0002-308 (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
ProfL*sionals Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
714198t / ��s l�f►i3li�at
,pat` e ='" %Signature of Contractora>4T-`
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.
(,>eI have and will maintain workers' compensation insurance, as required by
Sect' ioh 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.
(1,011410v 11N.'v i" lova, '`:° °% °411 ) t I
(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!(shall forthwith comply with those provirsions�l ,
I„prte; /� �GApplicant -_a/�
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, indemnity
& 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
theabove-mentioned property for inspection p`urpoosses.
.Sig/nature (Owner/Agent) -� '� Date
BUILDING PERMIT_ PERMIT#
DATE VALUATION 5106,968.20 SLOT -3.O-- TRACT y b}•�?k
JOB SITE ry�
ADDRESS JS4�"gMBERK LOUR
APN �1v4 �
OWNER
CONTRACTOR/DESIGNER/ENGINEER
r-t,^'ASY'tToy i-,1)r1A%rVII /`flA+a itrkrL..1t'�`vc
b_t lit ';I. 1, l.J\l/bG C. J:J4--711'lii -It Y[. 61
P ?Ai�:rriir�*t)ri�lf:rY r�r9lfA��lAiIi^Y�;s^
..,+ +t1.^^-L\e t1,4 1. J.JL,4 ,.!Jiib J I 1
1335 SO. `D` S1'I2EF 1`, SI'E. 4200
1535 St's. "Ll" ME I; S 112. fiM
SAN HbGBCNA1CU1NO CA 924(M
MAIN B.YKNAKOINta i;,A 424bN
USE OF PERMIT
SINt rl E.I AINAIA DWEI,iJNo
S .t�.19��. 1 t, is l'YJ 114111: ilk-i1V .t, 7 i8t.03 J!.'
titi!l.A.t,�fL:'ikfFtC�l2`1 ti`):i.Utl ;i t+'
..0,111 TI.ii ��`iRv,'01" �--VLi:L1iA.A. CrTa.i�A1
4,�?a�i.It06t)-11
PEkNiff 144, SUAIMAk
t 1(.) c8Y Kti`c."l'W3 1"EK I i i 1-000-418-000 1150014.w
.I{.x 5�t1 R;
P1,A-N t"1�(t✓� 'K t�FIR 1101-�j( 0-.14-itl{
*1 tI M
MEVIL1, JU lU.. I1;ti.� i011'V1/V ia^. i.° ODD
ELLAIIT; RAL flkh. 101."3{.+0-420-)0ij
PI 11LIMNINU Fla: 101 -(M 419 -M)
&,"t'itch+lfl Ni(IT10N VFI*-* 10.9tf) I1il =itQ(i-14141M $if n)
ONAI?Y,Xo Mbki tot 000 hut) fN)
AR'!' lid PLIP ,,IC PLACES - lLENAI? 701-000-2! , 4(h) X17.4;'.
it 1T2 `1'(Yf'd\1, t'ON:NIT1f 4`1t10N o-iNJI f'I AN "Mer
4 3,X 5 iV
VYLA[AIY°fRMY1, FE3,N /AIM NO
4.71`'-'/4.31
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
rC �p rV
Ducts
Slab Grade 3 c
_ (QO
Return Air
Steel
�.0
Combustion Air
Roof Deck
Exhaust Fans
O.K to Wrap--s.s
_.
F.A.U.
Framing
—1 —08
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans 8 Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
4 , 1j, Cap
Drywall - Int. Lath
,_�
Final v�
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
_2 _mQ
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
\
Pool Cover
Sewer Connection
'�
Encapsulation
Gas Piping
Gas Test
'7 _-T
Appliances
Final
Final ,G
Utility Notice (Gas) O
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Law Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm) '� c2
COMMENTS:
torr ta.�—f�a3 f'( )'+`^�I`heSS
09/26/2000 TUE 14:18 FAX 014
0
3 EXTERIOR WALL
Frame Tvoe .
A. Cavity Insulation
Material
Thickness (inches) 3112
B. Exterior Foam Sheathing
Material
Thickness (inches)
4 RAISED FLOOR
Material
Thickness (inches)
S SLAB FLOOR/PERIMETER
Material ' - I
Thickness.(inches)
6 FOUNDATION WALL
Material
Thickness (inches)
f
Brand Name O ENS CORNING
Thermal Resistance (R -Value) R13U
Brand Name
Thermal Resistance (R-Valje) ^�
Brand Name
Thermal.Resistance (R -Value)
Brand Name
Thermal Resistance (R -Value)
Brand Name '
Thermal Resistance (R-VaILe)
ueclaration
I hereby certify that the above Insulation was installed in the building and the above location in conforman--a with the current
Energy Efficiency Standards for residential buildings (Title 24, part 8, Califronia Code of Regulations) as indicated on the
Certificate of Compllance, where applicable.
9/26/00 PARAGON �N TULATI01 C;C.
Item #s Signature,. to Installi r ( r �116ame) OR
General. GCS r o. Name) OR Owner
Item #s Signature, Date Installing Subcor:tractor (Co. Name): OR
General Contrac, (Co. Name) OR Owner
Item #s Signature, Date Installing Subcortractor (Co. Name) OR
General Contrao: (Co. Name) OR Owner
July 1, 1999
INSULATION CERTIFICATE
IC -1
78-740 ROCKBERRY COURT
L.A QUINTA
Number and Street -
city
RIVERSIDE
23995 -
county
Tract No: Lot Number
Description�of Installation
1 ROOF
Material
Brand Name
Thickness (inches'
Termal Resistance (R -Value)
2 CEILING
.
Batt or Blanket To,
Brand Name OWENS CORNING
Thickness (inches) 12" ,. _
Thermal Reslstgnce (R-Va.ve) R136U
Loose Fill Type
Brand
_
Contractor's min installed weight square ft lb
Minimum thickness inches
Manufacturer's installed weight per square foot to achieve Thermal
Resistance (R -Value)
3 EXTERIOR WALL
Frame Tvoe .
A. Cavity Insulation
Material
Thickness (inches) 3112
B. Exterior Foam Sheathing
Material
Thickness (inches)
4 RAISED FLOOR
Material
Thickness (inches)
S SLAB FLOOR/PERIMETER
Material ' - I
Thickness.(inches)
6 FOUNDATION WALL
Material
Thickness (inches)
f
Brand Name O ENS CORNING
Thermal Resistance (R -Value) R13U
Brand Name
Thermal Resistance (R-Valje) ^�
Brand Name
Thermal.Resistance (R -Value)
Brand Name
Thermal Resistance (R -Value)
Brand Name '
Thermal Resistance (R-VaILe)
ueclaration
I hereby certify that the above Insulation was installed in the building and the above location in conforman--a with the current
Energy Efficiency Standards for residential buildings (Title 24, part 8, Califronia Code of Regulations) as indicated on the
Certificate of Compllance, where applicable.
9/26/00 PARAGON �N TULATI01 C;C.
Item #s Signature,. to Installi r ( r �116ame) OR
General. GCS r o. Name) OR Owner
Item #s Signature, Date Installing Subcor:tractor (Co. Name): OR
General Contrac, (Co. Name) OR Owner
Item #s Signature, Date Installing Subcortractor (Co. Name) OR
General Contrao: (Co. Name) OR Owner
July 1, 1999