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0002-299 (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 7141ii �.ebr Ifi uri Dart �� Signature of Contractor"' '_ 9 w 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 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: Carver60L0124"AG.1-1; INS, Policy No. WC' "r 40 y -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 that if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, 1-s all forthwith comply with those p-isions.,/ pplicant 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.1benefit 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 the above-mentioned property ffoor igsspectio 'purposes. Signature (Owner/Agent) Date BUILDING PERMIT PERMIT# DATE. VALUATION `i 14.7 t,. LOT TRACT JOB SITE'' J 11 <.! Z.}lJt: l�9► �Y� 1 1� 4� A APN ADDRESS -OWNER CONTRACTOR/DESIGNER/ENGINEER / *VlTG T fiY`i? 0k, rA%%rVT Y e*4 IR" 17 YA11" 9'fr70 • o,.: ra(�tra re smaq .q,•t.➢1e,.o �(L,��a'7[ 01-"Nul IpAf /-'tld iklluv Y !'r'}AtA i1 °rN'{'�%fU• ppr ,rew,{+�sca 1 J3�1 A' ' � 'TV ➢) 13'1.LT. Lir S 1. E� i' 00 y`�+.r.eet �(�n 1 53<J, ASO., ` D" U,.,M i `i :T� ii VF. �`4� 1;`0 SikNC } Ws Attf3fN0 CA 92408 SAN y31,Rk\?A1,U,0) 0 CA. 9244M 0094131••6007 1`NI USE OF PERMIT it°1.1=ix, 'It' 2i P jAIN S'li't} SsE3<Mi i l,3ck"'s '➢M J f '64C Li 101_� VALUCK \VAL'J, L+tt PO4 iL. 15';1 i'l.AN C;ftisA: 1a1d,1)U(:Tt0N f oii 110 T61jA,.18.'WANC b. t P.F `, ANIti 1;^':AN `1TYP1;. d41i1.(i11 Cs'Aeft*�Sy�'riKPi>jt�1' try: �i;8T1N1t�➢fED COST OF L`�_YN9�`[':2Ut�,"�'MN' 2. 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G.1 ti1.fD .9ct tC , `i'i3 YAL PERM11' Ff :VS 1iU;;;'NO'V%1 °S3,'In3:, RECEIPT DATE � BY, DATE FINALED INSPECTOR ) ° is � �� INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings --Z -C!p Ducts Slab Grade Return Air Steel r2 g -a* Combustion Air Roof Deck S-1 _ Exhaust Fans O.K to Wrap 5--o-06 F.A.U. Framing 57 ­Z_oo 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 4.11-60 Final Final COi BLOCKWALL AP OVALS 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 'i - 2 3 d6 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 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) ZZ ap COMMENTS: 09/26/2000 TUE 14:16,FAX INSULATION CERTIFICATE 78-755 ROCKBERRY COURT Number and street . LL; QUINTA City RIVERSIDE 23995 County Tract No: Lot Number Description'of Installation 1 ROOF Material - Brand Name Thickness (inches) Brand Resistance (R -Value 2 CEILING Batt or Blanket Type Brand Name OMENS CORNING Thickness (inches) 12" Thermal Resistance (R -Vallee) . R -38U Loose Fill Type Brand Contractor's min installed weight square ft Ib Minimum thickness Manufacturer's installed weight per square foot to achieve Thermal Rosletance (R -Value) inches 3 EXTERIOR WALL Frame Tvoa A. Cavity Insulation Material Thickness (inches) 3112 8. 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 OW=NS CORNING Thermal. Resistance (R•Vah) R13U Brand Name Thermal Resistance (R-Valu3) Brand Name Thermal Resistance (R -Value) Brand Name Thermal Resistance (R -Value) Brand Name Thermal Resistance R -Valued 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, Callfronia Code of Regulations) as Indicated on the Certificate of Complianoa, where applicable. PARAGON INSULATION CO, 9/26/op 12280 EAST END AVE - Item is Signatur a e 11 Installing 5 or (Co. Nerve) OR General Contract (Do. Name) OR Owner Item fis Signature, Date Item is Signature, Date July 1, 1899 Installing Subcontractor (Cc, Name) OR Genoral Contract (Co, Name) OR Owner Installing Subcontractor (Cc, Name) OR General Contract (Co, Name) OR Owner (6 005