0003-178 (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
,Pirdiessionals Code, and my License is in full force and effect.
License # Lic. Class Exp., Date
X714188 B n / 10/31/204
Date '! r -Signature of Contractor. F �� r' lA 2
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 noVintended 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). •-1 `
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.
( ) 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 Policy, No.
C01.OI�N EA.CLE, Tf & N�r'r' 3+41Q63 f?l.
(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 thel6bor
Code, I shall forthwith comply with those provisions.
Date: �1-y.�i C?« "Applicant -:t� A i l.•+ .c 7�' .,
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 .t6 .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
llie abuve=rnenlluried pruperty fur inspection purpuses. 3
Signature (Owner/Agent) At +l -"A4 j_:j�`p� Date �%���f��
u BUILDING PERMIT PERMI400-178 y-
DATE VALUATION S11<7.846.00 LOT- (to TACTR
� Sys � 9� _ �
JOB SITE -79�381 _SIERRA VISTA
APN 610'4 61-009
ADDRESS
OWNER
CONTRACATOR/iDpESIGN�E)R,/ENGINEER
7y��p1�/�E� y Y y t+ • p ry� pC+
C1 IV.0 UR l CR0 Oxfir.°. i, 1, l.�.iavii`i.1i :i k .FS
�f(ry'. p y �+
C.�.iti. URie C71.iOWr,'.Tr..ie Cr%� a�'li�i. 1 i1Gt;1S
1535 SO. "D" Sd°REET' STE. 000
15:35 SO. "D" S':1'REET,, S.f'E. #2.00 -
SAN EERNA`R.131NO CA 921 408
SAN .33E.RN.AR.1Ji1 O CA 92408
(909)381 7 CBL# 2120
USE OF PERMIT
:. Slt�i(sl.� l�A�+i.i1.,1' �)V✓�:.1.,�.i.f�t.f
'
SFD LOT 46 PLAN 50 PERNUT DOES NOT INCLUDE BLOCK WALL OR
1'CXX. 7:3ao 1'aLAN CHECK i7HE :KMILIG110N ON MUL IPLE ISSUANCE, OF
Si Vf.E, PLAN :f"YPE.
71ZACT CONSTRUCTION 2,008.00 -,F
PORC13iT'►ATIO 48.00 $
0Af(At`:+0C:;AFtK)RY' 417.00 SW
ESTU CLITED COST OF CONI &rRUCT ION
117M6.00
'PERMIT FEE SUMMARY ,
CX)NSTRUC11110N VEH :101-0()0-418-()00 $702. it)
PT.A1 rINFO h'F}, !()1.0{10^ 9-:1$ $146,01
�..,
�} 1-i[y)(i�Z��- . :53.50
;pit;�r�vi9a"i '1r7
2 "�
TEI1 j
`'i"i (tib-v�vr�t (� i
7.:d.fiCT 1.t�.iAL FrY= 1.�1'VLN^�'4��7"V��ii 5127.12
w"` ^•�S`
t�Lf1n21stnttif F 10.1-000-419-000 si46.75-
STRONn MO'n N f; IFF •- R Sr'D 101-000-'7.41.(,M $'111.713
;' , r; r t-"
#
L112tai)J2a`G C'f 101-000-42-1.000
DEVE1.0fJ:OR HVIPA.CT Fr -Z 51.907.00
.4
AAI N PUBLIC.: PLACES - R SW 701.000-255-000 $44.62
SUB-1"0q7U, fy.ONS'11Z(JCT10N AND PLAN CHECK
UNS .r- 0,E--PA1D fFVr:S
VIO0
T(D'1'A4.,.r'i,ik(i IVI' FEWS DUE NG►'lilr
S31159.30.
RECEIPT
DATE
BY
(//1.
DATE FINALED
INSPECTOR
14. OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
. [b- ft
Return Air
Steel
5-- _ -.0
Combustion Air
Roof Deck
G
Exhaust Fans
O.K. to Wrap
J (
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
Drywall - Int. Lath
15 -IT. pp CdFCK
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 I
I
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
' —3 s>'
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
Q.K. for Finish Plaster
Sewer Lateral
-
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
S>7
Appliances
Final
Final
Utility Notice (Gas) o
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 a
Utility Notice (Perm) Tit
COMMENTS:
INSULATION CERTIFICATE IC -1
79-381 Sierra Vista La Quinta
Number and Street City
Riverside 27519 46-
County
6-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
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)
r ,
6 FOUNDATION WALL
Material
Thickness (inches)
Declaration
Brand Name . Certainteed
Thermal Resistance (R -Value) R-13
Brand Name
Thermal Resistance (R -Value)
Brand Name
Thermal Resistance (R -Value)
Brand Name c
Thermal Resistance (R -Value)
Brand Name
-Thermal Resistance (R -Value)
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 Complianc ,where applicable.
9/27/00 PARAGON INSULATION
Item #s ignatur Date U 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