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61
LICENSED CONTRACTOR DECLARATION•
I hereby affirm Lander pendlty of perjury that I am licensed under provisions of
Chapter g (commencing with Section 7000) of Division 3 of the Business and
Professionals Code, and my License is in full force and effect.
r 'License # Lic. Class Exp. Date
13 t 0105
Date t Signature of Contractor
i
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 isnot 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 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.
( �.)' 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 NATIONAL I1 aN Policy No. 7165933
(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 totthe workers' compensation provisionsf%Section 3700 of the Labor
Code -11,s all fokhwith comply wit "these prcvislori, , ---%
D -a
�,�•te: 9U Applicant Y
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/9tate laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property -for Inspeec'tio�n/6urposes. j
Signature (Owner/Agent)-•*� Date(
BUILDING PERMIT PERMIT#
DATE VALUATION LOT 04,01-049 TRACT
$5 :0073
JOB SITE
ADDRESS $1.-684 DE: SKR T ZOW DPZf YR.
APN
764-27"l 7
OWNER
CONTRACTOR / DESIGNER / EN (NEER
M.MA LA CZt IWA Li t:;
aaLe A LA CjTTIWA LLC,
61260 AV1; AJE 62
81260 A;VTWYE 62
LAQt)WA CA 92253
IAQ(JIN'TA. C:A. 92253
(760)777.6005 CD14 'Tm
USE OF PERMIT
OWGL1? VAMLY Dii IL,ING
VD « 1rQT 5�, PI,.A J 5210A. 1PE121+t11T DOES NOT 1NC1.UDr1 BLOCK,'
WAUA, P661, SPA. OR DRIV YWAY APPROACH
CUSTOM CONSTRUCT ION 2,2U.00 3F
PO.RCHWA"s 10 221.00 S11'
GARACIFACA.12PORT 5)£1.00 BF
ESTMA ) cogr Or CONSTPlTori
C'ONSTgUC TION FU 101-000.418-000 $940,$0
PLAN CHECK PUE 101-000.439-418 M6.951
a? aSEC:HiO1ICAL VVE 101-000.421.000 $75,00
ZI,WTVUCAL FFR, 101-000-4.20-000 $121.14
.P1.fJtlhO)NO FEF 101.000-419-000 S14Z00
STR.OD1C9MOTION "LE - R.ES1D 101-000-24,1-000 $13.,M
31AD.11,10kiL101-000-423-000 $15.00
DZVi3®PER IMF -ACT C- .% $2 405.00
SUB -TOTAL CGNSTRU•C'7, ON AMD F1" C111FA rK
$4,414.14
U j EZ113 :ice? PAW PUS
$0.00
T d'WT1VWr.C# N DTE AM
$4,474,14
FSB 042004
CITY OF LA QUiNTA
FINANCE DEPT.
RECEIPT
DATE f ��
BY ��;+f
DAY F 4ALED
INSTP
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
I INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs'
Underground Ducts
Forms & Footings
_
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
_
6
Exhaust Fans
O. K. to Wrap
A el
F.A.U.
Framing
6q a
Compressor
Insulation
('
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Ab Al
Drywall - Int. Lath
a'
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
O.K. 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
FoQures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp` Use of Power
Final
Utility Notice (Perm)
STRUCTURAL JOB SITE OBSERVATION
Project Name: VXTA
Observer:
`10A11 'S-S0_JC1?A'T1S;,,1NC.'
trucwralEiigineers
Project Number:
fL yt.- Date of Observation: moi/ C
A visit to the project site was made on the-above,.date to:
13 Address specific elements.6f the work..
Cl Assist the field personnel with complying with the intent of the -construction -documents.
0 Assist. the field personnel :*rith:cornplyingwith,the firidings.firorn a' -.-pre vviclis'structural job -site observation.
At the time of our visit. work had nioeressedloAhe -1)01tit--6fi - Phase:
Address:
Bldg, l 49tN.um.ber:
Bldg. / Plan Type:& Elevation:
Aw
Foundation Trenched
Foundation Poured. 0
KE
Roof Sheathing qoy6red
:
RoofirigzMatenil Stacked and -Loaded C].
14
Exter6r.Walls. -Covered 0
Interior -Wall Covered
0
-b
Insulation1ristalled'
D"
Electrical, Mechanical; Plumbing -Complete
Final Framing Pi6k-u s.CaTripleted
Building Complete
Based :upon :.our visit:
Refer to"the-attached field notes ,t6,-.be'ad' Oe4:'by.Ahe*.con$tructib 11personnel:.
will need to be�addiesi the construction personnel.
13 Additional -information will be:sl�ilt,.�fr.0,M.0'*-Ui,..ofrice which
O It, is out -opinion that. this -.6uilding ng,.,,coft$tMcted in general: conformance with -the intent of the construction documents prepared by
oui--bMc;e.
Q Site_Obsaa!ioh ceased, framing was not at stage of completion inWIii1ch:.site, observation could be performed.
Q Concemsrou' g'hJJWhr eAtjp
-. p, -g _e d.,onprevaoussite�9,
to be addressed.
