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LICENSED CONTRACTOR DECLARATION
I•hereby affirm under penalty of perjury that I am licensed under provisions of
Chapl2r 9 !commencing with Section 7000) of Division 3 of the Business and
Prufessionais Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
,Dated-, ? Signature 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&RC. 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.
(K,)' 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 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 Calif orgia,,and agreeA at if I should become
subject to the workers' compensation.p ovisions ofySection 3700 of the Labor
Cod I shall forthwith comply with;rose)provi�sions�!,,..• � —.,
nom* �
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, Inde
& hold harmless the City of La Quinta, its officers, agents and employ,
2. Any permit issued as a result of this application becomes null and v
work is not commenced within 180 days from date of issuance of
permit, or cessation of work for 180 days will subject permit to cancella
I certify that I have read this application and state that the above informati is
correct. I agree to comply with all'iCity, and State laws relating to the buil ing
construction, and hereby authorize representatives of this City to enter u on
the above -men onecJ property for inspection purposes.
Signature (Owner/Agent)Date
BUILDING PERMIT
DATE VALUATION
PERMIT#
LOT (%MD, -'33 TRACT.11
i
*153.nl
IPIA W11 49
3 Of 11414
JOB SITE
APN
ADDRESS
I
3• :E`s 5 MR- s rx-,R ' SHADOWS
a)rUVE
OWNER
CONTRACTOR / DESIGNER /EN (NEER
.77,dL'.+C1 f7,���I.iL'��
ei>�..t':•li, !7.�iIr�.G:i .
81-34PQ Av:01U.:. 6-Z
1311 ^260AV17.11T(.TE 62
LA.QxiNTA :':A
.92,983
Y.fx',a42t3t��i•�fiCA.
,:�w'ii;s�I
9Yy'LtUtt�2'
USE OF PERMIT
i a .! LOT 4P P,'L:�d',fa r 5j0!;.��yf;��F:*LRaDlA•.'yi
Y�.gCL��,�+`'t�iG�-111 IINC�.Oa.{�• �i�;�rrl:
i
0►�d70. 4 d�� 01, r/3S,A , OR !}af.AY �.�v
A 7 ��°.�L-.f�.VACH
'NSITUAINT=
d:L`.;: alTj Mr
T.r011ry1 �Z
COM., OF
�i�s.?Ji"e•1��:�::1'1`+�
2Gix••t`liitj�tt3��3'!b $���.�.:
M'?CHA!41K:1 Lr -T?
10i'000.421-000
F IrfrC `Clili:.l# • tr'it s�
1 r1f _a:A)_42()-4100 j 21i7.U,�
Pa.UMBIT G M
101.c;00-419.00.0 ��ae •�n
STRONG All CIT : '4 F Z41?YM!X)
10'1-000-241-00,'
'I?l)TALFLIRKUr"3_ ;.mooDT.13:;1'tifiY
is3{):�ell
OCT 2 3 2003
CITY OF LA QUINTA
FINANCE DEPT.
t
RECEIPT
DATE
BY
DAT LED
I INSPf T R
.rr��re:nr�.rrirrirrii
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
a BUILDING
APPROVALS
MECHANICAL APPROVALS
SrR Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
ReturnAir
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K to Wrap
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
V
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final G
BLOCKWALL APPROVALS
steel
POOLS - SPAS
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
-+
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) i
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) (yo
COMMENTS:
Ia
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r^(:n•/::.�•YCi•,'•,+,.7%i fr rr 1./: -
i'
IFICATE
This is to certify that insulation has been installed in conformance with the current energy
regulation, California Administrative Code, Title 2.4, State of California, in the building at
