0002-306 (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
L i6"'iIt
ate,
"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
Sec ion 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.
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(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< ovisions.
Dater • .l _ Wit -Applicants
✓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.
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 ignature (Owner/Agent) - Dates" �pU
J
PERMIT#
BUILDING PERMIT
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OWNER
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RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
C J
C�y•' 94•
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings 3.2 • CA
-4,0
Ducts
Slab Grade
4- I - CLO PIT
Return Air
Steel
Combustion Air
Roof Deck
d
Exhaust Fans
O.K. to Wrap
. I6F.A.U.
Framing
_ L�. to
Compressor
Insulation
(� . Z - Oti
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
. 13
Finat
Final
.a
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
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
--Ll -Ot7
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
8 k 2- �"
Pool Cover
Sewer Connection
ZZ
Encapsulation
Gas Piping
Gas Test
> 1 _ ex,
Appliances
Final
COMMENTS:
Final
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 o
Utility Notice (Perm) s.
09/26/2000 TUE 14:18 FAX
Z012
INSULATION CERTIFICATE •
IC -1
78-720 ROCKBERRY COURT
LA QUINTA
Number and Street
City
RIVERSIDE
23995 ��
County
Tract_No: Lot Number
Description Qf Installation
-'
1 ROOF ,
Material
Brand Name
Thickness (inches)
Termal Resistance'(R-Value)
2 CEILING
Batt or Blanket Type
Brand Name OVENS CORNING
Thickness (inches) 12"
Thermal Resistance (R -Vale) R -38U
Loose Fill Type
Brand
Contractor's min Installed weight square ft Ib
Minimum thickness inches
Manufacturer's installed weight par square foot to achieve Thermal Resistance (R -Value)
3'EXTERIOR WALL
Framo Tvoe
A. Cavity Insulation
Material
Thickness (inches) 31/2
B. Exterior Fo2n1 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 OVv,ENS CORNING
Thermal Resistance (R -Value) R13U
Brand Name
Thermal Resistance (R -Valve)
Brand Name
Thermal Resistance R -Value
Brand Name
Thermal Resistance (R-Vah)
Brand Name -
Thermal, Resistance (R -Value)
pedaration
I hereby certify that the above insulation was installed in the building end the above location in conformance with the current
Energy Efficiency Standards for residential buildings (Title 24, part 6, Califronia Coda of Regulations) as indicated on the
Certificate of Compliance, where applicable,
7--F,RAGON INSULATIC)"4 CO -
9/28/00 12.280 EAST END AVE.
< n
Item #s Signature, a Installirg or o. Name) OR
General Contraol (Co. Name) OR Owner
Item #s Signature, Date Installing Subconzactor (Co. Name) OR
General Contract (Co. Name) OR Owner
Iter Ns Signature, Date -� Installing Subcon-factor (Co. Name) OR
General Contract,(Co,. Name) OR Owner
July_1, 1999
\t4 AT E ESTABLISHED IN 1918 AS A PUBLIC AGENCY
'D/STRIC�
COACHELLA VALLEY WATER DISTRICT
POST OFFICE BOX 1058 • COACHELLA, CALIFORNIA 92236 • TELEPHONE (760) 398-2651 • FAX (760) 39873711
DIRECTORS: " OFFICERS:
JOHN W. McFADDEN, PRESIDENT STEVEN B. ROBBINS,
PETER NELSON, VICE PRESIDENT ' GENERAL MANAGER -CHIEF ENGINEER
TELLIS CODEKAS JULIA FERNANDEZ, SECRETARY
RUSSELL KITAHARA DAN PARKS, ASST. TO GENERAL MANAGER
PATRICIA A. LARSON REDWINE AND SHERRILL, ATTORNEYS
September 3, 2003
File: 1112.
Sandy -Yard -
73 -956 Krug Avenue
Palm Desert, California 92260
Dear Ms: Yards
Subject: Account No. 507194,126.0.1
78-720 Rockberry Court, La 4uin.ta
In response to your inquiry, all sewer requirements for the above -referenced
property have been met. It will be the homeowner's responsibility to
connect their pipeline to the sewer lateral.
If you have any questions please contact Rosie Anacleto, Customer Service
Representative, extension 2420.
Yours very truly,
�mra, Steve Robbins
General Manager -Chief Engineer
RIA:ra
bc: City of La Quinta
Post Office Box 1504
La Quinta, California 92253
TRUE CONSERVATION
USE WATER WISELY