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LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
C-tpter 9 (commencing with Section 7000) of Division 3 of the Business and
Professionals Code, and my License is in full force and effect.
License tt Lic. Class Exp. Date
{ s)
3,�J 1104
pate;.'• rT' j r SSignature of Contractor �! 3
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.
NATIONAL ?fidICYIN :? 71� lW33
(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' compensatimprovisions of Section 3700 of the Labor
Code, I shall forthwith comply with those
Date 1 •,) 2`' • '-% Applicant 4 —• r` r
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, demnify
& hold harmless the City of La Quinta, its officers, agents and aees.
2. Any permit issued as a result of this application becomes null a
work is not commenced within 180 days from date of issuance uch
permit, or cessation of work for 180 days will subject permit to can la io is Or
I certify that I have read this application and state that the above infor til
correct. I agree to comply with all City, and State laws relating to thellbuil
construction, and hereby authorize representatives,,,of this Cify to en er upo4
the above-mentioned property for inspectiowp'u` poss.4 �?
Signature (Owner/Agentj' f'' '` " r --''� �l Date
Q
M
BUILDING PERMIT PERMIT#
DATE VALUATION LOT TRACT
JOB SITE
APN
ADDRESS
611 67 DESS"E RADOWS,, PRI
'IV—"4-017
OWNER
CONTRACTOR /DESIGNER / EN INEER
CA 94:q$s
L,tail T. A CA 92aF?
'
��q�lfs3��fl��r5 ::k3i.i� Fx87f
USE OF PERMIT
11ML E FAMILY TMi:U.'��1
YD > 1101114, PLAN, 421 s`.`. PEIZ.21IIT DOP1 11107 i'NCi1X1iOf: E1,0CK
WALUA WOOL, SPA OR VIRlV Eki A PRS ACH
;r'�.���utvt �q:;Z�Mr��•�C'rrc�':�. z,2�s.un i�'
a012C?iliP>'t`f �;0 214M S?
CA'R,0Et3i�? RPORT M,00 Sir
.w IMI'I IED (10NP7V OF M, N`.rAtXJC'1'€0N
TPI X17.949
PL.km Cit: K r9p, f 01 *_040_141139_319
WF.01INNICAI EIS:. 1911.0',?0-4111.Ono $x:1.4!•0
i VIE/C9.'RZAiL,.FEE 101).-tiiW-4SO-0010 01.€0
PLOT UMINOFRE 1131-Vetjeti`-=9.000 $1W.In;
,T1R `NC M(AION PAL • RESID 101 ••OPW -`d4•I -UCIr SD.9
'
OnA?IDING FEE - 1 f3l $13.00
.
UIMP.&OT nX $2,405AC-
b7•Y/Ai•.t�s•r`1��..-S..Sl•S.il`Jd a•..f.dt.e.�,,.3-ZC wii`41}b $"l.Id'Afil iw.'..L-•�i�+.[�•
.}i•� fl1i x.3•...90./
1.��s� 1''fLkrs•z'',!�IC�7�'I;•:a
�:rs.�11J
e
pyyo� yy� yy {� y p p�
''r l,A I '.'�.F].1�.5C': � �` fa J:i.FhliAala.�w�}.7
T 2 3 1003
OF LA QUINTA
ANCE DEPT.
RECEIPT
DATE
BY
DATE I ALED
INSP CTO
INSPECTION RECORD
O;r• 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
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wali Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
BLOCKWALL 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 Flhal
Plumbing Top Out
Equipment Enclosure
Shower Pans
OX for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation:
Gas Piping
Gas Test
77
Appliances
Final
Final
Utility Notice (Gas) EE] z
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 b
Utility Notice (Perm) Q
COMMENTS:
INSULATION CERTIFICATE 3 L --
This
-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 located at
60-262 DESERT SHADOWS DRIVE LOT 4, LA QUINTA CA
CEILINGS:
TYPE: BLOW MAUNFACTURER: Certainteed THICKNESS: R-38
WALLS:
TYPE: BLOW MAUNFACTURER: Certainteed THICKNESS: R-13
GENERAL CONTRACTOR: SHEA HOMES LICENSE #
BY: TITLE:.
PARAGON SCHMID BUILDING PRODUCTS A MASCO Company LICENSE #221517
BY: TITLE: ACCOUNT REPRESENTIVE DATE: .2— l G�
APR -02-2004 FRI 11:48 AM WESTPAC AIR COND
FAX NO. 909 739 9509
Inst-llalion Certitreate: Residential CF -6R
Site Address h o f - 7
60-262 TDmrt Siindow Drive
It. RUILll I k INFORMATION
Shea 11omes - Trilogy - LaQuinta
60311 4'riloo,y Pkwy
La Quinln, CA 92253-7042
INSTALLING CONI1zACFOR:
2. 1'110,jIWT INFORMAT[ON
i)1S_TRMUTION
If Y11 H
Flexible Daetwork
in Attic and
I lelwccn Floors
DUCT T Olt 111111NCT R_
VAi.i1R
hlexihle Ductwork
Will have a R-Vah1c
oF4.2 or 13etler
PERMIT #
SUBDIVISION: Trilogy n, La Quin(a
CITY; La Quints
COUNTY: Riverside
WEST PAC AYR C'ONDiTYONINC,
P. 04/24
1, (tic undersirnud, verify that the equipment listed in the category above my signature is the actual equipment
himallrcl and that the egaipiuent meets or exceeds the requirements of the Appliance Efficiency Standards. in
adilition,lhave verified that the equipment is equivalent to or more efficient than the equipment specified on the.
Certificate of Compliance submitted to demonstrate compliance with the Energy Ef cic:rney Standards for
residential buildings.
J. HEATING INFORMATION
)WATINO MANUFACT 11I:ATINC; UNIT AC'T'UAL EFF, HEATING EQUIP IiFATING
I;QU)I. MAK[? MODI I.1R AI UL' CAPACITY LOAD
171m11ca I t-nnox G40UH-4813-09OX 80% 88000
80%
4. COOLING INFORMATION
COOLING MANUPACT COMPRESSOR AC"I'UAL CFF. COOLING EQUIP COOLING
EQUIP. h1AKP MODEL l! SFFR CAi'ACITY LOAD
A/C Lernsiox 13ACC-018 12
I'lhe buildina design heat loss and design heat gain rate have been determined using a method specified in Scclion
150(h) of the 13,110egy Efficiency Standards, and are two of ilia criteria used for equipment sizing and selection.
6.THERIVIOSTATIC EXPANSION VALVE (TXV):
'I llcrmostalic F%pan,lon Valve (or Conimision approved equivalent) is installed and access is provided for inspection.
Yes No (_ ] NIA
6. SURR11WETD BY
A Y.)
aAA� DATE:
Silnalurc Installing; HVAC Contractor