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LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
Cnapter 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
e i
093j
Date l•• Signature of Contractor
c I
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 tp�operty, 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.
(�r ) I have and will maintain workers' compensation insurance, as required by
Se tion 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.
N&flTJtdAL 0WON 9: 17I658r13
(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' compensationjprovisitins of Section 3700 of the Labor
Code, I,shall forthwith comply withrthose provision's'..+�..•
Date j s+ �. Applicant
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, inI
& hold harmless the City of La Quinta, its officers, agents and a ees.
2. Any permit issued as a result of this application becomes null ai I id if
work is not commenced within 180 days from date of issuance f uch
permit, or cessation of work for 180 days will subject permit to can II ion.00
I certify that I have read this application and state that the above infor ati n i
correct. I agree to comply with all City,;and State laws relating to thl buildinpT1
construction, and hereby authorize representatives of this City toe FI
the above-mentioned propertj, for„inspWction purposes. 1•
Signature (Owner/Agent) Date_
BUILDING PERMIT PERMIT#
DATE VALUATION LOT tOV!&k -:b4f3 TRACT
�2 i z 2cJ3foC►t3 is.' s3
JOB SITE
APN
ADDRESS
OWNER +
CONTRACTOR / DESIGNER / EN INEER
e3TMA HOMO
IRYWIM
AvIiNTUR 621
-160 AVENXTE 6”
�.A
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r; iliJ�.t'��i`{3•'�1��� re''�.�:�t� +Ff'�.''i"i�
USE OFF•�PERMIT
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,M1, • 14T O, c3I.,A:N 43100, M(tilfl'T I)XY3 1,10T fN- i.A, t3E' Sl.+iX"Ir.
iWdlUA P0014 51% OR I)RPd'RWA'Y APPROACH
CUSTOM CONAW rRU'."'('ION, I;' Y ,Cp SF
1't' RC,IVI'6TIO sy
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&y��,�ntry • fir; `17-�t��•� .�� iUNITNIM:F
PIAN CHXCK YEE 101 -000 -4,W -31k
(/l�ty��6.21.0�:1�
MECITANIC.A`{. YE 101.0000-4
@i p3�Iq��N
01-tll�:!.,q— 46�7•'�1{/,'0f;0
8 MCI+ .f.. L',C'.4]: - 10
.
}ISlIWI k$S.1i.[',i
CY7.d W.PAaSJ l.X`i Sl ➢" &. 101 uti�'.'0-411,0-00:? 5111 C17
M,0NO.4¢:?9' ON :F12, - Its"aI0 101-(,W-.24.15..-Wri $17.11
O'R,AD190 FEE S!e VI..a
.
I3EVItWPF1d.1V•IPAMI' $3,40:4.iT
NOW -
S ,f ',64*
T 23 2003
OF LA QUINTA
ANCE DEPT.
RECEIPT
DATE
BY
DATE F ALD
INSPECTO
INSPECTION RECORD
' 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
Fireplaoe P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Encapsulation--.
Exterior Lath
nn,aan _ int i ath
Utility Notice (Gas) I Y 11
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 k
Utility Notice (Perm)
Final
Final_fi
BLOCKWAL APPROVALS
POOLS - SPAS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. 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 T,o --( 57
Appliances
Final
COMMENTS:
Utility Notice (Gas) I Y 11
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 k
Utility Notice (Perm)
r.-�c/Si."/%i!%/"/•Cr.:rf.'F':•1i %/:!'/.'!J/lisf/!!%/%'%/%/!//.%///fn•'��!a%/I/!Y/!/.'Y'I//.!Y'%//l%!/I/.!/.%Y////!//ry%///l/n%/l%1/Ni'/lf//l//L/%//l/{////////^`_ %/%%N/J//%l/f./%//.!/'!//////Y/ry%///i':/.•:gil: "•Y,!!i!!%'/.'l/:!•'l�
INSULATION CERTIFICATE
'Y
This is to certify that insulation has been installed in conformance with the current energy,,
R, regulation, California Administrative Code, Title 24, State of California, in the building at
1.
