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0007-151 (SFD)LICENSED CONTRACTOR DECLARATION?" ,tNa•v'wvrnr..v--'rtec,.i-rt.+I•._L.� L herebyaffirm under penalty. of perjury,thaflamXlicensed under, provisions of Chapter.9 (commencing with Section 7000),of,Di'visia of.the Businessand ProfessionalsrCode and mytLicense is in full force and effect r�^ :: t ; F; License #'' Lic' Class �; �. r w r� Exp Date �' *�/14I3€1 q•�ix=t'� ,s,o,�r`:r,ppr `• �,��.trX �j ��^ �fl0131rt6C :.��r.V.�%ejt 4r.:s"rl; Date fi%is- llU Signature of Contractod l f "t<r, , OWNER BUILDER DECLARATION ' •. 1 hereby affirm under, penaltyof perjury that I am exempt from the Contractor's License Law for the following reason r s `( ")rel; as owner' of the te property, or my employees with wages as their sole compensation will do the work sand the structure is not intended or offered for' %sale (Sec 7044, Business &Professionals Code). ` 0'(59 Has owner of the,property,am exclusively contracting -:with licensed contractors to ,construct. the, project'(Sec. , 7044,- Business & , Professionals :c _ .-• ;,' ,, .. ' ' �. - ( )it 1 am exempt +under Section ` ; B&P.C. for this reason Date7+ Signature of `Owner WORKER'S COMPENSATION DECLARATION, 1;hereby,affirm under penalty of perjury one"of the following declarations: (j) 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 1�perfor'mo-6e"6f the work for which this permit is issued. Aa,,;Q)�liheve and will mainta'in' workers' compensation insurance,'as required by SSection 3700 of the Labor Code for,the*performance of the work for which this" g, permit i ist issued.". My, workers compensation insurance carrier. & policy'no. are: ?;Carrier'olicy No. !, (oLvEN FAGLE 1N A4i&�C`. 4063 O2 "F(This sectio need not be completed if the permit valuation is for$100.00 or less). ti(;)f,l certify�tFiat iri 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, and agree that if I,should become :, ubject to the workers', compensation provision's of Section 3700 of the Labor Code I shall'forthwith comply -with those -provisions"" Date .;'r'�i :y Applicant 'y < �" - (. 1 J,Warning Failure to secure Workers'. Compensation coverage is unlawful and cy;hal l subject an employer to criminal penalties and civil fines up to $100,000, in t'. addition to the cost of compensation, damages as provided for in Section 3706 i' of the Labor Code, interest and attorney's fees. ':IMPORTANT •Application is hereby made to the Director of Building and Safety z.fo'r'-'a--.p.'.e'r-mi't""subj'ect to the conditions and restrictions set forth on his application.- 11.. 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 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 t above-mentioned property for inspection purposes. I/ / Signature`(Owner/Agent)% Date ` AbKPTRMIT #j ' y� � (✓<k,� ;t:BUILDING.PERMITr�,k,}, � y� � t , '0007 -asp F ,~ h �- iia:}. Y ..y..,. �,:. �.. �•. ,' DATE. .+.: •EVALUATION Jaa ,{'t;Z,}•, - r TRACT r •. rw.r t .� r-. J,� ,J?• �,.. �� i:-cr lr ,,;.it�- ♦ .� C 4�'i�: �` :'� � ,_, '�,�� •.�,It`sf4.€�i7 �� i5� �.- .,< ru =�,{-+ ��a ��t�27.a19.�; .�'.?'a a JOB SITE . {._rte .T,' w r v J S,er• f� ADDRESS `�' �� •nri: 4 , + a d„ C' r ;' ` V. f APN �lY 'YSSL°' dw C ''�iti c G' '-Cd�ifl-� . ..:. 3.:79-20 R, OWNER CF.1vit'iil Y CRCiWM...1,.'COMMWITFi,9 CONTRACTOR / DESI ER / EN (NEER (r ! e a i• " C'.EW1'tT.tYY',0R0W :I.I. C01mah!iLJ�TIL t 153580, 9)" S!'Mr1r. ISM, 0200, 153530, 97 MRM11 rM-200 %C S 13 I3A 13ii© CA 92408 , SM �ARD190- (909)3$1 6007 ,, ,., Cf31Aot,212[�(i��y+fy i USE OF PERMIT ... e�l�tl•'�1� I'Ai�rl°.D .. _... -.. _ - ., ., ,. Y4a � F � � "f SIF17- L07' 59a PLAN 2B PERMIT DOES iaOT 1NCLU17E 9Wt WALLS OR" 1' .