Please -note: 1 _
than 'I:rarnificatiQns'�Aiic ","t' --'d' Be -advised that changes to the
Our. findings and recommendations mqy-hav6'qi'.',' " have not 4 pesse,
construction d6purnents need ,approxylaidbiIiiie. b'b il ".4 dal.. :Out firm is not, authorizedto' act: as the Owner's -agent. Our findings shall not be
construcd:as authori-ii,hg,,the,e'x fidftiireof:addittonalfunds.
Site Observation!was made only to determine - gerieraletofifbiminc iond" ents.
e,.with �tke � intent of -.66tistruct-oburn - Observation was made of those
portions. of the; work which would best represent -,the ,.intent o-�,"tiie co nttrii,ct-ion**do'ct�ments-;,kqt- each and every.element ofthe work. Site.: bservation
did not include review-, approval or observation- of,,ar6png, oth, i. it6ffis:
1. The contractors safety precautions, procedures, designs; :methods oi,techniques.
2. Any shoring, scaffolding, underpinning; -temporary r6iaihing-or,excavations, o'r.Apy other. erection methods or temporarybracing.
y -to. t su iiirf e 9 s;,'or . -griyo-then soil related conditions.
3. Any.soils at.the site their-adequac support the-� '-i
id
p e
4. Any drainage courses or devises of atern por4r -y. nature or r�m
r.as-,.a-...pe4ndhtP'ot.of,,the structure; including roof and floor slopes, drains and
pipes.
The 'findings of this observation. are understood to',be;an expression of"p
information and:belief. As such, it consists of neither a.
guirantee nor wai
Field Superintendefit.(third copy)
Client.(se'cond copy via -mail)
Field. Engineer (rirst copy.)
If you have any questions please conta(
C I STA MESA, CALIFORNIA
SEVILI,Ej CALIFORNIA
SANRAMON, CALIFORNIA
LAS VEGAS, NEVADA
i0nal:o - T inion.'.by the engineer -based on his or herbest knowledge,
P�l�'orr . 714-513-7500
Phone: 916-774-7507
Phone 925-242-25.77
.P hohe.'.702., - 74045.427
Date: `'t./ V) / P,
Fax: 714,513-7555
Fax 9.16-.774-7599
Fax 915 242-2961
Fax :,702-740-5431'.-
INSULATION CERTIFICATE
This is to certify that insulation has been installed in conformance with the current energy
regulation, Califomia Administrative Code, Title 24, State of Califomia, in the building at
81-670 DESERT WILLOW DRIVE LOT 1,'O'§—'-'-?QUINTA CA
4 ,LJAA-
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 BUILDING PRODUCTS
A MASCO Company LICENSE # 221., 17
BY: TITLE: ACCOUNT REPRESENTIVE DATE:
Installation Certificate: Residential CF -6R
Site Address
81-670Desert Willow Drive
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 @ 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.
&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
r re ccY��nr�/ DATE: Q --O rV
O Signature Installing HVAC Contractor
JCM Inspections
1 39725 Garand Lane Suite F
_ I Palm Desert, CA 92211
INSPECTIONS Phnne- 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
Set ID Structure
JCM ID Location
Set A Phase 5A - Lot
273-215 Kitchen
Date: 4118104
Project No: 02-1109
Age of Test Compression Strength
Date Cast Cylinder ID (days) (psi)
Slab on Grade 3-5-04 Concrete
Required psi: 4000
6176 7 3490
6177 28 5140
6178 28 5190
Set A Phase 5A - Lot # 1055 Slab on Grade
273-216 Garage - Interior Side
8/6,92-D &Sen!727
•
0
Page 1 of 1
3-8-04
6202 7
6203 28
6204 28
�Le-CDC& CERTIFIED: %,"LL.
Concrete
Required psi: 4000
3800
5250
5290
Q, G.
J Inspections supplies the service
of compression strength test results only.
Per ASTMC39
L3Palm
-JCM Inspections
39725 Garandtan,e Suite F
1
Desert; CA 92211
INSPECTIONS
Phone: 760-345-5554 - Fax: 760-772-3895 : ' INSPECTIONS
PRESTRESSED CONCRETE INSPECTION REPORT: '• ,Date: 2�__o
Project Name:
"Project No:
Trilogy @ La Quinta - Shea Homes
02-1109
Project Address:
City:
Title 24 AWS UBC Other:
81-260 Avenue 62
La Quinta, CA
File # D L1
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, Inc/Suncoast Post Tension LP
t
6�_
Size and Type of Tendons: C3°�Q Se\)Fn - ct
Weather:
Jack Machine Calibration�e���y S�c, <tan's'k" (04:k—`'"ge-
Qkz,&.(tt0 'tom 05Z1 �
Unresolved Items:
`
V 1X&&'keya.'ho
((��
gL' k% n :,tea 6so0 �� �O '�S3,aw
'I \
%i �,2� 3�� O40 I�
.None
See Below
Calibration Date:Mu�
r)
�.s a� � �- � .,�. a 1n a) A• �1-�
�.5�� tea,\\pw ��:
Description of Work Inspected:
Specified
Lot # Location
Tendons Elongation (in)
Actual Elongation (in)
cric O.a-Q-
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a �' 01 �._
(4'1" 4 14
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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: J ck C. Millin ICBG Certificati n No: 0842216-89
Contracto'r's Representative:
Copy 1 JCM nspections Copy 2 Project Superintendent Copy 3 • Governing Agency Page —4of 4—