9909-174 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby 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
Professionals Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
CVHC
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:
(.<) • 1, 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 m exempt Under Section B&P.C. for this reason
Dote z Signature of Owner
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjuryone of the following declarations:
() I have and will maintaina 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
Setion 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:
CarverM.D-;e'E�(�ETLJRY TNS C" Policy No. B2007 43 .r0.
(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
workKttoclhe
ompensation laws of California, and agree that if I should become
subje workers' compensation provisions of Section 3700 of the Labor
C�d�e, I shall forthwith comply with those"provisions,'
yDate: r / 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
fora permit subject to the conditions and restrictions set forthon 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.agree to comply with all City, and State laws relating to the building
constructlon, and hereby authorize representatives of this City to enter upon
thee bove-mentioned property for inspection purposes.
W ignature (Owner/Agent) -~%~
Date e`�'
PERMIT0174 }:
BUILDING PERMIT j, nf M1'
DATE VALUATION "11424 -2'0 LOT - TRACT-
4
(1`1 49
JOB SITE '51-100 AVYWIDA RAM.1"g,
APN 7?X,-062,.0 4 .
ADDRESS
OWNER
CONTRACTOR/DESIGNER/ENGINEER
JCiE;fN RYAN PLA.1GH
OWNER.i BUTJ.DER kVIT1{ CVH
4.5701 MC)HItOE ST Si`E' G
LA t`T.1iF1'1`A CA 92253
11, DIO C.A. 92201
t►�1:)347-� 157 1213Uff
'
USE OF PERMIT
SINGLE FAMILY DWELLING
SME (I 320B) - POUiflT EX)ES WYYINCl..£JDF,, BBC WAi iL OR Ell...
PLAN CFIECR. FRE RE UC..91). 75%9 F'R 10A.T.IPLE ES.SUAN. CE OF SAW.
K,AN TYPE.
IT(AC'F (C)14'%T £1JC;' TON 1_47M,P,t3 V
PORCIRMATTO 114m S
GARAC?E `AMPORT MOO :W
S `1fjlBAt'Ec�1b COST 0 F Cd0,tl`R1.X''TItX N
PERMIT FEE SUMMARY
CONSTRUCTION FEE 101-000-418-0W
:PL.Iuq CFW.CK Fn iU1. •000-439=3.18 S 1ls.63.
,VMCHANICAL FEE .101-090 4 21.-000 fi33.50
EILECTRIC At, M 10i -000-420-01W' '
P'f EYNLRINO VEE? If3)( f)Dd3-rf,.ldt f)i3f1 $l.2 i.'y5
STRONG MUCiC3N M, E-RM'W. .151. 4AID-241-010 $a. w
GRAIDEN 1 F 1. i'-000-423-000 $ZO.Of3
DEWLOPP..R 1It•I.PACT:FEE' $1.907.W
PRECISE PLAN 101-004)44:1.345 S100.Chi .
SUD-TG'1',AL COh151 RUC":T`ION AND PLAN CHECK
$3,012.60
L1CM P'PE,-WA61a FEES
` 0.00
RECEIPT
DATEDATE
FINALED
INSPECTOR
YnY
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
4Underground
Ducts
Forms &Footings )
Ducts
Slab Grade }. -
O
Return Air
Steel
Combustion Air
Roof Deck`
j - s -
Exhaust Fans
O.K. to Wrap I
F.A.U.
Framing 1
-GO
Compressor
Insulation.
arp j;_77
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation }
Condensate Lines
Party Wall Firewall 1
Exterior Lath 1
-10m
Drywall - Int. Lath 1
-Gw
t
Final
Final Gp=1�-Do 1S
BLOCKWALL APPROVALS
POOLS - SPAS
steel
Set Backs j
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
1
Equipment Location
Underground Electric
i
Underground Pibg. Test
Final
Gas Piping
PLUMBING APPROVALS
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 1
Pool Cover
Sewer Connection I4=�dD
c,
Encapsulation
Gas Piping
Gas Test
�9 - L -,o d ST T
Appliances 1
!
Final
Final }
Utility Notice (Gas) '.
ELECTRICAL APPROVALS
Temp. Power Pole ' /,f-3 - f9 s%
Underground Conduit
Rough Wiring }
Low Voltage Wiring 1
Fixtures ;
Main Service 1
Sub Panels k
Exterior Receptacles
G.F.I.
Smoke Detectors ;
Temp. Use of Power i
I
Final
Utility Notice (Perm) I
COMMENTS:
ME
Certificate of Occupancy
. City of L a Quipta.
AA
d g and Safetv.,Oepa, t -e "'t O>t
This Cer#ificate .issued pursuant to tfie requirements •of section ,109 of the` Uniform °Bui/ding Code,
certifying. that, at the" trine: of issuance, thii'strocture was.. in comp/lance with the various oidmances_
of.th&zCity regu/sting bur/ding .cons#ruction-or use. For.the fo/%wing::.
