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0011-191 (SFD)LICENSED CONTRACTOR DECLARATION +" `,Jier,E'••by qff irm under penalty of perjury that I am licensed under provisions of Cl apt:ar 9 (commencing with Section7000) of Division 3 of the Business and Profe Wonals Code, and my License is in full force and effect. License # Lic. Class Exp. Date -714188 � ,r 1, oil ,nt Date Signature, of Contractor !!".t OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that•1 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). ' O 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 Policy No. a. (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' compensation' laws of California, and agree that if I should become subject'to the workers' compensation provisions of Section, 3700 of;the Labor. Code, I'shall forthwith comply with those provisions. Date: �!!� G Bks' jApplicant `'" :%'�'7 a!`r �. a 1 'r r ; r.. . � r,• Lam° . ...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 Buildirig 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 a4 whose request and for whose benefit work is performed under or•pursuant to any permit issued-asa 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. 1 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)r j . Ul {off f.% Datea' BUILDING PERMIT PERMIT# DATE {y r VALUATION LOT "� TRACT 275 19 JOB SITE yl ! APN ADDRESS 7942,49 FAXE0 DEL XXX OWNER CONTRACTOR / DESIGNER / ENGINEER Iix;, j3i�..' la ml��`r,:f 0o, "f�°' P1 ' '�`�.��`n 0200 3i .s"�hiJ?4 1)31 C CA ue408 SRW BMNARDINO : -CSC 9^.v-'f{3ts�` 20 USE OF PERMIT STPD LDT d 'PI AN SLH PERMIT L70F'S :1.401'. INCE,;iJDY, BIZCK WAL.`.P001, !APPROACH DRIVEWAY- fin PLANCHECK, FEE. REDUCTION Pr )R W.Kyu 3. i IM,OP SAME Pf.,d 41TYP .TCT CONOTRIJC` L011 -F 213 , 0 C1ARA0 JCAR1D43KT (5 PFJMB;a JjKV SUMMARY CONOTILOCTIi3TIVrF2,1 1.- "9)8"000: 018.a© PLAN Ct .Wr-K FEE i 14EC f%N`1CA1, MEZtIl' t3 #�.twiit3t� E6dr.Q F�.'�t�MYtY3AiV«i'1'YYi '' •. .• l.�P��yVPV�J'"`��-+i°V59V N�r�Gi't"� ' StRONCP•MOTIGHP?4!Z-RD 1.01.-000-` 1:-000 . 113,02 GR.ANPtTC7Iii? l•f91nDf9'ia� . •#If)CI $ ,t) -P,?Jvi ELOPRRS IMPACT FEE �1,94t'l1199 .S1: D-T."x TALCONRIMIJOIKKAND PLA9 CR ,CTC LESS PRE-11AID %TI'.� $0100 x a t y t 'mp's'p.m. NOW RECEIPT DATE ' BY _. 11 DATE FINAL ED INSPECTOR rf I INSPECTION RECORD OPERATION BUILDING DATE INSPECTOR APPROVALS OPERATION DATE INSPECTOR 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 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 00 Heater Final Water Piping Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral f2 $ Pool Cover Sewer Connection \ Encapsulation Gas Piping i 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: INSULATION CERTIFICATE IC -1 79-429 PASEO DEL REY LA QUINTA Number and Street City Riverside 27519 4 County Tract No Lot Number Description of Installation 1 ROOF Material Brand Name Thickness (inches) Termal Resistance (R -Value) 2 CEILING Batt or Blanket Type BATT Brand Name CERTAINTEED Thickness (inches) 12 Thermal Resistance (R -Value) R38 Loose Fill Type BLOWN IN Brand CERTAINTEED Contractor's min installed weight square ft 0.615 14 :14 inches Manufacturer's installed weight per square foot to achieve Thermal Resistance (R -Value) R-38 3 EXTERIOR WALL Frame Tvoe A. Cavity Insulation Material BLOWN IN Thickness (inches) 31/2 B. Exterior Foam Sheathing Material Thickness (inches) 4 FLOOR OVER GARAGE AREA Material Thickness (inches) 5 SLAB FLOOR/PERIMETER Material Thickness (inches) 6 FOUNDATION WALL' Material Thickness (inches) Brand Name CERTAI NTEED Thermal Resistance (R -Value) R13 Brand Name Thermal Resistance (R -Value) Brand Name Thermal Resistance (R -Value) Brand Name Thermal Resistance (R -Value) Brand Name Thermal Resistance (R -Value) Declaration I hereby certify that the above insulation was installed in the building and the above location in conformancs with the current" Energy Efficiency Standerds for residential buildings (Title 24, part 6, Califronia Code of Regulations) as it dicated on the Certificate of Compliance, where applicable. 2, 3A\ olmz 7/12/01 PARAGON INSULATION Item #s ignature, Pate Installing Subcontractor (Co. Name) OR General Contract (G:). Name) OR Owner Item #s Signature, Date Installing Subcontractor (Co. Name) OR General Contract (Co. Name) OR Owner Item #s Signature, Date Installing Subcontractor (Co. Name) OR General Contract (C:). Name) OR Owner E� -