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0003-182 (SFD)LICENSED CONTRACTOR DECLARATION 1-'9ereby affirm under penalty of perjury that I am licensed under provisions of Aapter 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 ii�1� f3 i.0+3.1i20i Date k/0 -I Mil 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'undei 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 maintair°a certificate of consent to self -insure for workers' compensation, as provided'for by Section 3700of 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"ca'rrier & policy no. are: Carrier GOLD04 EACL:C I.M. Policy No. - Iv IXC 571068.01. (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 tobecome 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. tt Date: j ^' Applicant— LI 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 d 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 the above-mentioned property for inspection purposes: - Signature (Owner/Agent) Dates - PERMIT�2 U •�U BUILDING PERMIT SATE VALUATION Sloo,"o.10LOT -Sd TRACT JOB SITE fi !11, 'i APN 6044--061-009 ADDRESS OWNER CONTRACTOR/DESIGNER/ENGINEER CEP," URY CROWELL cCDwwiJwivs CENTURY CRONVE3:,VCOMI INI"T.[CS3 i535 SO. "U" S'lKEFT, SIR 0200 1535 SO. `'.D'' SIRC. r, SFE. #1200 SAN SERN.ARDIM3 C.A. 92408 SAN BEItN.AKOINO CA 92408 (909)381.6407 C..11L# 2120 USE OF PERMIT SNOLE lAMIiiDWELLING VD -LOT 50 PLAN 3 Pfs"RAfTT DOES NOT INCLi7T71313L.00KWALL OR POOL. 7-V,',6 PLAN CHECK Y0-- fW(1L`'TION ON NIUL T[PLE 15SUANCS OF 3ANIE YL<ANTYP r. TRACT MNS x'i TCTTOiti 1,619M ST' P01ZC1f PAT10 M-00 `SF OARAQFJCAidkJ0Wf 417.013 SF LS TIMATE D COST OF f ONSTTtI.fMON 100,460..110 i3E3cNt1.e. FRE SUMMARY 0 ii STRUC 10N FEF 101-000-4.18-000 8(A3.00 �AA I—A�,J'cN r.;?Hp iC'K� FEW 101-000-439-319S/S� :\'7.I:.L.1'D&91tlTa�.f L L'�lUX". 101 -000421 -NO, $51.50 l XX,'TRSCAt 'f YsT i©l-f)Tii� aG�(31tA $i.tS.Gi KAJI19131NGr3FI ➢,0.1-000-419-0}"3() g•11RONG N110110,14 FEE, - RUSID 101-000.241-040 910.05 » .: i7R A1r I NCf FIsn_ '101�-000-423-0110 r:tiXF.L,0P -MP ACT FEE $1.907.00 AR'T 114 PUBLIC PLACES - RES11.1701.000-25.51-000 S20.00 '• w SUB -TOTAL CONSTRUCTION AND PLAN C REC;.h �3;0'11.4h LESS 'r.E-11;11.D ?EES 50.00 T f)"T, AL fi'Ih'.ItAUT IaDUENCSW $3.031.46 RECEIPT DATE BY DATE FINALED INSPECTOR ,✓1 6-, INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms 8 Footings Ducts Slab Grade Return Air Steel -Z _00 `,c Combustion Air Roof Deck v, z- , e040 Exhaust Fans O.K. to Wrap y - CO F.A.U. Framing co Compressor Insulation p 100 Vents Fireplace,P.L. Grills Fireplace T.O. Fans & Controls Pa all Insulation Condensate Lines P rty Wall Firewall Exterior Lath b00 Ca Drywall - Int. Lath 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 -1t -60 Heater 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 Appliances Final Final Utility Notice (Gas) p 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) COMMENTS: INSULATION CERTIFICATE IC -1 79-341 Sierra Vista La Quinta Number and Street City Riverside 27519 50 County r 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 lb. Minimum thickness inches Manufacturers 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 Standerds for residential buildings (Title 24, part 6, Califronia Code of Regulations) as indicated on the Certificate of Compliance, where applicable. 27/00 PARAGON INSULATION Item #s 68ignaturDate - 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 ON Signature, Date Installing Subcontractor (Co. Name) OR General Contract (Co. Name) OR Owner