0401-048 (SFD)t
LICENSED CONTRACTOR DECLARATION
1 •I hereby affirm under penalty of perjury that I am licensed under provisions of
Fes— Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
CIJ W Professionals Code, and my License is in full force and effect.
O n M License # Lic. Class Exp. Date
t--Qu7
C) Z r— —Date 7 6 i/ Signature of Contrac`c) `.- ---'
CD
J U C) OWNER -BUILDER DECLARATION
HWW 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).
C0 () I am exempt under Section B&P.C. for this reason
Ln
N Date Signature of Owner
ON
0)
Q WORKER'S COMPENSATION DECLARATION
IL
It 21 hereby affirm under penalty of perjury one of the following declarations:
cc
Fa- O () 1 have and will maintain a certificate of consent to self -insure for workers'
X W �L compensation, as provided for by Section 3700 of the Labor Code, for the
m� Q performance of the work for which this permit is issued.
< I have and will maintain workers' compensation insurance, as required by
D U Q Section 3700 of the Labor Code, for the performance of the work for which this
(1: LO Z permit is issued. My workers' compensation insurance carrier & policy no. are:
Carrier. IqA`f,(ONAL1)NION Policy No. 7165333
Cb 5
C
J (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
3 subject to the workers' compensation.provisions Section 3700 of the Labor
Code,-hsht 11 forthwith comply wjtt" those°proviiions.
JApplican , J
r
s 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 insp-ec�tlon purposes. 1 1
Signature (Owner/Agent) slDate
BUILDING PERMIT PERMIT#
DATE VALUATION LOT 04 l"046 TRACT
J f S140,730-50 54 30023
- _ / .cj
JOB SITE
APN
ADDRESS St 70 DEW16ff iI .WLOWDP,IVE
764-7,70-01
OWNER
CONTRACTOR / DESIGNER / EN (NEER
` .:t~AQ`17i1�`tAI1LC
S7iRAL.%�LiT� TA UC
81266 A�TF:2t�1: fit
F81260 .A�TF:t�J7, 62
L,-, a"TJ'i. CA 922.53
Lt; C MITA CA 9225-R
Q60)777.6005 CBLRI 'IBD
-
USE OF PERMIT
MKITLE, FAIN) X 17i}'itE LT90
SIM- r. OT 3ilj 14,AN 4110A. M1MI' DOES NOT INCLUDE 81k OCK
WAL.:iZ, kV 14 SPA OR DRIV wig AY APPROACH ,
CUSTOM CONS!'I;.1lCTION 1,633.00 VI ,
PORCH&'.% TIO 319.09 .sy r
GARA(MCAItf,'t?IRT47.1.00 SF
22.11 AIMID COST OFC(mmrJaI: ON
140,73O.W,
I&RM(TWEE SUMMARY
(°0J9ST:f1,IJCT10)41 ` 101-000-418-000 -000 l;7018D
PLAN CHECK TME i u i ,.00.3t -X139-31 i $644.94
tdi'ECIWICA14 FEE 101.000, 421.009) splp: S0
eUSCTI:ICAL F:,F,'101-000-420-000 X100.14
PL't3MBF90 FE ' 01.000-419.000 $14033
STRONO MOTION M - RESIE) 101-GW-241-OCY) 35401
O AiDMO FEV, 101-000.423-000 $15.00
DEVELOPEA IMPACT FEE $Is,4t)S.Oti
SUA-TOTAL COAiU RLiC!°I.aOX AT�7PUR CIMEC K
$4,202.40
MUM PIZE,-PATD FEES
$0.00
4
AIL PUNWrIF14MISDUE now
S43202A0
0 4 20C'+
CITY 01= L� "!A /
1:00ANCE DEPT.
RECEIPT
DATE
BY
DAT F ALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
Set Backs
Forms & Footings
APPROVALS
_
'' J
MECHANICAL APPROVALS
Underground Ducts
Ducts
Slab Grade
_
'
Return Air
Steel
Combustion Air
Roof Deck
_ _
Exhaust Fans
O.K. to Wrap
to �'�-
F.A.U.