BUILDING ADDRESS: 51-100 AUENIDA RAMIREZ
Use Classification: SFD Bldg.' Permit No.: 9909-174
Occupancy Group: R- 3 Type of Construction: VN ' Land Use Zone:... RC:
Owner of Building: JOHN. RYAN HAIGH
..r&4n
Building Official
Address: 50-701 .WASHINGTON ST.,#1621
City: LA QUINTA, CA 92253
By: STEVIE TRAXEL .
Date: 10'02-00
POST IN A CONSPICUOUS PLACE
to
4"'i
TM
0
THIS ATTIC HAS BEEN
Xt
This at
indicate
inSLII.ItiO
VQ 4
materia
to deliv,
il insulatio
cr, A.�
-Y
R -value i
higher t
If You V
home, c
7-
00
d<,
4W
4
vq, 7j;
V
RES
V
IDENCE ADDRESS:
INSTA
9A PZ_-%=1NS7A L ,Y.A TMiYY,
INSULATED TO:
81-771 01cander. Unit #1
Indio, CA 92201
BUILDER:
CERTIFICATION:
tic has been insulated to the R -value
d above, with Cocoon", the high -efficiency This is to certify that attic insulation has been instafled
n. Made from a minimum of 80% recycled
Is, Cocoon is scientifically formulated in conformance with the coverage chart recommenda-
r greater efficienq, per inch than other tions on the opposite side of this card using Z-,/Y—bags
n materials. to cover��sq. ft. to obtain an R -value of
s a measure of resistance to heat flow — the
he R-vakie, the greater the insulating power.
OLIld like to add more insulation to )'Our
ontact your Cocoon authorized dealer.
Or
J
TM
Cocoon Stabilized Insulation
30 lb. bag
Afanufactumd By,
ATOMIZED PNEUMATIC APPLICATION
GREENSTONE
R -Value at
A LOUISIANA-PACIFIC COMPANY,
Net Coverage No Adjustment for Trusses
C
75'F Mean
NOTE: This coverage chqra compensates for settling
Gross Coverage Based on
and is for estimating purposes only. Stated R-valUe is
R-13 (2 x 4)
provided by instilling the required number of bags
Temperature
per 1000 sq. ft. at a minimum installed thickness.
2' x 6* Trusses on IF Centers
Installation of.the required number of bags may yield
R 20 (2 x 6)
more than the specified minimum thickness and minimum
5.5
weight per sq. ft. Actual coverage will be influenced
by job conditions and application techniques, and
Installed
a
may vary as much is 10% without significantly
'a
f le c In
affecting the stated R-va[Lie. Failure of the installer to
8
V.
to' de
pprovide at least the required number of bags per
To Obtain an
000
1000 sq. ft. and at least the minimum thickness may
sq
res u I I n
result in a lower installed R -value. Compaction may
Square Foot of
occur during instillations above R-30, requiring more
Bags Required
thin the stated number of bags to obtain the
Should Not Be
m in I i In U I
inimum installed thickness.
Required Per
Installed
Square Feet
Per 1,000
GreenStone and Cocoon are trademarks of
Less Than:
Per Bag
GreenStone, a Louisiana-Pacific company. 0 1997
ATOMIZED PNEUMATIC APPLICATION
COVERAGE CHART
R -Value at
19.4
Net Coverage No Adjustment for Trusses
C
75'F Mean
Minimum
Gross Coverage Based on
Maximum Net
R-13 (2 x 4)
Minimum Weight
Temperature
Thickness
2' x 6* Trusses on IF Centers
R 20 (2 x 6)
Coverage
5.5
Per Square Foot
L
Installed
The Weight Per
V.
To Obtain an
Insulation
Minimum Bags
Square Foot of
Bags Required
Insulation
Should Not Be
Square Feet
Required Per
Installed
Square Feet
Per 1,000
Resistance (R) of:
Less Than:
Per Bag
1,000 Square Feet
I lation
Per Bag
Square Feet
(inches)
Should Not Be
Less Than: (Its.)
R-50
13.5
20.5
48.8
1.464
21.3
46.9
R-42
11.4
24.4
41.0
1.230
25.6
39.1
R-40
10.8
25.6
39.0
1.171
26.9
37.2
R-38
10.3
27.0
37.1
1.113
28.4
35.2
R-32
8.6
32.0
31.2
.937
34.0
29.4
R-30
8.1
34.2
29.3
.878
3.6.5
27.4
R-24
6.5
42.7
23.4
.703
46.4
21.6
R-22
5.9
46.6
21.5
.644
51.0
19.6
R-19
5.1
53.9
18.5
.556
59.5
16.8
R-13
3.5
78.8
12.7
.381
87.0
11.5
R-1 1
3.0
93.1
10.7
.322
102.8
9.7
4
5 11
I �'�
GreenStone Industries, Inc. All rights reserved.
4
19.4
.583
C
Printed in USA. RV 30M 8/97.
Sidewalls (pressure filled -density 2.0 PPCF)
8-97-Tr/G-A
R-13 (2 x 4)
.917
3.5
51.
R 20 (2 x 6)
5.5
32,
L
V.
4
5 11
I �'�
4
19.4
.583
56.7
17.6
7
30.6
.917
36.1
27.7
4
5 11
I �'