���++.�� POOH.,. 75% PLAN CHECK REDUCTION FISP. MULTIPLTI ISSUANCLE '; � � ���o• �''`;'; r�,�; 1 / TRACT CONSTRUCTION I,SOU.O®'SP FORCHIPA.TICJ OARAGTJCIARPORT (SP) 8,+232,00 y+A K h k: S`LfId+IA:Tl£10 COW 01r. (_-014 INUCITOE7 � y�)}�, ,� �,1� 1�iD CONSTRUCTION FEE 101-000-418-000 $399.00 PI .N CHECK FEE 101-000-4319-318 MECHANICAL IEE 101.000.1421-000 00c tiYi i,e' v e L'LECTRICAL PZ9 101-000-420-000 PLUM13INO FEE 101.000-419=400 5122 is f. 101-000-241-000 y`+. r 4P STROND MOTION FBI' - la ESID OR.ADING ITEE 101-M-423-000 •$�t OD. A ]a , } DEVELT OPL'R IMPACT 112—E T Ati%QO s'; rypt- li t - ♦ J 1. :< }F� ry�. '� i i ffUB-`I`aYAL COS(TON ARD PLAN CHWX 112 PRL -PAID I'' 'we a CiU; 'I'OJ"�e� WFfi' FEE6D`t1`1I;'i O RECEIPT DATE BY DATE FINALED IN J •. 'v a + i '=Ir?n,��ir j, rr. ,i. i`a`'�,°•M•. `'�"t�Jr'. .fit . .. 9 01. OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings Z► 1r0A Ducts Slab Grade Return Air Steel _ Combustion Air Roof Deck p Z Exhaust Fans O.K. to Wrap o F.A.U. Framing Compressor Insulation U2 Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath t o� Drywall - Int. Lath Final Final BLOCKWALL APPROVALS _ CJOL POOLS - SPAS Steel Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Underground Pibg. Test Final Gas Piping PLUMBING APPROVALS Gas Test Electric Final Waste Lines i0Q60EUSHeater Final Water Piping Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral ?,O Pool Cover Sewer Connection Encapsulation Gas Piping Gas Test Appliances Final Final Utility Notice (Gas) Cs .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) ,� COMMENTS: 01/22/01 09:08 FAX 760 346:7.276 e22 h INSULATION-CER,TIFlCATE 746-310 PASEO`DEL REYf _, LA QUiNTA Number and Street'.-. City Riverside -27519 tir�58 County Tract,No: I `"i ot=Number Descriptim of Instaili t!®n . 1 ROOF Material _ > Brand Name: Thicknessdinches) .__.® T6m1afR0si5tandef(R-Velue) - — - ------ 2 CEILING Batt or Blanket Tyge`..:BATT .:. — BrandName:, CERTAINTEED Thickness, ( Inches `:� � :12',:- •TKdimal Resistance;(R-Value)' ' R-38 Looseill Type:;: =' �-BLOWNJIN :: Brand .' - CERTAINTEED I Contractoet'.min nstall ;-weigtit,sgua�a ft -:0 615si6.. Minimum thickness �� 14 314 inches Manufacturer's,installedUweight per square foot'to achieve•Themral Resistance•{R-Value) - 3 EXTERIOR WALL Frame Type A. Cavity Insulation ' Material Brand -Name Thickness (InChaS){ Thermal esistance (R -Value) B. EztehorFoan .S thing Material Brand.Name I •hickn6ss:(inches). The(rilal Resistance R -Value 4 FLOOR OVER GARAGE AREA Material., Brand Mame Thickness onef5es) Thermal. Reaistance-(R-Value) ' 5 SLAB FLOOR/PERIMETER b,:, Material Brand'Name:,:. . Thickness:(inches), Therrr5al'•.Resist2ihce (R -Value), 6 FOUNDATION WALL Material Brind. Name. Thickness '(inches) , : f 'Thermal Resistance R-VaI60 Declaritiora , I hereby certify that me above insUletion was installed in the bililding and the above locat,on in conFo nce with the current Enemy Eff7ciency Standei6s for residential buiidings•(T'rtfe.24 part 6F CalrfroniL Code of Regu6Uor:" )) 2S indic�tsdon the •where Certificate of Complian applicable. I 2 1!19101 PARAGON INS LATtON Item #e 1griature; D e Installir® Sutico fi ctor,(Co. Name) OR General Contract (Co. Name) OR Owner IWri ft Signature, Date, Installing Subco�tractor (Co, Name) OR General Contract (Co. Name) OR,Owner !tem #s Signature. Date General h ractor(Co. Name) OR (CQ. Name) OR Owner