0007-146 (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
714188 i3 JI OJ3112C
Vate" ' 7� ! �Signature of Contractor_� f A
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 C',03/ISgN EAOLL INS, Policy No. 14WC-X06$-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,
Date =pp / 7 / t�
Warning Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions' and restrictions set forth on his
application.
1 Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta,-its officers, agents and employees.
2. Any permit issued as a result of this application becomes:null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
thg above-mentioned property for inspection purposes. r
,7 r
VSignature (Owner/Agent) # ? 1 �� f Date f/ + •°�-~
6 BUILDING PERMIT PERMIT#
(2(?t)17-1."
DATE . VALUATION *117A4,6°()0 LOT2$ TRACT 27519
JOB SITE
ADDRESS _ RA VISTA
APN
„ Wl-W9
OWNER
CONTRACTOR / DESIGNER / EN (NEER
C'FA1Tt RY CROWELL C0).AI&1rT MP
C!M4TURII'.' CR OWELL. CobllfU iMES
1535 30. 'D" SMWT, OM 0200
1535 S0. 13" M=, �9'.0 , H-200
SMBERNARDINO CA 92408
SANBEWARD.iNO CA 92408
(909)381.6007 C:B141 2120
USE OF PERMIT -
:#1 IJUX• FAi,QMY D WE Ln4(3
VD -LOT 29 OLAN SaRC PERMIT DOES NOT INCL.UIX BLOCK WALLS
('ifs POOL," o PUN CIiFCr, kF-DUCTION FOP. MULTIPLE I8SUANCi
TRACT CONSTRUCTION 21008.00 SF
PORCWPATIO 4900 SIS
CIARAGF/CARPORT (3F) 8.173.24
X9M1A1XD COST OF CONSIR-UC-HON
, 217,846.00 .
PERWr MW S0AVvURY
CONSTRUCTION FEE 101.000.418.000 M2150
PLAN CHUCK FEE 101-000-439-318 $146.04
MECHANICAL FEE 101-000-421000
EIZICTRIC.AL PRE 101-000-420-000 $127.12
PLUMBING FEE 10:1.000-419.000 $146,75
STRONO MOTION FEE - R.ESID 101-000-241-000` $11.78
GRADING FFR 101.000-423 000. $20.00
DEVELOPER IMPACT FEE$1,907.06
91)1 -TOTAL CONS'i'12UCT.IOX AND PU-9 C91 -WICK
$3,114.68
1"S PRE-PAtD M33
$0.00
W '4� fi}.. 1.+x;0/
TOTAL P11.:IMT LAS ME NOW
RECEIPT
�
DATE BYE
/j
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Jp
Underground Ducts
Forms & Footings
_f
x
Ducts
Slab Grade
Return Air
Steel
GQ
Combustion Air
Roof Deck
/o-�y���_
Exhaust Fans
O.K to Wrap
F.A.U.
Framing
f f_ o� ��.rL
Compressor
Insulation
Q4 VW"-
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final Zl,(�d� C-
BLOCKWALL APPROVALS
Final
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
$��
Waste Lines Gl
Gas Test
Electric Final
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Sewer Connection
q12a
Pool Cover
Encapsulation
Gas Piping
Gas Test
i 212�
Appliances
Final
Final Z
Utility Notice (Gas) aA__1
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fbdures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final F&2a
Utility Notice (Perm) (
COMMENTS:
01/22/01 09:08 FAX 760 346 7276 PARAGON INSUL, X15
79-290 SIERRA VISTA LA C�INTA
Number and Street I : City
f Riverside 27519
County Tract No --
IC -1
Description of Installation
- - --
1 ROOF
_
Material
Brand Name -
Thickness inches
Termal Resistance (R -Value _
2 CEILING
with the current
indicated on the
Batt or Blanket T BATT
Brand Same CERJAINTEED
Thickness inches 12
Thermal Resistance e R-38
R -Valu
Loose Fill Type BLOWN IN
.i Brand CERTAINTEED ;
Contractors min installed weight square ft 0,615 Ib
_
Minimum thickness 14 3/4 Inches
•
Manufacturer's installed weight per square foot to achieve Thermal Resistance (R -Value) I'
3 EXTERIOR WALL
Frame Type
A. Cavity insulation
-
Material
Brand Name.
Thickness inches)
Thermal Resistance (R -Value)
. f3. Exterior Foam Sheathing
Material
Brand Name I
Thickness (inches)
Thermal Resistance R -Value
4 FLOOR OVER GARAGE AREA
Material
Brand Name
Thickness inches
Thermal Resistance (R -Value)
5 SLAB FLOORIPERIMETER
Material
Thickness (inches)
6 FOUNDATION WALL '
Material
Thickness finches)
Declaration
I hereby certify that the above ,nsulation waas installed in the building and
Energy Effrci6ney Standerds for residential buildings (Tibe 24, part S. Cal'
Certificafe of Compliian , where applicable.
2 1/19101
Brand Name
the
rhonia
I
Thermal Resistance (R. -Value)
_
Brand Name
Thermal Resistance (R -Value)
above location in conformance
Code of Regulations) a
PARAGON INSULATION
with the current
indicated on the
Item #s nature, D e Installing Subcon ctor (Co. Name) OR
General Contractl(Co. Name) OR Owner
..T ,
Item #s Signature, Date Installing Subcontractor (Co. Name) OR
General Contract (Co. Name) OR Owner
Item #s Signature, Date Installing Subcontractor (Co. Name) OR
General Contractl(Co. Name) OR Owner