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LICENSED CONTRACTOR DECLARATION
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
.Professionals Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
672285 6MO105
,.,Date 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).
( ) 1, 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 ?I.A.PION_AL UNION Policy No. '7165,133
(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 alto become subject to the
workers' compensation laws of California, and agree that if I should become
subject to the workers' compensation provisionsrof Section- 3700=of the Labor
Code, I shall forthwith comply.4ith tfiose.provislons.
Date: Applicant
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. t /
Signature (Owner/Agent) Date 1
BUILDING PERMIT PERMIT#
DATE VALUATION LOT ()401-3" TRACT
36 30013
JOB SITE 1`
ADDRESS w-7aq v=i£ ARRA, 3 -Am AV e •
APN
7M-2704)17
OWNER
CONTRACTOR / DESIGNER /ENGINEER
mLCa iX77IW A1.x
aSUU AQTyAL1P,
91260 AVJMTB 62
'812,60 AVIINUI? 62
LAQ iNITA CA ?'2253
I. &QuZtnA CA 9225:3
(160)777.6005 CBU-J TBD
USE OF PERMIT
sn) -1A)T 36 PLAN 42100. PER?3IT OUISS NOT INIC-WDY.. POOT., SPA,
BLOC=K WALU, OR ORIVENAY f+PMOACH
CUBTOM CONSMUCTION 1,610.00 SF
P."IRC;liIPA,' 0 318.00 Sit
0ASSiAM1r;AF1PORT 5$7.40 SP
E+.111KATED 4:OFf OF C'ON�")r'E2UC:" ITOK
i 40, ma,%f
1;''YW%t'.4IEE il'ITADWZY
C:ONSTRUCTIOV FO, 101.000-418.000 5783.00
PLA14 CHUCK FLE 101-000-439-318 S(A5.16
MEC11.011CAL YFE 101-000-421-000 SAM
E,,LECTRICAL. FEE,' 101-000-470-000 $100,99
1N'TIMMNr1 FRE 101.004.419.1100 $140.?5
STRO440 NO T IGN FL+E « MID 101-0130-241-000 $14.96
?FCA 1)11401011 101-000-423,000 $15,110
DLrVZL0VJ7F!2 IMPACT Fjrlt 57,405.011
YC:1'[ON AND PLAN CJ]rtZK
$4,20146
FEB 11 2004T
CITY OF LA QUINTA
FINANCE DEPT.
RECEIPT
DATE / / � C,
BY �
DAT E FIN `ED �
INSPE�TOJa/
zi,fn "I �-
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 p 30 (1
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 APPROVALS
POOLS - SPAS
Steel
Set Backs'
Electric Bond
Footings! t ,
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 _
Encapsulation
Gas Piping
_
Gas Test z
Appliances
Final
Final
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 Power
Final
Utility Notice (Perm)
COMMENTS:
i
Installation Certificate: Residential CF -611
Site Address PERMIT #
60768 Fire Barrel Lane
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
SUBDIVISION: Trilogy @ La Quinta
CITY: La Quinta
COUNTY: Riverside
WEST PAC AIR CONDITIONING
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
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
jam— 67- (� /2 -/Z1 DATE: _4— 8 -D IV
Signature Installing HVAC Contractor
07/08/2004 09:31 17607769980 HOLLY PAGE 02
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
60-760 FIRE BARREL LANE LOT 1036, 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 PRODUCTS A MASCO Company LICENSE # 221517
TITLE: ACCOUNT REPRESENTIVE DATE: /c v y