0002-232 (SFD)f—
(V U)
W
� CY
W
6Zt�
L0 O
r
W '^
W W
I-- a
U)
Z
M
Ln
N
O�
UQ
It CL —
Z
LO
cr
Q O
LL
X W —
mVU
d �
qt : Z_,»
00 �
�p
Q
J
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
7 MISS
r✓ t.. 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
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.
{ Gi i�1 N Ir:1CLIi .C1�3 . '
(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
Codedj�shgll forthwith comply with tbtos• _p-ovisto s
Applicant - �"���+o�
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.
1Slgnature (Owner/Agent) 4'/�"7 Date
BUILDING PERMIT PERMITWOZ-323
DATEy VALUATION S",342.91) LOT �0 TRACT 'j�c,L1 -9-
ADDRESS 4:Y ttl �.O�tlllil•Tif OOK LA INE JOB
APN 604-040-016
OWNER
CONTRACTOR/DESIGNER/ENGINEER
r-'►''AP1Y Tr)\r(''ilr'1tt 7Y;r >��'4'il p`#rijLfhi7'1'q'L'
.talY t WJE. A lel\l,• Ii f..ti -� I.�W 111,1• lw 1.3 ll. i.
<�r+�Ir1Y�nx*�'r;�r-��i/nrr .�n�Ftt,a�tRltm�'s
\.I.la 1J Ll, f t\lJ 1Y t.1vN 1.71Yt.1lIL/, l t lv
1.33; So. ',u`! STRE- :1; STSG. 4,200
13535 SO. °C" SIRECF, STT. {I200
SAN j1hKttI.A.k.DINO C.A. 92409
4'�AN 13HMAltt 1NO CA. 92408
��a?j eI-�f107 CATIO 2120
USE OF PERMIT
S.INc:ar.,E 1 A.(l1MWELLING
-1.01 50 PL 3A-A�Is�Nv�%1 �Ji)lL i N.
1
`iirNT 4vIN.M-RUC ION i,u .. 9. (.61
.i6i3F
e3� it �aa7ii'CAit1r�?I<a 41'7.80 SF
4.1 STIA.iFi.A,ED �`-G31 Ol.' CN'i�..Y RI CYC7111 i`T
t),342.9
P.C.RTa11Ii F EJ SC7F►M/iRY
CC♦Ivty'!'.WC'OONF'HE S639.30
Pf 4N N' (' 1 r0K, FVIF f f 11-(}x}0- tQ.3 (R A5'i 1. 158
e7.\,TwC1"J4 CA 00
' r
E-LECTfdCALFEE Sti5.c;r
NI"UNIBI-NG-nFE 1.01-000-419-W) $1.34.75
r
, 'TRC>t 4 MCY ON
f rt.7�`Sithrc, tib 101-000.423-000 320.00
,IYOV ?LOP" &R. INIPACT F� SLW 7.00
1
t• 3 t f ..
tir Iii-'7't)T_A!, �t�NC"fi�(.at;'1InN AN(7 )�1.<1N l~l=fr•,('tZ
�_,�t()C a7
I. ESF.' PRE-PAUD 7 Eb,S'
x^.00
{
' `s+(��'AL P: M11111 FElis.S 4iSJ NOW
$3,405.37
RECEIPT
DATE
BY ��+/ y"` J
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR .
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts `
Forms & Footings
- I1D —am
Ducts
Slab Grade
. I -
Return Air
Steel
y igaoo
Combustion Air
Roof Deck
Exhaust Fans
O.K to Wrap
(j -Cl 4M
F.A.U.
Framing
6 t tq a
Compressor
Insulation
U. -LI :Q Q
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans 8 Controls
Party Wali Insulation
Condensate Lines
Party Wali Firewall
Exterior Lath
-7 - f,%- -
Drywall - Int. Lath
Final
Final c t oo
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
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
gt
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 10
Final
Utility Notice (Perm)
COMMENTS:
y.
OCT -11-00 WED 15;25 RICH BUTLER FAX NO. 17603606801 P,02
wood bumin�
EccDlace
II
Courtyard Option Shown
Plan 3
The Cortina
-7T1-7o if
INSULATION CERTIFICATE IC -1
yS-(�Q_.•
COLDBROCK LANE LAQUINTA
Number and Street City
RIVERSIDE 23995 Es. 04
County Tract No: Lot Number
Description of Installation
1 ROOF
Materia{ Brand Name
Thickness (inches) Termal Resistance (R -Value)
2 CEILING
Batt or Blanket Type Brand Name OWENS CORNING
Thickness (inches) 12" Thermal Resistance (R -Value) R -38U
Loose Fill Type Brand
Contractor's min installed weight square ft Ib Minimum thickness inches
Manufacturer's installed weight per square foot to achieve Thermal Resistance (R -Value)
3 R.XTERIOR WALL
Frame Type
A. Cavity Insulation
,Material
Thickness (Inches) 3 1/2
B. Exterior Foam Sheathing
Material
Thickness (inches)
4 RAISED FLOOR
i��aterial
Thickness (inches)
5 SLAB FLOOR/PERIMETER
(Material
Thickness (inches)
E FOUNDATION WALL
Material
Thickness (inches)
Brand Name OWENS CORNING
Thermal Resistance (R -Value) R13U
Brand Name
Thermal Resistance (R -Value)
Brand Name
Thermal Resistance (R -Value)
Brand Name
Thermal Resistance (R -Value)
Brants Name
Thermal Reslstance (R -Value)
Declaration
hereoy certify that the above insulation was installed in the building and -the above location in conformance with the current
E,,orgy Efficiency Siandards for residential buildings (Title 24, part 6, Califronia Code of Regulations) as indicated on the
Cervficete of Compliance, where applicable. rARAGOiN INSULA i 10i1 CO.
9/28/00 12280 ITAST END AVE-
12280
Ct, 41710
Item Os Signatur ata (Co. Name) OR
General Contract (Co, Name) OR Owner
Item 4s
Signature, Date
Installing Subcontractor (Co. Name) OR
General Contract (Co. Name) OR Owner
Item 85 Signature, Date Installing Subcontractor (Co. Name) OR
General Contract (Co. Name) OR Owner
July 1, 1999