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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
/ 714188 1 B 10111120t
D/j Signature of Contract
V 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.
)ill 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:
Carver Policy No.
(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 sti'all ,not employ any person in any manner so as to become subject to the
workefs' 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.pyovisi�sl. / „
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 purppoos�es.
Signature (Owner/Agent) ^`^^ 1 ^� Date
BUILDING PERMIT PERMI002-32.5
DATE VALUATION $87.372.80 LOT 52 TRACT 23995-9
JOB SITE
ADDRESS 45-720 COLDBi+OOK E.ANE AFN
OWNER CONTRACTOR / DESIGNER / ENGINEER
CD1411.1, .W11"ELL COXID iU;NMES Ci'sP:':T.'I'.. CR1'!WELL
1535 SO. "W STR M', afr`.. 6200 1535 SO. "D" STREf:'.i, S;M. #200
SAN l3ERNA1 E)lNO � CA 92408 SAN BERNAkL INO CA 92408
!038.1-6007 (;MAt 2120
USE OF PERMIT
81Nlt:11JR,RA ILY llbVl;LLDNO
3 -1 -D -LO 52,PLAie1AR -I i 'ci4 DOES NOT iNCLLiM' BLWX WALLS OR
75%.PLAN CHF 1 VL1 E• REUX"CION FOR ibflJfA11>Lf" 1SSUhN(_X OF
SAME PLAN TYPS.
1"R� vCT OGNS'Mur tTGN I,4660.00 2i
04RAGWCARPDXf 413.60 SF
..x,51-MATE1COS"T OF C01IN«S'i.RWa i
PERMIT EE, SUMMARY
VONATH.UC TICiN FFY. 101-000.418414 S1585
PitANS"i-iVr,!; ..FRF
R.'1�:0�WI-1iir��,..i'1M ..ivt.unit^.1%1,()00tAl
EIEL"TIUCAL FEE itis-600-i2V-Snit Si0
P.I::t�+lYlt�.l l'VCi .F.1� 1,iJ.1.-UU(}-�l 19-9i0i) 51.29
M0140 k4(7rFfr1 F ►i i 0 t -0M-7.41 A_ 1() eft
OlVdifl`G )TRE. t01-0011.423-000 Stu
I?t:Vi1 i'!'I�1 Jt. INIPA! "i' FEL -
AXI 3�
XI
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74
.00
$1, 907AA
Si 113-'1'CY_PAf:.�"Otv"917RUC'MIN AND PT,AnTCr EEK
MCE19., B'h;Uj►UI,1••N:.OS NOW 1 $2,927.24
RECEIPT I DATE I BY A• I DATE FINALED J INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
1
BUILDING
APPROVALS
MECHANICAL APPROVALS
r
Set Backs
Underground Ducts
Forms 8 Footings
-Ducts
Slab Grade
c 0• '
go
Return Air
Steel
Combustion Air
Roof Deck
br -1 .5 .gyp
Exhaust Fans
i
O.K. to Wrap
F.A.U.
Framing
- i q. �p
Compressor
Insulation
Vents
II
Fireplace P.L.
Grills
Fireplace T.O.
Fans 8 Controls
II
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
'7 -, •Z,.-cD
Drywall -Int. Lath
9_
�I
Final
Final
POOLS -SPAS
BLOCKWALL APPROVALS
.steel
Set Backs
Electric Bond
Notice (Perm) 'Z
Footings
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
1
BUILDING
APPROVALS
MECHANICAL APPROVALS
r
Set Backs
Underground Ducts
Forms 8 Footings
-Ducts
Slab Grade
c 0• '
go
Return Air
Steel
Combustion Air
Roof Deck
br -1 .5 .gyp
Exhaust Fans
i
O.K. to Wrap
F.A.U.
Framing
- i q. �p
Compressor
Insulation
Vents
II
Fireplace P.L.
Grills
Fireplace T.O.
Fans 8 Controls
II
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
'7 -, •Z,.-cD
Drywall -Int. Lath
9_
�I
Final
Final
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
L
PLUMBING APPROVALS
Gas Test
Electric Final
1
Waste Lines
. Z •-¢O
Heater Final
.
t
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
8
Pool Cover '
Sewer Connection
Encapsulation
Gas Piping
Gas Test
_
Z
Appliances
t
Final
COMMENTS:
ii
Final
Utility Notice (Gas)
p
i
ELECTRICAL APPROVALS
I
c
Temp. Power Pole
i
Underground Conduit
Rough Wiring
Law Voltage Wiring
'
i
Fixtures
'
Main Service
i
Sub Panels
i
Exterior Receptacles
G.F.I.
I .
t
Smoke Detectors
I
Temp. Use of Power
2
•
I
Final
.o �
1
Utility
INSULATION CERTIFICATE IC -1
.q5 -5,20Z COLDBROCK LANE LA QUINTA
Number and street -City
RIVERSIDE 23995 $�� f
County Tract No: Lot Number
Description of Installation
ROOF
Material Brand Name
Thickneee (inches) Termal Resistance (R -Value)
2 CEILING
Batt or Blanket Type Brand Name OWENS CORNING
Thickness (inches) 12" Thermal Resistance (R -Value) R -38U
_oose 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 Type
A. Cavity Insulation
Material
Thickness (Inches) 3 1/2
B. Exterior Foam Sheathing
Material
Tnickness (inches)
4 RAISED FLOOR
Material
Thickness (inches)
5 SLAB FLOOR/PERIMETER
,Material
'hickness (inches)
E FOJNDATION WALL
'Material
'hickness (inches)
Brand Name OWENS CORNING
Thermal Resistance (R -Value) R13U
Brand Name
Thermal Reslstance (R -Value)
Brand Name
Thermal Resistance (R -Value)
Brand Name
Thermal Resistance (R -Value)
Brants Name
Thermal Reslstance (R -Value)
Declaration
. hereoy carttfy that the above insulation was installed in the building and•the above location in conformance with the current
Eiargy Efficiency Standards for residential buildings (Title 24, part 8, Califronia Code of Regulations) as indicated on the
Cer,!r:.cete of Compliance. where applicable. FARf�COiN INSULA ;0i' CO.
9126100 1.2280 EAST END AVE
sit �1 C& 41710
ILe—.- ps Signatureoats Instelllig'SZeontractor (Co. Name) OR
General Contract (Co, Name) OR Owner
;em tis Signature, Date Installing Subcontractor (Co. Name) OR
General Contract (Co. Name) OR Owner
.e -n As Signature, Date Inatalling Subcontractor (Co. Name) OR
General Contract (Co. Name) OR Owner
July 1, 1999 `