0309-338 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
Cz._Vpter 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
Date i, `��=''Signature of Contractor -�'` e
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 iSignature 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. -
(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 proyision�gf•Section 3700 of the Labor
Code, I shallyforthwith comply with those provisions.. --
Date: `t t , c. s I ""a 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, Inde
& hold harmless the City of La Quinta, its officers, agents and emplo
2. Any permit issued as a result of this application becomes null
work is not commenced within 180 days from date of issuance of
permit, or cessation of work for 180 days will subject permit to cancell o .
I certify that I have read this application and -state that the above informs on
correct. I agree to comply with all City, and State laws relating to the b ildi
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection'purposes.
wniA e)Si nature (Omak ` Date
BUILDING PERMIT PERMITq
DATE VALUATION LOT 03W)-336 TRACT
;fit"0�3
JOB SITE /�
FAP
ADDRESS f
fa:HILPOWSi 3'ad f
`
74A-:270-017
OWNER
CONTRACTOR / DESIGNER / EN INEER
i 1Hi?Ai01.I:i
P�'�,bWO ,:�Y3iLY 6JA:i Y°.�JIE
{Y�'-�1.1�! .£�rY .�at't 0.��• 1'%:>;
?:.A Q'J.ttd`.I.A CAN. 92883
LA. q 1uT:tm& CA WZtv,8 3
(30V -133.."t R96 C'"13ut 'isfy?6
USE OF PERMIT /
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4.
SVC- - LCYr PLA14 42,10H. PEiaAVC .DOES NOT ANCL.tfiil7D ElL C)CK ;
MALI,°a g50014 PA OR DIfthrDW.N Y APPROACH
CUOTCW CC?NFFRUC"f ON 11111"A.W r
POlitICHMATIO 214,00 We:
a.�i�,t�./_4��v�.�r1.'ul •! P?
�f.�Ad�iJ C.T.HJ
,�y �/+y q. �f. �'+ {��y,•g� 'yyW�.yv
W1400-418.00 S`A,0,.V
!'SAN i -"HEM FEX 101-000-439-31,9 0s
•'14, .4 •rA.t SIC.A1, RE- 101-000-421-00 3il0
ELEC'1<IUCA.L. >' 101-000-42.0••c' 00 Vil'.21
1 X11 MUNG t?U 101-000-4-19-000 Mi '75
`37'1:iIGNO MOTION TION FEE - RMID 101 -000 -MI -000
,::#Rr1DC003� 1.03.0(#tai d3fJ;) 'n#s',t3
1SFIVEl..d PIM 041P.AC T FF.iti
Wk- TOTAL C( Asa TfP1Vy"YriON AW. , P,A �j~,/�X
$4,0091.4.4
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. Lf U
CT 23 2003
ITY OF LA QUINTA
FINANCE DEPT. .-
RECEIPT
DATE T
BY ,,
DAT LED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
�f
Forms 8 Footings
Ducts '
Slab Grade LV
Return Air
!�
Steel �
Combustion Air
Roof Deck ^'
Exhaust Fans
O.iC to Wrap --�
F.A.U.
14
Framing —
�i
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans &Controls
Party Wall Insulation
Condensate Lines
Pally Wall Firewall
Exterior Lath
Drywall -Int. Lath
Final
Final
BLOCKWALL APPROVALS
steel
POOLS -SPAS
(Perm)
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
F
"
Equipment Location
. Underground Electric .
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
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 Nottage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G. F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice
COMMENTS:
,
'
•
-
--
;
_
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. i
3
,a
(Perm)
APR -02-2004 FRI 11:46 AM WESTPAC AIR COND FAX NO, 909 739 9509
Installation Certificate: Residential CF -GR
She Addre,s L oT�� ".Z. PERMIT B
60-301 Deserl Shadow Drive
t, 111111,UIIAINFORMATION
Shea i (owes - Trilogy - LaQuinia
60311 'riilogy Pkwy
La Quipta, CA 92253-7642
1NSTAT,I.ING CONTRACTOR:
2. PROJECT IMORMA'TION
DISTRIIITI ;ION
�rvr�t;
Flexible 0aawork
in Attic and
Between Floors
DTJCT Olt I11PINGIR-
VALIM
Flexible Ductwork
Will have a R -Value
oJX1.2 or Metter
SUBDIVISION: Trilogy q. La Quinta
C1'1'Y. I.a"QiTinto"
COUNTY; Riverside
WEST 1'AC AIR CON ITIONING
I, ilio undersigned, verify that the equipment listed in the category above my signature is the actual equipment
inslatled and that I11e equipment meek or exceeds the requirements of the Appliance Efficiency Standards. In
addition, Ihnvc verified that the cquipmcnt is equivalent to or more efficient than the equipment specified on the
Certificalr of Compliance submitted to demonstrate compliance with the Energy tiliciency Standards for
rasideWial buildiq.q.
3. IWATING INFORMATION
1-11;AT1NG MANI FACT HEATING UNrr ACTUAL EFF. IIF.ATING EQUIP 1d13ATING
rQlJlp. MAKCs MODELil AFUL CAPACITY LOAD
Furnace Lennox 040UTT-40-09OX 80% 88000
80%
a. C0011NI ; INFORNIATION
COOLING
MANLMAC:T
COMPRESSOR
ACTUAL, HT. COOLINC't EQUIP C001ANG
11QUIP.
MAKE
MODEL, It
SEER CAPACITY LOAD
A/C
Lennox
13ACC-048
12
The building design heat loss and dcsiLii heat gain rate have been determined using a mcibod specified in Section
150(h) of th,: L'rnrihy En iciency Standards, and are two of the criteria used for equipment sizing and selection.
6,1111e,kMOSTATIC EXPANSION VALVE (TXV):
'I haruiostatie, f xl'lansion Valve (or Commision approved equivalent) is installed and access is provided for inspection.
Yes l�o I I N/Al.
6. SUltlY I T11,I) BY
Qno'_ P DATE: - -22i—
Stl;nantre Installing 11VAC Conlraaor
,.