Framing
We, j (j
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
3o p
Drywall - Int. Lath
d' 4910 —
Final
Final
POOLS - SPAS
BLOCKWALL
APPROVALS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVAL
Gas Test
Electric Final
Waste Lines
—
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
OX for Finish Plaster
Sewer Lateral.
Pool Cover
Sewer Connection
. �. �(
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
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 (Penn)
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
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 ff10 Slab on Grade
3-5-04
Concrete
273-213
Master Bedroom
Required psi: 4000
6172
7
3610
6173
28
5550
6174
28
5490
Set A Phase 5A - Lot # 1054 Slab on Grade 3-8-04 Concrete
273-214 Garage - Center Required psi: 4000
6205 7 3190
6206 28 4700
6207 28 4640
e / 6 7 0 / � e�eT 1` ce" ERTI
•
Page 1 of 1
JCMTiiI)Wions supplies the service
of compression strength test results only.
Per ASTMC39
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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 located at
81-682 DESERT WILLOW DRIVE LOT 105, 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 BUILD NG PRODUCTS A MASCO Company LICENSE # 221517
BY: WTITLE: ACCOUNT REPRESENTIVE DATE - 41,1061
•..•/r.r•r� iYrl/r>//!./%lllN .��'/P.. Jr I/ ,.�irrr.r....r/i:�•..^�r, i <�ryiiwrirr.•r.i�.r..r /.• .�.�,rig.:en•�iiniiii..,...�.�..�.....•�i.v.�.,i.�r�i�:..i.•......�a.rr� ,.. ..
•
Installation Certificate: Residential CF -611 t*5
Site Address PERMIT #
X81 682 Desert Willo�w-'Dr_ive
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
SUBDIVISION: Trilogy Pu, 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 80UHG4/5X-100 80% 100000
80%
4. COOLING INFORMATION
COOLING
EQUIP.
A/C
MANUFACT COMPRESSOR ACTUAL EFF. COOLING EQUIP
MAKE MODEL # SEER CAPACITY
Lennox 13ACC-060 12
COOLING
LOAD
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.
Yes ❑ No ❑ N/A ❑
• 6. SUBMITTED BY
&CIla ' co •dL-1 DATE: 3 -2c,- — O V
Signature Installing HVAC Contractor
.1
JCM Inspections
39725 Garand Lane Suite F
LTT%JPalm Desert, CA 92211
INSPECTIONS Phone: 760-345-5554 - Fax: 760-772-3895 INSPECTIONS
PRESTRESSED CONCRETE INSPECTION REPORT Date: ,.'C�_p
Project Name: Project No:
Trilogy @ La Quinta - Shea Homes 02-1109
Project Address: City:
81-260 Avenue 62 La Quinta, CA
Title 24 AWS F✓ UBC Other:
File # ❑ D 1.1
App# F-] D 1.4
❑ Other
Client: Sub -Contractor:
Shea La Quinta, LLC Sun Coast Tensioning
General Contractor: Architect:
Shea Homes Bassenian Lagoni
Structural Engineer:
Borm & Assoc, Inc/Suncoast Post Tension LP
(� n
Size and Type of Tendons: k o,,,,,,�-er �oo ^ ��„n �ckss_ Z. V a. \VZ 7AA nAu
Jack Machine Calibration: �Q�e\� S h o� \ c•, Sv.n
�1A �_ 11 ' " \ ' �. 3 y l �c� 3f nom®None
C:1 C � at.c t) \ a1 \ !>•, 5.��: ti �i� ti 3l t7 3
t
Calibration Date:�lac�r.1e 50 -ac)-CA
b osq Qt uk"lc..
Weather:
Unresolved Items:
❑ See Below
Description of Work Inspected: Specified
Lot # Location Tendons Elongation (in)
Actual Elongation (in)
LA* o
n C nLi
L
3 + 3 -a-21- 3-
n•\•� Othf fnnw '—Sl !\n W' WAM-\M
Al
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.r"
anak
Ll
3
f
3-4 3 u -I:
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C_n,: cx_ n
1 w_11Ty
I hereby certify that I have inspected all of the above work, unless otherwise noted, and to the besf 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 ICBO Ce 1 ti In No: 0842216-89
Contrac is Represe tat
Copy 1 JCM Inspections Copy 2 Project Superintendent Copy 3 Governing Agency Page _�f