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LICENSED CONTRACTOR DECLARATION
I,ti!phy affirm under penalty of perjury that I am licensed under provisions of
�1 -r 9 (commencing with Section 7000) of Division 3 of the Business and
ssionals Code, and my License is in full force and effect.
License # Lic. Class Exp. Date {N
Date - 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&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 Policy No.
}QATIOl1JO„.13NIOP Y�. 7165833
(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,SAon 3700 of the Labor
Code, I sliall fort with comply with those,provi'sions.
Dafen'Applicant Z t'
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 p
whose request and for whose benefit work is performed under or pt r t to
any permit issued as a result of this applicaton agrees to, & shall, in
& hold harmless the City of La Quinta, its officers, agents and em S.
2. Any permit issued as a result of this application becomes null an of if
work is not commenced within 180 days from date of issuance s h
permit, or cessation of work for 180 days will subject permit to canc lati
I certify that I have read this application and state that the above inform tion is CI
correct. I agree to comply with"all City, and State laws relating to the
construction, and hereby authorize representatives of this City to enter upon
the above mentioned proper rtyJfor inspection purposes.
Sign E tuKee, (Owner/Ageltp f ` �— Date
BUILDING PERMIT PERMIT#.
DATE VALUATION LOT' TRACT
Ik143.1.1 fid}
JOB SITE 7P14
ADDRESS
66',740 JYE&& r .'!• SH"QWS DRAT T
?64 -270 -?4.7
OWNER
CONTRACTOR/DESIGNER/EN (NEER
0x�s
k37 • air:2 �'i'iITt�PY"tTF.: �'!
t� 1 r,u�. 4 .�a4� T47ki �,("
LA QT1'f?+1'.VA CA. 92893
LA i jT:dW'd A CA SIM
Ilk
USE OF PERMIT -- r. ,
Co*.,T"rAMtLY):w411v. INC
; f ,� r 3A7 �S; P3.A,ld .4hiiulrc. PI?.EZ'1V;7'f30091rs Noll INCIJ. tht g Bib E"'
W4L?11X POOL, SPA fu1'ri. hRY"+1WA,`t' All PROACH
.®rARAC E1C!ARP0RT S" ,{tU R}''
F' t'�x�.mzf kw swmo.lkay
CV140'FAU� 1'YO}� ��j; 101110t34"••418-UWn S70330
G'<1:AN CHECK I�� 'v Gt U1,}tt.yf 39 3 I 8 1�64�• 31
l?Y�'4WiiA IY�`•f�1dFE? 101-00U-421-000 53M!
!?)�.1•�+lpp"�s,RIIi7C,.AL��pY fi 1tl4,''•'josae- wt2-/C��Yi2 Y $:1fel.19@
1.111 dYq�lS+G I•'1"•d'i l4}}'^10100 -t19_"000 $132.•1($
t ROND MOTION }1.1rX • Yd �, s1*-: 101-000-2-41-0-00
1 f3}-t1��J-�i.? aE3i}{!
OR�.(�(.LYWO FEY�sp(�
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T#1KV,r1;1',0 ER 17,\ PA.N.r'!•. Jr7LAw� t4f�. `aU�.Vlr
T,4,169.46
!CT2 3 2003
3qAY'ATw {' Tzl�d�'1�,.�'.fl-,.&Y s t� TF,- .`Jw
i1'b�g16` A6
ry OF LA QUINTA
F1 DEPT.
RECEIPT
DATE
BY
v
DAT N LED
INS C�TQR
•/77
Ei"
t'.,
INSPECTION RECORD
OPERATION
DATE
INSPECTOR OPERATION
DATE
INSPECTOR
BUILDING APPROVALS MECHANICAL APPROVALS
Set Backs Underground Ducts
Forms & Footings Ducts
Slab Grade r-- Return 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 POOLS - SPAS
BLOCKWAL A PROVALS Steel
Set Backs Electric Bond
Footings Main Drain
Bond Beam Approval to Cover
Equipment Location
Underground Electric
I
I
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 OX for Finish Plaster
f
Sewer Lateral. Pool Cover ,
,Sewer Connection Encapsulation
Gas Piping
Gas Test .o Z( S7
i
Appliances
Final
COMMENTS:
Final 6
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)
i
)
t
INSULATION CERTIFICATE
f
This is to certify that insulation has been installed in conformance with the current energy e
regulation, California Administrative Code, Title 24, State of California, in the building at
60-240 DESERT SHADOWS DRIVE LOT 5, LA QUINTA CA
CEILINGS
TYPE: BLOW MAUNFACTURER: Certainteed THICKNESS: R-38
WALLS:
TYPE: BLOW MANUFACTURER: Certainteed THICKNESS: R-13
GENERAL CONTRACTOR:. SHEA HOMES LICENSE #
BY: TITLE:
PARAGON SCHMID BUILDING PRODUCTS A MASCO Company. LICENSE # 221517
BY: P TITLE: ACCOUNT REPRESENTIVE DATE: 12-/( d
J
APR -02-2004 FRI 11:49 AM WESTPAC AIR COND FAX NO, 909 739 9509
)Installation Certificate: Residential CF -6R
:Site Address Lo
64-240 Desert Shadow Drive
1. RUII,T1FRINFORMATION
Slieu llonlcs - Trilogy - LaQuinta
00311 'Trilogy Pkwy
La Quinla, CA 92253-7642
INSTALLING C:ONTMCTOr:
2. PROJECTINFORMATION
t)i -!'p111xfrr0N_
J -y6"
hlexihlo Ductwork
in Attic and
11e1weea floors
I)UCf OP, PIPING R-
VA1.1JF_ y
I+lexible Ductwork
Will have a R -Value
of 4.2 or Better
11ERM1'1' V
SU13DWTSTON: Trilogy rr, I.a Quinta
eery: r,a Quinta
COUNTY: Rivv rside
WESTPAC AIR CONDTTIONING
P. 05/24
1, the undersigned, verify that the equipment listed in the category above my signature is the actual equipment
installed And 11urt the equipntruit meets or exceeds the requirements of the Appliance Efficiency S(andards. Tn
nrldiiion, lhave Verified that tile. equipment is equivalent to or more efficient than the equipment specified oil the
C'rrtificato of C:ompl.iance SUbmitled to demonstrate compliance with the Energy Efficiency Stftndards for
residential buildings.
3. Ill?ATING INFORMATION
iMATING MANUFACT ITL+AT1NG UNIT ACTUAL FFF. HFATJNG EQUIP 1i1:ATING
EQUlf . MAKE MODF1111 AFUE CAPACITY LOAT)
Fnivacc Lennox G4013I-I-4SB-09OX 80% 88000
80%
4. COOLV40 INFORMXFION
COOLING MANUhACT COMPRESSOR ACTUAL F.H. COOLING EQUIP COOLINCT
1:QUIlp, MAKF MOTEL # SEEP. CAPACI'rY 1.OA1)
AJC Lennox 13ACC-048 12
'I'lic building design heat loss and design heat Cain late have been determined using a method specified in Section
150(h) of the F.nct!gy Fff iciency Slandards, and are hvo of the criteria used for equipment sizing and selection.
63'HAAtl11ONTA'1'J>l: EXPANSION VALVE (TXV):
Tllcrn'10tilsllie Exp:uutiion Valve (or Cominision approved equivalent) is installed and access is provided for inspection.
Yes I No N/A (.
6.';U16M11I'1111111) BY
0—IMI—Al—J-D DATE:
Sirnaiure Installing IIVAC: Contractor