60-213 DESERT SHADOWS DRIVE LOT 49, LA QUINTA CA
CEILINGS:
TYPE: BLOW MAUNFACTURER: Certainteed THICKNESS: R-38
WALLS:
TYPE: BLOW MANUFACTURER: Certainteed THICKNESS: R-13
GENERAL CONTRACTOR: SHEA HOMES LICENSE If
BY: TITLE:
PARAGON SCHMID BUILDING PRODUCTS A MASCO Company
BY: TITLE: ACCOUNT REPRESE
Lel
LICENSE: # 221517
VE DATE: 1 6
r.+>rr>••.r..•r'rrs�sw.wma7fdW::v.Js:7vp:�fTr. ,�ar.,s.,•y.'n�� WYE.t�rvverovsswexa'l'I.7•vr�savn+>Mv:e^'•v,Yvsi�.tnmueri
faerefKs!•f�scnvavastas' i �ve�%mr..vav�r;y:r:rr.:v,>rraw.:�:+r.:ue+�.y:-sr.v.•iArme:,��.iyr.Pz
INSULATION CERTIFICATE
/ This is to certify that insulation has been installed in conformance with the current energy
1 regulation, California Administrative Code, Title 24, State of California, in the building located at
60-257 DESERT SHADOWS DRIVE LOT 50, LA QUINTA CA
CEILINGS:
TYPE: BLOW MAUNFACTURER: Certainteed THICKNESS: R-38
WALLS:
TYPE: BLOW MAUNFACTURER: Certainteed THICKNESS: R-13 's
7
GENERAL CONTRACTOR: SHEA HOMES LICENSE #
BY: TITLE: 00
PARAGON SCHMID BUILDING PRODUCTS A MASCO Company LICENSE # 221517
E
i
BY: TITLE: ACCOUNT REPRESENTIVE DATE: 9,// G .a
. a...i. i,/•. n•: n/. rri,/.,.i/isn/i/rr-✓r;.rf%.:w%'ArAL.IlrsYrr%//Y/1✓.'bi.✓rn./•//r4.r..A%r%/A'Y.»'M/••Y/LrAY1ry�.%Y/%YN.'r/i% W/.�'//Y��%l/,•YaN/rr. :rr/••%•%rh'L.r+riir/ . /. /r/r/ /. >: i
APR -02-2004 FRI 11:48 AM WESTPAC AIR COND FAX N0, 909 739 9509
Installation Certificate: Residential CF -6R
,SIN Address /- Or PERMI'17 0
60-213 %k sert Slmdow Drive
I.13111I,111;12'INF 0RMAT1ON
Sltca )lanes -Trilogy . LnQuiMB
60311 'Trilogy Pkwy
La Quinta, CA 92253-7642
INSTALLING CONTRACTOR:
2, PRt)JEC.'I' TNTIORNIATION
1')i'1'R111C 1'T;I�N
Fk7xiblo Ductwork
in Attic and
11chveelt Floors
D14(T -Qk PIP]NG Rt
VALUE
FI4xible rhietwork
Will have a R -Value
of 4.2 or 13cttcr
SUBDIVISION: Trilogy (a), Ln Quinta
CITY: La Quinta
COUNTY; Riverside
WEST PAC ATR CONUI'i'IONING
P. 03/24
1, Ilic mider,igncd, vk•tify that the equipniont listed in the categoty above my signature is the actual equipment
installed and hint the t:quiptttent meas or exceeds the requirements of the Appliance Eflicicncy Standards. In
iddition, (have verified that the equipment is equivalent to or more efficient than the equipment specified oil the
Certificate of Compliance : ribmitled to dcnionsirate compliance with the Energy F.fliciency Standards for
residenlial buildings.
3. I1FATiNG INI OIiMATiON
1TIsATING MANUFACI' HEATING UNIT ACI11AL EFF. FIRATING EQUIP HEATING
EQUll'. MAKE' MOTEL # A( -(JE CAPACITY LOAD
Furn ice Lennox G40UII-48D-090X 80% 88000
80%
a, COOLING IN FORM ATFON
COOLING
N1ANiJI'AC:T
COMPRESSOR
ACTUAL EFF. COOLING FQUIP COOLING
EQUIP.
MAKE
MODEL.
SFFR CAPACITY LOAD
A/C
Lennox
13ACC-048
12
The huilding design heat loss and design heat Lain rate have been dctermined. using a niethod specifier) in Seeliori
150(h) of the T?tuetty Efficiency Standurds, and are two of the criteria used for equipment sizing and selection.
6.TII MM(.)STA'1'ItC; ll'X'ANSION VAINE (TXV):
Tltertaoslatic Expamion Valve (or Commision approved equivalent) is installed and access is provided for in.qpeclion.
Yes No N/A
6, SIIliIN1C'1"i'I':Ti ISY '
DATE: —Z—U
SiE;nsturc luslalling IIVAC Contractor