0309-335 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
Chcu.ter 9F�ommencing 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
40934
TJ
S3.17,691.10 I
JOB SITE
ADDRESS — —
I� 3R7�a �Ei'i:l' SJ�iJ y`++i.s 11� �
Date,
Signature of Contractor,
CONTRACTOR / DESIGNER / EN (NEER
;3J ,P�iCf?siaaN�i
.
OWNER -BUILDER DECLARATION
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
O 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.
(ti, )% 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. .
Soda +.IONA1, UN11,4 IT.. 1YiDMX4
(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 thaVif I should become
subject to the workers' compensation pro isions of Section 3700 of -the Labor
Code, Q hall forthwith comply wit�h•ttiose provisions.:-^�
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
any permit issued as a result of this applicaton agrees to, & shall, indemn
& hold harmless the City of La Quinta, its officers, agents and employe .
2. Any permit issued as a result of this application becomes null and void
work is not commenced within 180 days from date of issuance of su
permit, or cessation of work for 180 days will subject permit to cancellatio i.
I certify that I have read this application and state that the above information s
correct. I agree to comply with all I'City, and State laws relating to the buildi
construction, and hereby authori2cArepresentatives of this City to enter upon
the above-mentioned�property for inspection -purposes.
S(/!`gnatu.,re.(}Owner/Agen,t) _ ✓�`" ! Date—"-'w-� f
� 1
e_..
BUILDING PERMIT PERMIT# 10000-
DATE VALUATION LOT TRACT
TRACT
S3.17,691.10 I
JOB SITE
ADDRESS — —
I� 3R7�a �Ei'i:l' SJ�iJ y`++i.s 11� �
APN
' M��••�.`Pilt3;� ;'
OWNER �—
CONTRACTOR / DESIGNER / EN (NEER
;3J ,P�iCf?siaaN�i
>ra3.l:� ,atC'y R7
X.14 -f AW3N1 ; E f-''2•
Clk 9 883
"T 1A. CA
Caw ."7nr
USE OF PERMIT
8,140MI..F.Va X' T.YWEILNf:3
6'itfti�?;IT D7P.,T W!DT Mr;1. 'aft;
WA f % POOL, SPA OR Dj8tSf EWAY APk'FQ&C°4J
J.
n?y(�
:
hX,}°1i:15,REF.r/��'M'�llf"Vsl'1 •`)fa3:lli S7'
101.000 418.00$7g3.ta�
PLAIL&I C HMIC : YEV. t0l -000-439-318 $YnZ
FrilFCHANIACAi.P:k: 1 1.sC3t3 �1X1•GCr3 S'�3.�?i
L( !�F:%It."-Az. F+: 1,�;pC24/t"t ay �qY:{([!� •[O�E;�1} $9lR1:�ffiy?
r'1.,\f.A�i�i�',a h•4'n`4r F y 1 �.V61f Y"G .1..'I4'✓'�/�� �R I�Y� /
$7;0f3NO1g,'ZwTIONYZE MS11", 1():-000••241„000
101 •C*0.4:3.000 air.;},
OFti 1.f ►3si? �. )'mpkO9" 5171d'' $r;HG .t�t3
I Lis I%1 T ;Ct'id t LJt md'1 )+ f TJ�k �.t , i FC:�3 `%
e ..
i,A <.". r.'; 6
OCT 2 3 2003 �'a. :,ag ; �* rt�� VE11 NOW
� p�:� i
CITY OF LA QUINTA
FINANCE DEPT. .
