0401-038 (SFD)LICENSED CONTRACTOR DECLARATION
�. I' hereby affirm under penalty of perjury that I am licensed under provisions of
HChapter 9 (commencing with Section 7000) of Division 3 of the Business and
(V Co . Proft?ssionals Code, and my License is in full force and effect.
C M' - Licensei# Lic. Class Exp. Date
LU i 722 3 7 A �� } fSi30105
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ctor _•
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I%- U(0 OWNER -BUILDER DECLARATION
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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 & P.rQfessionals 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 Sectioo-- , B&P.C. for this reason
Date ISignature of Owner
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty/.of perjury one of the following declarations:
( ) I have and will maiAtain 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 AIA1.10 AL U-1+IIQ'N Policy No. 716SB33
(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 tol become subject to the
workers' compensation laws of California„and agreerthat if I should become
subject to th``e workers' compensation, -provisions of+Section 3700 of the Labor
I
Code, shall,forth�with comply with/those prow pipns%
Date:-+ �a1 �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 1;or inspection/purposes.1112.
/Signature (Owner/Ag' ent) Date
BUILDING PERMIT PERMIT#
DATE VALUATIONLOT (1� TRACT
4W). go 49
JOB SITE
APN ,
ADDRESS 81-574 DESERT WILLOW DRIVE
7"2V-017
OWNER
CONTRACTOR / DESIGNER / ENGINEER
SHE& LAQiJWIAIJ.�
SIS,. LAC7i3ir3V aLC;
S 12 61D AVENUR 152
$1200 A.NrENilE 62
LCL QT-TNCA CA 92253
L.A. QU'`.It+ TA. CA 92253
(760Y777.600S C:BIX IrED
USE OF PERMIT
9WGI ; I A)-vIII.Y,' DWB711WO
•P LOT, I 49, PLAN 64700. ERM -IT NEIL'S NOT INCLUDE SLOCK
iSFD
C%1a.d.11.% Pr OL' SP,A, OR DIRIVEd AY'.APPRC'AAC H ,
CUSTOM CONSTRUCTION %300.00 SI;
PORCHIPATIO 323.00 SY
0.AFLACtW1CAF.PORT 615,00 `IFS
'nta}�i7WATED CORT OF C1 01 YrPs U C"n 011
211.,099.90 .
y�q '{- jq+y ••� ��^ry tp�r
St” ""JS-1►.,,.i Ae ��lLJu a➢33iC3.LVi.1/Ai4.i
CC N$URVIC'.TFON RZW. 103-000-418-000 51.031.50
PLAW CHECK FFY-, 101-000-439-318 .IS26.10
VIEC;I1.P'a3iiGAl.FEE 101.-000-4•21.ON $r�.(to
ELECTRICAL PEE 101.7;00- 20-000 *1:33.30
P"L1 TISI<'I'}RIG FRE 10, -000-419-000 $ (4'3.00
STRONOT�d1,OT'IO1 FEE -RBSID 731-000-741-000 $21.11
OR—ADINO FEE 101.000.423.000 $15,00
DY,V U,0P9R IMPAC!' FF,9 '$2,405.0
AiLT IN PUBLIC PLACES - .RU- 11270.000.445.NO U7,75
f ..'�- - 3` °PA E° S C1 JC�:'��F AND PIAN C"x3, K
$4,680.76
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RECEIPT
DATEBY
DA F ALED
OPERATION
DATE t
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs-
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Q �_
Exhaust Fans
O. K. to Wrap
f G'
F.A.U.
Framing
p 6
Compressor
Insulation
6
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
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVAL
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
< <D
Encapsulation
Gas Piping
Gas Test
/
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures Aalz
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
'
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B'OR11� S'S0Q, AT 8'. INC. I.
Structural Engineers
STRUCTURAL JOB SITE OBSERVATION
Project Name: VV TA Project Number:
Observer: L-A k I (-.•_ � �. Y__ Date of Observation:
A-visitto the project site was made on the above date to:.
❑ Address specific elements of the work..
❑ Assist the field personnel with complying with the intent of the construction documents.
❑ Assist the field personnel with_complying with the friridings from a previous structural job site observation.
At the time of our visify work had. progressed to the point=of< Phase:
Address:
Bldg../'Lot Number:
Bldg. / Plan.Type & Elevation: i
Foundation Trenched
Foundation Poured:
Roof Sheathing Covered
Roofing• Material Stacked and Loaded
Exterior Walls Covered
Interior Wall Covered
Insulation Installed
Electrical, Mechanical, Plumbing Complete
Final Framing Pick -ups -Completed
Building Complete
Based upon our visit:
Refer to the attached field notes to be addressed`by the"construction:personnel,
❑ Additional information will be -sent from our office which will need to be addreswd,by the construction personnel.
❑ It is our opinion that this building is being„constructed in general conformance with the intent of the construction documents prepared by
our office.
❑ • 'Site.Observation ceased, framing was not at a stage of completion inw fiich.site observation could be performed.
❑, Concerns brotight.ta.the.attention:of_ d:personnel_based.on+pre-vi
rm
Comments: _ ITL _ Ste' G S f Vi't
Please note:
be addressed.
