9909-172 (SFD)LICENSED CONTRACTOR DECLARATION
Thereby 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
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:
(V) 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
contrac • rs to construct the project (Sec. 7044, Bdsiness & Professionals
J r- �r
Zam exempt under Section B&P.C.,for this reaason
W)IA�l Signature of Owner.:%�� ✓ ! r ; a- E 7
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.
(Y..) 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:
CarrierF�11q-G I1°IJRY NS,C Policy No. E4'vOW 43 i0
(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'�ompensation laws of California, and agree that if I should become
k
'ect tothe workers' compensation provisions O�Section 3700'of the Labor
e, Lshall forthwith comply with those'provisio s:l K, Applicant APPlicant it <"F�c:'�' J: s 7`'F G�
,f
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up, to $100,000', in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit, subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct 'l agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection purposes.
Signature (Owner/Agent) Dates
r.-
BUILDING PERMIT PERMIT,,g_
DATE d VALUATION �'a� LOT TRACT
JOB SITE 51-M AV.XN1.DA &9IDi�A.11.641' Z
APN % i�-�S'F.-�%
ADDRESS
OWNER
CONTRACTOR / DESIGNER / ENGINEER
JOSE RAUDEL \«'r LEXCIAA NO
OWNER ! BUILDER i"JfTH CVHC
53-499 CAPRICORN SO ., APT. E
45701 MONROE 91' aSTEi O
MX0 Ck 92201
(NDN-) CA 92201
{7liG)347- 157 C'RUP
USE OF PERMIT
S11�I.;r1. E F��MILY I3WEIA,MIG
bl, V i, UIA) - 4't3tC,`O+i1' .' L)QtS NVY IP ;y.l1M k LA_Ati,K. WALL U 1.. ,
PLAN MCKFEE P.t?d3I3Cf C3 "i�/a � (J1� .f �iJf.�$RPl Es 1'.SStJANCB OF :hAiddiJ
PLAN IME.
TRAGI' CONSTRUCTION 1.320.120 SF
PiORC'iUPATIO 114.00 �'
GARtAGFJCAPLr0Kr 420,00 SP
05'HKA M0 COST Oft CONSTRUCMON
81,41A.20
PERMIT FEE SUNNUtR '
c•ONS'1.t7iCTION FFA 1131'•6?1tll x.15-ODf9 4BS`iR. u
PIAN CHECT9 P -EE 6.131.000-439-319
flrtM-IMOC(All 1:EEr 101 -000 -421 -WO 553,50
ELEC"'1'€d.,fCALTEE. 1E21-1ltl(3�kx13 i1Qi! $1 f3:.Ft)
P:I.I;7►UI13ING M S'1 75
S'4iC.0AfGMM ION FM, - RE -So . 111.1-000-241-000 $8.14
GRA47UNGM— i $70.00
DEVELOPER IA,i*P CT FEF 21.901.00
PtdECISF PLAN i€1.1-(?(liY441-345. $160.00
r .
Y
SUB-rrn'AL CONSTKUC°i 0 4 AND PLAN CHECKVA
�3,9.12.tiC1
�hSS PRE -PAW A r,,S�
�V.CJ
TOTAL k°ERMYr FEES WE NOW
$3,012.60
RECEIPT
DATE
BY :
DATE FINALED
INSPECTOR
INSPECTION RECORD
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
.��3 — OD
Exhaust Fans
O.K. to Wrap
— Z
F.A.U.
Framing
( . rym
Compressor
Insulation
—dft 157
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
S
Drywall - Int. Lath
Final
BLOCKWAL APPROVALS
Final
POOLS - SPAS
Steel
Set Hacks
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
�,,•/
Heater Final
Plumbing Final
Water Piping
Plumbing Top Out
Equipment Enclosure
Shower Pans
CK 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 A—S —
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 (Perm) �l Gfl
_0000P]))
THIS ATTIC HAS BEEN INSULATED TO:
R-1 I
This attic has been insulated to the R-valUe
indicated above, with C000011TI
, the high -efficiency
insulation. Made from a minimum of 80% recycled
materials, Cocoon is scientifically formulated
to dehver greater efficiency per inch than other
insulation materials.
R -value is a measure of resistance to hear flow — the
higher the R-valLie, the greater the insulating power.
