0107-162 (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
Date" i / 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:
( )F 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. X
( ) 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.
(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`shall,forthwith comply with those provisions. P:
Dater Applicant x' ^•. J?�77 '// / o
,S/ -' y/[/'! � ,r rte✓, y[,+•••..-•x./r/
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject ani employer to criminal penalties and civil fines up to $100,000, in
addition .to the.cost`6f 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 shmia.montion@d property for incpAation purp0000:
Signature (Owner/Agent�'�t' fN aRr'
Y� �..'i',f .� /e' t Date
VY i �.a• .v.r•/"
BUILDING PERMIT PERMIT#
DATE VALUATION LOT t`t?-162 TRACT
JOB SITE
APN
ADDRESS
'/S •421 Sf,C MA YRUA
QS�1 • ii t1�S .
OWNER
CONTRACTOR/DESIGNER/ENGINEER `• ti
l mi ,'D. olA� -ma, h lti, 0200,
1 X35 110.1.), WREWL ITE 6,1200
N MMWA.%+'DNO aA 924-08
SAN'BEPWFsltC7aINO C"fib 92408
(9. 09)3€61-600 AX. 2.120
USE OF PERMIT
XINGLE Z cplo.P:4. l "MUNG
SF1), OT 42 MAN ZA PXRMIT T10&S' 2• IX INC"%' UM BLOC'KWAIJ, OR
POOL
I.'�f:'f� i� �rta�. ��>'<%�•c3fx�' :��.ca� `rt�� ,��t���i�� �.�'�'.
TRACT CONSTRUCTION 1,500.0 OF
FORCHMAVO X00 Sr
0ARA016WARJIM 420.60 8F
me, 6'ambik 3.Y
C-0148TR UC"FHNN St3:.E ). t51 �C00� 3 F6-t34�J E�9�S.Ota
MAN CHWX ME 18
MECTIANIM FEE
ft..4. W14 .Tti°).CAIl .,E 1.01-ON1-420-000 994.40
P. INOFFI 101000-419-000 Sr12175
STROHL, 101-000-241-000
7 �, q,,�_av�r� RK J n 32A,00
dpp {/A.� yy��..p�1¢,�S���..yy FEE 22 00
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./J�
1EXEVELOPER I.MPACJ� %;. Q�
JUL 18 2001 E� I.
outi ixyly93..0 l?7mumflIP FC4`1'C i'(1.L .�6e.[7+iL'A•nC9. !
�V.TE «l'.�9
J 'A):TAL,1' T 11T."Es ME NOW
43; A9
s
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR,*
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set cracks
Forms & Footings
/ _ /
?`- ��
Underground Ducts
Ducts
Slab Grade
Return Air
Steel_
Combustion Air
Roof Deck
O.K. to Wrap.p
_
_ ,'id
Exhaust Fans
F.A.U.
Framing
Insulation
_
(> Q
l�Z d t —
Compressor
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath`�—
Drywall - Int. Lath
Final
EPOOLS
Final
- SPAS
BLOCKWALL
APPROVALS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Water Piping
_
_ ,J/ J
�` S�
Heater Final
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
=r
O.K. for Finish Plaster
Sewer Lateral
Sewer Connection
_
"- .e" _
�
Pool Cover
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.FJ.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
11/29/2001 THU 19:28 FAX
INSULATION CERTIFICATE
LA QUINTA
x-79=420 SIERRA_V.ISTA
r Number and Street City
42
Riverside Lot Number
C un Tract No
Description of Installation
ROOF Brand Name
Material Terrnal Resistance (R -Value)
Thickness (inches)
CEILING Brand Name w CERTAINTEED
Batt or Blanket 7 Pe BATT Thermal Resistance (R -Value) R38
Thickness {inches) 12
Loose RII Type BLOWN IN -Brand CERTAINTEED
16 inches
Contractors min installed weight square ft 0,815 R38 _
Manufacturers installed weight per square foot to achieve Thermal Resistance (R -Value) .
3 EXTERIOR WALL
Frame Dm '
A. Cavity Insulation
Material BATT
Thlcicness inches) 3112
B, Exterior Foam Sheathing
Material
Thickness (inches)
Brand Name CERTAINTEED
Thermal Resistance (R -Value) R13
Brand Name
Thermal Resistance(R-Value)
4 FLOOR OVER GARAGE AREA Brand Name
Material
Thickness (inches) _ Thermal Resistance (R -Value)
5 SLAB FLOOR/PERIMETER Brand Name
Material Thermal Resistance (R -Value
Thickness (inches)
6 FOUNDATION WALL Brand Name _ -
Material Thermal Resistance (R -Value)
Thickness (inches) —
Dec iration
I hereby certify that the above insulation was installed in the building and the above location in conformance with the current
Energy Efficiency Stenderds for residential buildings (Title 24, part 6, Calitronia Code of Regulations) as indicated on the .
Certificate of Compli,arqe, where applicable.
2+ 3 Prj►,vr 11129/01 PARAGON INSULATION
Item #s Va , l]at 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
Item #s Sigg a re, Date Installing Subcontractor (Co. Name) OR
General Contract,(Co. Name) OR Owner
Z008