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0002-320 (SFD)to H N_ U) W O=) co r`OLO o Z r - 0 O H(D J Z M LO N ON U °) Q 0 2 Z LO�O LL X W — 0 _J mUU O tl LO Z_ ccb =) O 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 7adl&R B10314.0(- �� atd Signature of Contractg _ OWNER -BUILDER DECLARATIO 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. ,,(J 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: Comer Policy No. GIIOILDE't,=i JEAGLE PATS. (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, I hall forthwith comply with ose�Srovisionsi �t 7-Applicant— Warning: . pplicant Warning: Failure to secure Workers' Compenation 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. � nature (Owner/Agerit)` Date BUILDING PERMIT PERMI0(HJ2-320 DATE VALUATION $116,75.3.60 LOT 66 TRACT 2,399548 7 -OU JOB ADDRESS 4}J5,%5 COL€liil OOK i�tb,t'�t.0 APN 604-040416 OWNER CONTRACTOR / DESIGNER / ENGINEER C1 IT1 A. Y CRf)1Vl. LL COMMUNMES C.ED1' URY CROW LL CC)1\ MUT:TIM''S' 1535 SO. "L'1" SITS. E 1', STE. 4200 1335 SO. ".0" S-I'RE- T, Si'rc•. #200 SAN BERNARDINO CA 92408 5.&N OF1(NAR.UIN0 . CA, 92408 (9093%1-t 0 0,71 C91Y. 21.20 USE OF PERMIT ' SINGLE FAIMILY .DWELL11NIG SIM -LOT -66 RiU: s ;t tc-t�.tsiuvl!i DCij:1!4Ui t:rvi::i.ut%is,Ni.uawiw LS QK ;a AAU 75,Q f,' ANC #iRt i:3 lGF [2 131J�"!.`1C��o! FCj (4tU1� 1 iC?!.E 3 SSUMIt i fel% aAME :PLAN 'ryn. TRACT C0,19WrRUC:f'1C)Di 2^0,00 CIF L'1ARi+.QrVCAcZt` 0R T 41.6.0SW 1��'P*77►�4 A nP'Li'4 I"V1 'Y`� 4�' !'6a'►Y '�'6Ag T!"!'Ir iAr ^• A'�� �..i.iilllYY!xM t.4Fl5 li u.Il 4gsi't�k$ilJi..S4�JY{ *qq�L Rs.`f E((py Jl .ff V.f JJ•N!/ C01g8111tUb."1'1.01q 11ER, 101-000-41,8-000 * $699.w Vf,AWQ, JV(',}*'Fi'$144.,'" r TJX11ANr1CAL VIM I01 -01N-42: 000 447.110 i ElFC'ri21CAL E,.. 101-000.4..20-1300 $126.82 PLLJf A8rNG }%1% 101-000-419.000 $134.75 - ' r • . ,TfRONO:,'0T'C)Af}'H1 —RPI ;:1y) 1101-(§f.4.241-000 SILO CRrFsia5ii.3.�'rl 1011-1:'`0423-0010 A. .G:t'sv1 t,.'1`�It +mak r!t"3 Ir1~1? ARIAN PUBLIC PLA0' S -10",5 >a 101.000-255-1300 ' 13 t; -! s, fit?-'t"(i 1'/> (. rc)13s1i�t lC."t•tl�?+f AP1 n PI. -AN r-HF'C K $$3;132.361 LESS & RE'-•M1U 1'E ES $0.100 TO'1AL .P1914A a.T iI'E:f S DUENOW $:3,132.36 RECEIPT DATE . BY DATE FINALED INSPECTOR . �i - / . r C. / 1` ./ l INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings Ducts Slab Grade Return Air Steel - y _&O Combustion Air Roof Deck _ it -©O Exhaust Fans O.K. to Wrap .-0 F.A.U. Framing c, -N,®O Compressor Insulation- Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath Drywall - Int. Lath Final Final- BLOCKWALL APPROVALS POOLS - SPAS steel Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Underground Plbg. Test Final Gas Piping PLUMBING APPROVALS Gas Test Electric Final Waste Lines 3- Z$ssX7 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 �O,L 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 2 Final Utility Notice (Perm) COMMENTS: Z026 INSULATION CERTIFICATE IC -1 45-505 COLDBROCK LANE LA QUINTA Number and street City RIVERSIDE 23995 168~ County Tract No! Lot Number Description of Installation 1 ROOF Material 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 footto achieve Thermal Resistance (R -Value) 3 EXTERIOR WALL Frame TYce 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 OWENS CORNING _ Thermal Resistance (R -Value) R13U Brand Name Thermal Resistance (R-Va(ue) Brand Name Thermal Resistance (R -Value) Brand Name Thermal Resistance (R -Value) Brand Name Thermal Resistance (R -Value) Declaration I hereby cartify that the above insulation was installed in the building and the above location in conformance with the current Energy E iclency Stenderds for residential buildings (Title 24, part 6, Califronia Code of Regulations) as Indicated on the Certificate of Compllance, where applicable'.. F"ARAGow aSUUTICNI CO. NN 9126/00 ?°c� EA$T END AVI- Item #s Signature, Installing Su'6,WA�ablUOT (Cb'.Name) OR General Contract (Co. Name) OR Owner Rern #s Signature, Date Installing Subcontractor (Co. Name) OR General Contract (Co. Name) OR Owner Item #s Signature, Date Installing Subcontractor (Co. Name) OR General Contract (Co. Name) OR Owner July 1, 1999