0309-336 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
Fes— Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
04W y Profe§sionals Code, and my License is in full force and effect.
O �'c- License # Lic. Class Exp. Date
Z r s' Date 4 e '' — t- `Signature of Contractor
�O�-I .. '
J U C:> OWNER -BUILDER DECLARATION
LU 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).
( ) I am exempt under Section , B&P.C. for this reason
LO
N Date I Signature of Owner
ON
0)d Q WORKER'S COMPENSATION DECLARATION
D Cc I hereby_ affirm under penalty of perjury one of the following declarations:
Lin P O (') 1 have and will maintain a certificate of consent to self -insure for workers'
X W 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 I have and will maintain workers' compensation insurance, as required by
O Q Q Section 3700 of the Labor Code, for the performance of the work for which this
fl 0)H permit is *issued. My workers' compensation insurance carrier & policy no. are:
`t Z CarrierPolicy No.
coo /=y .R �VONAL )MION 17.
V
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.ofrSection 3700 of the Labor
3 Code, I shall forthwith comply with thoseprovision `s. -- •--
Date; -j t. ApplicaCFp �^
i
11111111 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
�i addition to the cost of compensation, damages as provided for in Section 3706
111111 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 o
any permit issued as a result of this applicaton agrees to, & sh demnify�
& hold harmless the City of La Quinta, its officers, agents an
2. Any permit issued as a result of this application becomes nu void if
work is not commenced within 180 days from date of issua a of sl�i T
permit, or cessation of work for 180 days will subject permit to n ellation.
I certify that I have read this application and state that the above i for OI
correct. I agree to comply with all City, and State laws relating to the buil I NAI
construction, and hereby authorize representatives of this City t
the ab(5`cie mentioned property for inspection p rposes.
�vnature-16wner/Ag nt)i1'; (r,���— �..�., Date
BUILDING PERMIT PERMIT#
WOO
DATE VALUATION LOT QS , V, 6 TRACT
1' :' � • ` .�� �1.�l. 3.73 1. ?r.�`��
JOB SITE
APN
ADDRESS [�j y�( (�
!i1 O'2-ohiitin ru�ra.i��}�/ S Rl:RT.=
( }( }
OWNER
CONTRACTOR / DESIGNER / ENGINEER
VIiMSA40tt.1, �
MM, A.HOW113
QwNw.. CRA. M813
LA Q=7A (✓ti, 921!-1
MUP 6876
USE OF PERMIT
f?W 1iY1 F'ANfii Y ?:31i1T'EU.1901
a"•t"x: - t OT 1, PLAN -4520A. F'FRIVII1.' CORS NOT INMUDS SuIC:K
WALL' ,% K)Os., ISPA OR DRW M.AkY APPP.(M. 01, 75% REDUCTION TO 'N. AN
C1 EC PEZ DUX Tf,,I JMIUC;1'IP1 E; 1313101 N C 9 OF PLAN TYPE
CUM110141 CtIX F3'1'PLUC1'ION 1,661M, ET
MRCii+v.1 lio 171.03 S1r
t1A121ZAMCArilfORT 488.''10 V.
EF�.U41:AiED COS 3r COIN"I[UC 7C1
sqT yyySZe� 'Ry
("U14BI RUCT1ta1A, PRE 101-000-418-M ma6.30
10,A13, MM trl" ; $lsg. I5
MPCHA141CV, PES &T'.i O
Y-1,114UTRIC&L FlYM 101 -000-420-.000 $101.43
PLt:frnBIN0 F19 '� 01-000,419-000 53r:?f
STCtarlPlCi Rv1C)m1Lgl s X2,9. ZtASM 101-000-7411-000 X34.14
Eti�11iNCT I�1fl; 1651-f'tU�J-4 3w�t5 $15.00
21TID-TOTAL C;OMMUv''. tic .14.1W1:11?LA14 C I? C
a LIM0 MI -PAD FUM
TO, 00
2 3 2UUJ `Zit)�a1��.y�Z:!":�'.�%s::+'�ilr.�C.;•�
�3,4i1�'e.'��
LA QUINTA
CE DEPT.
