0309-340 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
1—
-Cha iter 9 (commencing with Section 7000) of Division 3 of the Business and
N W Profa$sionals Code, and my License is in full force and effect.
O =) M' ` License # Lic. Class Exp. Date
r- d � i
_ �.... _ /
o Z
CD 0t` Date ISignature of Contractor
Ti
J U ca OWNER -BUILDER DECLARATION
HW I hereby affirm under penalty of perjury that I am exempt from the Contractor's
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).
M () I am exempt under Section B&P.C. for this reason
N Date Signature of Owner
ON
Cr)d Q WORKER'S COMPENSATION DECLARATION
p Cr I hereby affirm under ,penalty of perjury one of the following declarations:
p () 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 � Q performance of the work for which this permit is issued.
C5 Q U (), I have and will maintain workers' compensation insurance, as required by
O U Q Seytion 3700 of the Labor Code, for the performance of the work for which this
H permit is issued. My workers' compensation insurance carrier & policy no. are:
? Z Carrier Policy No.
°CD O A.
W 'PiCy14IA1, NIO`k} P: r;�A*33
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
3 subject to the workers' compensation provisions of Section 3700 of the Labor
Code, I: shall forthwith comply with those ptovis'ions.
Date: Applicant J h
i
41111111 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, indemni
& 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 voi
work is not commenced within 180 days from date of issuance of so
permit, or cessation of work for 180 days will subject permit to cancellati
I certify that I have read this application and state that the above information iip
correct. I agree to comply with all City, and State laws relating to the buildi g
construction, and hereby authorize representatives of this City to enter up n
the above-mentioned property for inspection purposes.
Signature (Owner/Agent) , 1 - �• -�K'S.. Date (—) L- L
BUILDING PERMIT PERMIT#
DATE VALUATION LOT 03M �0 TRACT
•
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/� i. 4:E'4ctA.iR�.CiCi 4"� ,^5t�1::3
JOB SITE
APN
ADDRESS
OWNER
CONTRACTOR/ DESIGNER / EN INFER
9HM NOAH9.117,
,. HOI I
81-2C4)11l��UE 621
F,1 Att•7 LIF,62
LA QUIN'tA CA 92983
LA ,;�G`,I,ta rA t .41 tYUM
USE OF PERMIT
SFD . LICIT 93, P.UA14 4_94h. PEK'.7�11'&' aTLT!5'I�U7' Iitf: LUC1.G t!L t:lt:%
•tiW A*JI JA POOL, NMA OR WEDUC:T11011 O FLAW
CHECK EPEE .DUR TO MU1,T1PLn ISSU"CE OIr S A.M'R ?Lt01 `x YPZ
z
CUSTOM CO'1,43TRr14''•I'ION I.EikS.00 8F
POII.MIPA z 9U 46:t. tl: Sk
GARAMUCARPOV 8F
IS'M, cm, Or C.()11V1J11RCTC�'1°10.K
PERINU117.2 SUMMARY
(.-t;YNSTRUC:`f WN ME MIN '
PIAW CHECK i ,,L ]C?1-olGii•�#:I�'-3;� �I71.:4
RtliiCK'•HANICAI.
ELECTRICAL FEE •. 1� # ,.44�h�!?�i-tlflf) Z2�'7.G�
PUTA9I THO FEE $142.0 .
STRONG MOTION FEE= Imo" ID 101-Oai-V,I- W $94.(h. '
G RADINt' FER 101-1000-421.3-000 9,5.00
DF,VEt.OPER IMPACT FEE
1LT33-•TC`11'A • G i�I A i C` Z ICM r9 r:' P li.FSl�d cU�°i CIC
w�z,?tgp3;8�J.�1j2'
WEAL F'FXKff M! E :l UE I`lC1W
OCT 23 2003 .
CITY OF LA QUINTA /
FINANCE DEPT.
RECEIPT
DATE 0. ?
BY l
DATEZED ED
INSP C
INSPECTION RECORD
OPERATION
BUILDING
DATE INSPECTOR
APPROVALS
OPERATION DATE INSPECTOR
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
—'--
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
r–
Exhaust Fans
O.K to Wrap
F.A.U.
Framing
4
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
p,4 NA
Drywall - Int. Lath
Final
Final
BLOCKWA
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
APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Firial,..
Plumbing Top Out
Equipment.Eiiclosure
Shower Pans
O.K for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation ,
Gas Piping
Gas Test
O
Appliances
Final
Final Q
Utility Notice (Gas)
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 Pourer
Final 6
Utility Notice (Perm)
COMMENTS:
/ \
APR -02-2004 FRI 11:45 AM WESTPAC AIR COND FAX NO. 909 739 9509 P..03
lnclallation C:er(iPiestte: Residential CT -(alt
Site Address LO -7-g-?
60-345 Desert Shadow Drive
1,11(JIL0ISR INFORMATION
Sicca Ilnmec, - Trilwogy - LaQuinla
60311 Trilogy Pkwy
La Quhita, CA 92253-7642
INSTALT-ING CONFIZACI.OR:
2. PROJECT INFORMATION
D I.S'I`I UR ITTON
Flexible Di4work
iil Allic and
lietwcen I' lools
DUCT OR PTPINC, R-
VA 1 .1. TF
-
VAT.T.TT? —..---
Flexible Ductwork
Will have a R -Value
of 4.2 or Heller
rERMIT #
SUBDIVISION: Trilogy (ra), La Quinta
CITY, La Quinin
COUNTY: Riverside
WEST PAC AIR CONDITIONING
I, the undersil'lted, verify that the equipment llswd In the categoly above my signature is clic aCILLal cgLlipmcnt
iit.,llnlled .md Lbat the equipment meets or exceeds the requirements of the Appliance Efficiency Standards. In
additimi, Ilwve verified that the equipment is equivalent Lo or more efficient than the equipment specified on the
031ific:11c of Compliance submitted to demonstrate compliance with the Energy Efficiency Standards for
r:sidvnliA buildings.
3.11111,ATING, l N FORM A'1'ION
I IIwrlW MANUFACT I-IF.ATING UNIT ACTUAL FIT. HEATING EQUIP HEATING
EQUIP. MAICII MODEL # AFiJF CAPACITY LOAD
Furnace Lennox 010UII-4813-09OX FO % 88000
80%
4. COOLING I N VO RMA'rioN
COOLING MANLfFACT COMPRESSOR ACTUAL EFF. COOLING EQUIP COOLING
U,
1?QU111. MA MODEL it SWIR CAPACITY LOAD
A/C' Lermox 13ACC-048. 12
The building de;;ibnl heat loss anal design heat Pain rate have been determined using a method specified in Section
150(h) of the Pnerry F.fficieacy Standards, and are two of the criteria used for equipment sizing and selection.
G:rIIT,IaM<.DS'I ATI(. EXPANSION VALVL: (TXV):
Thcrmoswlic Expansion Valve (or Coilly) ,isioil approved equivalent) is installed and access is provided for inspection.
Yes 1. 4 No I j NIA
6. SUIIMI'rTF,! BV
Signature Installing IIVAC Contractor