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LICENSED CONTRACTOR DECLARATION
I he, eby 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
6 2 B 66130103
t'. i i
Date Sl.gnature 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 HATIOIiIAL UNION Policy No. 7163$33
(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, and agree that if I should become
subject to the workers' compensation provisions of Section 3700 of the Labor
'N 9, r ` Y t 1. y_4
Co, I h hforthwith comply with th6e,prov�ions
COO, .
Dater�'tAAnlicant �l
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 Staie laws relating to the building
construction, and hereby authorizejrepresentatives of this City .to enter upon
the above-mentioned propertyf r inspection' urposes. r
Signature (Owner/Agent r Date
BUILDING PERMIT PERMIT#
i
DATE / VALUATION q LOT UUi-043 TRACT
\0023
310 46
JOB SITE
APN L
ADDRESS 81-:591 DES1EW *VV%T10W 1A?1YF
764 -27f1 -RI 7
OWNER
CONTRACTOR/ DESIGNER/ EN (NEER
:1U2':ALA. QUINTA=
M-RI.ALA QUWTA11-C
81260 AMLIE 62
81 ZGO AVW-UB 62
LA CjURNTA CA 922:3
LAQUTWA CA 92253
f± W)777-6005 CIBL# IMD
USE OF PERMIT
:31iIGLE, Int "Iy DVM. -J—TKG
SI'"L7 - LOT 46, PAN 4520C. P.U1 J1 DOBS NOT INCLUDE BLOCK
WALIA POOL, SP.A. OR DPWOWA.'Y APPROACH
CUSTOM CONSTRUCTION 1,917.00 SF
e+014CWPATTO 177,00 SF
GtARA.WCARPORT 492.00 SF
2 ►'1r1NW 1rJ> C'£3 `7' OF CoNfrinlyC"I`£+„)m
10=120
CONISTRUCTION FEE 101.000-416.000 9500
PLAN CHECK 1t'U 101-000-439-319 $696,69
i'N ECHA'NIC4L FIE 1011-000-421-000 $20.00
ELZICTRICALMt 101-00"20-000 $110.36
PI,11tL!'DI,40 frFf? 101-000-419.000 S146.75
5'I OND MOTION WEE - RESSD 101-000-241-000 $16.13
C1FtADINQ FEE I0E-000423.000 $15,06
D_'NEI.OPLR IMPACT FE -0 $:4405.00
., 0TTT37MAr CnOW AND PLAN CILEC_K
*4,326.42
f r: i'r F1!.S ;t E NOW
04 ��--f(YrAL �'x 1�''
154,326.42
=�
I
6117 C: !-A Q'17 1' 1
RECEIPT
DATE
..,1 -
;
D�INALE9,
INS64
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Suet Backs
Underground Ducts
Forms & Footings
Ducts '
Slab Grade
Return Air -
Steel
Combustion Air
Roof Deck
3/ p -
Exhaust Fans
O.K. to Wrap
T7
F.A.U.
Framing
a 907
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wali Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
BLOCKWALL APPROVALS
POOLS - SPAS
Steel
Set Backs
z
Electric Bond
Footings
i
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 t
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring . O
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp: Use of Power
a.
Final
Utility Notice (Penn)
COMMENTS:
,
2
M
M
STRUCTURAL JOB SITE OBSERVATION
Project Name: _T7C I C UQ"1� L %- C _22A
Observer:
A visit to the project site was made on the above date to:
❑ Address specific elements of the work. v
BOR "S' SOCIATES, INC.
Structural Engineers '—
Project Number:
Date of Observation: V (0 C �
5 4Q
❑ Assist the -field personnel with complying with the intent of the constructionrdocuments.
❑ Assist the field personnel with complying with the findings from a previous structural job `site observation.
;:(,L C FlVfvn/k G
At the time of our visit; work had progressed to the point of : Phase:
Address:
Bldg. / Lot Number: 1 �—
Bldg. / Plan Type & Elevation: fl
Foundation Trenched
Foundation Poured
Roof Sheathing Covered r"~ra . G 4 G 0
Roofing Material Stacked and -Loaded 0 u . G U. J
Exterior Walls Covered G '"" C D G 0
Interior Wall Covered G G C ``;�. G ❑
Insulation Installed G 0 „~� ✓ 0 0
Electrical, Mechanical, Plumbing -Complete 30 = G 0
Final FramingTick-ups Completed 21C 7 _
Building Complete C C _
Based upon our visit:
5V Refer to the attached field,notes to be addressed by the constructiorL personnel.
❑ Additional information will be sent from our office which will need. to be addressedby'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 in which site observation could be performed.
❑ Concerns brought to the tion of fie#f sonnel iiased on revrous-site observation <tnade.on - have yet to be addressed.
Comments: �'fI do /t f -.F�
Please note: --- Y,•'
Our findings and recommendations maj-,have other.than structural ramificationswhich. we have not addressed. Be advised that changes to the
constn5c�t oi3 documents need approviLdf the building official. Qur firm is not authorized to act as the Owner's agent. Our findings shall not be
construed as authorizing the expenditui•e.oradditional. funds.
