0401-050 (SFD)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
:P_rofes�ionals Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
1 ir.2,P. S J 6130/05
""� 1 1 ('..r..--�»
Date 5ignature of Contracto
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 followingdeclarations:
() I have and will maintain a certificate of consent to self-insurejor 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 NA110NAL UNION Policy No. _ 7163833
(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 rovisions(of Section 3700 of the Labor
Code, 1 -shalt forthwith comply .Kith tlhose'p�rovisions.
Date: / 6tA-pplicannt-�,/
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 atiove-mentioned.property for inspection purposes.
Signature (Own/, r/,Age�t)� s� � Date
BUILDING PERMIT PERMITk
Q�4(31-tM
DATE VALUATION $x44,9fS.3Q LOT - TRACT 0023
Y
JOB SITE
APN
ADDRESS
31-639IMS3�� TWILl�'{�OW DR1M
1#164-27"17
OWNER
CONTRACTOR / DESIGNER / EN (NEER
S'HX .I .%, QUfU A U..C".
.4H A L.4 QUII TA 1=
81260 KUNUE 62
812603 AVENUE 62
IA Qlmrr 'i CA 92253
7.!', QUINTA CA 922.3'3
(760YI77-6005 CHL4 TBD .
USE OF PERMIT
laWOU FAMI. Z U1J'JE11.ING
SFD ., ..UOTf P3, PW.4 43200. PERMIT .0 MIS NOT YNC'Li DI?, BLOCK
hbA.LL% POOL4 SI'A OR ORiVEWAY.APPROACH
CUSTOM CONST RUCTICAN 1,683.00 OF
,
P01tCH%PAT10 11n.00 SF
QA..RAMIC.ARPORT 576.00 SF
. D COST Off' C;03�iS.II�Z ,11700
].�i4, O5.2i)
ryryyy 1�'�j�R'�,,{t``�� _ ��CC���� rrw,-�Aq--�� p,,l!TTEI�"21:i?1:i
K�tY.iY.lA.f.' ii1'�.,T gUh- dib�iaO. Y
CONSTRUCTION M- 101.000-418.000 $79?100
PLAN CHECK FXF. 101-000-4319-318 $644.92
MECI•IANIC AL FEE 101.000.421.000 SU S0
LLECTP-ICAL£YW 101-0010-420-000 $104.00
PLI,'iMBIN(} FEE 101.000,419.000 $120.11
STRONG IMOTION FEE- RESID 101-000-241-000 $14.49
GRA'OTHO FEE $13,00
0 VZLOPFPZ IMPACT PE!: s-6,405.00
" k3;.4'i�.c.TJ��'`fIOIST AND PT.E�Ir; MEC K
$4,176.06
� Ev"rl:'l�4-I� :i ' n�
"), 10
OTAL PEI��'>rI' �N' DUE NOW
kt 42004
$4,176.".
CITY OF L.4 QUINTA
FINANCE DEPT.
v
RECEIPT
JDATE
BY
DAT FI ALED
INSPEc�T
/� o
,h
INSPECTION RECORD
.OPERATION.
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
tet,
Ducts
Slab Grade
Return Air
Steel
Roof Deck
_ _ _
/6
Combustion Air
Exhaust Fans
O.K to Wrap
(v'�
F.A.U.
Framing
Plumbing Top Out
Compressor
Insulation
I O.K for Finish Plaster
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wali Firewall
Exterior Lath
Drywall - Int. Lath
Fi y 1617
. 1 W"ia
Final
,OMMEEN SS�� Z
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)
t
Final
Final
SLOCKWALL 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 P-11 i $
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans I
I O.K for Finish Plaster
. 1 W"ia
Final
,OMMEEN SS�� Z
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)
t
Installation Certificate: Residential CF -611
Site Address PERMIT #
181$4639 Desert�W�illow` Drive
:4: .yam
1. BUILDER INFORMATION
Shea Homes - Trilogy - LaQuinta
60311 Trilogy Pkwy
La Quinta,.CA 92253-7642
INSTALLING CONTRACTOR:
2. PROJECT INFORMATION
SUBDIVISION: Trilogy (a, La Qumta
CITY: La Quinta
COUNTY: Riverside
WEST PAC AIR CONDITIONING
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.
• 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
7:oSc-' DATE: 3 --29- 0141
Signature Installing HVAC Contractor
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
7:
81-639 DESERT WILLOW DRIVE LOT '10'43TLrA 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 BUILQING PJtODUCTS A MASCO Company
LICENSE #221,T17
. I . j
TITLE: ACCOUNT REPRESENTIVE DATE:
}
IN P E C T I O N S
JCM Inspections
39725 Garand Lane Suite F
Palin Desert, CA 92211
Phone: 760-345-5554 - Fax: 760-772-3895 INSPECTIONS
PRESTRESSED CONCRETE INSPECTION REPORT Date:
Project Name: Project No:
Trilogy @ La Quinta - Shea Homes 02-1109
Project Address:
81-260 Avenue 62
City:
La Quinta, CA
Title 24 AWS g✓ UBC Other:
File # ❑ D 1.1
App# F-1 D 1.4
E] Other
Client: Sub -Contractor:
Shea La Quinta, LLC - Sun Coast Tensioning
General Contractor:
Shea Homes
Architect:
Bassenian Lagoni
Structural Engineer:
Borm & Assoc, Inc/Suncoast Post Tension LP
���� \ n
Size and Type of Tendons a\n«.a''X r 4tVe., S�o,� �t•S�- fQ\(o—l�r,ltdnc
Jack MachineCalibrationp,,� f`w�c p�C—Nur, loa —Gane (t "s t "�b
`
Msci'l 12'nLQ 4 AV" nrr L4 OS% Aa 31.64
Calibration Date: % AA.,
Weather:
Unresoly tems:
® None
See Below
Description of Work Inspected:
Lot # Location
Specified
Tendons Elongation (in)
Actual Elongation (in)
Ua, r r W L IPX46, l
(O
3 3rd
w� d�
•� �.� peg W
Scinto 14 ;V Ue
S r'
el
3--
t� _Ink
i
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.
Inspect : Jack C. Millinr ICBG Certific�
n\No: 0842216-89
V no t�acVbr's Represe to ive:: }
Copy 1 JCM Inspections Copy 2 Project Superintendent _ Copy 3 Governing Agency Page --L of
. r
1 '
JCM Inspections
39725 Garand Lane Suite F �I
L� 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
JCM ID
Structure
Locadon
Age of Test Compression Strength
Date Cast Cylinder ID (days) (psi)
Set A
Phase 5A -
Lot #4 Slab on Grade
3-8-04 Concrete
273-217
Great Room
Required psi:' 4000
6196 7 3640
6197 28 5160
6198 28 5210
8
(� j
C!'S�2-/ Gc'/moo i.•�
-CERTIFIED: C�.
JCM Inspections supplies the service
of compression strength test results only.
Per ASTMC39
0
•
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