9801-113 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby,affirm under penalty of perjury that I am licensed under provisions of
CK ter 9`(eommencing with Section 7000) of Division 3 of the Business and
Professionals Code, and my License is in Lull force and effect.
License #� Lic. Class Exp. Date
t1i3 � 1 .'i ii 7134AIR
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 amLL,exempt under.Section B&RC. 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.
NI 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.
(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 Sectio 3700 of the Labor
1Code, ,•I s all forthwith comply with those pro igion
Date: Z- 0 Applicant—
Warning:
pplicant 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
the above-mentioned property for i spe, on*purposes.
/Signature (Owner/Agent) Date
PERMIT# CONTROL#
BUILDING PERMIT
DATE J� VALUATION 15420,647.40 LOT TRACT _ 6
JOB SITE
ADDRESS
APN
OWNER
CONTRACTOR� /YDESIGNER /pENGINEER
i.Z3� W.t1R°C��> ii.y
1282 W. MI ROW Ii�i� :r
LITILAND CA 9 170
UPLAND
USE OF PERMIT
3..1.3 i 'k !„ �;1,�3,[V 'd��#�. :��k.9 •� t•'�':i�i411'd. 91tJt•� IVt1 £ ll�f:l..i:r;L)� L#[.i�6�1:w Lto�l��;d.��
(YR, POOL" K.AIN (IR tea: REJ- t?CE-V 'i'i -i+ PHk .MIJL'PJ. -%9 J tiSUANC-"%'
OF SAA49 V4,A1•Y'L YT.
"f RAC7i01NaTRUCTJG.23(1S.C3 ar
1:101K+w'.I•IMA 10 14.f10 S)
3S3.00 SF
E!+1) � - T Off' �'ONK. t':"�_fi.�
PERMIT FEE ,SluNtf ARA
PLt11+f CIMC:`:I5:M',
113 L t:GL?J1ErAi, #r.#�L lot • t?f3ii-fi'� a �+1ili} �t7.6�
..ErLP-C��'fZp/z�:��;�ALL.iii�f i4jtl-i( �/U�/tf�t�� S{�130.44
{j {:�i
dbi.?.11.V71AINCY FEF - ft1.i1-000-41�--000 $148.00
STt7C, N0 kAOTION OFF-.RIESfi.`! 101-ia-vi-4 on Sty .m
1+IE?f�A +"i hF (; Jif2 E?F 225-00C"43-342 6a 71f3. Jt3
A T IN r 0.BJ fC PLACES - R: SIC 701.OW-25..(MO
!c'I tayl�n��
tp,Rttg 911 .
yli
p�_ r. r
RECEIPT
DATE _
BY
D:nXe
INSPECTOR
INSPECTION RECORD
j, OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
,,et Backs
r
Q
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air '
Steel
Combustion Air
Roof Deck
�7=�
Exhaust Fans
O.K to Wrap
- (/ .
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
Final
Final
-� —
POOLS - SPAS
BLOCKWALL APPROVALS
Steel^
Set Backs
=
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
—9 - Q& _
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
OX for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
— -
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wining
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles ;
G.F.I.
Smoke Detectors
Temp. Use of Power
;i
.&Final
.
:.UtHity Notice (Perm)
Residence Address: Desert Pride Lot 11 Plan 4B
45-170 Sunbrook La Quinta, Ca
CERTIFICATION: This is to certify that attic insulation has been installed in conformance with
the covelrag�hart recommendations on the oppo i�e side of this card using 56 bags to
cover F § 5 sq. ft to obtain an R•value of
Contractor's authorized signature 74a& 9 WJJA db
Date: May 14, 1998
Installed by:
ROVER INSULATIO14
74 741JON' DRIVE
PALM DESERT, CA 92260
Builder.
•
R -PRO P
(Formerly Cordex)
STABILIZED INSULATION
MANUFACTURED BY
GREENSTONE INDUSTRIES
Atlanta, Georgia • Elkwood, Virginia • Ft. Wayne, Indiana
Norfolk, Nebraska • Phoenix, Arizona • Portland, Oregon
ATOMIZED PNEUMATIC APPLICATION COVERAGE CHART
3.5
39.6
Net Coverage
.758
RA/alue at
Minimum
No Adiiistmanf for Tnm"s
Gross Coverage
Based on 2 x 6'
Maximum
Minimum
75°F Mean
Temperature
Thickness
Thickness
Trusses on 16'
Weight Per
Centers
Coverage
Square Foot
To Obtain
Installed
Square
Minimum
The Weight Per
Suare
Bags
an Insulation
Insulation
Feet
Bags
Sq. Ft. of
Feet
Required
Resistance
Should Not
Per
Required
Installed
Per
Per 1,000
(R) of
Be Less Than
Bag
Per 1,000
Insulation Should
Bag
Square Feet
(inches)
Square Feet
Not Be Less
Than: (lbs)
R-50
13.5
20.5
48.8
1.464
21.3
1 46.9
R-42
11.4
24.4
41.0
1.230
25.6
39.1
R-40
10.8
25.6
39.0
1.172
26.9
37.2
R-38
10.3
27.0
37.1
1.113
28.4
35.2
R-32
8.6
32.0
34.1
.937
34.1
29.4
R-30
8.1
34.2
29.3
.878
36.5
27.4
R-24
6.5
42.7
23.4
.703
46.4
21.6
R-22
5.9
46.6
21.5
.644
51.0
19.5
R-19
5.1
53.9
18.5
.556
59.6
16.8
R-13
3.5
78.8
12.7
.381
87.0
11.5
R-11
3.0
93.2
10.7
.322
102.8
9.7
Sidewalls (pressure Filled -density 2.6 PPCF)
R-13 (2 x4)
3.5
39.6
25.3
.758
R-20 (2 x 6)
5.5
25.2
39.7
1.192
Note: This coverage chart compensates for settling and is for estimating purposes only.
