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9909-167 (SFD)LICENSED CONTRACTOR.DECLARATION I hgreby 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 t: vl-kL Date Signature of Contractor ,OWNER -BUILDER DECLARATION I hereby affirm under' penalty of perjury that I am'ezempt from the Cont`ractor's License Law for the following -'r eason: f (�) I, 'as owner of the property, or my:employees with wages as t. eir. 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 lice'nsed contractors to construcf,the project (Sec. 7044, Business & Professionals (' dam exempt -under Section.' B&P CAor this reason <' ' ,,,Date Signature of Owner 1:a 7� P r�i✓ ii2<I r WORKER'S COMPENSATION DECLARATION I hereby affirm under -penalty of perjury,,one of.the,following declarations: (.) 'I have arid will maintain a certificate of consent to self -insure for workers', compensation, as provided ,fo"r, by Section 3700 of the Labor Code, for; the performance of the work ,for which'this'perririf-is -issued.'- 'I 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 I ��y� f� q ZY fwv�! Policy No. r W t (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 proJisioris of Section 3700-6f the Labor Codd shall fortwith comply with those°provisions/t mate: Q191 d26-APPlicant ' j e ✓.o G7 �?e ^► '. Warning: Failure to secure Workers' Compensation coverage is unlawful and shall subject an employer to criminal penalties and civil fines up to $100,000; in addition to the cost of compensation, damages as provided for in,Section 3706 of the Labor Code; int'e"rest and attorney's fees. IMPORTANT. Application is hereby -made to the Director of. Building and Safety for a permit' subjectto the conditions•.• and restrictions Set forth . on his application. I. Each person upon.whose behalf this application is made & each person 'at whose request' and for whose benefit work.is' performed under or pursuant to -any, permit issued as a result of this applicator agrees to, & shall, indemnify & hold harmless the City of,La Quinta, its officers,' agents and employees. 2. Any permit issued as a result.of.this application becomes null and void if work is not commenced within 180.days from date of issuance: of SUCH permit, or cessation of work for 180 dayswill subject permit to cancellation: Icertify that Lhave read thistaPplication-and State'thai the above information is correct.�gree to comply with all City, and State laws relating to the building const ctlon 'and hereby authorize representatives of this City to enter'upon the above mentioned property forinspection`purposes [�^ :Signature, (Owher/Agent) ✓-moi -1Date% PERMIT A ' BUILDINGPERMIT �►e>a,:ar - DATE / VALUATION. S7'9;2-+Rj,: +,io ' LOT • R TRACT 133JOB SIT12 1' ,IJP ADDRESS rot-5ti� k�slIlh�r�.VFA .>d9 APN�� Ir kriy8 OWNERA��\i.�l r`{('l ✓YP)4��j'Y.�..�1CONTRACTOR DESIGNER ENGINEER 'A01hjam%V/N7.J7RLpjy t a-3.'�9:�,tAI.,.A�C:IA;f 92 y/�• �y3�'ySiia�p/' C:+.adi3.C9�: 'i' `r � 11v.iJLq./ , (,j A. 7'2201 ,lA.tDiO 9nny l - USE OF PERMIT Arl) 0280AAK1 ' [.i NI( WAI..L OIz° :isCXX. i* LAT4 CHECK ME REDUCED 7:90A FOR 1MAJU 1PLR4S 1UAN(% 01F+' SAM I RACIT CONISTRUMIa.tti` i'TC>$sClt �tsJifrs`l0/ y p(i��(I� Ftfuil;#ia 4. j r _+ A: �pp7�p�8 ��wwE ®®[ _ pAqp�7Ap pp•Syy 79,2'sti,��i �;c�;�s,lsRUCTI[ONFES 50 ' Pd��!'��r;gv�y'�C,{�'a�:�•�;ly�s`Y1/��3�t�3,�D�(09-�f��(1���3��';�• .'��6�_5�� , Sa�f�+iR%S�rd'a�. L'$'di '. , •' 'fl V!�'•1F,1'U"'�.6V"81i���' orf! IV.yv� 4�!„tJP+�t�STv,#I%i~ IU.t-V £4f9- 2.f -SSD. 5125 7 82.Tt()N,Q etc a' 10N x1650 KESID '� i3?.-tl f)--�7i3f) m 9,3 §..; F:1�ELA.WI:R 'IILI'k'ACSk` 17,Q 9t4;'.tiu KkW&SE PLAN iUl. �it� �t4i- �s �stl�Cf ties . L PRE 4.1AID PETS- MOO ESS ,,�:KJo� k"'F'rRdr'EI FEES NPdJ.07r!' OVV AL RECEIPT DATE BY ` DATE FINALED INSPECTOR - - yr INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings Ducts Slab Grade Return Air Steel Combustion Air Roof Deck Y-13- ocz> yc— Exhaust Fans O.K. to Wrap — -p'7 F.A.U. Framing 5 Compressor Insulation —Cfb 5% Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath Drywall - Int. Lath ARA ��(i t rC Final Final POOLS - SPAS BLOCKWALL APPROVALS 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 Heater Final Water Piping Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral Pool Cover - Sewer Connection _ o o Encapsulation Gas Piping Gas Test • Appliances Final COMMENTS: Final 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 Final Utility Notice (Perm) cocoon 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 — the higher the R -value, the greater the insulating powe( If you would like to add more insulation to your home, contact your Cocoon authorized dealer. RESIDENCE ADDRESS: �-zzs3 INSTALLED BY: '191rSUPIP, CA 92 0 BUILDER: 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'``sq. ft. to obtain an R -value of 3 LER'S AUTHORIZED SIGNATURE /DATE • J TM Cocoon Stabilized Insulation 30 lb. bag A9anujacrured By: r ` GREENSTONEG4i'" -k- L, A LOUISIANA-PACIFIC COMPANY Net Coverage No Adjustment for Trusses 56.7 75°F Mean NOTE: This coverage chart compensates for settling Gross Coverage Based on and is for estimating purposes only. Stated R -value is } provided by installing the required number of bags ~ u., per 1000 s% ft. at a minimum installed thickness. - -. Installation of the required number of bags may yield more than the specified minunum thickness and minimum r weight per sq. ft. Actual coverage will be influenced ' by job conditions and application techniques, and Installed may vary as much as 10% without significantly affecting the stated R -value. Failure of the installer to f- t provide at least the required number of bags per ` 1000 sq. ft. and at least the minimum thickness may ' result in a lower installed R -value. Compaction may t occur during installations above R-30, requiring more r than the stated number of bags to obtain the - rA r , minimum installed thickness. Required Per Installed Square Feet r GreenStone and Cocoon are trademarks of f r'y Per Bag 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 Fool - - 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) d: Less Than: Per Bag 1,000 Square Feet Insulation Per Bag Square Feet (inches) Should Not Be Less Than: (Ibs.) 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 (2 x 4) GreenStone Industries, Inc. All rights reserved. 51.4 19.4 .583 56.7 Printed in USA. RV 30M 8/97. Sidewalls (pressure filled -density 2.0 PPCF) ' J 8-97.17/13-A 30.6 R-13 36.1 27.7 (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