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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
714198 B M11120(
Qadte � � 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 - //�,� y ue.0 pp,, x.S Policy No. " pA 06 !
friJl.l.�&�� �ri.C7{ .4 114+e,�. iV fV4' � :Y�i'lVV�)•'V A
(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 orthwith comply with t ose, • io ns/ + ` :xk
Date:
" t'3y Applicant i < r
I
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 I spectiori p rposes,
VSignature (Owner/Agent g—oVim" Date
BUILDING PERMIT PERM11O 311
DATE VALUATION ,Pj"442.90 LOT 33 TRACT 239935.8
0 C3
JOB SITE 'fir -J955 C.t�.R,.�jDR.WK LAME
APN
`
ADDRESS
OWNER
CONTRACTOR/DESIGNER/ENGINEER
FiP:l�i°iYrt�V'F'1)f`l�`f/F+f Y F•!'\ .'rRye+e(f�7P1 1,'c
d 1iC� ! V•'4 F �.+1�.,f �6 �e 1JN l.-�..��84ll Visa!0 1.. �.1
rrrrrg1�,�•jr�°)/`fit f f F'I(l�
k..Lt�d"R i C"Ro`p I.,li L�,/lY��t�J:
15'15 SO, `W STREET, STE. rf2100
1.535 so. "U, grRE ET, STE. 4200
SAN M14NARDMTO CA. 92409
&AN t3E NAWANO CA 92408
(909);tR 1-6w SLS 2120
USE OF PERMIT
S144C1LE F A= iLY GWELUNG,
rGm-LU1-.VLtLMt1'IJ0.4S NU'IANk:.LUUJi)Si-UA;tC WALLS UK
1IGJOL, 73%e PlaAtsf t,:k?!<CK F',EH REDUCTION FOR MUL'i".i.PLE ISSUANCE' OF
SAME PLAN 6 YPE.
TRACT CONS'I'W IOtii 1.,6 -moo xu
Gt1RAG31riCA:RPORLT 417.Ka SF
1 A1l�tl.!S'3 i, �A�1.. .6, �!'.1� Nom-. �•+ti ',t, A\lJi�..rl Y,♦J1 Vr
••�1yl��y-{. .Yp.S�e{
0411 '0
l*pp1 {yp�' y� ��
CON:i9RWI'10N FfX, 10.1-01004it3•.000 $639.30
P?. AN C't•IECK RE f 32.91}
A WHANICAL FEE 101-000-421-000 $47.00
1:1ECIRiCAL F UE 101,-000-4120-000 $115.61
P1.. M113D'NGk'f R 101-0W419-000 $134.75
STRONG M.OTfON FF - Ri 8n) 101 -000 -?41-000 1199.93
"•,
CRADa_VC FE,2; 101-000-42:3-000 $20.00
DEVELOPER .IWACf HiS 51,907.0
SUB:- )TAL CONSTR UC"I fON AND PLAN. Cf i !.'("K
� f;(1 iti)
Lar.'.S'S i 4U-i►.,U) FEES
L..J $0.00
RECEIPT
DATE.
BYf
DATE FINALED
INSPECTOR
0
C�i-�
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 •
Combustion Air
Roof Deck's
-,cam
Exhaust Fans'
O.K to Wrap
F.A.U.
Framing
_ -
Compressor
Insulation
_-60
_ a -
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
(e. .Z„ a -
Drywall - Int. Lath
4 .-Lo _.o 0
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 Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
174Heater
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
Appliances
Final
Final o ft -Z.
Utility Notice (Gas) /p
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 O
Utility Notice (Perm)
COMMENTS:
09/26/2000 TUE 1
(6 017
INSULATION CERTIFICATE IC -1
45-495 COLDBROCK LANE LA QUINTA
Number and Street • City
RIVERSIDE 23995 .33
County Tract No: Lot Number
Description of Installation
1 ROOF
Material Brand Name
Thlckness (inches) Termal Resistance (R -Value)
2 CEILING
Battor'Slanket 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 Tvos
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)
6 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-Valua)
Brand Name
Thermal Reeistance (R -Value.)
Brand Name
Thermal Resistance (R -Value)
Declaration
I hereby certify that the above insulation was installed In the building end the above location in conformance with the current
Energy Efficiency Sfenderds for residential buildings (Title 24, part 6, Califronla Code of Regulations) as indicated on the
Certificate of Compliance, where applicable:
ATION- Co'
�t,
AST END AVE'
Item #s SignatInstalllinN0,ob ( , Name) OR
General Contract (Co. Name) OR Owner
Item #s Signature, Date Installing Subcontractor (Co. Name) OR
General Contract (Co. Name) OR Owner
Item #e Signature, Date Installing Subcontractor (Co. Name) OR
General Contract (Co. Name) OR Owner
July 1, 1999