d7.Sf/I'nY/vYftYlo+.gra%1:(/:•/}Y47`r✓J70�J/o-'Vi/I��:Y.'7.;%;'rv7n:NY/}N:w.y>•i:N:Nt:n.NrYr. /1.:4Y/ �:r/.'.'1CY �!
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 located
81-917 SUN CACTUS LANE LOT 1018, LA QUINTA CA
CEILINGS:
TYPE: BLOW MAUNFACTURER: Certainteed THICKNESS: R-38
WALLS:
TYPE: BLOW ' MAUNFACTURER: Certainteed THICKNESS: R-13
GENERAL CONTRACTOR: SHEA HOMES LICENSE #
f
BY:
TITLE:
PARAGON SCHMID BUILDING PRODUCTS A MASCO Company LICENSE # 221517
n
BY:
E
TITLE: ACCOUNT REPRESENTIVE DATE: / loll
I
Installation Certificate: Residential
Site Address
81-917 Sun Cactus Lane
1. BUILDER INFORMATION
Shea Homes - Trilogy - LaQuinta
60311 Trilogy Pkwy
La Quinta, CA 92253-7642
r
CF -6R
PERMIT #
SUBDIVISION: Trilogy Pa, La Quinta
CITY: La Quinta
COUNTY: Riverside
INSTALLING CONTRACTOR: WEST PAC AIR CONDITIONING
2. PROJECT INFORMATION
DISTRIBUTIONDUCT 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
EQUIP. MAKE MODEL #
Furnace Lennox G40UH48B-090X"
4. COOLING INFORMATION
ACTUAL EFF
AFUE
80%
80%
HEATING EQUIP HEATING
CAPACITY LOAD
88000
COOLING
MANUFACT
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.
.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
DATE:
Signature Installing HVAC Contractor