0401-053 (SFD)LICENSED CONTRACTOR DECLARATION
:,!hereby affirm under penalty of perjury that I am licensed under provisions of
H Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
C14 WF' Plofessionals Code, and my License is in full force and effect.
o ch - License # Lic. Class Ezp. Date
t
w 2 t35 13 ! 6W/05
Z r— Date Signature of Cont ctor
r
J U OWNER -BUILDER DECLARATION
W W I hereby affirm under penalty of perjury that I am exempt from the Contractor's
~ Il 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).
( ) I am exempt under Section , B&P.C. for this reason
L
N Date Signature of Owner
O�
Q WORKER'S COMPENSATION DECLARATION
CL
p Cc I hereby affirm under penalty of perjury one of the following declarations:
O () 1 have and will maintain a certificate of consent to self -insure for workers'
X W compensation, as provided for by Section 3700 of the Labor Code, for the
O J Q performance of the work for which this permit is issued.
Cal Q () (.) I have and will maintain workers' compensation insurance, as required by
O Q section 3700 of the Labor Code, for the performance of the work for which this
LO
tl rn f— permit is issued. My workers' compensation insurance carrier & policy no. are:
It z Carrier WJ IONAJ, UNION Policy No.
Co n .71651333
r` O
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, anj agree that if I should become
subject to the workers' compensation'- rovisro s of Section 3700 of the Labor
Coded. sh 11 f hwith comp�y�with ithosproviions �-"h°
�Date:�I Applicant
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 inspection purposes.
ature (OwnerAgent) f✓'-`"O� Dat
A_�L
BUILDING PERMIT PERMIT#
0401-
DATE 4VALUATION LOT TRACT
f/
�zs,7�.�t? 40 30023JOB
J`
`
SITE
APN
ADDRESS 81-687 D1 = WILLOW DP.M
764-27("17
OWNER
CONTRACTOR / DESIGNER / ENGINEER
rl
SHEALAQU NTALLC
0I'.f'ALA QMTA.LJ C
81260 AVENUE, 62
81260 ffir UE 62
LA QUIffrA CA 92253
TLA QIT.MTA CA 92253
(760)777.6005 CSL# TDD
USE OF PERMIT
C}Ll~ rAMU Y DWMJ.11 G
:iTeD - LOT 40, PLAN 65058. PERMIT DOES NOT INCLUDE BLOCK
WALLS, P004 SPA OR 1}it.1'VEWAY APPROACH
CUSTOM CONSTRUCTION 2676100 3P
PORC:WPATIO 4880 SF
0ARA,CDI?dCARPOtl.i ?55.00 2F
R:v;t1MK17FID COST or CONS MTHI >DN
229,?4130)
CONSTRUCTION FED, 101-000-418.000 SLM.50
N.O. AN C:H& 1C FfiL 101-000-4-49-318 S88S.01
MRICIYWIC &L FEI? 101.000.421.000 $94.iU
ELECTRICAL. FEL101-000-424-000 S14U6
P1,1.iMBDOG FFE 101-000.419.040 $172100
STIZONO MOTION PEP,-11.&SI D 101-000-241-000 $22.97
GRAD NO FEE I01-000.423.000 $15.00
DZI1WPF,R IMPACT MR x'2,/405.00
ART N PUBLIC PLACES - RUSK 270.000.445.000 %74.37
I A 2rfi�0 170'fAL! 1; F0'ri2Ta•G'7CTOM A14D PLAMN CTir=1.
LI LEZ3 PRE -PAM .T.L &I
$4,9'1a 61
$0,00
I
�
I r�,1
S4,911.6 1c
RECEIPT
DATE
I //
BY J
L���1
DAT FI LED✓/
INSPECTOR
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings,
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck Q
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing 7Q91
Compressor
Insulation p
Vents
Fireplace P.L. f
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath p
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 0./
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
Rough Wiring
Low VaRage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Penn)
COMMENTS:
STRUCTURAL LOB SITE OBSERVATION .
Project Name: . J �//'�. % e- 7`r �:. A V /.'