RECEIPT
DATE
BY
DATE FJ LED
INS CTO
INSPECTION RECORD
- OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
S1% Backs ,—Underground
Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck A
Exhaust Fans
O.K 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
BLOCKWALL PPROVALS
Steel
POOLS - SPAS
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 Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
OX for Finish`Plaster
Sewer Lateral
Pool Cover
Sewer Connection —
Encapsulation -
Gas Piping
Gas Test
Appliances
Final
Final
Utility Notice (Gas) — 2-,
ELECTRICAL APPROV LS
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)
COMMENTS:
-
J%J.///IX/%/d//dH//.%/U/L1/IN;P/.Y✓N:!�?/M%///F//!/%.!d///.0/t/N:{/.(%iO"L%;V-I/%/l//./////Ill%/%ll/!/.tif/%/'iT� r//.%%%/A%%y.%9/!/•///Y/Ni!///%///J'I/l/5%%i
INSULATION CERTIFICATE 3
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 at
60-306 DESERT SHADOWS DRIVE LA QUINTA CA # L
c -
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
s
INSULATION CERTIFICATE
This is to certi that insulation has been installed in conformance with the current energy
regulation, Califo *a Administrative Code, Title 24, State of California, in the building located at
CEILINGS:
TYPE: BLOW MAUN GTURER: Certainteed
R-38
WALLS:
TYPE: BLOW MAUNFACTURE a inteed THICKNESS: R-13
GENERAL CONTRACTOR: A HOMES L ENSE #
BY: TITLE:
P �GONCHMID BUILDING PRODUCTS A MASCO Com
BY:
TITLE: ACCOUNT REPRESENTIVE DA'
E # 221517
APR -02-2004 FRI 11:47 AM WESTPAC AIR COND FAX N0, 909 739 9509
Installatioli Certificate: Resideutial CF -6R
Silc Addrerns /—Or �L
60-306 Desert Shadow Prive
1.11IJI1,01,11 1N1'0TZMXi10N
Shea )ladles -Trilogy - T.aQuinta
00311 `]tangy Pkwy
La Quinti, CA 92253-7047
1 uALLINCT CONTRACTOR:
2, PROJ>»:CT YNFORMA LON
1)1S'fI:1R1ITI0N
TYPi?
Flml.)1e Ductwork
in Attic and
13(jwml F loots
DIJCTQTi Plf,1NGR-
VATIM
Flexible Ductwork
Will have a R -Value
(if 4,2 ar Better
PEI RMIT #
SUBDIVISION: Trilogy (a), La Quinta
CI'T'Y: La Quitita
COUNTY: Riverside
WEST PAC AIR CONDITIONING
1, the muh signcd, vcTify that the equipment listed in the catc�ory above my signature is the actual equipment
installer) aml that the equipment meets or exceeds the requirements of the Appliance Efficiency Standards. In
odditic»T, lhrrvo verified that the equipment is equivalent to or more efficient Than The equipment spceilied un the
Cciiificate of Compliance submiltcd to demonstrate compliance with the Energy Lfliriency Standards for
rer,idcrnial buildings.
E
3. ITF,A,rmG INFORMATION
ITEATiNG MANT)FAC 1', HFATTNG UNIT ACTUAI. EFF. ITEATING EQUIP IILiATI NG
LQUIP. MAKE MODEL # AFUL CAI'ACfTY LLAT)
Furnace Lennox G40T.JTl-48R-090X 80% 88000
80%.
4. C 001JNG INFORMATION
COOLING MANI)FACr COMPRFSSOR ACTUAL, F.H. COOLING EQUIP COOLING
EQUIP. MAKE MODEL # SEER CAPACITY LOAD
A/C Lcrurox 13ACC-048 12
The building design heaT loss and design heat gain rate have been deternuned using a method specil ied in Section
150(h) of the Energy E licielicy Standards, and are two of the criteria used for equipment sizing and selection.
G,'f'F1F;ItM()5'I'A'l'I(':1'�XPAN51()1�J VALVE (FXV):
Thernw5lalic Expansion Valve (or Commision approved equivalent) is installed and access is provided for inspcctiou,
Yes No L I N/A [ 1
6. tiYJ11l11I'L"I'i:U MIY
DATE: Z�1 _
Signature Installing I1VAC Contractor
I