0002-319 (SFD)C14
LU
O =) M
�w�
rZ
o Z
O O
J
r`
Wa
U)
Z
co
LO
N
ON
C)
CL Q
`rQ0
LL
xw—
mVU
O
d rnH
"T Z_
cb 5
IC)
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
•1.141.88 13 10;31,120(
Dat - 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.
GGLDI N EAa 1 E INS. 'NVC, WtD68-01
(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. hall forthwith comply with those• provisions.
vDate: ' �— �fJ Applicant•.�+�'
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.
SigrSature (Owner/Agent) ` �' r�� ;� Date._ eV
.j
BUILDING PERMIT PERMI04")Z4319
DATE .— / VALUATION 41<f!,�, j4Z�" LOT 41 TRACT 2*4"5-4
JOB SITE
ADDRESS d.5-5801 C.OLDEPt�®�..LAINL _T
PN G 604-040-016
OWNER
CONTRACTOR DESIGNER /�Dt'ESIGNEpR / ENGINEER
}y� rq� /^� ii.. q�( ,ry 7� }�(
CLN1 I'lik r Ci�ON ELL COMIN`ft �1IU- J
/v�y {� (� 7�}(*� {C
CE.N 1 4117 CR OV �lE.'LLs C0x*cl+ti+i i. lilES
1535 SO. "D" SIUEOF, 91E. #.200
1535 SO. "L'+ STRUT, T, S"TE. 4200
SAN BERM AF2TANO, CA 92409
SAN BERNARDINO CA. 92408
USE OF PERMIT
S1NGLIR rAIMILY DVERLUNG
SED -LOT 41 PLAN 38-PER?vHT DOES NOT fhta.' ME BLOCK WALLS OR
'PC0.. 75�u PLAN CHECK FFER FOR A'11A,TIPL13188UAN Ei OF
SAME LAN TYPE.
,. t.cctt4_i'. %wtv.31 ZU e ION 1,07 j() Or
' GARA+.�Ea"GAgu"K WC_ 417,00 8F
ERTV0,i.�lTr:.'� COST i+:' �:®i�aa4�f•a.1�.IYa..' .a'O
` , •' :°. Y3
P7lIRMi L 1tr.&.E
C 0NS'IRUJC r1.ON'FF. E 101-000-41.8.OW $639.50
+
Pt,A-1.4 04FC"K FF67,
&M U i 'S Y71�P'
V.�GIVIi�/V�U,+b'I.�.f-
ELEC11F1r; AL FEE 1.01-00e0420-000 S.i 18.61
"Pr'L�1'90 1iW 101-0100-4197000 S1:s4.75
C l C fit,
STRONG MOTION FOR, - RF;Sie� 101..t1t?()-241-900 x4•yi
. ; )
GRADING FIS 1:111-000.423-000 8^.0.00
1 d
OL, V1^f.G1;ECt 1WACT U-6.1'%,"9(.)1.0
i'+�T hM1
Q.3
SUIR-'r(?TrAL c.r.3MIMI 3CTON ANO PIdANICHECK
$Vf* 644
L1 SS ARE-PIAM EELS
0.00
•51MSP6J.7-Eq\AA71.A FEl!+.S 6ii.tEiV'+-1''Yr
4
4
$3,006.69
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
. / -do
Return Air
SteelCombustion
�s
Air
Roof Deck
cti-®p
Exhaust Fans
O.K. to Wrap_
. QQ
F.A.U.
Framing
. I'L-OO
Compressor
Insulation
to,lp
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
`Im
Drywall - Int. Lath
(f •'L(� .
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
-'j, % - EAR
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure -
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Sewer Connection
17
Pool Cover
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final o
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) ff
COMMENTS:
0 025
INSULATION CERTIFICATE IC -1
45-500 COLDBROCK LANE LA QUINTA
Number and Street City
RIVERSIDE 23995 Al ►
Countv 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 foot to achieve Thermal Resistance (R -Value)
3 EXTERIOR WALL
Frame Tvoe
A. Cavity Insulation
Material
Thickness (inches) 31/2 _
B, Exterior Foam Sheathing
Material
Thickness (inches)
4 RAISED FLOOR
Material
Thickness (inchesl
5 SLAB FLOOR/PERIMETER
Material
Thickness (Inches)
6 FOUNDATION WALL
Material '
Thickness (inches)
Brand Name OWEN$ CORNING
Thermal Resistance (R -Value) R13U
Brand Name
Thermal Resistance (R -Value)
Brand Name
Thermal Resistance (R -value)
Brand Name
Thermal Resistance (R -Value)
Brand Name
Thermal Resistance (R -Value)
Declaration
I hereby certify that the above insulation was installed in the building and the above location in conformance with the current
Energy Efficlency Stenderds for residential buildings (Title 24, part 6, Cal'rfronia Code of Regulations) as indicated on the
Certificate of Compliance, where applicable. Fj,RAG0N INSULATION CG.
122GO -QAST END AVE.
9/28100 i..u�
Item6 Signature 015 instal.ing u contractor (Co. Name) OR
General Contract (Co. Name) OR Owner
Item ks Signature, Date Installing Subcontractor (Co. Name) OR
General Contract (Co. Name), OR Owner
Item tts Signature, Date Installing Supcontractoir (Co. Name) OR
General Contract (Co, Name) OR Owner
July 1, 1999