0007-152 (SFD)LIbENSED: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
714188/ B _ 110/31/2(
/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:
( ) 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 tIOL1)Ppi EAC3LL rN9. Policy No. NWC444068-02
(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 so as to become subject to the
I workers' compensation laws of California, and agree that if I should become
subject to the workers' compensation provisions of Section 3700 of the Labor
kode, I shall forthwith comply with those provisions.
Date: Applicant %�✓� I+' r.! % �' •,> -�
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. t
1."6ch 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 abdve-mentioned property for inspection purposes.
Cnature (Owner/Agent) r t ' /.� ? l t Date Ax
J14 %. 0� BUILDING PERMIT PERMIT#
0007-11.52TRACT
DATE VALUATION LOT
$10,7,547.1 (1 60 27519. .
JOB SITE -
ADDRESS 7 . Ii A p 4 se6 �� �
APN ,
604 -06J. -Ow
OWNER
CONTRACTOR /DESI R/EN INEER
CFHrLYRY CkROW1'c,LL COTvfiW_1M=
CM7JRY MOWELL COMMUNNd'TM S
1535 SO. 'Do UrRM, STS 0200
1535 SC), °U° ST._RMT, Tr17,, #200
SAN BtFRWARi7 TO CA 92405
SAN i FRNAR:DINO CA 9240E
(909)381-60M CBLit 2120
..
USE OF PERMIT
MOLE I+'AII,Y i�t�'E�1.1:.T1 G
VD• LOT 60 PLAN SRA PkRMIT DOE. NOT INCLUDE BLOCK WALLS OR ,
POOL. 75% PLKN CHECK REDUCTION FOR MULVI'LE WUANCE
TRACT CONSTRUMION 11718,00 SF
PORCH/PATIO 48.00 Sig
CARAGRiCAPORT (Sl) 116"100
1:9170AATM COST OF CONSfi UCnO1V'
1'Cb7 .S0
PERMTrV09 SUADOWRY
`
C".ONOTRUCTION FEE. 10'11-000-410.000
PLAN CHECK Ira? 101-000-439-315 $IV.9
MECH"ICAL IEEE 101.000-421.000 $47.00
..
ELECTRICAL FEE 101-000-4.20-000 $122.33
PLtJMl311`1(1 IEE 101.000-413.000 $123.75
STRONO MOTION FEE • R.ESID 101-000-241-000 $10.73
ORADIAIG FEE 101.000-423.000 $20.00
D&VELOPER IMPACT FILL? $1,907.00
SUR, -1` YrAL CONSTRUCTION ANI) PLAN CHECK
$3,041.49
LESS PRE -PAU) MMS .
$0,00
`I`WrAL. P=wr MES 3—)ATE NOW
$ sj'041,49
RECEIPT
DATEBY.
,"j %
.'1 f/
7 1
DATE FINALED
INSPECTOR
INSPECTIONAECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
$ 00
Underground Ducts
Forms & Footings
s3�7�1-0
Ducts
Slab Grade
Ia :)
Return Air
Steel
$ 21 00
(p
Combustion Air
Roof Deck
p 2
_
Exhaust Fans
O.K to Wrap
to-1F.A.U.
Framing
it
Compressor
Insulation
�C )C_
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 2 ( C
BLOCKWALL APPROVALS
POOLS -SPAS
Steel
Set Backs
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
g cn
CQ�Y
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
l�
_
�'�
Pool Cover
Sewer Connection
24D
Encapsulation
Gas Piping
Gas Test
Appliances
Final
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)
COMMENTS:
01/22/01 09:08 FAX 760 346 7276 PARAGON INSUL.
INSULATION CERTIFICATE
79.320 PASEO DEL REY
Number and Street
Riverside
Description of Installation
1 ROOF
Material
Thickness inches
2 CEILING
Batt or Blanket Type BATT
Thickness inches 12
Loose Fill Type BOWN IN
Contractor's min installed weight square ft 0.615 Ib
Manufacturer's installed weight per square foot to achieve Thermal Resistance (R -Value)
City
27519
Brand Name
Z23
3 EXTERIOR WALL
Srand Name
Frame Type
Thermal Res
A. Cavity Insulation
Malarial
Brand Name
Thickness (inches)
Thermal Res
B. Exterior Foam Sheathing
Material
Brand Name
Thickness (inches)
Thermal Res
4 FLOOR OVER GARAGE AREA
Material
Srand Name
hickness inches
Thermal Res
5 SLAB FLOOR/PERIMETER
Material
Brand Name
Thickness inches
Thermal Res
6 FOUNDATION WALL
Material
Brand Name
Thickness (inches)
Thermal Res
iWza
Declaration
I hereby certify that the above insulation was installed in the building and the above location in conformance with the current
Energy Efficiency Standards for residential buildings (Title 24, part 6, Califronis Code of Regulations) aindicated on the
Certificate of Complian , where applicable.
2 11191011 PARAGON INSULATION
Item s nature, to Installing Subco 'tractor (Co. Name) OR
General Contra (Co. Name) OR Owner
Item vis Signature, Date Installing Subco4tractor (Co. Name) OR
General Contra (Co. Name) OR Owner
Item RFs Signature, Date Installing Sub tractor (Co. Name) OR
General Contract (Co. Name) OR Owner