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LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
_._Ch voter 9 (commencing with Section 7000) of Division 3 of the Business and
r Professionals Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
W3=5�� 1.
Date , I"iSignature of Cont af�ctofi
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 -
() 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 conse6t 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 NATIOWAAI,U111t:.;1 Policy No. 705333
(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 bf.Section 3700 of the Labor
Code,'IpshAi forthwith comply with those provisions. �^
Date: �� � f'` IApplicantI/
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%tate that the above information is
correct. I agree to comply with all City, aqState laws relating to the building
construction, and he�pby:author,Lze reprepAtatives of this City to enter upon
the above mentionjjd prop -4-11--11 fy for rispeetto. n purposes. ^�
Signature (Owne'FrAgent,) \337 �,•�, Date '
BUILDING PERMIT PERMITk
DATE VALUATION LOT G401'051 TRACT
-�; a r"/I S1 43,113M 42 30023
JOB SITE
APN
ADDRESS 8—&SI DMES'EI�T MIL W %).R.� VE
1
7454-270-01.7
OWNER
CONTRACTOR/DESIGNER/EN (NEER
SMA LA, Qil`1RDA, I,I,+:.`
SEMA LA QLTSN'TA I.LC
81260 AM`FIT.E 62
81260 A.VMIF 62
Ui.QU'TvrTA CA 92233
LA.Q MnA CA 92233
060,)77-1-6005 C73L# TSD
USE OF PERMIT
MGM, EAIdlMY D'%VM1.1 G
3FD •- LOT 49, PLAN 4520.B. P&RMIT i OFS NOT 114CLUDE BLOCK
WALL% P001, SPA OP, (yltiVi:°tAlAY.APPROACH
CUSTOM CONSTRUCTION 1,662.00 8F
POFdCIWRA'TIO I'a'1M SIS
O.ARAWCA PORT 576.00 SFr
EIM1 ATM) COST OF C.i9iYMUMiON
714.30.13 N)
MAM, YkE SUMMARY
C014STIRUCTIO14 DUE 101-000-418-000 X3.30
PLAN CHECK FEE 101.006-439-318 5642.21
11490HANIC.AL FEE 101-000.421.000 S71$0
ELECTRICAL "1.8 1011-000 420-0100 �IO�i.I9
PL11MBINO FEE 101.000.419.000 Si22, i
S t MONO MOTI014 FSE • FXESII7 101-000-•241-000 $19.7k
G AMM FEE 101.000-423.000 315.00
DZ'.FLOPF,k?.h11F`ACT FEZ V,405.00
I;JLM-TaIIAL x.,01 PSIITRUM10.I.Y A.4VJ..F MAX Ck m p
U,169.46
D
PrX?? ff 7MES DUEHOW
J,69A6
F =3 042094
f
C111YC4 LACc, Ulc1'FA /
FWANCE DET. T.
RECEIPT
DATE"
? r,/- r i%
,
!Z,f
DATE F L
i
INSPE OR
OPERATION
4
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Forms & Footings
i3
Underground Ducts
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
/ o
F.A.U.
Framing
z 6
Compressor
Insulation
p 6'
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wali Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
_
6
i
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
Ao $7
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit Lzz
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)
CORP
Installation Certificate: Residential CF -6R
Site Address PERMIT #
81-651 Desert Willow Drive
1. BUILDER INFORMATION
SUBDIVISION: Trilogy P, 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
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
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
�rs
n_�L,�,��Li�-/�l DATE: —2
Signature Installing HVAC Contract."or
w•/•z%����rr.:r..i•r: /.�/-�:n •nr. �.,•,i,•.iiiuivt ✓r�.irrJJ7!ii✓. �rvriirrerr.r»wr..-,.. rva•..vr/✓»�rn✓ria- �mrvn��i:rni•.,r;•,o-i•�i,n•/rinnrv.•arfr /i�rvvirii/vr:r•..
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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
81-651 DESERT WILLOW DRIVE LOTjI 42 L-A QUINTA CA /
CEILINGS:
TYPE: SLOW MAUNFACTURER: Certainteed THICKNESS: R-38 Y
WALLS:
TYPE: BLOW MANUFACTURER: Certainteed THICKNESS: R-13
GENERAL CONTRACTOR: SHEA HOMES. LICENSE #
BY: TITLE:
PARAGON SCHMID BUILDING PRODUCTS A MASCO Company LICENSE # 221517
TITLE: ACCOUNT REPRESENTIVE DATE: , CS
Y �.•ii�iri•rii.•isiiiiii/�:i.i.Xi/iii.n:.,iri�r„�:.i�:.;iw/.:i*•.i%:dPP.%/P/!./i/Ii/il'/.I'P.r ir.•vrvivviiviniirr�ir.,r:....,...�rrr:• inir�, i i.r�,...•.:.1 :..,-...�...•.:•...•r,f.
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
Project: Trilogy @ La Quinta - Shea Homes
81-260 Avenue 62
La Quinta, CA 92274
Date: 4/18104
Project No: 02-1109
Set ID
JCM ID
Structure
Location
Date Cast Cylinder ID
Age of Test
(days)
Compression Strength
(psi)
Set A
/�
Phase 5A -Lot # 1042�4J Slab.on Grade
3-8-04
Concrete
273218
Kitchen
Required psi: 4000
6199
7
3020
6200
28
4540
6201
28
4590
8/ 6.6
•
•
Page 1 of 1
oese71--/ W1 e - "X -kJ L)VCERTIFIED:
)aL-,9G._. 01- -W -�1`��
JCM Inspections supplies the service
of compression strength test results only.
Per ASTMC39
Copy 1 J n ections Copy 2 Project Superintendent Copy 3 Go Irning Agency Page 4- of
JCM Inspections
39725 Garand Lane Suite F
Palm Desert, CA 92211
INSPECTIONS
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:
City:
Title 24 AWS F/ UBC Other:
81-260 Avenue 62
La Quinta, CA
File # F—] 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,lnc/Suncoast Post Tension LP
�
Size and Type of Tendons:,
\\ ee 1 {� 1- n
An
Weather:
Vn n r
Un resollved Items:
Jack Machine Calibration \ ,�. -� ('
C5.5
None
("kn nei _
_ n
❑ See Below
Calibration Date��n��
0. (0 1 W. n. c
Description of Work Inspected:
Specified
Lot # Location
Tendons Elongation (in)
Actual Elongation (in)
O
LA
—Ing, M
A^ A.r ri QaUlravy%y
S''•
G �t'a
r. 01 o !� S i n
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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: ack C. Millin ICBO Ce ific5tton No: 0842216-89
Contrac
epFeser+tetiv1.e.:_
"
'1
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Copy 1 J n ections Copy 2 Project Superintendent Copy 3 Go Irning Agency Page 4- of