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0002-313 (SFD)U) H N C7 W Ouch d u7 ' W t` I p Z O� P: O JV� W LLI I- a rA Z M L-0 N ON _5 °) ItIL Z Lo Q' CrO LL X W — m U U O Ii Lo 19T Z_ c r` 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 71:188 B > W311/20f /atev I- 1^1U Signature of Contractdf- " 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. , Q)' 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: CarrierCiL�L11Li4 P�Ci1.'L:1N"z. Policy No. l�'111'C S11-41068-01 (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„ I- hall forthwith comply with t ose pr -visions. D to a Applicant ! _ Q Warning: Failure to secure Workers' Compensation coverage is unlawful and shall subject an employer to criminal penalties and civil fines up to $100,000, in addition to the cost of compensation, damages as provided for in Section 3706 of the Labor Code, interest and attorney's fees. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the, conditions and restrictions set forth on his application. 1. Each person upon whose behalf this application is made & each person at whose request and for whose benefit work is performed under or pursuant to any permit issued as a result of this applicaton agrees to, & shall, indemnify & hold harmless the City of La Quinta, its officers, agents and employees. 2. Any permit Issued as a result of this application becomes null and void if work Is not commenced within 180 days from date of Issuance of such permit, or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that the above information is correct. I agree to comply with all City, and State laws relating to the building construction, and hereby authorize representatives of this City to enter upon the above-mentioned property/for ins action urposes. J nature (Owner/Agent) " = Date f / BUILDING PERMIT PERMIT r 3x DATE VALUATION S116.7d.60 LOT JS TRACT 21998 - / _ C) C) JOB SITE 45,UO COLDBiROOk LANE APN ADDRESS OWNER CONTRACTOR/DESIGNER/ENGINEER f11TVkFMTk$'V $- DfN%An l T PnAA'AATJT.f1`fll7ll ♦-•L\YJ VY L..R 2- \-V lYli\1 1 V.11 31.6 f"/tGTYT1`bTRv v(1l'1/pr T f %.i %.n TAr1'f'tr L t.l l J. L\ 1 LA\V YV E..1.. 1.f UYJ/Y l4Y ll.JI V.L S I I..a> i535 SC). "D" S'lWF . 51E. ii200 15.35 SO. "D" Si'REET, SBE. 9200 SANT BERN. RDLNO CA 924015 SHIN BERN.ARDINO CA 92408 f4IKi).�R,f -6007 CIRN 2120 USE OF PERMIT S IDLE E.AN41" Y DW&GLNG , -!,QT .iy .t1L,t�R JtiiA -t'i; kNU i` LQES NO L' INQ.L,ubk, Li1.Ui.:.K WAL.L�`- OR PJ' (jI.. 75%PLAN CREC K FEE fCEDUI:1"30116 k+OR MI17f.-T'(PLE ISSUAtvC E O S xll C PLAN TYPF. MACr CONSTIR.UCT1ON 2000.00 Ss GARAiiEICARPORT 416.00 Sr •N� nAaflay,i a Y�,.V.ItYk 0YF 1..'�./.t�VTC,�Y�i <.. Wit Alts." 11 �J�.�U 1'ERCIKIT ,k k7R SU1MMARY .. CIONS"3`RUCTION FEE 101 -000 -1418 -WO :%99.00 P! , F1N C_ HECK K 3���t's11 i (�i t-(tq({�)-d �9 $144,23 13,(1t($ ��tttil�CRh11^4 L�.+1lL. L'j:d] A A-V4V-rF.o1-Vt)f� 1' i.ECTWCAL, FEE lOt-000 X20-000 PLUMAINQ FEE 101-000-41Q- W 1134.75 4YM?r?T4Q M CMN REM - REM 101-000-741-000 r.4.MC)INC .F UE. 1.01-000-423-000 3"3"s-i'1•st.011a IA41ACT 17't? AP,'r IN PUBLIC; RLAr:'.HS - kES'IC 701-000-25.5-000 $0.88 U °+8 SKIII-Ti:fP1 %j07NC'iPti(s;"[101N lNDP��I �t?'y1�C;1.r81;.Cq:'f il+ vE 07,0 111 1'O ABS i'Eliy9IT FE P S OU F, NOW $3,132.36 RECEIPT DATE BY DATE FINALED INSPECTOR /// INSPECTION RECORD OPERATION DATE INSPECTOR BUILDING APPROVALS Set Backs Forms & Footings y S Slab Grade3-co ' Steel --5 -60 Roof Deck ► �j ��� O.KtoWrap Z(4, 4 Framing v Insulation -do Fireplace P.L. Fireplace T.O. Party Wall Insulation Party Wall Firewall Exterior Lath 6• zg �+fl© Drywall - Int. Lath 'U -D Final p >� BLOCKWALL APPROVALS Set Backs Footings Bond Beam Final PLUMBING APPROVALS Waste Lines `s- L,) . OD A Water Piping Plumbing Top Out Shower Pans Sewer Lateral Z Sewer Connection Gas Piping Gas Test 8 rh ( o© Final I I o\ Utility Notice (Gas) I t C e 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) OPERATION DATE INSPECTOR MECHANICAL APPROVALS Underground Ducts Ducts Return Air Combustion Air Exhaust Fans i F.A.U. Compressor ---- Vents Grills Fans & Controls _ Condensate Lines Final Steel Electric Bora! Main Drain Approval to Cover Equipment Location Underground Electric Underground Plbg. Test Gas Piping Gas Test Electric Final Heater Final Plumbing Final Equipment Enclosure O.K. for Finish Plaster Pool Cover Encapsulation Final COMMENTS: POOLS - SPAS 0 019 INSULATION CERTIFICATE IC -1 45-380 COLDBROCK LANE LA QUINTA Number and Street City RIVERSIDE Description of Installation 23995 Tract No: 1 ROOF Material Brand Name Thickness (inches) Termal Resistance (R -Value -35 Lot Number 2 CEILING Batt or Blanket Type Brand Name OWENS CORNING -Thickness (inches) 12, Thermal Resistance (R -Value) R -36U 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 (inches) 5 SLAB FLOOR/PERIMETER Niaterlel 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 -Value) Brand Name Thermal Resistance (R-Velue) Brand Name Thermal Resistance (R -Value) Declaration 1 hereby certify that the above insulation was instal)ed in the building and the above location In conformanoe with the current Energy Efficiency Standards for residential buildings (Title 24, part 6; Califronid Code.of Regulations) as Indicated on the Certificate of Compliance, where applicable. Ff PAGCR WSULATI0e4 CO. 9/26/00 122cO EF.ST ENIfl AVE, ., r9^o1714 Item#Signature, OWInstalKno'SiAlcontractor (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