0401-393 (SFD)LICENSED CONTRACTOR DECLARATION
U) I hereby affirm under penalty of perjury that I am licensed under provisions of
H Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
04 W Professionals Code, and my License is in full force and effect. `
C) License # Lic. Class , Exp. Date
UJ
r5j w / 5 .- 373
o Z r-- Date Signature of Contrac/tor- "' /
r� H OWNER -BUILDER DECLARATION
WW 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). ` It
co () I am exempt under.Section , B&P.C. for this reason
N Date Signature of Owner
O N
rn
a Q WORKER'S COMPENSATION DECLARATION
p Cr I hereby affirm under penalty of perjury one of the following declarations:
Lin FZ O () 1 have and will maintain a certificate of consent to self -insure for workers'
X LU li compensation, as provided for by Section 3700 of the Labor Code, for the
O _J JQ performance of the work for which this permit is issued.
m Q_C) ( ) I have and will maintain workers' compensation insurance, as required by
dC Q Section 3700 of the Labor Code, for the performance of the work for which this
a Z permit is issued. My workers' compensation insurance carrier & policy no. are:
Carrier Policy No.
oob O 27A1`:IOWAL "Un9iON 71614833
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, andfagree tKat-if I should become
3 subject to th'e workers' compensation"provisions of Section 3700 of the Labor
Code, I shall'forthwith comply with -those provisions. ��`v
.-Date: /Z 11 U Applicant r
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
b of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
I for a permit subject to the conditions and restrictions set forth on his
application. • - i
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. ,�
,.Signature (Owner/Agent)' f ` Date
BUILDING PERMIT PERMIT#
DATE VALUATION LOT 0401-393 TRACT
4;11,'�,faJt.iJ 38 30023
JOB SITEAPN
y �
ADDRESS 60-012.�?':A�c �G+,L''��L�`i�`4H.ee LAM i J �
�,e
764-%.7"17
OWNER "
CONTRACTOR /DESIGNER / EN INFER
SHE -4 1,A QL1iNTA LiP_
%W A LA. Q UINI'A UdC
812.06 AWER—RIE 62
81260 AVERWCT L, 62
L-%QUI1dTA CA 92253
LAQ1nNTA CA. 92253
(760 177.6005 MAW Ti3"1)
USE OF PERMIT,
7,, �p 7' }
7y DW
Su .' J'L.F.i 714-1111I -r 3 J Vro 177 st-D V.
SFJ) - LDT 31, PLAN 4210& PP.,I4MIT DOES NOT INCLUDE }BOOL, ::PA,
BLOCK WALLA Cit DR.rVEWAY APPROACH
CUSTOM CONS`f'PUM, 10ki LM.AD OF
P01LC:k9IP ATIO 214,00 F
QARAGFJCA.RP0RT 4X00 2F
RTTSW f't?' 0' C:OfVSUC.1'1C3R!i
117,&A.10
C:(?1QST.RUC:`1 i%..1 FRIE4 �3i-OIC►r)�11 f3 -OCU �"�i1�.513
PLAN C111=91 t+'EE101-�U-4341-31fs ra
MIRL° RAMCALFrl.1Q1"QO(1'�i.Lt" `4i'a 575,00
,G4 LECTUI C,A+L. r19Ed 101-000-420.000 $90.41
ff4,11114P0401+EE 101-nU4-419-WO V 16
STR ONO A4t'91'ION F11%, • RIPISSID 101-000-;Z4I-000 $tL`l7
OPIADIHO FEE 101 000-423.000 $18.00
0EVE_OPER IMPACT 11,?0 $2,40S.00
.1
s�U RO1A� M)1a1:.,P NGi�F�:'YC
� *T 3 TIRE -PAW I
$:3,"9.'26
$0.00
tFEB 1 1 Z00 'roa, , . f Pyr in, M.ISDO: OW
CITY OF LA QUINTA
FINANCE DEPT. /
RECEIPT
DATE /
BY
DATE FIN#LEr,4
INSPE,P
JT
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
Ifp� p
Compressor
Insulation
a
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
I
Exterior Lath
p
i
Drywall - Int. Lath
o (o
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 I
PLUMBING APPROVALS
Gas Test
Electric Final I
Waste Lines
Heater Final I
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
b
Encapsulation
Gas Piping
Gas Test
Appliances
i
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:
Installation Certificate: Residential CF -6R
6
Site Address PERMIT #
60-812 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 (a, 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
"ScA rso m an DATE:
Signature Installing HVAC Contractor
07/08/2004 09:31 17607769980 HOLLY PAGE 07
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
60-812 FIRE BARREL LANE LOT 1038, LA QUINTA CA
CEILINGS:
TYPE: SLOW 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
BY: TITLE: ACCOUNT REPRESENTIVE DATE,