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9909-166 (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 . 0VrHC • Date Signature of Contractor t` OWNER -BUILDER DECLARATION ' I. I hereby affirm under penalty of perjury that I am exempt from the Contractor's License Law for the following reason: t ' ( j() •I, as owner of the property, or my employees with wages as tApi.r 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. fo'rr this reason r ate �/ .�� � Signature of `Owner Yziu,4 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: s = 49 7� (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 subjet to the workers' compensation pri5 isions o fiSection 3700 of the Labor de, I sha 1 orthwlth comply with those`provision_ �'Date:�J/��v'�i Applicant ��!�F.9 /•/xr_✓.�•7. 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, indemnity & hold harmless the City of La Cluinta, 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 permifto 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. ' a•.'� 1. ignature (Owner/Agent)' Tr % /'f " Date • PERMIT# BUILDING PERMIT "09-166 ' ,'Ci9•iJ' ' DATE �y VALUATION LOT 7 TRACTJOB S1 I ADDRESS 5. ^ft -I��f� a+�. �A EN .773-065-07 OWNER CONTRACTOR/DESIGNER/ENGINEER .ht fkNL"1SCO . ;F.»SP.ii�i il,A O'�Y1 ER / DiT.(�,DER tN �� CV11C P.O. BOX 1464 45701 MONROE STs t a� O C;,,,k 92254. 19910 1 '. CFS. 02201, CBU USE OF PERMIT t SWIGU RAIMIL!° T)iu0.,LFKCi ) (1_%20 iAR) - PERPA l €' iO]; NOT INUU0,8BLOCK WALL OR POOL PLAN CREC"•K FEE RE.DUCTO 7_i% FOIR 11MU;L'1'.IPLn J331JANUX OF SA&W 1rZAC i. 1,320.W F;F - PO.iZCMIA-vATIO t14.t10 X53,+ . .. s.,aNY A11D.A1 Y�i'COS fa. 49A �V+CINYOURUCs9L�lY ti k.VlC�iv�lY 00N3'1.10JC;!'I.ON FEE Iii!"f31T4)'d-t1^JCB $Rft1.5U pP�Is'�,;c�F�v,nn:4�f?t�i - 4�Y;A6"+��1..I'um))A'[Y1li},.AL ,7.''Liti ilii-nfi4i^�•{8y41"{�Slli „oar pd.•!*F'•. fr'k.flsi✓ l IV�yAM �1:dY. `. ,1.\P�.•'V11V'•�'!'d.�t'•FhF�i �S. 1L1V.�� PLUMB NA O FF8 • 101-000-419-M `S's RON{y'.PR(?Z7C. N FEt - RV,8I1� 101-0011-74i-00£4 r IAJ, ING T. .t34 Ct; _Al2'10f01 S�s•i�i DE #FAXJPh JAIP.Ad: T �Tla �#,9U7.fib PR.EC SE PLAN 101-11DO-441_345 �ItJt), t9 A �. 4- } ST 3-Ttrr_°J.00N.81RI:.K;1"If. N AND N,AN (:i;IF1,17.K LESS P ;.R4_1'1iO'i r1ES $0.00 TOT&L PERWr f VS IME NOW $3,01L60 Q4 RECEIPT DATE by DATE FINALED INSPECTOR :r.. - -. . .: INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings vil Ducts Slab Grade ( Return Air Steel Combustion Air Roof Deck Exhaust Fans O.K. to Wrap F.A.U. Framing _ L- –&e) 5 Compressor Insulation —�'– c -9c) S 7 Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath Drywall - Int. Lath– Z – 4N9 $7 wAIAE %�'tv S Af Final Final Ctl 2A 1 CZ91. 1Elt_v POOLS - SPAS BLOCKWALL AP ROVALS Steel Set Backs Electric Bond Footings Main Drain Bond Beam l=C L Approval to Cover Equipment Location Underground Electric Underground Plbg. Test Final Gas Piping PLUMBING APPROVALS Gas Test Electric Final Waste Lines Heater Final Water Piping Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral Pool Cover Sewer Connection ..69 – Oo Encapsulation Gas Piping Gas Test Appliances Final COMMENTS: Final Utility Notice (Gas) 26 4 ELECTRICAL - PPROVALS Temp. Power Pole o – S – F4 S T 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) z . ' (� r f�� a �� ,t ♦Cy. 1( � i fir. t iA � : u /.' ¢�,�,y � ��' -4 41 r� w THIS ATTIC HAS BEEN INSULATED T0: This attic has been insulated to the R -value indicated above, with Cocoon, the high -efficiency insulation. Made from a minimum of 80% recycled materials, Cocoon is scientifically formulated to deliver greater efficiency per inch than other insulation materials. R -value is a measure of resistance to heat flow — higher the R -value, the greater the insulating poi If you would like to add more insulation to your home, contact your Cocoon authorized dealer. RESIDENCE ADDRESS: INSTALLED 74:�,: ' .