0007-144 (SFD)EICENSED 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
713188 13 t�. ,.10/3142(
z
ate 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 isnot intended or offered for
sale (Sec. 7044, Business & Professionals Code).
( ) I, as owner of the property, am ei clusively 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, e.
( ) 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. COWXN %Ac1LZ TANS, Policy No. T5WC-544068-0a
(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 soas 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
Qode, I shall forthwith comply with those provisRons.
bate: Applicant .'1�.�
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 Fthe 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
Zi
above-mentioned property for inspection purposes. zl
l -nature (Owner/Agent) 7 � � � - �9 Date � i,
Y 1. !. 1 r
BUILDING PERMIT PERMIT#
DATE VALUATION LOT OW7-144 TRACT
$117946.00 27 27519
JOB SITE
ADDRESS
79k-2 70 MMOU VWA
APN
6044X1-009
OWNER
CONTRACTOR / DESIGNER / EN (NEER
CF.AiTGT'tt. Y CROWE11, commCi3 rrm
CF.:A1 L°URY .0WFU C0M\oR ;1I1WS
1535 30, `D` SrRE1: T, FSM 4200
SAN :Br"ARDTNO CA 92408
SAN 1` EWAitT' = CA 9U08
(90.9)381-6007 C?BIX 2120 .
'
USE OF PERMIT
811~Tq'LE FANMY DW1� 1 LING
SFD• LOT ZI PLA115f RA PZRMIT DOES NOT INCLUDE BLOCK WALLS
OR K-101., 75% PIAN CHWX REDUCTION FOR. MU i IPI.F. IS IJA:NCE
TRAM'CONSTRUCTION 4008.00 sig
POi.CWPATIO 48.00 SP
OARAGUCARPOR.T (FiF)8,17 d,24
ES73MA= C09f OTC COlWURUan'On
1.17 .00
CO NSTRUC1`IOAI FEE 103.000.4.18,000 $702,50
PLAN CHEM FEE 101-000-439-318 1146.03
MECHANICAL FEE 101-000-421x000
ELECTRIC,AL FEE_ 10.1-00"20.000 $161.12
PL,UII�HINt 1 F8 101.000.4.19.000 $146.75
TRONCMO"ON FEE -R&STD 101-000-241-000 $11.73
ORADtNO FRP, 101 -000-423a,000 $140,04
DEVELOPER IMPACT n% �1,90?00
SIM -TEAL CONvI RUC`TI:ON AND PLAN CHEM
LESS PRE-PAW,.4
$0.00
m a` yy �$*1� A 9 -p tyE py
d J4 � ;(STAT PEMa ' FMD!.' ^E NO 9T T •
t!¢�l3'S •Trl�iA
4
RECEIPTDATE
_
BYP '
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE TINSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
01(�
Ducts
Slab Grade
"Z5
Return Air
Steel
Z
Combustion Air
Roof Deck
Exhaust Fans
O.K to Wrap
2
F.A.U.
Framing
Insulation
Fireplace P.L.
(�`–) ��C
(r��` (y ���
Compressor -
Vents
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
uh.1gO
itA; CQ'�
Final
�•i_
-
21 Il
Final
POOLS -SPAS
BLOCKWALL
APPROVALS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground PIN. Test
Final
I
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
?rte
Pool Cover
Sewer Connection
\2p. Cd
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)
01/22/01 09:08 FAY.760 346 7276
PARAGON INSUL. X 13 -
aNSULATION CERTIFICATE
IC-1
79-270 SIERRA VISTA
LA Q INTA
Number and Street
City
Riverside27_
—County
Tract No Lot Number _
Description of Installation
1 ROOF
Material
Brand Name .
Thickness Inches
Termal Resistance (R'-Value}
2 CEILING
Batt or Blanket iype BATT
Brand Name CERTAINTEED ,
Thickness (inches) 12 �
Thern'ta Resistance (R-Value) R-36
_Loose Fill Type BLOWN IN
Brand CERTAINTEED 1
Contractor's min installed weight square ft 0.615 Ib
Minimum thickness 14 3/4 inches
ManufaCturer's installed weightper square foot to achieve Thermal Resistance (R-Value) I
3 EXTERIOR WALL
Frame 12e
_ A. Cavity Insulation
Material
Brand°Name
Thickness (Inches)
Thermal Resistance(R-Valk
B. Exterior Foam Sheathing
-
Material
Brand Name
- Thickness Inches
Thermal Resista nce (R-Value
4' FLOOR OVER GARAGE AREA -
Material
Brand Name I
Thickness inches
Thermai Resistance (R-Value)
5 SLAB FLOOR/PERIMETER
Material
Brand Name
` Thickness inches
Thermal Resistance(R-Value)
6 FOUNDATION WALL
Material
Brand Name
Thickness 'inches
Thermal Resistance
(R-Valu),
Declaration
I hereby certify that the above insulation was installed in the building and the above location in conform
nce with the current'
Energy Ef ency Standerds for residential buildings (Title 24, part 6, Califrania Code of Regulations) as'
indicated on the
Certificate of Complian ,where applicable.
' 2 1118/01
PARAGON INSULATION
-
Item #s c0mature, Datb
Installing SUbcon
General Contractl(Co.
dor (Co. Name) OR
Name) OR Owner
A
Item #s t Signature, Date
Installing Subeon
actor (Co. Name) OR
_
General Contrad(Co.
Name) OR Owner
Item #s Signature, Date
Installing Subcontractor
(Co. Name) OR
General Contract
(Co. Name) OR Owner