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LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
CI1apter 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
67 2295
Date/—,K-,l Signature of Contra t, or gy m
%r' v.
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
permit is issued. My workers' compensation insurance carrier & policy no. are:
Carrier NAT IQ14A.L 0141.IDN' Policy No. -7163333
(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 povisions�of Section 3700 of the Labor
Coderf*shall forthwith comply,with those proVi ons.
Date:
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 representatives of this City to enter upon
the above-mentioned property for,id§pectionpurposes.
,Signature (Owner/Ager�t - Date
BUILDING PERMIT
PERMIT#
I _P' 7`D
DATE VALUATION LOT
;di3.7.0o
TRACT
31
30023
Lj �/
JOB SITE
ADDRESS alta-•697JUTIN PER..LAR
APN
-
OWNER
CONTRACTOR/DESIGNER/EN (NEER
%IM LA QU WrA 7
sum Tom. C2t'f1N rA I r c
81260 AVENUE 62
83 260 AVENUE 62
LA.QIiWA, C -A 92233
LAQMTA CA
6922:53
Q60YI77-6005 CSVI'
'9,"M
USE OF PERMIT
1391-F. ti' 1-11,0C'k WALL1, 13? .L, F. 3' BLOCK VeAL1, Ht:Yt'f; ORC O
SYSTEM
6 nWALL
137.9A LF
4 Nx'. WA.L.f.,
'437.00 LF
Es c�1 T COST 0X0 CONS'�`2�3'MION
0
5,61700
- = COAIW`1:UC` ION 1rE 105 -000-4a s-CiOti� sa1,r
I
FEB 0 4 2004
CITY OF
LA CUINTA
FINANCE DEPT.
f
J
1=3 PRE -PAW 1=11
$0.00
TtY1:.'AL 111-13Mr FEE.8 DVE NOW
$01100
RECEIPT
DATE /
BY
DA;/f,&ALE
INSP
v
INSPECTION kECORD
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
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 - Int. Lath
Final
Final
BLOCKWALL APPROVALS
POOLS - SPAS
Steel
Set Backs
Footings
Bond Beam (�_� y _�
Electric Bond
Main Drain
Approval to Cover
Equipment Location
Underground Electric
�y
Underground Plbg. Test
Final // G
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
Fbdures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
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INSULATION CERTIFICATE f.
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
60-697 JUNIPER LANE LOT �01� 1; I1 h QUINTA CA
CEILINGS.
r TYPE: BLOW MANUFACTURER: Certainteed THICKNESS: R-38
WALLS:
TYPE: BLOW MANUFACTURER: Certainteed THICKNESS: R-13
GENERAL CONTRACTOR: SHEA HOMES LICENSE #
BY: TITLE:
/ PARAGON SCHMID BUIL DkNG PRODUCTS A MASCO Company LICENSE # 221517
��BY: � TITLE: ACCOUNT REPRESENTIVE DATE:
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i
INSULATION CERTIFICATE
This is to certify that i ation has been installed in conformance with th rrent energy
regulation, California Admi ative Code, Title 24, State of Californ' , in the building located at
CEILINGS:
TYPE: BLOW MAUNFACTURER: Ce teed THICKNESS: R-38
WA LS:
TYPE: BLOW MAUNF URER: Certainteed T NESS: R-13
GENERAL CONTRACT LICENSE #
BY: / TITLE:
i
PARAGO SCHMID BUILDING PRODUCTS A MASCO Company LICENSE* 221517 s
BY: TITLE: ACCOUNT REPRESENTIVE DATE:
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4
Installation CerNf Cate: Residential
Site Address }
60-697 Juniper 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
CF -6R
PERMIT #
SUBDIVISION: Trilogy a, La Quinta
CITY:. La Quinta
COUNTY: Riverside
WEST PAC AIR CONDITIONING
1, 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
1 addition, Ihave verified that the equipment is equivalent to or more efficient than the equipment specified on the
Ix
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
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.
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: 3— 2C/- ® y
Signature Installing HVAC Contractor