9801-110 (SFD)1 LICENSED CONTRACTOR DECLARATION .
U)_ F.R, Ikhlereby 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
W - _ Professionals Code, and my License is in full force and effect.
O =) M License # Lic. Class Exp. Date
t` LL1 O 691684 1M r 1� 115
o OZ r- \Pate , s� Signature of Contractor ` • ����
CD_-
J U C) OWNER -BUILDER DECLARATION
FW- a- I hereby affirm under penalty of perjury that I am exempt from the Contractor's
U) License Law for the following reason:
Z_ ( ) 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
LO
N Date Signature of Owner
ON
a)
2< WORKER'S COMPENSATION DECLARATION
C) Z I hereby affirm under penalty of, perjury one of the following declarations:
LO p () 1 have and will maintain a certificate of consent to self insure for workers'
X W t : compensation, as provided for by Section 3700 of the Labor Code, for the
O � Q performance of the work for which this permit is. issued.
m Q U ( ) I have and will maintain workers' compensation insurance, as required by
O CD Q S ion 3700 of the Labor Code, for the performance of the work for which this
rn H p, rmit is issued. My workers' compensation insurance carrier.& policy no. are:
'It z Carrier Policy No.
°�° O SrAll FUND 1411093:1-97
Q (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
3 subject to the workers' compensation provisions of Section 3700 of the Labor
Code, I shall forthwith comply with tho "'p�(ovisiens. `�
Pate: % Applicant ` .� `
Warning: Failure to secure Workers' Compensationte 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 inspection purposes.
�rZZ
ignature (Owner/Agent)\ Date'
BUILDINGPERMIT PERMIT# °°NTR°`"
DATE-'� f VALUATION.,¢P .40 LOT �J TRACT
JOB SITE
ADDRESS riti•Bwl)��A1fVi+9{i�t1Ei �1?.
APN
Q;11�8�.9�9A.-i39�
OWNER
CONTRACTOR / DESIGNER / ENGINEER
INIM 1 ;tE
."Co .1i0;;IIES CORP.:
1282 W. ARROIN HWY
1282"W. ARROWYWY
UPLAND CA. 91785
UPIAND CA 917€ 5
(qww� A -87,R') 0313LIt 3118 .
USE OF PERMIT
.OT 9, PLAN 4,13PL SVD - K't'r D013S NOT MCLIJDE BLOCK t6r'LLLS
T'klit; t' C(a earsru 1' ow 12I NUO 3F
POKC: i-UP'rl`. IO 14.00 5TH
C' IARAf,F+:JC;Ard'6Xr 583.00 SF'
N9 -TX 31AT1,,'D (: 0;? WNW RUCTION
820,647.40
PERMIT P EXSUMMARY
PLAN CHFC X FIE 101-OW439-31,8 $59 LI 6
< )NS';fMICTION FEE 10,14401-419-000 1.''Q,2-5
Z1iCI'ANICM1 1119E IN -OW -421-000
O.13";:
INSPECTION RECORD
- OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab GradeE�
-la-- Q
Return Air
Steel
Combustion Air
Roof Deck
—
Exhaust Fans
O.K to Wrap
3_ fi
F.A.U.
Framing
—3 —
Compressor
Insulation
X &
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
— —Q
Drywall -.Int. Lath
— p — ,•
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
Sewer Connection
3 —
Pool Cover
Encapsulation
Gas Piping
Gas Test
Appliances
Final
1 ,
COMMENTS:
Final
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
Utility Notice (Perm) �_ Q�
Residence Address: Desert Pride Lot 9 Plan 4B
45-210 Sunbrook La Quinta, Ca
CERTIFICATION: This is to certify that attic insulation has been installed in conformance with
the coverage chart recommendations on the opposite side of this card using 56 bags to
cover 1, 915sq. ft- to obtain anR-valueeof 3,0,,r
Contractors authorized signature 4\A clo -M is
Date: May 14, 1998
Installed by:
ROVER INSULATION
74-741 Jl0N' DRIVE
PALM DESERT, CA 92260
Builder:
anR -PRO PLUS
(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
R -Value at
5.5
No Adjustment for Trusses
Gross Coverage
75°F Mean
Minimum
Based on 2 x 6'
Maximum
Minimum
Temperature
Thickness
Trusses on 16"
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
Feet
Required
Resistance
Should Not
Per
Required
Installed
Per
Per 1,000
0) of
Be Less Than
Bag
Per 1,000
Insulation Should
Bag
Square Feet
(inches)
Square Feet
Not Be Less
Than: (Ibs)
R-50
13.5
20.5
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
.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 9 Plan 4B
Insulation Statement 45-210 Sunbrook CertainTeoll
La Quinta, Ca
Ifusulsafelli,
Fiber Glass Insulation
Insul-6afe V 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
tQ_suwer Conuaaor (Sign)
Batts and Blanket
R -Value
Insulation Thickness
R-38
l(', 12'
R-30
81/41, 10'
R-22
6'/i
R-21
5'/i
R-19
8'/.'
