0309-337 (SFD)U)
U)
W
O � M
0 u7
' W
C:)
Z
O�
r— _
J
Waw
U)
Z
• .. N
0 N
U_ °)
C Z
T H O
xw_
mUU
LO
v 9 Q
Cb Z)
r0
J
LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that 1 am licensed under provisions of
Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
-Professionals Code, and my License is in full force and effect.
Licedse # Lic. Class Exp. Date
r
bate �' 1 V 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:
Carver 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 shqll 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.1of Section 3700 of the Labor
Code, I shall forthwith comply,.with'those provisions.
Date: I. t'A L..:A;-'Applic`ant-- J
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnity
& hold harmless the City of La Quinta, its officers, agents and employ
2. Any permit issued as a result of this application becomes null and v
work is not commenced within 180 days from date of issuance of
permit, or cessation of work for 180 days will subject permit to cancella
I certify that I have read this application and state that the above informati is
correct. I agree to comply with all City, and State laws relating to the buil ing
construction, and hereby authorize re' esentatives'of this City to enter u on
the above-mentione$p rope rty for inspection purposes.
Signature (Owner/Agent) \�4 -•` t�• -• Date
BUILDING PERMIT PERMIT#
DATE ' V,ArLLI TION' LOT �3'.�.i1 TRACT
300
JOB SITE
APN
ADDRESS
011,19 5 S". . 'r�i�tWOWN TiRIVU
70217E.L'f;u 7
OWNER
CONTRACTOR / DESIGNER / EN (NEER
M'EA,H'JWS
;u".F.:"r'.a6:,1403uuIE3
87 ^260 ? N?MAT-i3.s Cyt
01.160 AWi TIE 62
7A Q. 71WA Ch. 92883
YA{auwlk t, C.M M43
(909)823435/96 01.'7.9 6876
USE OF PERMIT
WT OLE RAl'.xll YDW _ .�?KG
SrD . I.s;r .91, PLAJa 45300. PEP -MIT !?DOES 1107 INCLUDE BLOCK
WAUZ,1100 4 SPA OR ViR1V1QVAY AF'€'R0jzX1i
CtUSTOM. C'OMTi3U TION J.'U3,44, aN
F'oR. n -UP TIC' 1A.00 a3'
OA1I.AOP'4"Al% C!rt'y 4 .4,'�;l SY
1 3"T1 i l�li s C�!1;"f c31 a'Qt`� F,b f"1:fl"iD�r
146,347.70
aIM"faVT 1'Mr IRTM 1( A1.1 v
��C?i'3�1'.illfi`1`tC{t`i �•n }S li)i'4U00�^4i�Kii017 �13[�:�?
KI..A'!3 CHiEVIX ?SIF,. 1 i'f'1-000-439-31€1 $643.90
M&i°iiialJK,1AL FEE 101 • .000 V5, 50
.
F.1,15MTRICA1, F.,1t 1;:1-S1Cf3-' ;G Ot7 abi0i.!33
P1,Li1~31li3 O FEE 101 -000 -419 -ow S i 1631
SV10140 )V-01710141'ZE • I2MM 101 _000-2,.1.000 114.61
.
OMIDING Fitt" 101M_4e13 Mo I1S;N
r-2VEE.A1.MI .IMP4ACT KIX $2,ol.L'a
i�13 '+��i''C1`« • Cf NT. 1170C;`1 OtT fXf) PIAN C.'•Td.�:'.C,
,1 a8.-�U
Q
OCT 23 2003
TA _
-
CITY OF LA QUINFINANCE DEPT.
BY f�
DA LE
INS R
INSPECTION RECORD
OPERATION DATE INSPECTOR
BUILDING APPROVALS
Set Backs
Forms & Footings
Slab Grade
Steel
Roof Deck
O.K. to Wrap
Framing
Insulation
Fireplace P.L.
Fireplace T.O.
Party Wall Insulation
Party Wall Firewall
Exterior Lath
Drvwall - Int. Lath
OPERATION DATE INSPECTOR
MECHANICAL APPROVALS
Underground Ducts
Ducts
Return Air
Combustion Air
Exhaust Fans
F.A.U.
Compressor
Vents
Grills
Fans 8 Controls
Condensate Lines
Final
COMMENTS:
Final 5 a
ELECTRICAL APPROVALS
Temp. Power Pole
Underaround Conduit
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
Final
Final
BLOCKWALItA"
P
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 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 Pininn
Final
COMMENTS:
Final 5 a
ELECTRICAL APPROVALS
Temp. Power Pole
Underaround Conduit
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
APR -02-2004 FRI 11;46 AM WESTPAC AIR COND FAX NO, 909 739 9509
Installation Certificate: Residential CF -6R
SilcAddrm Gof -5-1
60-279 Desert Shadow Drive
1. 111 If INFORM ATION
Shea ITornes - Trilogy - LaQuinta
60311 T rilo y Pkwy
Int Quinla, CA 92253-7612
1NS•fALLING C:ONTRAG" FOR:
2.PROJECT INFORM A1'10N
C)IS'1'1 I1111'1'lON
rlcxihlc Ductwork
in AI1ic And
liviwccn Moors
DUCT OR PIPING R-
VAI.i IF_
Flexible Ductwork
Will haven R -Value
of 4.2 or Batter
PEI IZM IT #
SUBDIVISION: Trilogy rt, I.a Quinta
CITY: La Quinta
COUNTY: Riverside
WEST PAC ATR CONDITIONING
1, the undeusigued, veriry that the equipment listed hi the category above my signature is the: actual equipment
hi,stalled and that the cgiijpment meats or exceeds the requirements of ilia Appliance Efficiency, Standards. In
,mdklition, Yhave vri if led flint the equipment is equivalent to or more efficient than the eq� ipment specified on the
Cerlificale of Compliance submitted to demonstrate cornplimnee with the Energy L'flieicncy Standards for
reshk-nlial buildings.
P. 06
c� •
3.1IPA'ITfNG TNI`()kM47'1ON
11FATINO MANUFAC"T 111IATING UNIT' ACTUAL 217- . HEATING EQUIP HEATING
EQUIP. MAKE MODEL # AFUE CAPACITY LOAD
Furgace l,onmix 80UIIG4/5X-100 80% 100000
80%
4, COOLING INVOItMATTON
C00UNG
MANU AC:f
COMPRI—SSOR
AC`rUALL'l'a)~, COOLING EQUIP COOLING
l?QUIP,
MAKE:
MODEL /I
SI LP, CAPACITY LOAD
A/C:
Lennox
13ACC-060
12
'Ilia hailding; design Lcat loss and design heat gain rale have been deter,niried using; a method specified in Section
150(h) of tfte Uilergy lsrliciency Smridards, and are two of the criteria used for equipment sizing and selection.
f,.'T'lil?T21V1()S'i'A'1'IC: �;X1'ANSIOjV VALVE (TXV):
'I'herttlostolic Expallsiott Valve (or Commision approved equivalent) is installed and access is provided for inspeclion.
Yes I —rNo N/A I .. I
6. SI1HNAIT't IO) BY �(
(91 -J)
DATE-
Sig.o.1ture Iostalliug IIVAC; Conbactor