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60-218 Desert Shadows Drive, Lot 88, La Quinta, California
r CEILINGS:
v
f TYPE: Blow MANUFACTURER: Certainteed THICKNESS: R-38
P
a WALLS:
R
TYPE: Blow MANUFACTURER: Certainteed THICKNESS: R-13
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GENERAL CONTRACTOR: Shea Homes, Inc. LICENSE#:
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BY: - -' '- TITLE-:
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PARAGON SCHMID BUILDING PRODUCTS, A Masco Company LICENSE # 221517
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BY: TITLE: ACCOUNT REPRESENTATIVE DATE: 02/04/2004
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. .._...� ..i ... rri.v.i..u.,:,.�iv;i •_.rivi.� r.i.�ii�r!ii�.riirirririrrii�iir�rv..ir.�irriiiiar.i/,iiirrriiiiii/r✓/ra/r�:ry/�/r//.!i/ri/.f/.�i:�/!Y/.�/li/O/!l/V/�✓//)/J/l/,:�//....�/.i/lJ/ri/If,•.�/.�:COi!i"//.ilN/."i/moi rJ/.�/r�r,:J'_/'lGl_�//.'J:Y 1!:s:.:
INSULATION CERTIFICATE
This is to certify that insulatioly has been installed in conformance with'the current energy
regulation, California Administrative Code, Title 24, State of California, in the building located at
CEILINGS:-.. _ _ ��-
TYPE: Blow MANUFACTURER: Certain eed THICKNESS: R-38
WALLS:
TYPE: Blow MANUFACTURE : Certa nteed THICKNESS: R13
GENERAL CONTRACT .
r
BY: TITLE:
PARAGON SCH ID BUILDING PRODUCTS A Masco Comr
BY: TITLE: ACCOUNT REP
A
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a•.•!l.U/':'rrl,I.'!I//I.lfllYl//J///%/!l!/iJ%//J.lJ.%I/l.%///,�,/!,I!/.�/,%IIJryH!/!/.!//p/!//!/!Y/l/.:!/,rl//%/%/.%J%//l%/%I%J!%I.%/VII.:
LICENSE #
ny LICENSE # 221517
ESENTATIVE DATE: 02/04/2004
APR -02-2004 FRI 11;49 AM WESTPAC AIR COND FAX NO. 909 739 9509
Instillation Certificate: Residential
Site Address `®
60-218 Dewrl Shadow l)rive
L lillll,DER INFORMATION
Shea I lotnos -'Trilogy - LnQuinta
60311 'Trilogy Pkwy
1,1 Quit)ta, CA .91253-7642.
INSTALLING CON•TRACI'OR:
2. PROJE,Ci` IiNFORMA ION
TYPE
Fle;xiblo Ductwork
in Attic and
Oetwr'e,t I'loors
DL)C t' OR P f PTNO TZ -
VALUE. --
Flexible Ductwork
Will have a R -Value
of 4.2 of Better
C F -6R
PERMIT 4
SUBDIVISION: Trilogy (cr), La Quinla
C1'1'Y: La Quinta
COUNTY: Riverside
WEST PAC AIR CONDITIONING
P. 06/24
undrrsigned, verify that the equ4milunt listed in the category above my signam•e is the actual equipment
installed ane] ilial the: egttipnu:nt mccls or exceeds the requirements of the Appliance Efficiency Standar(k rn
addition, lhave verified that the equipment is cgaivalCnt to or more efficient than the equipment spccihed on the
Certi(icate of Complimice submitter) to demonstrate compliance with the Energy }7fficiency Standards for
residential buildings.
3. TIVATING INFC1RMAT[ON
111:ATING MANUFAC1' IIEATING UNIT ACTUAL EFF. JiIiA ING EQUIP HEATING
I;QLIIP, MAKE MODT'sl,ti AFUI's CAPACfIT LOAD
furnace Lennox G40UH-48B-090X 80% 85000
80% _
4. COOL•INC:1NFORMATION
(,'00[,1N(3 MANU AM' COMPRESSOR ACTUAL FFF. COOLING EQUIP COOLING
1:QIJJP. MAKE MODEL # SEER CAPACITY J.OAI)
A/C Lezutox 13AC%C-048 12 _ . _...
The building design heat loss and design heat gain rate have been determined using a method specified in Section
150(11) 01,01': l'snergy Efficiency Standards, and are two of the criteria u. -.cd for equipment sizing and selection.
6311VRMOSTA'I'IC EXPANSION VALVE (TXV):
' burtioslutio I'xpirision Valve (or Conirnision approved equivalent) is installed and access is providers for inspection.
Yes �No ( ) NIA I ..
6. S1111MITI'Ili) BY
.� DATE.:
-
Signature Inslall iug IIVAC Contractor