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9909-168 (SFD)LICENSED CONTRACTOWDECLARATION. I'herebv.,affirm under penalty of perjury that I am licensed under provisions of Chapter J (commencing with Section 7000) of Division 3 of the'Busine_ss and Professionals Code, and my License is in full force and effect. License # Lic: Class Exp. Date CVHC Date Signature of Contractor OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury:that.l: am exempt from the Contractor's License Law for the following reason: O. 1, 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). f ( ') I, as owner of the .property, 'am exclusively contracting with licensed contractors to lconstruct'the, project (Sec.. 7044, Business & Profes'sionals' Code).,. ! ( 1 am exempt under Section B&PC: for'this reasofi t,DaY. - el t / �F 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;tfie. Labor Code, for'the performance of the work for which this permit is issued. My workers' compensation insurarice carrier'& policy no. are' Carrier I " . .. ' • Policy No MiD-Ch-NT RY INS C . 1132007 43 70 (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 sub -to the workers' compensation provisions'of Section 3700 of the Labor C e, I shall forthwith comply with those provisions. ' =' • ate: f ` ' � _... Applicant "'�"�: , C � �•. ... ,G Warning: Failure to secure Workers' Comp'•ensation coverage is„rinlawful and shall subject an employer to criminal penalties and civil fines up to $100,000, in addition,to the cost of compensation, damages as provided•for in Section 3706 of the Labor Code, interest and attorney's fees. IMPORTANT Application is hereby made to -the Director of Building and Safety for a. permit subject to the conditions and -restrictions set forth, on his t application: Y 1. Each person, upon, whose behalf this application is made & each person at ” whose request and for whose benefit work is performed under o(pursuant•to any permit issued as a result of this applicaton agrees.to, & shall, indemnify &.hold harmless the City of La Quinta, its officers; agents and employees. 2. Any permit issued,as a result of this application becomes null,and void if .work is not commenced within 180 days from date of issuance,,of such permit, or cessation of work for 180 days will subject permit to cancellation: I certify that I have read this *application and state that the above information is correct. I agree to comply wdh all City, and State laws relating to the building construction, and hereby aufforize representatives of this City to enter upori the above-mentioned. property for. in"sp'ectionpurposes. 4' signature (Owner/Agent) BUILDING PERMIT PERMIT#® DATE VALUATION S-79j,21A�.2fi LOT8 TRACT', 1870,U9JOB .. ADDRESS 51- :��Yr; i YDA VE.Lf., •' ^ O APN' �tl1;�4 OWNER CONTRACTOR / DESIGNER / ENGINEER MIARLhNIO CA:i?;.R17. L0 St.LR:,flNAS . • OWNER /.WILDER WITH CV�1C P.O. BOX 272. , . - _ 4 701 MONTROE 'St' STE O, THERMAL CA. *i274 INDIO. i CA 92201 (760)347-315.7 (;FIui USE OF PERMIT .i i i„ ,I=AMti,Y DWS]t,i..4:NG lfFD (1280BR) - PE—MUT C10F,S'NOT INCLU,M BLOCK WALL OR POOL. , PLAN CMC'K FEE REDUCE D IT,;.FOR MU M.E 13SLIANCF! OF SAW, 'TRACT C:ONSSTTtfJCTION 1.2110.00 SIF PORMPATTO GARACrSICAPUK)R @" 420.00 aE . ES'9'I13'$ta,;4`&+ 0 COST ($•1i 01 811110 ` FEE SUMMARY COINS11RUCr10NVEE. I -1110 4184WO $549.50 . PLAN CIIEC6..k'.M 1014N )-439_318 $116,911 MECHAAN[CA1.,1'EB 101-OOQ-421-000 15,.50 ia1S.,t',"1 ICALPREs 11�1�1'C1Q fl?.0-ifDiit� $116.70 PLUMBING 1�'E!a 317A.75 S11WNG'X401' t7Ai re tm f S1 101t -OW -241-00 $ 7,33 ilitrli JWG FkZ 1611-00"-23`000 420.00 VE'VELOPERINIPAC'9 f6b PPY.C..rSE PLAN . 1.11,1-000441,-:345 } q, SUB'nyfAL CONA"I"RM"i'ION A,Nt?,I'LAN CHECK LESS P -iF.AD FEES. Ulm ' 'VEAla ig' i6tIT g+'1WS DUE ;t ~RECEIPTDATE BY 4 �-` DATE FINALED INSPECTOR INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Forms & Footings j Underground Ducts Ducts Slab Grade Return Air Steel Combustion Air Roof Deck Exhaust Fans O.K. to Wrap Framing �c5�7 Lj /so 7 —mss - cpm z F.A.U. Compressor Insulation 5-7 Vo S7 Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath Drywall - Int. Lath .✓i1fLt- /Z -Q- Final Final POOLS - SPAS BLOCkWALL APP OVAL 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 Water Piping Heater Final Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K for Finish Plaster Sewer Lateral Pool Cover Sewer Connection - . zpo 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: Rm. 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 If you would like to add more insulation to your home, contact your Cocoon authorized dealer. RESIDENCE ADDRESS: is � .Gtv INSTALLED'BY:"�` "' AD VAiVCED IN gZALL1 tTIONS 81-771 Oleander, Unk #1 ln lndloq �.A 2201 BUILDER;-Ce'%7 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 7d bags to coved Wit. to obtain an 11 -value of INSTAILLER'S AUTHORIZED SIGNATUA DATE A1anujachved By: , GREENST®NEF.K. A LOOISIANA-PACIFIC COMPANY NOTE: This coverage chap compensates for settling I and is for estimating purposes only. Stated R -value is provided by installing the required number of bags per 1000 sq. ft- at a minimum installed thickness. Installation of the required number of bags may yield more than the specked 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 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 result in a lower installed R -value. Compaction may d 11 . bo R 30 ,I occur unng nista aeons a ve - , requmng more than the stated number of bags to obtain the minimum installed thickness. GreenStone and Cocoon are trademarks of GreenStone, a Louisiana-Pacific company. © 1997 Cocoon Stabilized Insulation 30 lb. bag 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) cf: 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 (2 x d) GreenStone Industries, Inc. All rights reserved. 51.4 19.4 .583 56.7 Printed in USA. RV 30M 8/97. Sidewalls (p.,essure filled -density 2.0 PPCF) 5.5 B-97-TT/G-A 30.6 R-1 3 36.1 27.7 (2 x d) 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