0007-137 (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
74188 B
Vate /��' <� ���Signature of Contractor..,"" •, -' F L •l ^j>- /
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 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
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. CiOL151+'N E,AOLZ INS, Policy No. WWC-344063-02
(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 sous to become subject to the
workers' compensation laws of California, and agree that if I should become
sy 6ject to the workers' compensation provisions of Section 3700 of the Labor
Code, I shall forthwith comply with those�provision"s' 7
Date:W� Al/ Applicant—
Warning:
pplicant 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
c_ r struction, and hereby authorize representatives of this City to enter upon
t e above-mentioned property for inspection purposes.
Signature (Owner/Agent)Z�)/Date
W& -O BUILDING PERMIT PERMIT#
�
7+1.
DATE VALUATION LOT TRACT.
a7
9D.aViyRV.iV 4 f 27 519
JOB SITE
APN
ADDRESS 79-299 PAST1'O 1413, RFY
604-•061-M
OWNER
CONTRACTOR/ / EN INEER
CEld7 my cRoum—L COmAolt1NTTtE9
Ch1d'!f JRY C:ROWELL CO)AMUNIT
1535 �;O. 97 9r r, 9111 0200 200
1535 SO. "V E' rRI ETT. ST`E, 02.00
SAN BTAR DINO CA 92405
SSM BENNARDI40 CA 92408
(P•09)331 �6007 CBVL 2120
USE OF PERMIT
MOLE F1 .Y p'd4M_ NG
SFD- L,OT 17 CLAN 3REi PERMIT 0025 NOT MCLUDE BLOCK WALES OR
POOL,
TRACT CONu7RUCTION 1,6'7 .00 SP
PORCH/PATIO 84.00 SIS'
GAILAMC:ARPORI (SI) 81173120
F1*F..D cosr or commucrnow
10%460.10
$' 1!'. r FKE SMI]i/J ARY
CONSTRUCTION ri: 101-000.418000 $643.00
PLA:1'•I CHECK P'EL 101-000-Q1.39-318 $334.21
AAZCfIAWIC.AL FEE 101.000.421.000 $53."
ELECTPLICAL VEX 101-000-420-000 $115.6.1
PE.L MBINO M. 101.000-119-000 $825,95
STRONCI MOTION FELE • RESID 101-000-241-000 $20.0
S�
aRADING FFS 101.000-423.000 $2.:
�•'`
DEVELOPER IMPACT FEY $],1 .00
SUB -TOTAL C'OMYRUC".TIOAT AND PLAN C1WCK
$3,412.12
IMS:PRE-PA1D 473
1$0100
. 'SY)�" L'_'k4AW.' TNS DUF NOW
&3,412,12
RECEIPT
DATE
BY,
FINALED
INSPECTOR
� INSPECTION! RECORD
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
:. Set Backs !
QQF—
Forms & Footings ]
.ae)
Slab Grade I
1
\
R oaf Deck f
Roof
�•�"'•—
O.K. to Wrap I
Framing
Insulation i
Fireplace P.L. I
Fireplace T.O. I
Party Wall Insulation
Party Wall Firewall
Exterior Lath I
�Qi--
Drywall - Int. Lath I
l
Final I
BLOCKWALL PPROVALS
,
Set Backs 1
Footings
Bond Beam 1
1
1
I
Final I
PLUMBING APPROVALS
Waste Lines I
Water Piping t
Plumbing Top Out
Shower Pans i
Sewer Lateral i
1211 00 ceeQw,
Sewer Connection
�l-
efCom"
Gas Piping I
Gas Test !
Appliances i
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring I
Low Voltage Wiring
Fixtures i
Main Service I
Sub Panels
Exterior Receptacles
_
11
G.F.I. I
Smoke Detectors I
Temp. Use of Power
i
1
Final
Utility Notice (Perm)
OPERATION I DATE I INSPECTOR
MECHANICAL APPROVALS
Underground Ducts
Ducts
Return Air
Combustion Air
Exhaust Fans
F.A.U.
Compressor
Vents
Grills
Fans & Controls
Condensate Lines
Steel
Electric Bond
Main Drain
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Gas Piping
Gas Test
Electric Final
Heater Final
Plumbing Final
Equipment Enclosure
O.K. for Finish Plaster
Pool Cover
Final
COMMENTS:
11V1��`1
01/22/01 09:08 F07:610'3'_4_0_-'-7"276-- ° PARAGON INSUL.
INSULATI®N10ERT FIC -ATE
7,9=299 PASEODELh_RE`l _ i `.. I.AQUINTA
►Number and°3Sreet ' ' City
IC -1•
003.
1 ROOF
Material Brand..Name
Thickness (Inches) Term6l Resistance (R -Value
2 CEILING + I
;y
Batt or Blanketjjpe BATT.: Brand NameCERTiAINTEED
'Thlckn655 (tridne5) 11` - Thgrmal:ResisrmnCe'(R-Valueh R-38
Loos6flit•Type BLOWN IN.:, Brand ' CERTAINTEED I
Contractors min installed LWdight square ft 0.5,15113' Minimum thlWass 14.314 inches
Manufacturers installed weight per'square foot to achieve Thermal Resislance'(R-Value)
3 EXTERIOR WALL
i
Frame Type` I
A. -Cavity Insulation
.Material Brand Name
,Tild tress pncnes),. Thermal Resistance `(R -Value),
5.,=enar,Foam SheaMing
Material Braritl`Name
Thlckness,(inches): " ThettrW-Resistance (R -Value)
4 FLOOR OVER GARAGE AREA
Material .Brand Name l
Thlckness;(Inches)The''mal`Resistance:'(R-Value)
5 SLAB FL06R/PERIMEfER
Material grand'Name* -
::.
Thickness (inches) y •Th4rmalResistance
6 FOUNDATION,WALLF..
Material: ' Brand.;Name.:
K��, �•._
ThlcknessUnchesL
The mialRes�stance (R-Vsiue);
Declarati®n
I ber�byceltiiy that the above insulation wras installed•in the building and the above location inted formonce with`the'current
Energy Efflftncy'Staildero'S for�reaidenbal'buikling5 (Title 24 part 6' Califronia Cod®of'Ragulatioris)'2s indicated onthe
CeNfigte 9(Complian ,-where applicable.
2 1/19/01 PARAGON INSULATION
_ ,,,
tem #s natJr te'' ' InstallingsSubt.ontractor(Co. Name) OR
Geiiera�Gontractl(Co, Name) OR Owner
. I
Item #s Signature, Date Installing Subc6ntractor (Ca: Name) OR
Generai Contracti(Co. Name) OR Owner
Item tis Signature Date Installing Sut contracton(Co. Name) OR
+... General Coritractl(Co. Name) OR Oar
i
.A.k..