0401-045 (SFD)LICENSED CONTRACTOR DECLARATION
I h; reby affirm under penalty of perjury that I am licensed under provisions of
H Chpapter.9 (commencing with Section 7000) of Division 3 of the Business and
w+ '"Professionals Code, and my License is in full force and effect. A
O =) M License # Lic. Class Exp. Date !
o Z r- /,Date Signature of Contractor
(D0�, I
J UCO
OWNER -BUILDER DECLARATION
HUJI J I hereby affirm under penalty of perjury that I am exempt from the Contractor's
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). /
co () I am exempt under Section , B&P.C..for this reason
L
N Date Signature of Owner
ON
0)d Q WORKER'S COMPENSATION DECLARATION
p CcI hereby affirm under penalty of perjury one of the following declarations:
HLo
0 () 1 have and will maintain a certificate of consent to self insure for workers'
X W �= compensation, as provided for by Section 3700 of the Labor Code, for the
O J Q performance of the work for which this permit is issued.
m Q I have and will maintain workers' compensation insurance, as required by
O U Q Section 3700 of the Labor Code, for the performance of the work for which this
rn H permit is issued. My workers' compensation insurance carrier & policy no. are:
'IT ZPolicy No.
oo .0 Carrier NA'tiOlaAi lINIUkJ 7tdR837
Q (This. section need not be completed if the permit valuatiorris for $100.00 or less).
J ( ) I certify that in the performance of the work for wh ch;this permit is issued,
I shall not employ any person in any mannerzso as t8 become subject to the
workers' co6pensation laws of California, �and�agree[that if I should become
3 subject°to the wo"rke'rs' compensation provisions of Section 3700 of the Labor
Code, I hall4forth w ith comply with.those provlsl jns,.� �.
r,,Ddte: �4. tt Applicant—
Warning:
pplicant 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. ((
Signature (Owner/Agent). Date
BUILDING PERMIT PERMIT#
DATE VALUATION LOTTRACT
$134A53.50 44
41 30023
JOB SITE
ADDRESS RY-41.5 `aE.iKTT `M,160W IfDIZZVF
APN
764-270-017
OWNER
CONTRACTOR /DESIGNER/ EN (NEER
MIK kLAQUtI`TAIZC
%`f ALAC,f[i - ALLC
81260 AVD1 4 M— 62
812.60 AV0r 62
1-kQUJl+i3•A CA 9225:3
LA.Q1M4T•A CA 92253
C76i1)777-6005 CLL# 'CAD
USE OF PERMIT
S.YD - LOT 44, PLAN 4$18A. PERMIT I70IFS NOT INCLUDE BLOCK
WA1,SA P004 VA, OR DRIVEWAY APPROACH
CUSTOM CONSTRUCTION 1,530,00 SF
PORCHs`F+ATIO 0157,00 SF
0AR4k0VOARP013T 470,003F
RS'd'J1 TAXXJ) COST W, CQNS'MiJ1'C710N
ii .Q�9.1T Lw'd.B1y.1�edJ! 1l ii.lY.ld`7J+1}i��t
CONSTRUCTION FEE 101-000-418-000 $762.00
PIAN CHECK FUE 101-000-439-318 $60.6i
MECHA141MFEE 101-000.421.000 184.50
ELECTRICAL 3'EE 101-00"20-000 $96.6:3
PLUAMRINCi FSE 101 _000.419.000 $113,00
STRON O MO t ION FERE - R y'iID 101-000-2A I -000 $13.47
ORADIN:1 FEE 101.000.423.000 S1S100
]DEVELOPER IMPACT TLE $3,40.5.il0
ID t 3E -. o2 kL C57t�S'cCTJG:':` 0.)4JU4D I�LAN C.}1 4X
$4,414.21
!` I LESS I�R-PAm IF
:Ct3. QG
rQf�r
�IWCRMII "EES
vFr3fln u�3.� NOW
$4,414.21
$4,4 04.20
Lily e; I_P c ut .' • r
_.
RECEIPT
DATE,
BY �
DA F ALED
INS ,C ,
I
R OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Q
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
— .6 �'�--
Exhaust Fans
O.K. to Wrap
/
F.A.U.
