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LICENSED CONTRACTOR DECLARATION 1
I hereby affirm under penalty of perjury that I am licensed under provisions of
Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
,'P rofessionals Code, and my License is in full force and effect. 1
License # Lic. Class Exp Date
22
13 __:P6131
I _
Zate�.` 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:
Carrier NATIO) Policy No. 7100431
(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 X-1
s� to become subject to the
workers' compensation laws of Caiiorni andree that if I should become
subject to the workers' compensation,p o Islo_Section�3700 of the Labor
Code;-l�sh forthwith comply with -those p�rovis,ns.
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.
1 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, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is '
• correct. I agree to comply with all City, and Sta a laws relating to the building f
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property_for inspection urposes. ^J
-{ e
• Signature (Owner/Ag nt) Date
„t
BUILDING PERMIT PERMIT#
DATE VALUATION LOT 0403-112 TRACT
>• _:P/. $117j69 .10 3^023
JOB SITE
APN
ADDRESS 6"M DENNXPII IS.su7i.1's O'WS DIUV.E
7W.470-01
OWNER
CONTRACTOR/DESIGNER/EN (NEER
WFA1-kQUI TA7..X
'OW-Ai.AQUOTIMl,,.,C
ifs 1.260 AVf ss rE 62
R 1,2,60 AVl<PI't7L 62
A QUiWfA Cly. 92253
LA <),TJ fA. CA 92253
C1,60)777-6005 CBLA TWO
USE OF PERMIT
ZSC1U'tmaLy1a�F 1�I:t1d4
SFT? - LOT 9, P.WJl 42.10A. P1RROT DOES "NOT dNCLUDE POOL, SP.A,
BLOCK Vi'.f'?wi LA Oil Ditrvmw� m'PF.C7Ac H. ?5Vo.PXDU0'Ti0*N TO PL&W
CHECK FEE OUZ TO ''Vl J1,TtPLZ 1SSCUk~110E OF SAME P Ahi TYPE
CUSTOM CONSTRUCTION 11355.00 3F
PORCHIP1t.:P1O 314.00 SY
0AR.A01V0ARP01tT 474.00 Sid
xs'n1.ViA►'. ym cosm or comaxRut:.°':i:: on
1.17,691.10
P F'RM'i>i RX, SUMMARY
C'ONSTRUOTIOAI I'7F, 101-000-418-000 V02,30
MAN CHOCK VFE 107-000-439-319 $143.21
bAEC°W1ICAL FE 101 -000.42,1.000 $75,00
ELEC:TR1CkL, PEE 101-000-4120-000 $90.41
PIAIMBINO FFE 101-000.419.000 111.6,71
S'rAONO P11rJ4'.IGIN ME 101-000-241-000 $11:77
(M41DIN0I,9E 101-C*0-423-000 SiSM
O'-"dELOP _rt IMP1'XT FES $W,*'N145.OG
Z--rcrimL '
COWS RUC 7101 AND PLAN 6:RECK,
$3,5%64
(1 xJ's�� T'J:'.Ib•k�.Ak� I�,'E�.S
�Li. CiL'
D YS79 ty e, q i�C� 1�yy 9�g�T tV7l�w1t
"U�deIL%S.T:..h`t.FVJ.R.6 .T.k IOSDda.iN.L NOW
MAR 2 4 2004
a4w �4
.1*3,55,9,64
CITU OF LA ( UCNTA /
FINANCE DEPT.
RECEIPT
DATA 4� (
'J jr `
BY !
w!''rf
DAT FI ASD
-S d
INSPE�%
16
,r
" OPERATION
DATE.
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
_
Zan.Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
�'�(ge,
F.A.U.
Compressor
nsulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Farts & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
BLOCKWALL 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 Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
o
Encapsulation
Gas Piping,
Gas Test
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Polder Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fbdures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
I
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
60-636 DESERT SHADOWS DRIVE LOT 1009, LA QUINTA CA
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 P ODUCTS A MASCO Company LICENSE # 221517
BY: TITLE: ACCOUNT REPRESENTIVE DATE: 7 tJ�
.. i
Installation Certificate: Residential
Site Address
60-636 Desert Shadows Drive
1. BUILDER INFORMATION
Shea Homes - Trilogy - LaQuinta
60311 Trilogy Pkwy
La Quinta, CA 92253-7642
INSTALLING CONTRACTOR:
2. PROJECT INFORMATION.
DISTRIBUTION' -
TYPE
Flexible Ductwork
in Attic and
Between Floors
DUCT OR PIPING R -
VALUE
Flexible Ductwork
Will have a R -Value
of 4.2 or Better
CF-6R,�
PERMIT #
i
SUBDIVISION: Trilogy (@,, La Quinta
CITY: La Quinta
COUNTY: Riverside
WEST PAC AIR CONDITIONING
IJ
I, the undersigned, verify that the equipment listed in the category above my signature is the actual equipment
installed and that the equipment meets or exceeds the requirements of the Appliance Efficiency Standards. In
addition, Ihave verified that the equipment is equivalent to or more efficient than the equipment specified on the
Certificate of Compliance submitted to demonstrate compliance with the Energy Efficiency Standards for
residential buildings. .
3. HEATING INFORMATION
4
No
HEATING
MANUFACT
HEATING UNIT
ACTUAL EFF.
HEATING EQUIP
HEATING
EQUIP.
MAKE
MODEL #
AFUE
CAPACITY
LOAD
Furnace
Lennox
G40UH48B-090X
80%
88000
80%
4. COOLING
INFORMATION
COOLING
MANUFACT
COMPRESSOR
ACTUAL EFF.
COOLING EQUIP
COOLING
EQUIP.
MAKE
MODEL #
SEER
CAPACITY
LOAD
A/C
Lennox
13ACC-048
.12
The building design heat loss and design heat gain rate have been determined using a method specified in Section
150(h) of the Energy Efficiency Standards, and are two of the criteria used for equipment sizing and selection.
&THERMOSTATIC EXPANSION VALVE (TXV):
Thermostatic Expansion Valve (or Commision approved equivalent) is installed and access is provided for inspection.
Yes ❑ No ❑ N/A ❑
6. SUBMITTED BY
DATE: S — 2 6-0
Signature Installing HVAC Contractor