Observer:
A visit to the project site was made on the above date to:
❑ Address specific elements of the work.
❑ Assist the field personnel with complying with the intent of the constructionfdocuments.
r'AI•r.. :a
❑ Assist the field personnel with complying with the findings frorn a previous structural job sitF.e observation.
C F ryf Pn / e1 G
At the time of our visit, work had progressed to the point of : Phase:
BOR "�.SSOCIATES, INC.
Structural Engineers
Project Number: `'"/�%
Date of Observation: _/ r9 G
Pv ��
Address:
Bldg. / Lot Number:
4�0
q 5"
z
L' 7
Bldg. / Plan Type & Elevation:
(12
Foundation Trenched
JV
Foundation Poured
STRUCTURAL LOB SITE OBSERVATION .
Project Name: . J �//'�. % e- 7`r �:. A V /.'
Observer:
A visit to the project site was made on the above date to:
❑ Address specific elements of the work.
❑ Assist the field personnel with complying with the intent of the constructionfdocuments.
r'AI•r.. :a
❑ Assist the field personnel with complying with the findings frorn a previous structural job sitF.e observation.
C F ryf Pn / e1 G
At the time of our visit, work had progressed to the point of : Phase:
BOR "�.SSOCIATES, INC.
Structural Engineers
Project Number: `'"/�%
Date of Observation: _/ r9 G
Pv ��
Address:
Bldg. / Lot Number:
4�0
q 5"
` =
L' 7
Bldg. / Plan Type & Elevation:
(12
Foundation Trenched
JV
Foundation Poured
eel
Roof Sheathing Covered
Roofing Material Stacked and Loaded
)lFyiyC J
0
0
Exterior Walls CoveredU.-"`
"'C
7'
=
0
Interior Wall Covered
C
C
C
0
Insulation Installed
0
7
,"
0
v ,0
Electrical, Mechanical, Plumbing Complete
:1
0
=
G
Final Framing Pick-ups Completed
C
Building Complete
C
_
Based upon our visit: -
Refer to the attached field. notes to be addressed by the construction personnels
❑ Additional information will be sent from our office which will need to be addressed by'the construction personnel.
❑ It is our opinion that this building is being constructed in general conformance with the intent of the construction documents prepared by
our office.
O Site Observation ceased, framing was not at a stage of completion in which site observation could be performed.
❑ Concerns brought to
based
•have=yet-to be addressed.
i•, /"D _I
Please note: 4Z!31�1
Our findings and recommendations may have other than structural ramifications which we have not addressed. Be advised that changes to the
constr"ucti"on documents need approval'of the building official. Our firm is not authorized to act as the Owner's agent. Our findings shall not be
construed as authorizing the expenditure of'additionaf funds.
Site Observation was made only to determine general conformance with'the intent of the construction documents. " `Observation,,was made of those
portions of the work which would best represent the intent of the construction documents, not each and every element of the work. Site observation
did not include review, approval or observation of, among other items:
1. The contractors safety precautions, procedures, designs, methods or techniques.
2. Any shoring, scaffolding, underpinning, temporary retaining of excavations, or any other erection methods or temporary bracing.
Any soils at the site, their adequacy to support. the building, expansiveness, or any other soil related conditions.
4. Any drainage courses or devises of a temporary nature or as a permanent part of the structure, including roof and floor slopes, drains and
pipes.
