0309-333 (SFD)LICENSED CONTRACTOR DECLARATION
U) Thereby affirm under penalty of perjury that I am licensed under provisions of
E- Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
N W s Professionals Code, and my License is in full force and effect.
O M License # Lic. Class Exp. Date
rr- d LO
ti F� �
oZ r— Date y" Signature of Contractor
O r� / t
U �+ OWNER -BUILDER DECLARATION
U W I hereby affirm under penalty of perjury that I am exempt from the Contractor's
~ U) License Law for the following reason:
Z_ ( ) 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).
co () I am exempt under Section , B&P.C. for this reason
LO
N Date Signature of Owner
ON
M
9< WORKER'S COMPENSATION DECLARATION
o 2 Z I hereby affirm under penalty of perjury one of the following declarations:
r< O () 1 have and will maintain a certificate of consent to self -insure for workers'
X U compensation, as provided for by Section 3700 of the Labor Code, for the
O J Q performance of the work for which this permit is issued.
m Q U t(') I have and will maintain workers' compensation insurance, as required by
O U Q S tion 3700 of the Labor Code, for the performance of the work for which this
rn H permit is issued. My workers' compensation insurance carrier & policy no. are:
I'* Z Carrier Policy No.
J (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 diose provisions:
,Daate:l.,: Applicants
Warning: allure 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
11110 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
k* 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 jrepresentatives of this City to enter upon
the above-mentioned property for inspection purposes.
�Signatu(e`(Owr)er/Agent)' DateA--'
L
BUILDING PERMIT PERMIT#
DATE VALUATION LOT (OM 31-0 TRACT a
$163AUG St1 atm
JOB SITE
APN
ADDRESS
60L257 =451= SEE&DO" DMJ9
OWNER
CONTRACTOR/ DESIGNER / EN INEER
9HKA HOMES
itiiV.:HCW .3 4
81.2.E AVE * 01' Rig
81-260 ,AWNTT$ d�
LA (,KJXW1.A CA 9141"S
LA QUD :t'1: CA 2411.143
USE OF PERMIT
iiJkTC�I-L I+s'��+�Ii,�.r �'Vit!?t�tCt
LDT 5;i, Pt,.AN 434 3. PERMIT [XWZ X,0T IXCIAJ0H! BI.+t r,%
WM" KX 44 Di'A 01tDRIVEWAY APPROACH
CUSTOM t'cO1+ STRti{"FOA 1.00.0 BF
PORCHePA7 0 T'13.30 81r
(16A{yWXAPU11 RT 4K 4W
IMMIAMD CCW (3F CraNMITC1ION
PkT14ft'YKX 6tU1lT,d4RY
t~"•C�:'TMU('i"IC3r1I
PLAW CHF(.,K f Y. W i -004439-31 E+
t�'Ii�(° {ANtC'JiLPs: 101-,000-4214M
�'C 8J�"►"ittt" I< �! .. 1 i; t -CW-11 20 -Mi
plIUMB'.NO In r (i`-LR'i?>419.000
3T1:CV0 MOTIOV f<' 1, RABID V 1-000-241-000
:3 i1I2vTCt t*F.I; i I-000-423.000
J'I`A "X'+%GCJ11C) 6 AND P1,AN ui C + '�C
'. l "• �. SS
D I .9:.1; PrZE - %kTzi
.
SOXX
OCT 2 3 1003 A t., rmwr m Pair now
CITY OF LA QUINTA
FINANCE DEPT.
�. .
RECEIPT
DATE
BY
DA IN LED
INSP C O
r
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
A
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
r
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 A PROVALS
Steel
POOLS - SPAS
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final I
I
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
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final !l
Utility Notice (Perm) 4_—
COMMENTS:
VAS
APR -02-2004 FRI 11:48 AM WESTPAC AIR COND FAX NO. 909 739 9509
Insiallation Certificate: Residential CF -6R
Site Address Lo f 15-0
60-257 Desert Shadow Drive
1. YlIlll.t)I R INFORMATION
Shea f Ionics - Trilogy - I nQuinta
60311 '1'tilogy I'1,-wy
f .a Quinta, CA 92253-7042.
PERMIT #
SUBDIVISION, Trilogy C) La Quinta
CI'1'X: 1.1 Quinti
COUNTY: Riverside
P. 02/24
INSTALLING CON'1'RAcT6R: WEST PAC AIR CONDITION LNG
2. I'Ii0J11Y;'I' INV0R.MATI0N
DT.q'l, I21ItlI_ ION _ 1)UCI_OR PIPING R-
T -V P.I:, V AT,i J1
Flexible Duclworlc Flexible Ductwork
in Allic and Will have a R -Value
13ctwCen T'lnors of 4.2 or Better
I, Iho undersigned, verify that the cgairment listed u1 the calegory above my signatury is the actual equipment
installed and that the equipment meets or exceeds the rcquircments of the Appli2mce Efficiency Standards. In
addition, Ihavc veri flikl That 1110 equipment is cgnivalent to or more efficient than the equipment spceified on the
C'ertificalc of Compliance snbinitted to demonstrate compliance with the Rnergy Efficiency Standards for
rVsklential hnildings.
3. HEATING IN'VO11MATION
111iATING MANUFAC"l' I[EATING UN[T ACI'UAL EFF, HEATING L,QVII' IMATING
L,QUIP. MAKE MOT)F,T,// AI+UI: CAPACfl'Y LOAD
hurn:lce T.cnnos G401714•4813 -090X 80% 88000
80%
4. C00T,1NG' INFORMA'1'[UN
COOLING MANCI[-'ACI' COMPRESSOR ACf(JAL EFF. COOLING BQUfP COOT.ING
P.Q131p. MAIC I: MODEL# SEER CAPACITY THAI)
A/C Lonox 13,ACC-048 12
Tho building desi'n hent Inas and desi; n heat gain rate have been determined using a method specified in Section
150(1►) of the Isnergy Efficiency Standards, and are two of the criteria used for equipment siving and selection.
631WRM05'I'ATIC; EXPANSION VALVE (TXV):
Thennnglatic Expansion Valve (or C'onnnision approved equivalent) is insialled and access is provided for inspection.
Yes j No ( N/A
C. St1 TB104I'Y'TTa.I.I I3Y
9-a wL.
• Signature Ii�stalliilg TIVAC (�llulraclnr