0002-307 (SFD)LICENSED'CONTRACTOR DECLARATION
I hereby affirm under. penalty:of. perjury ,that I am licensed under provisions of -
Chapter 9 (commencing with Secti6n•7000) of Division 3 of the Business and
Professionals Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
7'1=!.1 EtEt r 1(V31/2-
,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 wiih licensed
contractors to construct the project (Sec. 7044, Business & Professionals
Code). • - • ' - . , .
O I am exempt under Section b&P.C. forthis 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 Policy No.
C;OL=N'3 Ac T1'JS: s'1fL4r% 3/t=fC1G >L'1
(This section need not be'completed if the permit valuation is for $100.00 or less).
(y) I certify that in the performance of the work for which this permit is issued,
I shall not employ any person in-any'manner sous 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
Cod'-/ shall forthwith comply with-tho;0, wisio -
t (5'141 pIi6ant ����� .
Warning: Failure to secure Workers' .Compensation coverage is unlawful and
shall subject an employer to`criminal.penalties and civil fines up to $100,000, in
addition -to the cost of compensation, damages as provided for. in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
fora a permit subject to the conditions and' restrictions set. -forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request*and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton -agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance,of such
permit, or cessation, of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with -all City,, and,State laws 'relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property fo :inspection purposes.
�$i nature (Owner/Agent)-- • ' - Date w j
u BUILDING PERMIT PERMIT# n ! rt
DATE "7 VALUATION $99,342.90 LOT • L°9 , TRACT 44995-8 • +
JOB SITE 73"it!"1 9��ii� .0 1�9�T.
ADDRESS
APN,`-
&0'7
OWNER
CONTRACTOR / DESIGNER / ENGINEER
rin:rr'ilfaid! Uiitifri:7 r i f19rAri7Arinhi34'`
5,,.+.es s i, t, rt\ S. '.,.r..'.V U! ir.\,,,?.• 41--L* {Y=4.l: 101.1 J., wl
017rr•r9 rrvr!T.) v%rar r;,r1iy-npv,n rmvr1i 4`
L 4.n L11,J !1 L„1.,.:.e 4w.-"1 f.1.11 IQ,,es ;, .f.iswr
1 , So . 'thy IM E1 Ll , S FI.11200
�s� ;,u.. 9:�" S '��� � .r. �-[,.p. Pl'�i ,
SAN BERNM(.:t:1iNO CA 02400
SAN IiERNAUM0 CA 92408 -
(9,19), 1..6007
USE OF PERMIT
ANNOLE'RAMIL-Y DWELLING
S
• ial+li',+•-�..t,31. NJ i'.L1+�1d +i:3i� �';uttt�+l1 A T:4).1:r�i tdtJ� !�'dC:i.6�.P;, b$:.�.1�.'�h. �/�I1.:L�b' lllf . .
1100L. 7vJ,o _PLAhf t'ld1FL.f 1'1SI�.4i!'1JUC:'t Tr i 1+EJ3# IgfiJl.`F'ff�i,t~ 1"i�rt1!\AVEr� Uk' ;
- .'a'�2•: a+C"', �°CYiv<Te'�i.�Gi'IOi:I i,fiio:t3i+ Sig
C%tiAAaiVCARPQR"i' V l,Uu 8F
,
PER NW44 :$s ER SUMMARY
i
C0f4STKU< '1'ip'N Fr:J 101 -000418 -ow
PL AN CitKK FFrz !t1? -000-434-31$ $:_1 W0
`
l'�,13Ca',A'v`IC:AI TT? 1Qt-QOt1-1<1-(900 4`47.00
CLE t`YitCAL,.FCB: i�:l.-t?ii&3-a 4 v►�b l:l .�:f
t ,;5 :
1?LtffVf JNGFEE 101-000-4.19-000 51174.'75
ST lv10110N FIT- -
4
31:A;.7i O FM7 1fl:1-000-�-923-fl00 312tt,QJ
�" 1
P. 4Wni,.�y..
•
�. j, A.
��t i►�- lY i A t. C.QN.iTf�7 Ir.1'f(„9N ANT) PI r.1 t( o
!��ef}6}�i 6() '
_ ,AN
Lass PRE -;?AID For,3
4:OTAL PERAIAT ;1+E1?.S D5)ENOW
S3,11P6.69
RECEIPT
DATE-,
By /� j 1
J j
DATE FINALED
INSPECTOR
��
k..
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
'3-29-00
Ducts
Slab Grade
q -7-M
Return Air
Steel
3 .2q _ coo
Combustion Air
Roof Deck
5 —`r? -dpp
Exhaust Fans
O.K to Wrap-Z'i
��+0
F.A.U.
Framing
Insulation
5 3 i -60 ir
4 • t -VO
Compressor
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
U Al .
ti
Final
Final 0 2
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
st-t - BO FC
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
rg 7�,
Pool Cover
Sewer Connection_
k
Encapsulation
Gas Piping
Gas Test
'7 - •Z .*0
Appliances
Final
Final (0 2
Utility Notice (Gas) d y
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) co Co
COMMENTS:
09/26/2000 TUE 14:18 FAX
INSULATION CERTIFICATE IC -1
78-730 ROCKBERRY COURT LA QUINTA
Number and Street City
RIVERSIDE 23995 29—
County Tract No; Lot Number
Description of Installation
1 ROOF
Material Brand Name
Thickness (inches) Termal Resistance (R-Valua)
2 CEILING
Batt or Blanket Type Brand Name OVENS CORNING
Thickness (Inches) 12" Thermal Resistance (R-Valye) R -38U
Loose Fill Type Brand
Contractor's rein 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) 31/2
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 I I OWz-NS CORNING
Thermal Resistance (R -Value) R13U
Br6nd Name
Thermal Resistance (R-Valt„e)
Brand Name
Thermal Resistance (R -Valval
Brand Name
Thermal Resistance (R -Valu,?)
Brand Name
Thermal Resistance (R-Valu:3)
Declaration
I hereby certify that the above insulation was installed in the building and the above location in conformance with the current
Energy Efficiency 5tendercfs for residential buildings (Title 24, part 6, Celifronla Code of Regulations) as ndicated o
Certificate of Compliance, where applicable, PARAGON (nSUlLjkTIiN
9126100 12°30 CAST ESD AVE:
-wt[ a CA 91710
Item#Signatur ate Installing Subcorwactor (Co. Name) OR
General Contract (Co, Name) OR Owner
Item #s Signature, Date
Installing Subcon:ractcr (Co. Name) OR
General Contract:(Co. Name) OR Owner
Item Or Signature, Date Installing Subconvactor (Co. Name) OR
General Contract(Co, Name) OR Owner'
July 1, 1999
0 013