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LICENSED CONTRACTOR DECLARATION
Lhereby,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
•Pr6fessionats Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
2285 13�/ {130105
Date �Signature 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.
(1��) 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 H.A TIONKI, UNION Policy No. 7x63333
(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 provisionrs�oof,Section 3700 of the Labor
Codel. shall forthwith comply with those provisions.
Datov J i N"I Annil anti J �-
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 herebyrauthorize representatives of this City to enter upon
the above men/tio�ned"pro erty'�fo`insdction purposes.
Signature (Ow" neer/Agent)-Date
BUILDING PERMIT PERMIT#
I3 Q01-047
DATE VALUATION S143�180AG3 LOT S TRACT 30043
'�
JOB SITE
ADDRESS 8.J-6A46D' Wf
APN
764-27"17
OWNER "'
CONTRACTOR/ DESIGNER / EN (NEER
SHFk LA 011,t1.ITA I=
tR # LA QU1t TA LLC
81260 AVEIT(3.0 62
81260 AV TE 62
LA QCiDFfA. CA 92253
LA QITR7TA CA 92253
(760y177�6005 Case m
USE OF PERMIT
MNGLF FAW, ,Y DWfLLNG
.5FO - LOT 53, PLAN 4330.A. PZRMI T t' O&S NOT iAIC.L.UDE BLOCK
WAI.iA P904, WPB. OR t)RIVEWAY.APPROACH
CUSTOM CON19T17UCTIUN 1,685,00 SP
IPORCIIiIF?ATIO 177.00 SP
CARAODC;r'11ti°POWf 498.00 SP
EIYMIA:1ED x-05"1 `:ski' CO.t`I.i.1RUICTION
143,180 ,40,
'
CONS`a'RUCT1014 FEE 101.000=118.0013 SIN3.10
PLAN CHRICK YZE 1011-000-439-315 $6 LH
M, CH.ANICAL PER 101-000.421-000 $71.50
ELECTRICAL FEE 101--000-420-000 $102.24
P1aUM8INO FEE, 161.000-419.000 S127105
STR.CYNG MICITION FEE a RESID 101-000-W-000 $14.31
C1.RADNO ISE 101.000.42.3.000 $15.00
l:ii?V LOP911 IMPACT IVE $;4405.00
rCQN-3_' UC 0, W eb,.ldl[['!((771'VAK� CRECIC
$4,168.29yy
I.�x
PFX.^P.."`1M X'.FSL1�3
$0,00
I TO'TA1(;::4�'�iz ! yr rus :aaUE Now
_
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1
0 • {_V�
i
RECEIPT
DATE / {//
BY
DA F ALINSPE�j�Qj/i
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
Set Backs
'Water Piping
_
Forms & Footings 1 d L
Slab Grade z —D
Steel
Equipment Enclosure
Roof Deck
O ,
0. K. to Wrap
/ e
Framing
Zo
Insulation
D
Fireplace P.L.
Fireplace T.O.
Party Wall Insulation
Party Wall Firewall
Exterior Lath
L
Drywall - Int. Lath
ns LCL
BLOCKWALL APPROVALS
Set Backs
Footings
Bond Beam
OPERATION DATE INSPECTOR
MECHANICAL APPROVALS
Underground Ducts
Ducts
Return Air
Combustion Air
Exhaust Fans
F.A.U.
Compressor
Vents
Grills
Steel
Electric Bond
Main Drain
Approval to Cover.
Eauioment Location
POOLS - SPAS
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
I Pool Cover
Gas Test
Final
COMMENTS:
ELECTRICAL APPROVALS.
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I. IZ
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
Installation Certificate: Residential CF -6R
ite Address
81-646 Desert- Willow Drive
• 1. BUILDER INFORMATION
Shea Homes - Trilogy - LaQuinta
60311 Trilogy Pkwy
La Quinta, CA 92253-7642
INSTALLING CONTRACTOR:
2. PROJECT INFORMATION
PERMIT #
SUBDIVISION: Trilogy (u, La Quinta
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
�f(.✓ir�S— •�;l DATE:
Signature Installing HVAC Contractor
INSULATION CERTIFICATE
t energy
This is to certify that insulation has been installed in conformance with the curr en ene y
regulation, California Administrative Code, Title 24, State of California, in the building located at
81-646 DESERT WILLOW DRIVE LOT 10537,1LA QUINTA CA
CEILINGS:
TYPE: BLOW MAUNFACTURER- Certainteed THICKNESS: R-38
WALLS:
TYPE: BLOW MAUNFACTURER: Certainteed THICKNESS: R-13
GENERAL CONTRACTOR: SHEA HOMES LICENSE #
BY: TITLE:
PARAGON SCHMID BUIL PINGPRODUCTS AMASCO Company LICENSE #221.517
I/ fiv 11, 4,
)///L)
BY- TITLE: ACCOUNT REPRESENTIVE DATE:6
JCM Inspections _--
39725 Garand Lane Suite F
Palm Desert, CA 92211
INSPECTIONS Phone: 760-345-5554 - Fax: 760-772-3895 I N S P E C T I O N S
COMPRESSION STRENGTH TEST RESULTS
Client: Shea La Quinta, LLC Date: 4/18104
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 #
'053F,Footing 3-4-04 Concrete
273-212 Kitchen, Exterior Walls Required psi: 4000
6164 7 3220
6165 28 5280
6166 28 5250
CERTIFIED:
JCM Inspections supplies the service
of compression strength test results only.
Per ASTMC39
•
Page 1 of 1
-
INSPECTIONS
JCM Inspections
_ 39725 Garand Lane Suite F
` Palm Desert; CA 92211 Th
L J
Phone: 760-345-5554 - Fax: 760-772-3895 INSPECTIONS
PRESTRESSED CONCRETE INSPECTION REPORT Date: -2
Project Name:
Trilogy @ La Quinta - Shea Homes
Project No:
02-1109
Project Address:
81-260 Avenue 62
City:
La Quinta, CA
[:]Title 24 AWS 0 UBC Other:
File # D 1.1
App# E] 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,lnc/Suncoast Post Tension LP
� ^
Size and Type of Tendons S V) e ., !)!;7(n , l�! S�(- e 5 - C�'� �v e. ) C' J OA c
\
Jack Machine Calibration:��C_@%y C;�r -�� ��n� �,n ��,n. T-G�ae Oro " n os:
M &\ a r .� � h 51 hn ra t �r7 321, D4 Kt ca^ 3 6 N�
Calibration Date0oc"v,-;�g`
REQ 5 k� I r s3 Q r AvcJ_ q�c,n S:12 SX 2-1-l� l�fle ,��ovi flt
Weather:
vrnlX
Unresolved Items:
®_None
E] See Below
.
Description of Work Inspected:
Lot # Location
Specified
Tendons Elongation (in)
Actual Elongation (in)
Ll
I -
I If 44- 1 13
n�To h'r nom., _ Hc.r
Ll
'1
A
3
13
3 4,3
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: Jack C. Millin ICKQ Certification No: 0842216-89
Contract )es Representa^ve: -r
Copy 1 JCM Inspections Copy 2 Project Superintendent Copy 3 Governing Agency Page 4 of