0002-316 (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
714188 13 1&31120(
Date -/—" Signature of Contractof
e,_1�24
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.
GO1.D1sN EAGLE INS,
(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 SeAction 3700 of the Labor
Code �l shall forthwith comply with those pr visions.
[ to 7- I Z7 -C, licant — r'�"_""'"
Warning: Failure to secure Workers' Compensation erage 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.
(-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.
Sig atu�e (Owner/Agent) Dated
BUILDING PERMIT FERMI 011411 316
DATE VALUATION $116,7?3.60 LOT _W TRACT 1,3995-R
JOB SITE
45-440 CO�.DR.iROG LANE
APN 604-040-016
ADDRESS
OWNER
CONTRACTOR / DESIGNER / ENGINEER
CEP.''i'1JRYCRO4'T11 CONAIMUNTUMSC,cP:7'�.Ilr
CR(?To't?;.1.:"0N4;1fi?.t irrEs
i535 SO). "D" IMMECt, S x F.. #1200
1535 30. "O" 5'i STM 'T, SM 4200
SAN .BERNA WINO CA 92408
SAN BEKNARDI NO CA 92408
(�09)381-6007 C111.0 2170
USE OF PERMIT
i1..NGLE FAIMILY D'Wr.LLING
Sru-ir4 at, PLAN 50C -fit iZ14f1i WES NOT Imr; c.LDi' 131.GGri roi+d>(:i:S est
WOOL.. 75:o PL AN ,OE.11;CK FEE 1.1 KUUCrJUN FOR IDAULTW&E ISSUANCE, Ula
SAA% PLAN TYPE.
2 i`t%l1. S CaJl`YJ C Ufi3U.{1 AS`
M1`..AOD.' 'CARPOR ` 4116.00 SF
.e ;.9 i'l�Y�A�+tA C4>>,1�it th'ail �.'a6a �i: rS aAi �J�.i1Vti7
.1.�.`4�It✓.�is1i
.
P2��v' �� {�p ��{{���yy Vh,11� T
r'�CiVf'.�•'R S' 2'. E .S' 1114IMARY
CON fRUC•T1ON.1~a-', 101-=)-4J&000 s���,c�,
• '
$14423
Pa,NN4;rMCK FEr, i1r1li�(n�(�)(o� d
~I
♦-ziR
Al
PLIXI'V1131No :H�E 101-000-419.000 S134.7-5
1lt�??�TCi tett '1,'1CJN�E -? .i��Lf) !.Q! -IN 0 24)-M1
ORAOMz3 rci 101-000-•42:1-0()0
ART 1N IPUi1 LIC PLACF3 - WSW 701 -000-Z5-000 1.88
� ; � w•. )
�w
SUB-TOTA), CONKYRUC'1'ION AND PIAN CHECK
$1,11716
Liras PRE -PAID 1'LFS
$0.00
$3,132.36
RECEIPT
DATE J
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
S- .oe
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
_j _ a
F.A.U.
Framing
_,-
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
-14 -
Final
Final o
BLOCKWALL APPROVALS
POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
27 - Go
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
2
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
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 Z
Final — o
-Utility Notice (Perm)
COMMENTS:
-.16022
INSULATION CERTIFICATE IC -1
45-440 COLDBROCK LANE LA QUINTA
Number and Street City
RIVERSIDE 23995 '`38' t
Countv Tract No: Lot Number
Description of Installation
1 ROOF
Material Brand Name
Thickness (inches) Terrrmal 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 Type
A. Cavity Insulation
Material
Thickness (inches) - 3 112
B. Exterior Foam Sheathing
Material
Thickness (inches)
4 RAISED FLOOR
Material
Thickness (inches)
5 SLAB FLOOR/PERIMETER
Material
Thickness (inches)
5 FOUNDATION WALL
Material
Thickness (inches)
Brand Name OWENS CORNING
Thermal Resistance (R -Value) R1 3U
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 Efficiency Sfenderds for residential buildings (Title 24, part 6, Califronia Code of Regulations) as indicated on the
Certificate of Compliance, where applicable. CZULATION Go.
9126100 i?2°L BAST END AV
Item #s Signature, D Installi o c 1 (C '. Name) OR
General Contract (Co. Name) OR Owner
Item. #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