Framing
Compressor
Insulation
O
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wali 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 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
, p
Encapsulation
Gas Piping
Gas Test
/7
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:
•
Installation Certificate: -Residential CF -6R
Site Address
81=615,' Deser-t-Willow Drive'w'<
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
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.
6.THERMOSTATIC EXPANSION VALVE (TXV):
Thermostatic Expansion Valve (or Commision approved equivalent) is installed and access is provided for inspection.
6. SUBMITTEDBY
_
Signature Installing HVAC Contractor
Yes ❑ No ❑ N/A ❑
DATE: 3 -d 9,0x/
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 -615 DESERT WILLOW DRIVE LOT JL44:,LA QUINTA CA
CEILINGS:
TYPE: SLOW MALINFACTURER: Certainteed THICKNESS: R-38
WALLS:
TYPE: BLOW MAUNFACTURER: Certainteed THICKNESS: R-13
GENERAL CONTRACTOR: SHEA HOMES
By:
LICENSE 0
TITLE:
PARAGON SCHMID BUILDING PRODUCTS A MASCO Company LICENSE * 221517
BY: TITLE: ACCOUNT REPRESENTIVE DATE:
JCM Inspections
39725 Garand Lane Suite F
f Palm Desert, CA 92211
L7-
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
81-260 Avenue 62
La Quinta, CA 92274
Project No: 02-1109
Set ID Structure Age of Test Compression Strength
JCM ID Location Date Cast Cylinder ID (days) (psi)
Set A Phase 5A - Lot #!1041 Slab on Grade 3-3-04 Concrete
273-210 Great Room, Cen er Required psi: 4000
0/ 61,5--
o/,5-- D6 -5C72-7-
0 6-5C7 2- fie,/G�a�
•
Page 1 of 1
6142 7 3220
6143 28 4900
6144 28 4860
FIED:�,_C.�Vo
JCidFif specti ions supplies the service
of compression strength test results only.
Per ASTMC39
JCM Inspections
39725 Garand Lane Suite F
Palm Desert, CA 92211 ER
INSPECTIONS Phone: 760-345-5554 - Fax: 760-772-3895 INSPECTIONS
PRESTRESSED CONCRETE INSPECTION REPORT Date: _b
I
Project Name: Project No:
Trilogy @ La Quinta - Shea Homes 02-1109
Project Address: City:
81-260 Avenue 62 "• La Quinta, CA
E] Title 24 AWS QUBC Other:
File # F-1 D 1.1
App# Ej D 1.4
F] Other
Client: Sub -Contractor:
Shea La Quinta, LLC Sun Coast Tensioning
General Contractor: Architect: Structural Engineer:
Shea Homes Bassenian Lagoni Borm & Assoc,lnc/Suncoast Post Tension LP
,, p
\\ +e -
Size and Type of Tendons: �.o e��� 5Q ve r Ar *"AQ A(' e S � . Ce`t cv'z I C�
Jack
Jack Machine Calibration:$*-ce�V � S� -o1n `l�tr1 Cp n Gg c'C-p (e SSvc c_i,n Qr; % kb
"
Calibration Date:'�nQ����r��
f ll
r►ttLSC� �A ( oke., n -s i n N 9, 1-W '— VNc o Wi� n i
Weather:
Unresoly terns:
FQ None
❑ See Below
Description of Work Inspected: Specified
Lot #'Location Tendons Elongation (in) Actual Elongation (in)
L
o 10 L'.f q Gr, t 0!4s=
$
.s
t't1aiQc gs�, �QcQrn�r, aif�Q.
3
3 3:i s 3 'a 3
_ Si IrrL.
Ir\- q
y �
VX\cf�sTe, cJ L.0-_"neraV,
q
L43
Ll
3-3
I hereby certify that I have inspected all of the above work, unless otherwise noted, and to the bestof 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 IC OCertification No: 0842216-89
e..Q. L.�
Contracto ssReeepresentat
e:
Copy 1 JCM Inspections Copy 2 Project Superintendent Copy 3 Governing Agency Page of