Our findings and recommendations may, have other: tham structural ramifications which we have not addressed. Be advised that changes to the
construction. documents need approval of the building,official.. Our firm is not authorized to act as the Owner's agent. Our findings shall not be
construed as authorizing the expenditure of additional hinds.. ,
Site Observation -was made only -to determine general conformance with<the intent of the construction documents. Observation was made of those
portions of the work which would best representthe',interi of the construction documents;tnot each and every -element of the work. Site, -observation
did not include review; approval or observation of; arho'ng. other items,.-
1.
tems:1. The contractors safety precautions, procedures, designs,:me, ods or'techriiques.
2'. Any shoring, scaffolding, underpinning, temporary: retaining ofexcauations;;or;any other erection methods or temporary bracing.
3. Any soils at the site, theiradequacy to support the building expansiveness; or any other, soil related, conditions.
4. Any drainage courses or devises of a temporary nature�.or as a permanent ,part of'the structure; including roof and floor slopes, drains and
pipes.
The findings of this observation. are understood to be expression of p
information and belief. As such, it consists.ofneither'a.guarantee nor a wai
Field Superintendent.(third copy).
Client (second copy via mail)
Field Engineer (first copy)
If you have any questions please con
COSTA MESA, CALIFORNIA
—`"°'`ROSEVILLE, CALIFORNIA
SAN RAMON, CALIFORNIA
LAS VEGAS, NEVADA
otincxTry A o r7ry t A
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k
0orrrt@5 714-513-7500
Phone: 916-774-7597
PFione> 925-242-2577
Phone:
I opinion by thel engineer based on his or her best knowledge,
tressed or implied
G
Fax: 714-513-7555 r
Fax: 9,16-774-7599
Fax: 925-242-2961
Fax: 702-740.-543'►
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Refer to the attached field notes to be addressed`by the"construction:personnel,
❑ Additional information will be -sent from our office which will need to be addreswd,by the construction personnel.
❑ It is our opinion that this building is being„constructed in general conformance with the intent of the construction documents prepared by
our office.
❑ • 'Site.Observation ceased, framing was not at a stage of completion inw fiich.site observation could be performed.
❑, Concerns brotight.ta.the.attention:of_ d:personnel_based.on+pre-vi
rm
Comments: _ ITL _ Ste' G S f Vi't
Please note:
be addressed.
Our findings and recommendations may, have other: tham structural ramifications which we have not addressed. Be advised that changes to the
construction. documents need approval of the building,official.. Our firm is not authorized to act as the Owner's agent. Our findings shall not be
construed as authorizing the expenditure of additional hinds.. ,
Site Observation -was made only -to determine general conformance with<the intent of the construction documents. Observation was made of those
portions of the work which would best representthe',interi of the construction documents;tnot each and every -element of the work. Site, -observation
did not include review; approval or observation of; arho'ng. other items,.-
1.
tems:1. The contractors safety precautions, procedures, designs,:me, ods or'techriiques.
2'. Any shoring, scaffolding, underpinning, temporary: retaining ofexcauations;;or;any other erection methods or temporary bracing.
3. Any soils at the site, theiradequacy to support the building expansiveness; or any other, soil related, conditions.
4. Any drainage courses or devises of a temporary nature�.or as a permanent ,part of'the structure; including roof and floor slopes, drains and
pipes.
The findings of this observation. are understood to be expression of p
information and belief. As such, it consists.ofneither'a.guarantee nor a wai
Field Superintendent.(third copy).
Client (second copy via mail)
Field Engineer (first copy)
If you have any questions please con
COSTA MESA, CALIFORNIA
—`"°'`ROSEVILLE, CALIFORNIA
SAN RAMON, CALIFORNIA
LAS VEGAS, NEVADA
otincxTry A o r7ry t A
r
k
0orrrt@5 714-513-7500
Phone: 916-774-7597
PFione> 925-242-2577
Phone:
I opinion by thel engineer based on his or her best knowledge,
tressed or implied
G
Fax: 714-513-7555 r
Fax: 9,16-774-7599
Fax: 925-242-2961
Fax: 702-740.-543'►
:7
•
Installation Certificate: Residential
Site Address
pop I
t81-574 Desert Willow 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 4ZIAfl
PERMIT #
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
EQUIP. MAKE
HEATING UNIT ACTUAL EFF. . HEATING EQUIP HEATING
MODEL # AFUE CAPACITY LOAD
Furnace Lennox G40UH48B-090X 80% 88000
G40UH36A-070X 80%
4. COOLING INFORMATION
COOLING MANUFACT COMPRESSOR ACTUAL EFF. COOLING EQUIP COOLING
EQUIP. MAKE MODEL # SEER CAPACITY LOAD
A/C Lennox 13ACC-036 12
13ACC-036
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
sr-- V (QyNC%Sr DATE: 3—,2C/_-1-5
Signature Installing HVAC Contractor
- _ JCM Inspections
39725 Garand Lane Suite F
Palm Desert, CA 92211 an
u
INSPECTIONS Phone: 760-345-5554 - Fax: 760-772-3895 INSPECTIONS
COMPRESSION STRENGTH TEST RESULTS
Client: Shea La Quinta, LLC Date: 4/18/04
Project: Trilogy @ La Quinta - Shea Homes Project No: 02-1109
81-260 Avenue 62
La Quinta, CA 92274
Set ID Structure Age of Test Compression Strength
JCM ID Location Date Cast Cylinder ID (days) (psi)
Set A Phase5A - Lot # 1Q49 Slab on Grade 2-24-04 Concrete
273-2111 Bath YGuest Suite Required psi: 4000
6076 7 2830
6077 28 4980
6078 28 4940
8 / 5 74/ V �� 0572-!