RECEIPT
DATE
s
BY ' i
DAT IN/(%QE)
2
f
INSPECTION RECORD
0
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
j
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
BLOCKWA
6
L APPROVALS
POOLS - SPAS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test .
Final
Gas Piping
PLUMBING APPROVALGas
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 6r
Utility Notice (Gas) t
ELECTRICAL APPROV "S~
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 Q
Utility Notice (Perm)
COMMtN' TS: .
'p —f
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R
INSULATION CERTIFICATE
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
60-328 DESERT SHADOWS DRIVE LOT 1, LA QUINTA CA
a CEILINGS:
TYPE: BLOW MAUNFACTURER: Certainteed THICKNESS: R-38
0
WALLS:
TYPE: BLOW MANUFACTURER: Certainteed THICKNESS: R-13
i
P
R
GENERAL CONTRACTOR: SHEA HOMES LICENSE #
r
{
BY: TITLE:
PARAGON SCHMID BUILDING PRODUCTS A MASCO Company LICENSE # 221517
e .
s BY: t11,4 C2 TITLE: ACCOUNT REPRESENTIVE DATE: 7 .6
i
j
APR -0272004 FRI 11:46 AM WESTPAC AIR COND FAX NO, 909 739 9509
•a
111staliation Certificate; Residential CF -6R
Site Address o 7' l
60-128' Dewrt Shadoty IDI'ivc
1. 1>;IJYLDKIZ INFORMATION
Shea Iromcs -Trilogy - LaQuinta
60311 Trilogy pkwy
La Quin(a, CA 92253-7642
INSTALLING CON- TRACTOR:
2, TPROJECT IN ORMATiON
ISI TI:1 Ili JTION
Flrxible Ductwork
in Attic and
llelw;�rn Floors
TH-1 1' OI: P11?TNG R-
VALIJE
Flexible Ductwork
Will havo a R -Valeo
of 4.2 or Better
PERMIT 11
SLJBI)TVISION: Trilogy 5) La Qt►intl
CITY: La Quinta
COUNTY: Riverside
WEST PAC ATR CONDiTTONING
1, the undersigned, verify that the equipment listed in the catogory above my signature is lite actual equipment
installed au4 that Iltt, cipipment Incus or exceeds the requirements of the Appliance Efficiency Standards. in
acklition, Ihave vorified that the equipment is equivalent to or more efficient than the egniptnent specified on tlhc
(.'ertitir•.1lo OfCainpliance submitted to demonstrate compliance with the Energy Efficicucy Standards for
r.5idelli ial buildings.
P. 07
3. HEATINIG INFORMATION
IIiiAIING MANUFAC,T HEATING IWIT ACIVAL EFF. IIEATINQ1'QUTP HEATING
EQUIP, MAKE MODEL // ACIJF, I CAPACITY LOAD
Furnace I.Cnllox 640U114813 -090X 80% 88000 _
80 'yo
4. COOLING TNFO1Y,YMA'I'ION
C:0011NO 1vrAMFAC4' COMPRESSOR ACTUAL EFF. COOLING EQUIP COOLING
1?Q1111'. MAKE 1vMODiET.t/ SLEI: CAPACITY LOAD
A/C I.cnnox 13ACC-048 12
The building design heat loss and design heat gain rate have been determined using a method specified in Section
150(1) Of the Ilnergy Efficiency Standards, and are two of the criteria used for equipment sizing and selection.
631114: CXPANS ION VALVb: (TXV):
Therntosiatic Iixpansion Valve (or Conutdsion approved equivalent) is installed and accoss is provided for inspection.
Yes jC J No i _._ N/A l
6. SUBMITTED BY
Q)AA-J DATE:
Signalure; Installing 11VAC Conlract4r
I