0007-147 (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
71418 B 0131/2c .
)Kate r��'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: f
( ) 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).
O 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 OOLO)3N RAOLr. iNs. Policy No. NWC-S4.4068-02
(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
ode, I shall forthwith comply with -those provisions: 7,!
Date: 4 11�. .:/ :;'1 Applicant Y' r
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, 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
th above-mentioned propertyfor inspection purposes. /
! �P meq, ?'
Signature (Owner/Age..-)_.r '.'C•�`z�✓I�r Date !
+ ` BUILDING PERMIT PERMIT#
7-1.47
DATE VALUATION LOT TRACT
,16020 30 x'1319
JOB SITE
APN
ADDRESS 79.300 S� V=A
_
OWNER
CONTRACTOR/DESIGNER/EN (NEER
CKA1'1"[MY CROWML COWA 1'MJ(',CI,W
CEN 1. Tl Y C"12OWaL t"+tiWAi.7Ni°i7 A
1535 30. "33" tiv171 d' T, l #200
SAtd DERRARD1.90 CA 92408
UN BERWAR113.1 TO ` CA 92408
(909)381.6007' C13L# 2120•
USE OF PERMIT .
MWOLEFA- MY 73V,MJIWG
Slyri- 1A:)T '30 PLAN ?.A PERMIT 000 NOT INCLUDE SL.00K: WALLS OR
POOb, 75% PLAN CHECK REDUCTION FOR MUL;i'IPLF I831JA.1' C
TRACT CONSTRUCTION 11300.00 OF
PORCHIP.ATIO 36.00 Sr
OARAOFIC.ARPORT (8F) U32,00
X&TWAM C0.Vf OFC-IDKST11UC' Oft
5U,9.+f►t1.1�
CONSTRUCTION FEF 101.000.418.000 3�9A,00
PLA14 CHECK FEE 101-000.439-318 S i Y4.3a
MECHANICAL FLEE 101-000-01-000 $47.0.9
ELECTRICAL. "M 101-.000-4207-0110 $109.40
PLIUMBING FEE 101.000-419=000 $122,75
STRONG MOTION FFE • RESID 101-000-241.000 $9,02
GRADINO F 101-000-423.000 $20.00
DWEL•OPER IMPACT FRE. $1,907.00
&M -TOTAL C01~T:1T1. UC31C)M AN73 PLAN CHECK
$2,916.69
w �,y
4
i +y
RECEIPT
DATE
BY 1(
DATE FINALED
IN$P,EGTQR
4
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
a
Underground Ducts
Forms & Footings
---`""
Ducts r�
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
1Cj % oa
Exhaust Fans
O.K. to Wrap
1.0 « �'ocS —
F.A.U.
Framing
Compressor
Insulation
IIAL
Vents
Fireplace P.L.
cam'
Grills
Fireplace T.O.
Fans 8 Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
ap
Drywall - Int. Lath
(.sw
Final
Final
BLOCKWALL APPROVALS
POOLS - SPAS
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
Lg IS o 0
Heater Final
Water Piping .
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
_
Cf
Pool Cover
Sewer Connection
_
( cp(�d�
Encapsulation
Gas Piping
Gas Test
2
Appliances
Final
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 $ o
Final
Utility Notice (Perm) c (>(
COMMENTS:
01/22/01 09:08 'FAX -760 346 7276
PARAGON INSUL.
INSULATION CERTIFICATE
79-300 SIERRA VISTA
LA dUINTA
Number and Street
I City
Riverside
27519
County
Tract No-. 'L`ofNumbe`r
Description of Installation
i
1 ROOF
Material
Brand Neme
Thickness Inches
Termai Resistance (R -Value)
2 CEILING
Batt or Blanket Typ2 BATT' '
Brand Name CERTAIN'TEED
Thickness Cinches) 12
Thermal Resistance R -Value R-38 '
_
Loose Fill Type BLOWN IN
Brand CERTAIN. EED
orftctors min installed weight square ft 0.615 lb
Minimum thickness 14 3/4 -inches
Manufacturefs installed weight per square foot to achieve Thermal Resistance (R -Value) _ 1'.
3 EXTERIOR WALL
Frame Type
A. Cavity Insulation
Material
Brand Name
Thickness (inches)
Thermal Resistance R -Val
B. Exterior Foam Sheathing .
Material
Brand Name
Thickness (InchwL
Thermal Resistance R -Valu
4 FLOOR OVER GARAGE AREA
Material
Brand Name
Thickness (inches)
Thermal Resistance (R-Valule)
5 SLAB FLOOMPERIMETER
Material
Brand Name
Thickness inches
1hermal Resistance R -Value
6 FOUNDATION WALL _
Material
Brand Name
Thickness (nches) -
Thermal Resistance R -Value
Declaration
I hereby certify that the above insulation was installed in the building and the above location in conformance
with the current
Pietigy Efficiency Standerds for residential buildings (Title 24, part 6. Califronia Code of Regulations) a�
Certificate
indicated on the '
of Complian , where applicable. .
x
?
1!19/01
PARAGON INSULATION
Item Ns MN.nature, DateOInstalling
Subcontractor
(Co, Name) OR
General Contract
(Co. Name) OR Owner
Item NsSignature, Date
- lulling Subcontractor
(Co. Name) OR
General Contra
(Co. Name) OR Owner
Item #s Signature, Date
installing Sutuorjtractor
(Co. Name) OR
General Contra c4
(Co. Name) OR Owner
i