0403-099 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
HCh?ter 9 (commencing .with Section 7000) of Division 3 of the Business and
04 W Pr&+ssionals Code, and my License is in full force and effect.
-0 c4„ License # Lic. Class Exp. Date
9 r— dLO -7 20 r t? j(y
C:) ZZ r --Date � � ` : �S gnature of Contractor
co _
J U C) OWNER -BUILDER DECLARATION
Hd 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).
f ( ) 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 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.
(,p).i 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 NAMPIAL UNION Policy No. 710R3
(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 asjto become subject to the
workers'compensation laws of California, and a�'ree that if I should become
subject to the workers' compensation -provisions of Section 3700 of the Labor
Code,.l.shall forthwith omply with th se p ovisions.
Dater�AK� plicanA % e 9 •-- +
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, 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 State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection purposes. -
I Signature (Owner/A`gent) .�' �`+-� Date�,}i1
BUILDING PERMIT PERMIT#
DATE VALUATION LOTS TRACT
t204,025J)0 91 300V
JOB SITE
APN
ADDRESS 60-:e:31 DIV.) laa SHWOWS DRAM
'764-270-017'
OWNER
CONTRACTOR / DESIGNER / EN INFER
SF3i::A i A.QU19rA LLP_
:1rir.N.L A QU.TITM1LC'
511260 .mrMTF 62
9 12 60 A`MILM 62
TA qF.Jwr.,,i CSA 92253
XA QIJ CA CA. 92233
USE OF PERMIT
mau :FlmiLCf,,'1C i)tfll?'L.L-ftTC's
Sim • LOT 91, F1LhN 3310A. }a.Efn'.'MIT 00111 HOT 111CI.,t.UUE POOL,
SPA, 131.,OL'IC WWALLS, Ofi.1';RI EWAYAPPROA.CH.
CUSTOM WflSTRUCPION d,451,00',R
PORCHA),ATIO 131.60 SF
0ARAOWCARPORT $19.00 +F
la'S17WI .TI?"1.3 COV OF C0J1'5'1.`.�ZUMION
Z0002151(9)
DWI. ?WT iM214UAW'iRY
C011PTRUCTION 1 LIE 101-000-418-0010 M,01)70
PLAN CHECK.",E 101-000-d39-318 $016.67
MECHANICAL 1•M1~ 101-000-421-000 $41.00
ZLWT 1C.AL tr1? ? 101-000-420-000 $1,29.65
MUKKING FEE 1 C+1 -000-4119-000 $166,110
S'PRDN. 0 MOTION ITZ • RESID 101-000-241-000 $4.40
GI AMNO RIE 101-000423-000 $j 3>00
DEVELOPER IMPACT FRE, $1,403.60
ART IN PUBLIC P1AC1i;3 - RESK 70.000-445.000 $10,06
S1I1 -I lonAS, C0.14'1'.1.'1,.' U(n, 0i-' AND W,W OWECK
$4,660.18
US
7s1psalstTPRT''�PATD
Vie, µ.��{sip.00'
MAR 2 4 2004 U
CITY OF LA QUINTA
FINANCE DEPT. V{
RECEIPT
DATE
BY
DAT F ALED
INSPE TO
^/! C-1
1,/,1_1
z o
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APP OVALS
MECHANICAL APPROVALS
Set Backs
44Underground
Ducts
Forms & Footings" .
Ducts
Slab Grade
Return Air
Steel
Roof Deck
3�
Combustion Air
Exhaust Fans
O.K. to Wrap
Framing
Insulation
Fireplace P.L.
_
(pew
�_
F.A.U.
Compressor
Vents
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
POOLS - SPAS
BLOCKWALL
APPROVALS
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
A
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K for Finish Plaster
Sewer La eral _
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main gervice
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
v r: I:'1'i `>!/.'1: •.:I:.�..rl.�y r.• rr r��./. .YVY :... .r :r. r. . 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 located at
60-653 DESERT SHADOWS DRIVE LOT 1091, LA QUINTA CA
CEILINGS:
TYPE: BLOW MAUNFACTURER: Certainteed THICKNESS: R-38
WALLS:
TYPE: BLOW MAUNFACTURER: Certainteed THICKNESS: R-13
GENERAL CONTRACTOR: SHEA HOMES LICENSE #
BY: TITLE:
PARAGON SCHMID BUILDING PRODUCTS A MASCO Company LICENSE # 221517
BY: TITLE: ACCOUNT REPRESENTIVE DATE: �Z
Installation Certificate: Residential CF -6R
Site Address ' .
60-653 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
PERMIT #
SUBDIVISION: Trilogy @a, La Quinta
CITY: La Quinta
COUNTY: Riverside
WEST PAC AIR CONDITIONING
1, 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
HEATING MANUFACT HEATING UNIT ACTUAL EFF. HEATING EQUIP HEATING
EQUIP. MAKE MODEL # AFUE CAPACITY LOAD
Furnace Lennox 80UHG4/5X-100 80% 100000
80%
4. COOLING INFORMATION
COOLING
EQUIP.
A/C
MANUFACT COMPRESSOR ACTUAL EFF. COOLING EQUIP COOLING
MAKE MODEL # SEER CAPACITY LOAD
Lennox 13ACC-060 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
1610'n DATE: 5-26--o �Z
Signature Installing HVAC Contractor