0003-185 (SFD)I 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 rry License is in full force and effect.
License ,# Lic. Class Exp. Date,
f 141E�1 .� i(ir�111tii
Date ,�,&rtF.� 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 corfstruct 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:
Cattier iiOi U lei A i.c !1413. Policy No. N rJC 54.4058-01
(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 iri 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 r)
Date:" = ] j,.% 'Applicant "_� �� . a,i r
,I
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, indemnity
& 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 above-mentioned property for inspection purposes. j
Signature (Owner/Agent) -7 r ` Date
V BUILDING PERMIT PERMIT '�,�
TE VALUATION $100,400.10 LOT TRACT
JOB SITE RP�PnA��4�y T!t
APN
ADDRESS
OWNER
CONTRACTOR / DESIGNER / ENGINEER
C131-111'tT XCIRONb{fiLLr✓O'NI-NfU �RIMIS,
t;:ENTUR`1'CRO"W LLCONI PILIt?UIES
15.5 SO. "D" MEET, S'r'1 . -4200
15.35 SO. "U" S'TREE!', STE.- #200
SAN BER:NARDINO CA 92408
SAN URNAP DWO CA 92408
(,9fi91� 1.-ft007 CBT,# 2120
USE OF PERMIT
iINGLErANl LYWELLNii
Z)V IJ -LV 1: 73 r.R.AW 1 MC;SW. I L L Ubb NQ A .114UL,VUL t41.L rL t. WALL VX VL e JL,.
%sun 4+1..A1V C:k(F:C;K:E'1�� ►ZA;1�UC`f'1ON ON �1U1:Td4'1.d31S8[iA;N4Es OE' :3i1t1riF'
P1.AN'1``IT?F.
TRAM» r Cl 14-S—RIXTION 1,079.00 sr
PORC111PAT.IL"9 .itff SF
G�14ZA.L�f:/CA?ti�.,R'3:' �4 i'i.(alf Sf
.v P 1'A"A TKe 61' 'CO'S H .0F C0N4 ..U1i U'1...Y 101,
Y 19.460.10
PERMIT FEE S6ltYtNIARY
COAL `fRUC 1ON:l-E lO1.-U!)0-�IkKditH) S+Fv13.�J0
PLAN C CY., FES 503.55
.NZ E-0-1t0,111C Al, TIE 10114 1-421 �00 i $5�.3fJ
" : r: p ....
E-I,ECTR1CA1,F:rEX 101.000-424'.-3IV $115.61
PLUJA46f G FEE 101-000-419-000 $123.75
� 1 ri.1�`
-STRONG, rsri7VO N1TT,- REID l()1�tO",,.41-W) $10.05
t F � i:..�
GRAO ING i'!tf
DEVELOPER iNWA.CT FEE S1,907.00
ART.1N PUBLfC PLAM - it.f^SID 701-000-255.Oi i gni+ aDU
„
SUB -7Y: AL. COWS 71t.UCTION AN) PLAN CHECK
g 0:31.4
LESS PR -PAID- FEES
Woo
TOTAL PERI%Iff :H% DUE NOW'
$3,031.45
REfFIPT
DATE
RY �.l
DATE FINALED
INSPECTOR
'. 7 '
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
°j 'A
Ducts
Slab Grade
5—(t) - iyb
Return Air
Steel
F -1 --ea 5
Combustion Air
Roof Deck
, ILL. X
Exhaust Fans
CK to Wrap
.,r
F.A.U.
Framing
• Q .00
Compressor
Insulation
jy <0
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
OD
Drywall - Int. Lath
z) cc7
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 I
I
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
,Z,p .0+o
Neater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
R 66
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
Final Z-5
Utility Notice (Perm) inZ7i
COMMENTS:
INSULATION CERTIFICATE IC -1
.79-3111 Sierra Vista La Quinta
Number and Street City
Riverside 27519 .53
County ` Tract No Lot Number
Description of Installation
1 ROOF
Material Brand Name
Thickness (inches) y Termal Resistance (R -Value)
2 CEILING
Batt or Blanket Type batt Brand Name Certainteed
Thickness (inches) 12 Thermal Resistance (R -Value) R-38
Loose Fill Type blown in Brand Certainteed
Contractor's min installed weight square ft Ib Minimum thickness inches
Manufacturer's installed weight per square foot to achieve Thermal Resistance (R -Value)
3 EXTERIOR WALL
Frame Tvoe
A. Cavity Insulation
Material
Thickness (inches) 3.5
B. Exterior Foam Sheathing
Material
Thickness (inches)
4 FLOOR' OVER GARAGE AREA
Material
Thickness (inches)
5 SLAB FLOOR/PERIMETER
Material
Thickness (inches)
6 FOUNDATION WALL
Material
Thickness (inches)
Brand Name Certainteed
Thermal Resistance (R -Value) R-13
Brand Name
Thermal Resistance (R -Value)
Brand Name
Thermal Resistance (R -Value)'
Brand Name
Thermal Resistance (R -Value)
Brand Name
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
Energy Efficiency Sfanderds for residential buildings (Title 24, part 6, Califronia Code of Regulations) as indicated on the
Certificate of Compliance, where applicable.
9/27/00. PARAGON INSULATION'
Item #s iMe, Installing Subcontractor (Co. Name) OR
General Contract (Co. Name) OR Owner
Item #s Signature; Date
Item #s Signature, Date
Installing Subcontractor (Co. Name) OR
General Contract (Co. Name) OR Owner
Installing Subcontractor (Co. Name) OR
General Contract (Co. Name) OR Owner