The findings of this observation are understood to be awexpression of professional opinion by the engineer based on his or her best knowledge,
information and belief. As such, it consists of neither a guarantee -nor a,warrantee express d or impliee,pt. -�
�[ f FT vv
Field Superintendent (third copy) 4A rl A' (Z Date:
Client (second copy via mail)
Field E'ngi amen a (first copy) Date:C' y
If you have any questions please contact our of ice
COSTA MESA, CALIFORNIA Phone: 714-513-7500 Fax: 714-513-7555
ROSEVILLE, CALIFORNIA Phone: 916-774-7597 Fax: 916=774-7599
SAN RAMON, CALIFORNIA Phone: 925-242-2577 Fax: 925-242-2961
LAS VEGAS, NEVADA Phone: 702-740-5427 Fax: 702-740-5431
ovnc,.Tr ADT?nXTA ot—..c,)z_cxo_nxm G�v•!�2_4!o_n�no «'',;'e';''
INSULATION CERTIFICATE
This is to certify that insulation has been installed in conformance with the current energy
t
regulation, California Administrative Code, Title 24, State of California, n the building a
81-687 DESERT WILLOW DRIVE LOT 1040,1A 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 SCHMIp BUILDING PRODUCTS A MASCO Company LICENSE # 221517
BY: TITLE: ACCOUNT REPRESENTIVE DATE:
O,
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t.�i ir.r...y.•i.•ririrv.....rrriirrrir-i�.riiirr...�•nir�•w•.r.�rri�fn:�:..�.iiiiiiii:�in.• i irrrr�.'i�'/9rr/.•l.%7l//7r.� iriii.io-.rrir-�iimrriis..�i.i.p>r:�.��ia.r�.r.�.r.,..ii� •�
JCM Inspections
39725 Garand Lane Suite F
Palm Desert, CA 92211 L=
INSPECTIONS Phone: 760-345-5554 - Fax: 760-772-3895 INSPECTIONS
• COMPRESSION STRENGTH TEST RESULTS
Client: Shea La Quinta, LLC Date: 4/18/04
Project: Trilogy @ La Quinta - Shea Homes Project No: 02-1109
81-260 Avenue 62
La Quinta, CA 92274
Set ID Structure Age of Test Compression Strength
JCM ID Location Date Cast Cylinder ID (days) (psi)
Set A Phase 5A - Lot #.1040 Slab on Grade 3-9-04 Concrete
273-220 Casita Required psi: 4000
6216 7 A 3280.
6217 28 WWII'
6218 28 4780
7'D CERTIFIED: G,
JCM Inspections supplies the service
of compression strength test results only.
Per ASTMC39
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IBJ
is
Page 1 of 1
Installation Certificate: Residential CF -611
Site Address
8.1V687�D`eser ill_ow Dri_v"e
• 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 #
l.,dCYo
SUBDIVISION: Trilogy c@ 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
G40UH48B-090X 80%
4. COOLING INFORMATION
COOLING MANUFACT COMPRESSOR ACTUAL EFF. COOLING EQUIP COOLING
EQUIP. MAKE MODEL # SEER CAPACITY LOAD
A/C Lennox 13ACC-042 12
13ACC-042
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
—B�YY
DATE: —Z51-6 4/
Signature Installing HVAC Contractor
rj
JCM Inspections
};.39725 Garand L"aneiSuite F
LT.M.%J- Palm Desert, CA 92211 1E
INSPECTIONS Phone: 760-345-5554 - Fax: 760-772-3895 INSPECTIONS
- PRESTRESSED CONCRETE INSPECTION REPORT Date:
Project Name:
Trilogy @ La Quinta - Shea Homes
Project No:
02-1109
Project Address:
81-260 Avenue 62
City:
La Quinta, CA
Title 24 AWS ❑✓ UBC Other:
File # D 1.1
App# ❑ D 1.4
❑ Other
Client: Sub -Contractor:
Shea La Quinta, LLC Sun Coast Tensioning
General Contractor: Architect: Structural Engineer:
Shea Homes Bassenian Lagoni Borm & Assoc,lnc/Suncoast Post Tension LP
`"
Size and Type of Tendons. �r, , -050
Jack Machine Calibration��cewc?�:S4�oA�ron,J���
Calibration Date:��t���� 50
&C-10sirs'\
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V P t n V -'Q S t e C'n n,l
i�as(J�.Q�CUrE���, o!,'t Tn
t 1allone
3 OV
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Weather:
Unreso -'Items
See Below
Description of Work Inspected: Specified
Lot # Location Tendons Elongation (in) Actual Elongation (in)
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10
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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: ck C. Millin ICBG Certif ratio o' 0842216-89
ontract • is Represent a ive:
\_ I / \.--
Copy
Copy 1 JCM Inspections Copy 2 Project Superintendent Copy 3 Governing Agency
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