0003-183 (SFD)LICENSED CONTRACTOR DECLARATION
,M'dreby 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. Dat714188 11 1le+i1%Zi)1
Date � ' 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 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:
Carrierr., Policy No.
L;OL.OE't31vAG'G�? tN3. N'lVC 544063-01
(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 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
Code, I shall forthwith comply. -with those provisions.
Date: uApplicant 11'`r1y ,{� j � 12
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 applicator 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
the above-mentioned property for inspection purposes. ,
Signature (Owner/Agent) }\t Date
BUILDING PERMIT PERMIQI��
DATE1 VALUATION MO -TA -51V TRACT
JOB SITE f9� 7 ` 3y1 +�i�4�
APN 6".061-09
ADDRESS �
`
OWNER
CONTRACTOR/DESIGNER/ENGINEER
C'7N' I CY ;.'::;ti ITT V; Cfr 41WMt3T.F"
CEN T1.P:V CRIC3 �VY111- C,u3;111111 'NJr1"E:,
1535 SO, ".D" S =I.E, T. STE. #€200
1535 SO. "D" S 'RF I €, STP.. #200
SAAB 1 ERMAltDWO Cts 42408
SAN FiLit NARDINO CA, 92409
(9(14)3$1-6007 CIRL#€ 2120
USE OF PERMIT
SNO—Ch FAMILY UWTi., NG
LWAl-E:U1 N PL"J `Z VWY NUI OU" NU1 11NQ. U1)ht%-)C &WA1. L UKPOOL.
75+°,0 YLAN C10,;K F J_:E REX)L1C ION (_:t3 MU MPLE ISSUANC R O SAME
NL X14 'i"lfP&
I
'Tli,= C,),NS U MN 1,w0.00 Sly
P0IiGWPXr10 %.00 SP
0ARAGfdCrAfU'10Kf 430.00 $F
ESIMM ED COST OF CONSTRUCTION
901160-18
WIl`tMI T i+1H;.E SU.Nii'vf11R1t`` ..
C>ONSTP,W110N Fh 1014K* -418-000 $5 i.titr
PLAN C;K M, 101410439-3 18 $!24.52
& Cid' N11CAL .+its 01.-OGG 1211-000 S f7.00
+" Y
ELECIT iCAL FEE 101-000-420" $109.40
P'LL&f131NC't FRE 101-M-419-000 $122.75
STRON- 15 MG►'riON Fe-1tFiS.m 101-000-241.ON $9.92
MADING ia.' '
of
SUR-!'O'sA . C.0N`.ZM 1(."1'100 AND PLAN CHECK.
L?SS P IRE -.PAID FEES
$0.00
TOTAL PERMIT T .FE S DUE NOW
r'4
RECEIPT
DATE
BY / %
DATE FINALED
INSPECTOR
L11 V
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
S7- rp-tgyb
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.IC to Wrap
r r'7_ Q®
F.A.U.
Framing
Insulation
_
2 4 (aV OL
_
Compressor
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
C31 ) y 00
Final
Final o _ �-�
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
ao
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
eZ,p_�y�i
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final
Utility Notice (Gas) o (Z
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 ZZ
Final
Utility Notice (Perm)
COMMENTS:
_
INSULATION CERTIFICATE
IC -1
79-331 Sierra Vista
La Quinta
Number and Street •
City
Riverside r
27519 51
County
Tract No Lot Number'
Description of Installation.
1 ROOF
Material
Brand Name
Thickness (inches)
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
r
Frame Type
A. Cavity Insulation
Material
Brand Name Certainteed'
Thickness (inches) 3.5
Thermal Resistance (R -Value) R-13
B. Exterior Foam Sheathing
Material
Brand Name
Thickness (inches)
Thermal Resistance (R -Value)
4 FLOOR OVER GARAGE AREA
Material
Brand Name r
Thickness (inches)
Thermal 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 -Value)
Declaration
hereby certify that the above insulation was installed in the building and the above location in conformance with the current
Energy Efficiency Standerds for residential -buildings (Title 24, part 6; Califronia Code of Regulations) as indicated on the
Certificate of Complianc , where applicable.
/27/00 PARAGON INSULATION
Item #s ignatu , Date U Installing Subcontractor (Co. Name) OR
General Contract (Co. Name) OR Owner
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 Contract (Co. Name) OR Owner
t,