Stated R -Value is provided by installing the required number of bags per 1000 sq. ft. at a
minimum installed thickness. Installation of the required number of bags may yield more
than the specified minimum thickness and minimum weight per sq. ft. Actual coverage will
be influenced by job conditions and application techniques, and may vary as much as 10%
without significantly affecting the stated R -Value. Failure of the installer to provide at least
the required number of bags per 1000 sq. ft. and at least the minimum thickness may result
Builders Desert Pride Lot 11 Plan. 4B
Cerlain eeO
.rl
Insulation Statement 45-170 Sunbrook
La Quinta, Ca }
12
k1sulsafeill
Fiber Glass Insulation
InsuP afe Ufa has been Installed with the
manufacturer's recommendations to pro-
vide a value of R using bags
of Insulation to cover square feet of
area at a minimum thickness of
inches
ict,sralWr Cams&= (Sign)
Batts and Blanket
R -Value
Insulation Thickness
R-38
1fr, 12-
R-30
81/4". 10'
R-22
6'/i
R-21
5'/8,
R-19
6'b'
R-15
3'/.
R•13
3'/:
R-11
3'/#
Complus with ASTM C 666
Flber glass batts or rolls have been
Installed In accordance with the manu-
facturer's recommendation to pi5vlde
an R -value of 38 In the ceiling, In
the exterior walls, in the floor
ter.
awl spa
ir etauw Contractor (Signa).
ROVER INSULATION R ACCX S] TTr, Tnr
Company Name
May 14, 1998
e
Buildw (Sego)
company N"
Date
Thermal Performance — Attic Blowing Application
• in accordance with the chart bellow, you mutat Install uw miturnum number of bap, pow -1,000 4q
of net area for each R -Value listed.
• Tlw maximum net coverage must not exceed that specified for each R -Value.
• The installed insulation must be at or above the specified minimum OucWwss for each R-Vahw.
Is Failure to install the required mulunum weight per sq. h, of irlsulaUon at or above the rWwr4(n
thickness will result in reduced R -Value.
is This product stlould not be mixed with ottwr Blown insulations or to OwmW clairne will beoom
invalid.
R•VALUE
BAGS PER
1000 So. FT.
MAXIMUM
SO. FT. PER BAG
MINIMUM WEIGHT-
POUNDS PER SO. FT.
MINIMUM
THICKNESS
To obtain theirrial resist"
(R) ot:
per
to
000 W. h.
of net mox
Contents of bap -
should not cover
more than: (sq. IL)
Nkprr lint sq. k d
resoW nsulauon should
. oato au awl (ns)
Wuld not b
Ibss Iron:
Irlchwl
R-60
42.6
23
1.064
23'
A-49
34.3
29
0.868
10114,
R-44
31.1
32
0.776
17V4*
R-38
29.6
38
0.666
15 Y0
R-30
20.8
46
0.521
12'/e'
R-26
19.1
56
0.452
11'
R-22
15.0
67
0.374
9'h!
R-19
13.2
76
0.330
6'/.• 7-7
R-13
9.0
111
0.225
614'
R-11
7.4
136
0.184 ,
1'%l
WValues are determined in accordance with ASTM C 687 and 518. Corro" wiM Aa'T 7
as Type 1 insulation.
'R' means resistance to heat flow. The higher the R•Value, the grater ft haulaflnj power.
get the marked R-Valus, it is essential that Iha insulation is uwtalled property.
DANGER: RECESSED LIGHT FIXTURES — TO PREVENT OVERHEATING, DC NOT
INSULATE ON TOP OR WITHIN 3' OF SUCH DEVICES. DOES NOT +1PPLY
TO TYPE IC LIGHT FIXTURES OR TO FLUORESCENT FIXTURES WITH
THERMALLY PROTECTED BALLASTS.
Framing Adjustment
To compensate for framing members the number of bags per 1000 sq. ft. of net ares Should
reduced as follows:
'.Joist Size
Bags b Dorhad / 1000 sq. L
Joists 16'O.C.
W to Deduct /1000 sq.
Jun 24 J.0
2' x 4'
0.5
0.4
2'x 6'
0.9
O.E
2-48,
1.1
O.E
2' x 10'
1:4
I.C.
CertainTeed Corporation, P.O. Box 8601 Valley Forge; PA 19482
Code No -30-2+0W 01995 CenaintTeed Corp*rWw