If you would like to add more insulation to your
home, contact your Cocoon authorized dealer.
RESIDENCE ADDRESS: ,,2
INSTALLED BY:
Y11.1! 11 V&3,1/1LLj7_-'U.&UjVS
8-1 M Okwn&-, b1nft #1
Awlo� G4 922tw
BUILDER:
ffee) VZ_ 2-10
CERTIFICATION:
This is to certify that attic insulation has been installed
in conformance with the coverage chart recommenda-
tions on the opposite side of this card Using �� bags
to coveDo!q��sq. ^ obtain an R -value of _zk
STAYLER'S AUTHORIZED SIGNATURE IDA
4-
05 0 �on
4
Cocoon Stabilized Insulation
Alarfufactured 13y.- 30 lb. bag
ATOMIZED PNEUMATIC APPLICATION
GREENSTONEEN.'"
R -Value at
A LOUISIANA- PACIFIC COMPANY
Net Coverage No Adjustment for Trusses
Sidewalls (pressure filled
75*F Mean
NOTE: This coverage chan compensates for settling
r
and is for estimating purposes only. Stated R-vaIUC is
4
provided by instilling the required number of bags
Temperature
per 1000 sq. ft. at a minimum installed thickness.
2' x 6' Trusses on 16' 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
t
by job conditions and application techniques, and
Installed
may vary as much as 10% without significantly
affecting the stated R -value. Failure of the installer to
provide it least therequired number of bags per
To Obtain an
1000 sq. ft. and at least the minimum thickness may
result in a lower installed R -value. Compaction may
Square Foot of
occur during installations above R-30, requiring more
4
than the stated number of bags to obtain the
Should Not Be
minimum instilled thickness.
Rect " Per
ui'
Installed
Square Feet
Per 1,000
GreenStone and Cocoon are trademarks of
Less Than:
Per Bag
GreenStone, a Louisiana-Pacific company. @ 1997
ATOMIZED PNEUMATIC APPLICATION
COVERAGE CHART
R -Value at
19.4
Net Coverage No Adjustment for Trusses
Sidewalls (pressure filled
75*F Mean
Minimum
Gross Coverage Based on
Maximum Net
R-13 (2 x 4)
Minimum Weight
Temperature
Thickness
2' x 6' Trusses on 16' Centers
R-20 (2 x 6)
Coverage
5.5
Per Square Foot
Installed
The Weight Per
To Obtain an
Insulation
Minimum Bags
Square Foot of
Bags Required
Insulation
Should Not Be
Square Feet
Rect " Per
ui'
Installed
Square Feet
Per 1,000
Resistance (R) of:
Less Than:
Per Bag
1,000 Squar a Feet
Insulation
Per Bag
Square Feet
(inches)
Should Not Be
Less Than: (lbs.)
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
36.5
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-11
3.0
93.1
10.7'
.322
102.8
9.7
17 p
GreenStone Industries, Inc. All rights reserved.
19.4
Printed in USA. RV 30M 8/97.
Sidewalls (pressure filled
-density
2.0 PPCF)
8-97-TT/G-A
R-13 (2 x 4)
.917
1
3.5
51.4
R-20 (2 x 6)
5.5
32.7
0 r�
19.4
.583
56.7
17.6
30.6
.917
1
36.1
27.7
0 r�
Certificate of Occupancy
City of La QuAN
inta
- -Building and,Saft-tyDepartm-
ent
This' Certificate ssuedA-'p want to ahe .requirements of Section: mof the Uniform Bui/tling Code,
certifying ttiat, "a# the }time of issuance; this#ructure was in comp/lance with the various' ordinances
of. fhe City regu/atirig bui/ding construction or use. For the ,fo/%wing;
BUILDING ADDRESS: 51-160-AVENIDA RAMIREZ
Use Classification: SFD Bldg. Permit No.: 9909472
-Occupancy Group: At 3 Type of Construction: VN Land . Use Zone: RC
Owner of Building: '-JOSE RAUDEL VALENCIANO Address: 837499 CAPRICORN ST, APT. E
City: INDIO, CA m 92201
By:.,STEVE TRAXEL
Date: 09-26-00
Building Officia
POST'IN A CONSPICUOUS PLACE