0007-148 (SFD)e� LICENSED CONTRACTOR DECLARATION
I'tereby affirm under penalty of perjury that I am licensed under provisions of
-Chdpter 9 (commencing with Section 7000) of Division 3 of the Business and
V Professionals Code, and my License is in full force and.effect.
License # Lic. Class Exp. Date
7141: r rI(31f11'2(
Date 'f /�? % �` Signature of Contractor 74 % • ! -! t f �'..l
t � �
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.
( ) 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 001.D8N lAoLg INS, Policy No. NWC-544068••02
(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.
DAode, I shall.forthwith comply with those provisions?
Date: % % Applicant
Warning kFai I /reRZ)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 186 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
;h/ebove-mentioned property for inspection purposes. fgnature (Owner/Agent) �t' i d" �1 f r r Date"
ate •�, f 1{/ -
X6-•00 BUILDING PERMIT PERMIT#
DATE . VALUATION LOT W07-148
TRACT
$100,460.1() 54 27519
JOB SITE APN
ADDRESS -.01 SJI=AYLLS-fA �-
OWNER
CMMRY CROVI T. COMtv/UNilMS
1535 80.9)" ST 'f. 917 47,00
SM 13Jlr , ARDINO CA 92408
USE OF PERMIT
—%N01XRAl,4iI._:Y' DWEI:JNG
CONTRACTOR/DESIGNER/
C '1'(7RY CROWEC L CohoduNn=
1535 30, ODD S°!?if�s" 1', WM 0200
SAN BERWA8.DWO : CA 92408
(909)381•600"3 C1.31,0 2120
SPD-, WT 54 PLAN N WC PERMIT DOES NOT INCLUDE XiLOCK 'dJ.F LLS a=Jlq.
P006 M PLAN CHECK RF; UC T ION r,(.)1t MULTIPLE €sSU.ANCR
MACT,CONSYRUCTION 1,679.00 OF
PORCWPA'T10 94.00 SP
GARA.(} CARPOR'I' (SP) 13,1`i3 o
EkrrM nW + ogr OF CE3n s"Y! ucrI 7H
T C Tr'1':E S"iT&i'1U"Y
CONSTRUCTIONN FEED
1101.000.41.8 -OW
8643,00
PLAN CHECK FILE
101 -OW -439-318 t'
$133.55
MECHMICAL F99
101-000-421n000
03.50
ELtYXTPJC L FEE,
10.1-000-420-000
$115.61
PLUM13510 Flt %
.101-000-419-000
$128,75
STJ(,ONO MUFICIN FEE - RESID
101-000-241-000
$10.05 •
G ADINO FEE
101=000-423-000
$20.00
DEVELOPER DAPACT YELP
$1,"7.00
1Z9S PRE -PAM F.EW
y e' j
RECEIPT DATE By'J .,� DATE FINALED IN'PFrTnR
aOiJ,460.14a
$3,011.46
$0.00
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
�� DI
Underground Ducts
Forms & Footings
_
Ducts
Slab Grade
I�l�p
�_
Return Air
Steel
/(p
_
Combustion Air
Roof Deck
Exhaust Fans
O.K to Wrap
A*=4d64_
F.A.U.
Framing
_ _
Zct
�+�—��
Compressor
Insulation
y
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
R' 1-2—
Drywall - Int.. Lath
otws
y g
_
�
Final
__
t% y O_�
`
tJv
Final G►'
POO S -SPAS
BLOCKWAL
' PPROVALS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final I
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
��1c90
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
(7ivj�{
Pool Cover
Sewer Connection
Gas Piping
�Z�1 ''
C0—E6L
Encapsulation
Gas Test
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL PPROVALS
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)
I
01/22/01 09:08 FAX 760 346 7276 PARAGON INSUL.
INSULATION CERTIFICATE
IC -1
F
79-301 SIERRA VISTA'
LA dUINTA
Number and Street
I city
' Riverside
.27519 '54
Count
Tract No i
Lot Number ,
Description of Installation
j
1 ROOF a
Material
Brand Name
j
Thickness (inches)
Termal Resistance (R -Values --
2 CEILING
j
Batt or Blanket Type BATT
Brand Name CER1fAINTEED
-
Tnicknew (inches) 12
Thermal Resistance (R-Valye)
R-.18
Loose Fill Type BLOWN IN
Brand CERTAINTEED
_
Contractors min installed weight square ft
0.615 IG Minimum thickness 14
314 inches
Manufacturers installed weight per square foot to achieve Thermal Resistance (R -Value)
3 EXTERIOR WALL
- Frame T e
A. Cavity Insulation
Material
Brand Name
Thickness (inches)Thermal
Resistance R -Value
S. Extedor Foam Sheathing ,
Material
Brand Name
j
Thickness inches
Thermal Resistance R-V2Iue
4 FLOOR OVER GARAGE AREA
Material.
Brand Name
Thickness. (inches)
Thermal Resistance (R -Val
e)'
5 SLAB FLOORiPERIMETER
<,
Material
Brand Name
i
Thickness inches
Thermal Resistance R-VaI
e
ar
-
�r T6 FOUNDATION WALL
Material
' Brand Name
Thickness Inches
- Thermal Resistance (R -Value)
.° ®eclaraflOn
' I hereby certify that the above insulation was installed in the building and the above location in conhor'm
nce with the curnir�
Energy Efficiency Standerds for residential buildings (Tine 24, part 6. Califronie Code of Regulations) a5
indicated on the "
' Certificate of Complian where appkgble,
2
1119101 PARAGON INSOLATION
Item #5 nature, to
Installing Su
tractor (Co. Name) OR
General Contra
(Co. Name) OR Owner t
Item #s Signature, Date
- Installing Subconh
ctor (Co. Name) OR
General Contra
(Co. Name) OR Omer -
Item #s Signature, pate
' , Installing Subcontractor
(Co. Name) OR
General Contraci
(Co. Name)'OR Owner
t _