� h15T74EL4T10XS ;i . hr -;r &2, 92201 BUILDER: 1 ,� //�.I /�J► CERTIFICATION: This is to certify that attic insulation has been installed in conformance with the coverage chart recommenda- tions on the opposite side of this card using bags to covet/,,Zt;0Vsq. ft. to obtain an R -value of 3e ALLER'S AUTHORIZED SIGNATURE DATE Cocoon Stabilized Insulation 30 lb. bag � A4auufactured lay: GREENSTONEF.R.r" R -Value at 19.4 Net Coverage No Adjustment for Trusses A LOUISIANA-PACIFIC COMPANY 7 J Minimum Gross Coverage Based on NOTE: This coverage chart compensates for settling c 4 and is for estimating purposes only. Stated R -value is V provided by installing the required number of bags -+7 per 1000 sq. ft. at a minimum installed thickness. -++ Installation of the required number of bags may yield more than the specified minimum thickness and minimum weight per sq. ft. Actual coverage will be influenced - by job conditions and application techniques, and may vary as much as 10% without significantly I affecting the stated R -value. Failure of the installer to ' provide at least the required number of bags per - 1000 sq. ft. and at least the minimum thickness may Square Foot of result in a lower installed R -value. Compaction may 1 occur during installations above R-30, requiring more r TM - {- minimum installed thickness. . � J Per 1,000 Resistance (R) of: Less Than: GreenStone and Cocoon are trademarks of �< Insulation GreenStone, a Louisiana-Pacific company. ©1997 Square Feet '60 ®® Should Not Be Less Than: (lbs.) R-50 13.5 Cocoon Stabilized Insulation 30 lb. bag � A4auufactured lay: ATOMIZED PNEUMATIC APPLICATION GREENSTONEF.R.r" R -Value at 19.4 Net Coverage No Adjustment for Trusses A LOUISIANA-PACIFIC COMPANY 7 J Minimum Gross Coverage Based on NOTE: This coverage chart compensates for settling c 4 and is for estimating purposes only. Stated R -value is V provided by installing the required number of bags -+7 per 1000 sq. ft. at a minimum installed thickness. -++ Installation of the required number of bags may yield more than the specified minimum thickness and minimum weight per sq. ft. Actual coverage will be influenced - by job conditions and application techniques, and may vary as much as 10% without significantly I affecting the stated R -value. Failure of the installer to ' provide at least the required number of bags per - 1000 sq. ft. and at least the minimum thickness may Square Foot of result in a lower installed R -value. Compaction may 1 occur during installations above R-30, requiring more r than the stated number of bags to obtain the - {- minimum installed thickness. . � J Per 1,000 Resistance (R) of: Less Than: GreenStone and Cocoon are trademarks of �< Insulation GreenStone, a Louisiana-Pacific company. ©1997 ATOMIZED PNEUMATIC APPLICATION COVERAGE CHART R -Value at 19.4 Net Coverage No Adjustment for Trusses 56.7 75'F Mean Minimum Gross Coverage Based on Maximum Net 30.6 Minimum Weight Temperature Thickness 2' x 6' Trusses on 16' Centers Coverage Per Square Foot Installed The Weight Per To Obtain an Insulation Minimum Bags Square Foot of Bags Required Insulation Should Not Be Square Feet Required Per Installed Square Feet Per 1,000 Resistance (R) of: Less Than: Per Bag 1,000 Square Feet Insulation Per Bag Square Feet (inches) Should Not Be Less Than: (lbs.) R-50 13.5 20.5 48.8 1.464 21.3 46.9 R-42 11.4 24.4 41.0 1.230 25.6 39.1 R-40 10.8 25.6 39.0 1.171 26.9 37.2 R-38 10.3 27.0 37.1 1.113 28.4 35.2 R-32 8.6 32.0 31.2 .937 34.0 29.4 R-30 8.1 34.2 29.3 .878 36.5 27.4 R-24 6.5 42.7 23.4 .703 46.4 21.6 R-22 5.9 46.6 21.5 .644 51.0 19.6 R-19 5.1 53.9 18.5 .556 59.5 16.8 R-13 3.5 78.8 12.7 .381 87.0 11.5 R-11 3.0 93.1 10.7 .322 102.8 9.7 r GreenStone Industries, Inc. All rights reserved. Printed in USA. RV 30M 8/97. Sidewalls (pressure filled-density2.0 PPCF) 8-97-TT/G-A • I J � + J � I R 13 (2 x 4) 3.5 .51.4 19.4 .583 56.7 17.6 R-20 (2 x 6) 5.5 32.7 30.6 .917 36.1 27.7 I � Y "