9801-119 (PAT)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
6916A4 !i "xl_a "t tryS
aie 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:
Carrier Policy No.
y' A:11' : 'MUNI
(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
de, I shall forthwith comply with those provisions
ate: F Applicant—
r
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 propertyforinspection purposes.
/Signature (Owner/Agent) f �Date
BUILDINGPERMIT PERMIT /1 °°NTR°`"
nATF VAI I IATION -a ;y;� I (1T .� , TRAr:T V76-
7,1
JOB
ADDRESS ''45-19' ; SU:I��S.R�SOK LANE
APN , 6*U-302-001
OWNER
CONTRACTOR/DESIGNER/ENGINEER
IINCIO1401�VIF C )'2.F'.
7C Fd;3It1F"s5 1'O.:f'.
1282 W. Al2ROW 1-1WY
1282 W. A1t13.0W HWli
UPLAND CA 91785
UP1_ ANO CA 91.78.5
-8089 :. �.: BUY' 3318
USE OF PERMIT
PATIO
LOT 11- �
1-14 S.F . t..KrVIC".E P.0010 Li >! 10t.
ESTIMATED CWT OF CONSTRUC-1101\1
2,79100
t'i RiV U FEV,S61MMARV
(.", `tdS'i'RUC'rI ON "FE6 1014)00-418-000 1540)
.§7`1tC'YtirCa fC�?'9S ?�11TF-.R3'(y ► Ii31.,(lfj(12,5!_t111b 5.50
c'
r #5
a {
S(JP1401-A- 1, ClvtW1RUC.7110N AND PLAN CITECK.
$51.50
USS PRE -PAID FEES
$0.(i()
RECEIPT
DATE
BY/
DATE FI ALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING ' APPROVALS
MECHANICAL APPROVALS
_ Set Backs
Underground Ducts
Forms & Footings —
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
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 Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
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
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Maln Service
Sub Panels
Exterior Receptacles
G. F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
Residence Address: Desert Pride Lot12 R AI
45-195 Sunbrook, La Quinta, Ca
CERTIFICATION This is to ccrnfy that attic insulation has been installed in conformance with
the covcragc j%, on the opp(joe ,idc of this card using 52 bags to
,over I sq it to obtain an Rvalue
Qoof 33 _ -
Contractor's dutho(t_eJ agnanlre 4Vz _ice(�UU A -
�
�, 22, 1998 - ATOMIZED
----
Daic
n0 & R PRO PLUS
•
(Formerly C)rdex)
STABILIZED INSULATION
MANUFACTURED BY
GREENSTONE INDUSTRIES
Atlanta, Georgia • Elk -wood, Virginia • Ft. Wayne, Indiana
Norfolk. Nebraska • Phoenix, Arizona • Portland, Ore. -on
PNEUMATIC APPLICATION COVERAGE CHART
3.5
39.6
Net Coverage
1 .758
R -value at
5.5
No Adjustment for Trusses
Gross Coverage
1 1.192
Minimum
Based On 2 x 6'
Maximum
Minimum
75°F Mean
Thickness
Trusses on 16'
Temperature
Net
Weight Per
Centers
Coverage
Square Foot
To Obtain
Installed
Square
Minimum
The Weight Per
Suare
Bags
an Insulation
Insulation
Feet
Bags
Sq. Ft. of
Feel
Required
i;esistance
Should iat
Par
Required
Installed
Per
Per 1,000
;R) of
Be Less T a.^..
bag
Pcr 1.000
Insulation Should
Bag
Square Feet
(inches)
I
Square Feet
Not Be Less
20.5
Than: (Ibs)
R 50
13.5
) 48.8
1.464
21.3
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
1 .758
R-20 (2 x 6)
5.5
25.2
39.7
1 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. It. at a
minimum installed thickness. Installation of the required number of bags may yield more
Builders
Desert Pride Lot .12 CertainTeedint
Insulation Statement 45-195 Sunbrook
La.Quinta, Ca
InsuiSafeill'
Fiber Glass Insulation
Insul-Safe III' 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.
4gstaller Contractor (Sign)
Batts and Blanket
R-Value
Insulation Thickness
R-38
10-,12'
R-30
81/41, 10"
R-22
6'/i
R-21
5'/a
R-19
6'/:
R-15
31h"
R-13
3'/:'
R-11
3'/:
Complies with ASTM C 665 1r
Fiber glass batts or rolls have been
installed In accordance with the manu-
facturer's recommendation to provide
an R -value of 38 in the ceiling, 15.. 'in
the exterior walls, In the floor
Ta
awl spaeter.
ller Contractor (sign)
ROVER INSULATION R AMID..qTT(` Tnr-
Company Name
Date
May 22, 1998
Builder (Sign)
Company Name
Date
rt
P% Code No.30-24-092
a,
Thermal Performance —Attic Blowing Application
■ In accordance with the chap below, you must Install the minimum number of bags per 1,000,sq, ft.
of net area for each R -Value listed.
r The maximum net coverage must not exceed that specified for each R -Value.
Is The installed insulation must be at or above the specified minimum thickness for each R-Vabje.
is Failure to install the required minimum weight per sq. ft. of insulation at or above the minimum
thickness will result in reduced R -Value.
e This product should not be mixed with other blown insulations or the thermal claims will beanie
invalid.
R -VALUE
BAGS PER
1000 SO. FT.
MAXIMUM MINIMUM WEIGHT-
SO. FT. PER BAG POUNDS PER SO. Fr.
MINIMU'd
THICKNESS
To obtain a
thermal resistance
(R) of:
Bags per
1000 sq. R.
of net area:
Contents of bag Weight per sq. ft of
should not cover installed insulation should
more than: (sq. R.) not be less than: (lbs.)
Should no. be
less thas:
(inches -
R-60
42.6
23 1.064
23-
R-49
34.3
29 0.858
R-44
31.1
32 0.778
174/4-
7'/:'R-38
R -38
26.6
38 0.665
15'/i
R-30
20.8
48 0.521
12'/s
R-26
18.1
55 0.452.
11'
R-22
15.0
67 0.374
9'/:
R-19
13.2
76 0.330
8'/:
R-13
9.0
111 0.225
51/:
R-11
7.4
136 0.184 r
4'/:
R -Values are determined in accordance with ASTM C 687 and 518. Complies with ASTM16764
as Type I insulation.
"R" means resistance to heat flow. The higher the R -Value, the grater the insulating power. To
get the marked R -Value, it is essential that the insulation is installed properly.
DANGER: RECESSED LIGHT FIXTURES —.TO PREVENT OVERHEATING, DO NOT
INSULATE ON TOP OR WITHIN 3" OF SUCH DEVICES. DOES NOT APPLE
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. h. of net area should pe
reduced as follows:
Joist Size
Bags to Deduct/1D00 sq. R.
Joists 16'U.C.
Bags to Deduct / 1000 sq; Q.
Joists 24'0.C.
2" x 4'
0.5
0.4
2'x6'
0.9
0.6
2" x 8'
1.1
0.8
2' x 10'
1.4 -
1.0
CertainTeed Corporation, PO. Box 860, Valley Forge, PA 19482
01995 CertainTeed Corporation 10/95