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0002-310 (SFD)U) H N t) W Ouch d r oZI� O O I— to W W H d to Z 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 7141981 B 1(W31120( D / ' 11212 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 SectionB&P.C. for this reason Date-' Signature of Owner 1_ 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 Setion 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." G.OU).Ai, rIA'GLE f`e4 1. Ir'V'C.� d•1(tfi„�3-UI (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 Se tion 3700 of the Labor Code, I hall forthwith comply with those r Islons< i p y -p �� 7` Date• % ' Applicant Warning: Failure to Secure Workers' Compensd ion e.rage 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 ins ection purposes. Signature (Owner/Agent) BUILDING PERMIT PERMI`AJOL-3141 DATE VALUATION g317 37z 80 LOT 32 TRACT 23995-9 ( JOB SITE .5CDBROOK.LAN ADDRESS 45-41+OL APN OWNER CONTRACTOR/DESIGNER/ENGINEER CIl:P,' UTILY r.'.ROIV•w;LL t.'.C?NIMUNTrI t!ES CEi` TUR.Y CT ?,0W;.3_J, CO3,1NIUNf1.1 E S 1535 SO, "D` S-FRLL"i, STE 4,200 15335 SO. "D" S"i'REi; i, :i 1*9. f:2OO SAI\' JI RNAliii.INO CA 92408 S.AN 8FRNAMNO CA 52408 90)M1-6007 CBL # 2120 USE OF PERMIT SN rLE FAMILY D-01Ei. UNG S1±D-LO7' ?2:PLAN 2A. -PETUi ff DOES I OT INCL.UDis B1.C)M WALLS OR POOL. 750/'* PLAN C HFf_,1a. !"1:F3 2t►';1: L1 TI©N •! (ilk {i+fUl:.'1:TPLE 1S,SUANCF O SA9F PLKN'1Y E. TRACT CONSTRUC..RIONC 1.460.00 SF GAR.&A CARPORT 413.00 SIS PE RAHT FEE SUIUMARV CONSIRUC CION F8E 101 -WO-418-titin P!,AN � .HIFE.C>;. FFF.• 101.4010-439-318 M2.39 01-000-4121-000 $1^, .00 1%,111;{."f IANICtV. FRIW 1101-000-421-000 E L _0 TR I C A L FEE 101-OW4110• 000 81.07.8o " f?•f,-UNILAINO FEL 10.1-000-419-S1ltSi 3128.75 PITR0NC¢iviC)TK)A1VER- VS10 101 -OM -241-000 Vx.74 rf;ikDINC FFM 101 -000423-000 $20,00 I)EVELOP01t.TWA.r...:. FEB S1,907,00 • I i j=- . •y m� SLIT -TOTAL CONSTR'UC" C[ON .AND PI AN CHECK $2,97,724. LESS PRE -1'.1,11) FIFES $0.010 TOTAL TAL PEVUWIT $+'.1;US 0)7:1;";N ONAI 112,x327.2 b RECEIPT DATE BY 1 'G DATE FINALED INSPECTOR I-/'C'J /% INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings ; - Ducts Slab Grade Return Air Steel 3- k Combustion Air Roof Deck Exhaust Fans O.K. to Wrap F:A.U. + Framing 6 _ i -ba Compressor Insulation Vents Fireplace P.L. Grills Fireplace T.Q. Fans & Controls Party Wall Insulation Condensate Lines Party Wali Firewall Exterior Lath -1 (e . Drywall - Int. Lath (p • t p _ 00 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 - Z 7 - 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 2,51 --X3 C2 Appliances Final Final Utility Notice (Gas) VJ 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 p Utility Notice (Perm) COMMENTS: Z016 INSULATION CERTIFICATE IC -1 45-415 COLDBROCK LANE Number and Street LA QUINTA C ity RIVERSIDE 23995 ,S2 County Tract No: Lot Nurnber Description of Installation 1 ROOF Material Thickneas (inches) 2 CEILING Batt or Blanket Type Thickness (inches) 12" Loose Fill Type Contractor's min installed weight square ft Ib Manufacturer's Installed weight per square foot to achieve Thermal 3 EXTERIOR WALL Frame Tyoe A. Cavity Insuletlon 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) 6 FOUNDATION WALL Material Thickness (inches) Brand Name Termal Resistance (R -Value) Brand Name owENS,CORNING Thermal Resistance (R -Value) R -38U Brand Minimum thickness inches Resistance (R -Value) 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) Brand Name Thermal Resistance (R -Value) Nclaration I hereby certify that the above insulation was installed in the building and the above location in conformance with the current Energy Efficiency Standards for residential buildings (Title 24, part 6, Califronia Code of ,Regulations) as indicated on the Certificate of Compliance, where applicable. ' pp.RAZON INSULATIO14 CO. 12280 EAST END AVE, 9/26/00 , r1A 01730 Item As Signature, 95tid Installln 1ltractor (Co. 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