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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
P-cfessionals Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
,•4t? 3ra 131 !€ 4
Datet t R Signature of Contractor,_f / -
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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). 4 v
( ) 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.
(tQ 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 wissued. My workers' compensation insurance carrier & policy no. are:
Carrier Policy No.
(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 provisions of,�Section 3700 of the Labor
Code I shall forthwith comply with, those, provisions.
Date: > -> •"�, �« Applicant
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, &shall indemnify
& hold harmless the City of La Quinta, its officers, agentsVe
e
2. Any permit issued as a result of this application becomes
work is not commenced within 180 days from date of issuchpermit, or cessation of work for 180 days will subject permit9o7
I certify that I have read this application and state that the abov 4nfrmaMC is
correct. I agree to comply with all 1City, and State laws relating to t
construction, and hereby authorize, representatives of this Cit to enter OF
the above-mentioned property forf inspection purposes. } FINAF
Signature (0G ner/Agent) 4 r- ,`` ».-... Datel
2
BUILDING PERMIT PERMIT#
DATE VALUATION LOT TRACT
0f?1.',3
JOB SITE
APN
ADDRESS
.Ei2l• t�� Tse:°�x °: ;..ax Af<2 1'i�;; Yr) :Yitt�
761-27ti• 017
OWNER
CONTRACTOR/ DESIGNER/ EN INEER
;91-311.:1a7'3Aitt3���Prgl+ 1
4p++`1S?``A((4TtA?'tpr73
CC
811-'2,60 AVEN E i•-' •
rL �y
81 ^ 260 AVENUE rib
CA, 12883
LA QU114TA CA 92813 3
(519)833.19%.�(i GriVI ir$rl(l
USE OF PERMIT
L`;d'CI1 F1+ix1+1LY,''?3re"L:;✓11+F
;SPO • .LOT 7., PI.Ali 4314'.', 1PErdiffY L)OF_S >-10•17 INC.r,.UD9 N.1 (XK ~�
WALI A, P.06L, SPA .-IR ).' RN '- + A Y .A PPROACH
CUSTOW.IIIXM",11iICTION iP
PORMPAM, 411P
All,'dR•'A.:C' D t10YE, 031, +.P'£�i•y'd.Pe►i�° €��t,,nT
1i.�34�4t3a.:°.i3
:f:'k'.1z"lVC4' vim ISUMAMARY
C;:JAI S RUC TON KM 101.000.4) £I )n
P11AW CHECK ME 101.OGO-439-318 Stw�1 3
MEIMJAITICJM, FFE 10i .000 M3.30
ZVZC' RICA.L. FEK 201-000--420-000 $104,06
PLL MB1140 FEE 101 -OM -419 -OV) i t r1.:A
STRONG R#0TIM i 11j' • I..01D 101-000-2,41-000 514.0
GRADING FE -9 it�I»C1t10.4?,3aG�iU b3�,.�1
CO ; 31RIMi` ON AND 01.jhm MR. t1?S.
TA, 1 ` 6 66
d.`.:6NS rR.L-1 JQX3:•r"I:;,_',;
$0.00
Ti3TA2. PY-RACT VMS 'DUE A'E9'if~f
S-4,1 �o,"
3 1003
QUINTA
R
DATE
BY /
DAT /LED
INSPE TO
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Slab Grade VCReturn
Ducts
Air
Steel -
Combustion Air
Roof Deck
Exhaust Fans
OX 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 41PPROVALS
POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVAL
Gas Test
Electric Final
Waste Lines p A
Heater Final _
Water Piping
Plumbing Final
Plumbing Top Out
Equipment.Enclosure
Shower Pans
OX for Finish Plaster
Sewer Lateral
Pool Cover _
Sewer Connection -
Encapsulation.
Gas Piping
Gas Test „D
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 (o
Utility Notice (Perm) tea.
COMMENTS:
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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
86 Desert Shadows Drive, Lot 87,La0u[ntm.California
CEILINGS:
�
TYPE: Blow MANUFACTURER: Ce�oinbeed THICKNESS: R'38 J
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WALLS:
TYPE: Blow MANUFACTURER:Cadonteed THICKNESS: R'13
GENERAL CONTRACTOR: Shea Homes, Inc. L|CENGE#:
BY: TITLE:
�
PARAGON SCHK81DBUILDING PRODUCTS, AMasco Company LICENSE #221517 6
v
TITLE: ACCOUNT REPRESENTAT|VE DATE: 02/04/2004 �
INSULATION CERTIFICATE
Nks been installed in conformance with the current energy
This is to certify that insulation
regulation, California AdministratiOq Code, Title 24, State of California, in the building located at
^ �NGS: -.�.
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TYPE: Blow MANUFACTURE TH|QK1�E88: R-39 �
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APR -02-2004 FRI 11:49 AM WESTPAC AIR COND FAX NO. 909 739 9509
Installation Certificate. Residential CF -6R
Site Address /-�o f 7
60-196 Desert Shadow Drive
1. B VI LLDER l iNV ORMATION
Slica llumos -Trilogy - LaQuinla
60311 Trilo, y Pkwy
La Qniuta, CA 92253-7642
INSTALLING CONTRACTOR:
2. PROdH.C'TINFORNIATION
I)Tsyi 1.rt[1TI()N,
T_Y IAF,
hlexible Ductwork
in Attic ajul
Ilem,een floors
DTiCJ OR P) PING R-
V
Plt.xihlc Ductwork
Will have a 11 -Value
of 4.2 or Better
PERMIT ff
SUBDIVISION: Trilogy (ci)T a Quinta
C'TTY: La Quinta
COUNTY: Riverside
W1:S'T' I)AC AiR rONDIT1ONING
P. 07/24
I, the undersirn.,d, verify that Clic equipment listed in the categoryabove my signature is die actual equipment
installed and that the equipment n►erts or exceeds the requirernents of the Appliance Efficiency Standards. In
addition, lhave, verified that the equipment is equivalent to or more efficient than the equipment specified on the
Coitificalc orCompliance ompliance submitlod to demonstrate compliance with the Energy Fflicieney Standards for
residential buildings.
3. i1FATIN(`V' IN 1'01ZMATION
11L'A'I'IN<.i
MAN ()VAC1' HFATING UNTr ACTUAL 11,1 1'. I EATTNCT EQUIP IIEATING
1-,QUIL', MAKE MODEL 0 Arl1E CAPACITY LOAD
Furnace Lennox G40UTT-4811-09OX 80% 88000
80%
4. COOLING INFO"lATION
COOT,IN(T MANUPACT COMI'RF,SSOR ACfL1AT, EFF. COOLING EQUIP COOLING
IiQUIT'. MAKi? MQDFT, it SFF.R CAPACITY LOAD
A/C Leunox 13ACC-048 12
1110 building design heat lass and design pleat gain rate have been determincd using a method specilied in Section
150(h) of the Friargy Efliclency Standards, and are two of the ctitea is used for cquipnutnt sizing and selection.
6: 1-11P.RMOSTATIC EXPANSION VALVE CfXV):
lterniostalic FNlmnsioa Valvc (or Coajinision aphrnved equivalent) is installed and access is provided for inspection.
Yes I. --
No ( N/A
6.81111NI1'I"1 ED BY
HATE:
Signanirc Installing IIVAC Contractor