0003-171 (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
7141813 B 10/311V
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 0Signature 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 0OL DEN FdAciL I139. Policy No. 1d11dC 544058-01
(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 1 should become
subject to the workers' compensation provisions of Section 3.700 of the Labor
Code, I shall forthwith comply with those provisions. `
Date: Applicant
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety,
for a permit subject to the conditions and restrictions set forth on his
application. -
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
thp. nhnve.mantinnarf prnpQrty fnr incpprtlon pUrp^£4£.
Signature (Owner/Agent) Date
BUILDING PERMIT PERMIT#
DATE VALUATION LOTS(- 0.1471. TRACT
JOB SITE
APN ,
ADDRESS A tnrxverw
�l rscr
6D4 -0614.M
OWNER V
CONTRACTOR/DESIGNER/EN (NEER
CENTURY C ROWELL. CO-fdMLr1 TTX3
CENTURY CR,OWELL C01V%.q* 1;T M
1535 SO. V M�:Tr M 4€2010
1535 30.9711'3'FF.;1T1', MOM
SAN' Bk:R$IARDWO CA 9240th
SM BEMARI)I lO CA 92408
(909)381.600/ M4 2.120
USE OF PERMIT
MNOJ Y, F AUTLY DWiIAZIC1•
SFD• LOT 36 PLAN 3 PERMIT .L OES NOT INCLUDE BLOCKWALL OR
FOOL,. 13% PLAN CHECK F10, REDUCTION ON MU6T.IPL,8 ISSUK14CE OF
SAME PLAN TYPE
TRACT CONSTRUCTION
PORCHIPATIO 84.00 SF
SlARA,GVCARPORT 4.17,00 SF
ESTI1i3ATRID COST OF C014S"T`1! UC OR
100,460£,10
PERMU ME SUIM"RY
COASTRUCTION FSE 101.000.418-000 $643.00
PLAN CHECK P99 101-000-439-318 $133.35
4AECHANIC AL FEE 10141100-421-000 $53.50
ELECTRICAL PEZ 101-000.420-000 $113.61
PL.UM81ING FRE 101-000-419-000 St28.75
ST'RIONCI MOTION FEE • RESID '1111.000-241-000 $I0,05
ORADINO FRE 101.00(1.423-000 $:20.00
DEVELOPER IMPACT ISE $1,907.00
ART IN PUBLIC PL.AC 88 - RT?.SIL 701-000-253-000 $20.00
SUB -TOTAL. COMMUCTI ON .AITO PLAW C 1.WC_C.
$3,031.46
LUSS PRE -PAM FEVI
TOTAL PEMI iT M6 DIM NOW
1 ,
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
t go
Ducts _
Slab Grade
to. eS
Return Air
Steel
F- I . W [
Combustion Air
Roof Deck
U a 0 -0A
Exhaust Fans
O.K. to Wrap
.4 . ,
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
1514 --
Drywall - Int. Lath `
Final
Final
o
POOLS - SPAS
BLOCKWALL
APPROVALS
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
e(. rt -cue
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
�2q oo
Appliances
Final
COMMENTS:
Final m
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 o v
Utility Notice (Perm)
INSULATION CERTIFICATE IC -1
79-360 Sierra Vista La Quinta
'Number and Street city
Riverside 27519 36
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
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
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 Compliance', 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
11
Installing Subcontractor (Co. Name) OR
General Contract (Co. Name) OR Owner