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6002-304 (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 � e� a' a Signature of ContracCo , 7,, 7 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. ( )r 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: CarrierPolicy No. fi�tj' l'7/ `` f•AR P \ p�Y T"I9.lu. Y11}0 a :1 1F!(1 ;(i'P (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 thatif I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. �Da;e " blicant '-r" �^ , ,G Warning: Failure to secure Workers' Compensation col 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 inspection purposes. % S' nature (Owner/Agent) Date"' / BUILDING PERMIT PERMITF�'�a 1. DATE VALUATION, ? a'�, ,�f LOT //�� TRACT ' 1 P • ZW- 3JOB SIY-ff C �Itl APN ADDRESS iD-dilJ_ 11iSa',ti OWNER CONTRACTORER�R G'iI:N "IFNai viyt iya1r10WEI r .� �.�.r. v� a, 9E14 YE �f/ 51DTyE`SIG�N' t ) „iv' ,- �.•a i.Y_i �.rvo- ;t Sao Ae.... 153 i S 0, "Ui SI-REPA." �Ml,.,. 3_jjiris. �I1"6AR l I,:ik�;.i%Z,4a ;SAN f31. (' '���(e �A� Eih'it�at�(tf)P`�f.F f'A 92,10, USE OF PERMIT + rXt, (J: !p'i 441L,Y 04VF,IAALN-k; '�xla-A��y .;� IyjL♦i��i�t �5e4lt. •A'Clti`wlA! ilt�L., 6vt.i'1 FPa�".i.t'dlr wY'A�utr1.`,",11G tt4t;�t�,A� �1_,b. �i.. "•`A'�c f l+..t11"t ���� �°�� tf {y".s,�ils�+� �i��i �'���. .�'�t<It '�.'.L�y�s�'i Xe)���I�i �k'. �l!• -SA&P PLAN •1`VPt,'. ;+a�n.10. •,l ',419.�tit 4c�t 4�'}. ki Jq'q Lt -71.6,10 3W i .++°Auz f.i��•�6,�AA �, C+rz 4+Nr♦acr'"LI i Vy X Z *$1 af:.:� \31Y L 4 ♦;�A NIT!1.V..t\:. A. �t.l:i l c � ��►p .✓Y•.l K.,y LS' 0C af' &A'I VJG7110N FE.' 1(1 (1l}i?-14tH P1 ANI (f F PTfs t } i�Iff-d 39-315 � f i 41A 1.47L 1.01 0100 a^1.000 Kitt AL t -F 1ii1 frCi(3 3�'i► �'il tA(t �` V1_41 f� 0 i f't�.. to I - 01IM'-41111-0 ff,t) SO4, a Y 5015!i'YPc$14MCi1(VN Ti>'F.•R1�STI) Int-0fU)-?4IJUM a •.113I1ti0 ?.� ;; 1,0;-(T0-423 000 Sf.Ft-ti'1'A1.t`()NIS- V',ttCt"i'I A N 1 NVFII(K 0144,INO ; RECEIPT DATE BYDATE FINALED INSPECTOR klL 5 INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings a© A4V Ducts Slab Grade J-7-44 Return Air Steel L ,o Combustion Air Roof Deck - .-Qp Exhaust Fans O.K. to Wrap .,0 F.A.U. Framing .00 Compressor Insulation eL_ Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wali insulation Condensate Lines Party Wail Firewall Exterior Lath a , Drywall - Int. Lath <m0 Finales BLOCKWALL APPROVALS Final 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 a- /3 -00 iC Heater Final Water Piping Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral6 Z2_ '�� Pool Cover Sewer Connection ?2 _ Cp Encapsulation Gas Piping Gas Test Appliances Final Final p V => Utility Notice (Gas) o 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) 2 .00 Q COMMENTS: 09/26/2000 TUE 14:17 FAX 0010 ' tf V? INSULATION, CERTIFICATE IC -1 78-705 ROCKBERRY COURT LA-�UINTA Number and Street City RIVERSIDE 23995 2 61 County'Tract No: Lot Number Description of Installation 1 ROOF Material Brad Name Thickness (inches Termal Resistance(R-Value;) 2 CEILING Batt or Blanket Type - Brand Name OWI -:NS CORNING Thickness (inches) 12" Thermal Resistance R -Value R-3BU Loose Fill Type Brand Contractor's min Installed weight square ft Ib Minimum thickness inches Manufacturer's installed weight per square foot -to achieve Thermal Resistance (R -Value) 3 EXTERIOR WALL Frame Type A. Cavity Insulation -- Material Thickness (inches) 3 112 . B. Exterior Foam Sheathing Material Thickness (inches) - 4 RAISED FLOOR Material Thickness (inches 5 SLAB FLOOR/PERIMETER Material Thickness (inches) 6 FOUNDATION WALL Material Thickness (inches) Brand Name OWENS CORNING Thermal Resistance (R-Valus) R13U Brand Name Thermal Resistance (R-ValuE) 'Brand Name Thermal Resistance (R -Value) Brand Name Thermal Resistance (R-Vgluel Brand Name Thermal Resistance (R -Value Declaration I hereby certify that the above insulation was installed in the building and the above location in Conformance with the Current Energy Efficiency Stenderds for residential buildings (Title 24, part,6, Califronia Code of Regulations) as ir-4icated.on the Certificate of Compliance, where applicable- PARAGON INSULATION CO. 9/2sroo 12260 EAS I END AVE• Item #s Signature, e n Installin 6iu ' n for ( d. Name) OR General Contract 0:'o, Name) OR Owner Item is Signature, Date Installing $Ubcontoctor (Co. Name) OR General Contract (:o. Name) OR Owner Item #s Signature, pate Installing Subcontractor (Co. Nam 9) OR General Contract (Co. Name) OR Owner July 1, 1999