Site Observation was made only to determine general conformance"'A' fie intent of the con3truction documents. Observation .was made of those
portions of the work which would best represent the iritent of the construction documents, not each and every element of the work. Site observation
did not include review, approval or observation of, among_other items:
1. The contractors safety precautions, proc,.ediires;.designs, methods or techniques.
2. Any shoring, scaffolding, underpinning, temporary retaining of excavations, or :any other erection methods or temporary bracing.
,. 3: Any soils at the site, their adequacy to supportahe 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:an expression:of professional opinion by the engineer based on his or her best knowledge,
information and belief. As such,.it consists of•neither a guarantee.nor a. warrantee expresscd�or implieA., �? k
Field Superintendent (third copy)
Client (second copy via mail)
Field Engineer (first copy)
If you have any questions please cont:
COSTA MESA, CALIFORNIA
ROSEVILLE, CALIFORNIA
SAN RAMON, CALIFORNIA
LAS VEGAS, NEVADA
Phone: 7.14-513-7500 Fax: 714-513-7555
Phone: 916-774-7597 Fax: 916€7.74-7599
Phone: 925-242-2577 Fax: 925-242-2961
Phone: 702-740-5427 Fax:702-740-5431
A
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
81.591 DESERT WILLOW DRIVE LOT V0406q,-L-A4IUINTA CA
CEILINGS:
TYPE: SLOW MAUNFACTURER: Certainteed THICKNESS,R-38
WALLS:
TYPE: BLOW MAUNFACTURER: Certainteed THICKNESS: R-13
GENERAL CONTRACTOR: SHEA HOMES LICENSE #
BY,
TITLE:
PARAGON SCHMID BUILPING PRODUCTS A MASCO Company LICENSE # 22151.7
BY: 4 )j (,Mja D64fT . ITLE: ACCOUNT REPRESENTIVE DATE:41z- dd
:i '
Installation Certificate: Residential CF -611
Site Address PERMIT #
f81 �1'�rtillow Drive:
• 1. BUILDER INFORMATION
SUBDIVISION: Trilogy La Quinta
Shea Homes - Trilogy - LaQuinta CITY: La Quinta
60311 Trilogy Pkwy COUNTY: Riverside
La Quinta, CA 92253-7642
INSTALLING CONTRACTOR: WEST PAC AIR CONDITIONING
2. PROJECT INFORMATION
DISTRIBUTION
DUCT OR PIPING R -
TYPE
VALUE
Flexible Ductwork
Flexible Ductwork
in Attic and
Will have a R -Value
Between Floors
of 4.2 or Better
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.
• HEATING INFORMATION
3.
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
�-- 00 tcc) /� /t -f DATE:
Signature Installing HVAC Contractor
JCM Inspections
39725 Garand Lane Suite F
_ Palm Desert, CA 92211 _
INSPECTIONS Phone: 760-345-5554 - Fax: 760-772-3895 INSPECTIONS
COMPRESSION STRENGTH TEST RESULTS
Client: Shea La Quinta, LLC Date: 4118104
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 Locadon Date Cast Cylinder ID (days) (psi)
Set A Phase 5A - Lot #4046 Slab on Grade 3-1-04 Concrete
273-208 Casita Required psi: 4000
6126 7 4100
6127 28 5570
6128 28 5600
F.
DCERTIFIED: Q,,
M Inspections supplies the service
of compression strength test results only.
Per ASTMC39
•
•
Page 1 of 1
JCM Inspections
39725 Garand�Lane Suite F
L L_ Palm Desert, CA 92211 '
INSPECTIONS Phone: 760-345-5554 - Fax: 760-772-3895 I N S P E C T I O N S
- PRESTRESSED CONCRETE INSPECTION REPORT Date:
Project Name: Project No:
Trilogy @ La Quinta - Shea Homes 02-1109
Project Address: City:
81-260 Avenue 62 'L'a Quinta, CA
E]Title 24 AWS UBC Other:
File # ❑ D 1.1
App# ❑ D 1.4
❑ Other
Client: Sub-Contractor:
Shea La Quinta, LLC Sun Coast Tensioning
General Contractor: Architect: Structural Engineer:
Shea Homes Bassenian Lagoni Borm & Assoc, Inc/Suncoast Post Tension LP
Size and Type of Tendons:,R" �,.. e r S��G �� S\c (XA! Skt � SS - V.,\k k\Js') � ori
Jack Machine Calibration:,«;J,.X coa j�—C9ac,�e P't r-, OS�� To
MA&1t0'e'\o6.QF�tG�'� \�yOfi DO O 33 a oca
Calibration Date:�c�y
\��.s.�SiL•��� ��y� c o��,�: ,-��a���aL ��-S�j� Des��f�i�„o��'
eather:
1 y
Unresolved Items:
ML None
LJ See Below
Description of Work Inspected:
Specified
Lot # Location Tendons Elongation (in) Actual Elongation (in)
Chasr q:11 c e el e
Q
S '�
-7 . '..- .
144Fate''
3
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: �a�cck C. Millin ICBG Ufti kation No: 0842216-89
Contractor s Represe t tive:
Copy 1 JCM\ Inspections Copy 2 Project Superintendent Copy 3' Governing Agency Pagef