0008-186 (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
�
i' 7714.188 P �fj' �/t 10!^ I /V
tDa" to g+�y Signature of Contractor ,`�'"y y�
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:
O 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 0OLDEW FAOL$ M8 Policy No. NWC-5 44063-03
(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
worker 'compensation laws of California, and agree that if I should become
subject to the workers' compensation provisions of Section 3700 of the Labor
Code,
vfSate: Y%s�haI l�l6 o" rthwith comply with th 6
U� Applicant- mi
l
Warning: Failure to secure Workers' Compensation cov rage 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 ' spection�p irposes.
gnature (Owner/Agent) v�f/ Dater ' W
BUILDING•PERMIT PERMIT#
DATE f'' .-- VALUATION LOT g10848 TRACT
16 27519
JOB SITE
APN
ADDRESS 79 PAV_0 PXL WY
6D4 -4D61-009
OWNER
CONTRACTOR / DESIGNER / EN (NEER
CM`i'1'URY CROWELT, COI<iWUAt;[7`LES
CE I URY CROWELL COMWINUM
1535 SO. -17° ffrRTW, �. #200
1535 so, -D. S'1Rpm , um #200
SAN EF"JI TZ IMO CA 92408
BA14 BE,RNARDI O CA '97A08
(909)381.6007 CBL# 2120
USE OF PERMIT
MNGJ-E EAl%M-Y DW0,U21G
SFO -LOT 16 PLAN 5JB-PERMIT DOES NOT INCLUDE BLOCK: WALL OR
TRACT CONSTRUCTION $1335100 OF
GARAGE/CARPORT (SF' t�,aas.6o
]ESI.i1►tIAI" COST OF CONS"!RUU.[Z0.K
L'1U,1fU.ii7�
CONSTRUCTION PER 101-0004418-000 $748.00
PLAN CHECK FEE 101-000439-31€5 $617.82
MECHANICAL FEE 101.000-421-000 St"/8,00
ELECTRICAL FEE 101--000-4.20-000 $122.75
PLUMB1NO FEE 101-000-419.000 3131.25
STRONO MOTION FEE - RESiD 101-000«241-000 $13.02
(31RA.T ING FBI, 101.000-423.000 $20,00
DEVZLOPER IMPACT FEE' $1,90' oo
FEE DEPOSIT 101-000.439-318 -6250,00
_
hr
SUB -TOTAL C0A18TRUil 'F1014.P D PLM CHRXX
L3-0.3 PRE -PAID IS -W
g w$3,65IN
.. ;-$Z50:U0:
TOTAL POMM ITEES DUE.IS O
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
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
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 I
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 I Leo
Pool Cover
Sewer Connection Dp
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
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)
01/22/01 09:08 FAX 760 346 7276
�y '.;PARAGON INSUL,* Z02
INSULATION::C.ERTIF110'E ..
' IC-1
79-3090ASE6DEL!REY.lA
4UINTA
w
Numbe�`and Strge4
City
Riverside'
27519 I 16
- -
Cour
Tract No r ' I `utter
Description of`Ilistill, i®f1,'
1 ROOF
Meterial.
Brand_Name
Thickness (inches)
- Tenrial°ftsitt'6 R-0/alue
2 CEILING
Batt or Blanket Type BATT : -
' Bran Name `' CERTiAINTEED.
Thickness;(inchesl 12
TherTnW Res istancd(RVelUs R-38
.;
Loose Fill -T,ype BLOWN; IN; i x : Brandf-,:.CERTAINT1rED `.I
Contractor's min installedweight`square`It �, :
0.6151b Minirnum fiiperiess*�" � 14 314 inches
Manufacturers installed weight per square fent ie atiiev.E Thermal Resistance (R-Value) I
3 EXTERIOR WALL
Frame Type
A 'Cavity Insulation
r
Material
Brand Nam®.
Thickness (inches} _ .,
Thermal'Resistance (-R-value) '
B. EiWrIdr.fo9jjjrL ,Sheathin8
Matar�dl
Br2nd•N2me t i
Thickn6m (inchesi,
, Thermal;Resistance;(R-..Value)
4 FLOOR OVER GARAGEAREA
Material
Brand Name
TFik*ness (inches)
Thennai•Resistance (R-Value)
5 SLAB FLOOPJPERIMETER
Material,
Bra4islame '. I
Thickness'(inchesD "s .
ThermehResisience (R-Vatue)
6 FOUNDATIONVAL L
Material
;:,..
Brand Nartme. .. '
Thickness finches)
Ther`Bial=Resistance'(R-Value}=
QaClarau6n
I hereby certify that the above insulation was install®d in'the'building'and the abov® locaVbn fn conformincs
with the current
. EnerBy E�f le'ricy Sfai�d®rds for r®sldenbal buildings'ITf�®r24, part fi; Caldronia':C6de of Re as
Indicated an the
Ceitificaee a1 ComplidnCe pare applicatai®:
_ r
2
PARAGON IN8pIlATION
Item ft nature, ijat6 "
:' Installing si. r'tractnr.((;o.
Name) OR
General "Contract
((Co. Narrie) OROwnter
.Instalifng Sub
` 'General�Cont
Ins
Name) OR Owrtar
Name) OR Omer .