R-15
3'/a*
R-13
3'/i
R-11
3'/i
Compass with ASTM C 865 - — i
Fiber glass batt& or rolls have been
Installed In accordance with the manu-
facturer's recommendation to provide
an R -value of In the ceiling, 13 in
the exterior walls.._in the floor
awl spa p� imeter.
I laver Com==er (Sign).
ROVER INSULATION & AMIgTTr, Tnr-
conroany ams
May 1998
=0 7,
Builder (Sign)
Company Name
Date
Thermal Performance — Attic Blowing Application
rr In accordance with the chen below, you must Install me nwumum number of Daps per 1,000 ttq
of net area for each R -Value hated.
• The maximum net coverage must not exceed that specified for earn R -Value.
is The installed insulation must be at or above the specified minimum Utickness for eacr R-Vebw.
■ Failure to install the required mutunum weight per sq. ft. of insulation at or above f ¢li W ulfn
thickness will result in reduced R -Value.
■ This product should not be mixed with other bbwn insulations or tw thermal Bairns vA becorn
Invalid.
RNALUE
BAGS PER
1000 So. FT.
MAXIMUM
SO. FT. PER BAG
MINIMUM WEIGHT-
POUNDS PER SO. FT.
MINIMUM
TJICKNESS
To obtain a
Ihernal resivance
(R) of:
Baas par
1000 W. ft.
of net area:
Contents of bap -
should not cover
mon than: (q. IL)
V*.q r W sq. 0. d
lhswix! insulator snoul0
. oa be b66 share (ba)
6MUld not b
less Irian:
(vxhhu)
FI -60
42.8
23
1.064
23'
R-40
31.3
29
0.868
19'/:
R-44
31.1
32
0.778
17 Y4*
R-38
26.6
38
0.666
15 Y0
R-30
20.8
48
0.521
12 'is'
R-26
18.1
55
0.452
11'
R-22
15.0
67
0.374
9'1,'
R-19
13.2
76
0.330
8'/:
R-13
9.0
111
0.225
5114'
F111
7.4
136
0.164 r
-1 H.'
R-Vatuea are determined in accordance with ASTM C 687 and 518. Complies will TSTA' .7
as Type I inaulabon.
'R' means resistance to heat lbw. The higher the R -Value, the grater the Insulating power.
gel Uw marked R-Valus, it is essential that the insulation is Installed property.
DANGER: RECESSED LIGHT FIXTURES — TO PREVENT OVERHEATING, DO NOT
INSULATE ON TOP OR WITHIN 3' OF SUCH DEVICES. DOES NOT APPLY
TO TYPE IC LIGHT FIXTURES OR TO FLUORESCENT FIXTURES KITH
THERMALLY PROTECTED BALLASTS.
Framing Adjustment
To compensate for framing members the number of bags per 1000 sq. tL of net area bhould
reduced as follows:
Joist SUB
Bags to Deduct / 11100 sq. L
Joists 160.C.
Bapt to BWW IF 10W tq.
Joists 2e"O.0
2' x 4'
0.5
CIA
2'x6'
0.9
OB
2'* 8'
1.1
08
2' x 10'
1 A
110
CertainTeed Corporation, p0: Box 8601 Valley Forge; PA 18482
Code No.30.24-092 of 995 CertalnTeeo Concretion