•
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JCM Inspections supplies the service
of compression strength test results only.
Per ASTMC39
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4
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JCM Inspections supplies the service
of compression strength test results only.
Per ASTMC39
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INSULATION CERTIFICATE
This is to certify that insulation has been installed in conformance with the current energy
regulation, Callfornia Administrative Code, Title 24, State of California, in the building at
81-574 DESERT WILLOW DRIVE LOT 1&-:§,jLA 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
s
BY: UJUAL Val TITLE: ACCOUNT REPRESENTIVE DATE: �S U
' V
rir.! ii//..:/ilii iii i�/.v �/./..: i i��.rrn i'/rn.ri»•..rrrrI'i rri.•s..rsi rrn.%/:'i%///i'%/.%%%'%1.'/:rl//.:�%:%//:%%!/.%'//l////r'I/I%/./I.'Ir/r<r//iri.•iir/i/ :•i!//�ri.'r:vrt�. :�.rr.�.�..�!/
��.:�•i.r,.n✓r"i.9.!r.9;�."J."i.r.'i.iH•��>'fY/."i wJT w.'P:'I..'/J'r.'T.`%'7.!s:9!:'!:/:Y•:M:b:M'y:'VYr:�i.:4:N.N:x•�v�9sT'r.:v.�`%.y%1.yvs:P!fV:YY.r.'+Y/:!r7:"J�I,n.vl�ir./.. .�ri...� � .r, ./i �r %'/. ./:•/.!�.
INSULATION CERTIFICATE '
This is to certify RaSrtsulation has been installed in conformance with the current e
regulation, California Ad trative Code, Title 24, State of California, in ing located at
's
�r
CEILINGS:
TYPE: BLOW MAUNFAC ER: Ce teed THICKNESS: R-38
s
WALLS:
TYPE: BLOW MAUNFACTURER: Certainteed ICKNESS: R-13
GENE CONTRACTOR: SHEA HOMES LICENSE #
B TITLE: r
PARAGON SCHMID BUILDING PRODUCTS A MASCO Company LICENSE# 2215
BY: TITLE: ACCOUNT REPRESENTIVE DATE:
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Copy 1 JCM nspections Copy 2 Project Superintendent Copy 3 Governing Agency Page 4 of
JCM Inspections
., 39725 Garand Lane Suite'F
= Palm Desert;"CA�92211
IN P E C T I O N S IN
Phone: 760-345-5554 - Fax: 7.60-772-3895 INSPECTIONS
PRESTRESSED CONCRETE INSPECTION REPORT Date: -3 ¢
Project Name:
Project No:
Trilogy @ La Quinta - Shea Homes
02-1109
Project Address:
City:
Title 24 AWS F✓ UBC Other:
81-260 Avenue 62
A•, 1La Quinta; CA
File # ❑ D 1.1
App# D 1.4
Client: Sub -Contractor:
Shea La Quinta, LLC
Sun Coast Tensioning
Other
General Contractor:
Architect:
Structural Engineer:
Shea Homes
Bassenian Lagoni
Borm & Assoc, Inc/Suncoast Post Tension LP
R
Size and Type of Tendons--
N1
Weather:
So.te+n n �� S \•acc- eQ\iCty�?L�Tev
cl s
S.a4.r
Jack Machine'Calibration: \`c cCl c?.j �r a:n' Cur (on�r- r", I <<U rn_ •I
Unresolved-Ite s:
Vo Mt�c�ltr,n
((�� tt
�n��l `,nK�D��Or7 U!=ad33.ra� �OSI33.nn..,��
®'None
Calibration Date: \N\ ,-,�3- O_
EJSee Below
L4 wi.4 q Q���, \��-I (pyo2'n C_ q1-5'1`4 VA)gS �►•1,��v a%'r
Description of Work Inspected:
Specified
Lot # Location
Tendons Elongation (in)
Actual Elongation (in)
LAS` p GQ c QV_'_
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RR
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I hereby certify that I have inspected all of the above work, unless otherwise noted, and to the best of my ability I have found this work to comply with the approved
plans, specifications applicable building laws. Final report issued at project completion.
Inspector: Jack C. Millin ICBG ertific
'o No: , 0842216-89
Contrac oCs-Representative:
I—
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Copy 1 JCM nspections Copy 2 Project Superintendent Copy 3 Governing Agency Page 4 of