9801-117 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
F. Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
04 UJ Professionals Code, and my License is in full force and effect.
O ch License # Lic. Class Exp. Date
Wt l 3 r� iiy ^;v
oZ r /Date Signature of Contractor
Ca O
J U C=) OWNER -BUILDER DECLARATION
W Lu r— I hereby affirm under penalty of perjury that I am exempt from the Contractor's
~ a License Law for the following reason:
Z_ ( ) 1, 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
L
N Date Signature of Owner
ON
a- Q WORKER'S COMPENSATION DECLARATION
o zCc I hereby affirm under penalty of perjury one of the following declarations:
Lin H p () 1 have and will maintain a certificate of consent to self -insure for workers'
X w Y= compensation, as provided for by Section 3700 of the Labor Code, for the
O J Q performance of the work for which this permit is issued.
CD Q U ( ) I have and will maintain workers' compensation insurance, as required'by
O Q Section 3700 of the Labor Code, for the performance of the work for which this
liLIDH permit is issued. My workers' compensation insurance carrier & policy no. are:
Z Carver Policy No.
r O `ai'�lli:i`t'nvi3 i3'°<ft'41•�i
J
(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 fort with comply with those provision
/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 cancellatioh.'
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'nspectioi p oses.
VSlgnature (Owner/Agent) Date
PERMIT # CONTROL #
BUILDING PERMIT
DATF VAI IIATION �. W4),IYuGb, tfD LOT n : TRACT `y�,
ha
JOB SITE
ADDRESS 4;-255 i JN&iiifli.Il0.K LANE
APN
6 04 i"W �':� ;
OWNER
CONTRACTOR /DESIGNER /IENGINEER
f4xl��ul(,fi7�t:�,
li �qi. a� /tkill1to
itow
3�ti't�11i ��1:
(411AM) f',A 'Will*
('A
#010 3W14,
USE OF PERMIT
Lt ) 11,i. IMLs N iliit oa&%1,► - Y'i'',IFWt 1 0 h.S iM �l 1.1V':1 -t 01,, P.41,( A tv W AI L5
to VCAN,
RAC "r (NAN441C t X710:4 1,11 l.t yt18i ,
i?0Xt_J*NE4.f11) 141, 9 S1;
(3• AR.AC11y('A1&( IP),i'�J IQ-
Y t,oilAr b: ndJ (UST t. FCO S 1114AX;! 4'l N
i7 ii AATsy�, ;y �i { [C. i A y A .i'.sW
,g�n�'X. Ys► 91'
:iQfiP
_Va7P71.?'
' 9
14,Aa(.
s`JX%jyZllt"TI()Mr1iI InI_010-4)I,,49if) 'N4tI fir)
_NVfiK7TA!`'4W A L VVI: 10140.19:1-OVO t.qf
W,1;(.'I C�lt-`WAL i' LI I O3� �f?il -e ft-CiJai �f l ttII>o� 1
?JINTBINN l PH— I 'tot - -M-4 111,.0 19Sl 3 � r9t4
rraC�r�fl�ac��ir�tivf�l.)°��,t��tt:y )i11�f1tlft•,��I$ ls�t1 �r3ia��
t" f?r^%1-)1 G HI i(91 ()1>t1 � 3 R`11t °,'ar tfif
22.: AA) -443-142 St: ,fry :Vi
Nev Ji ITY"All,, (A ANO P1.,AN1 t V'('N'
LESS PkVKVWVY'T',S
19 1�11
Tij'VA11-.r Y �'�li�'.'t A•T• X'�Lja �v l/i���, !iVb /)�!
�.7 �oE).�L�J
{a._,,x Y
RECEIPT
DATE
By t° '-
DFyTEA D' g
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
TINSPECTOR
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
—/L
F.A.U.
Framing
— c? —Q
Compressor
Insulation
_ / —
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
a —13 —
Drywall - Int. Lath
Q — 2,3 —
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
—/O — ,
Heater Final.
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
— 3 — ff zr
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
Main Service
Sub Panels
Exterior Receptacles
G. F.1.
Smoke Detectors
Temp. Use of Power
c
Final -
Ulifty Notice (Perm) � ,
Residence Address: Desert Pride Lot 15, Plan 1
45-255 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 54 bags to
cover 1, 458 sq- fc to obtain an R -vat 38
Contractor's authorized signature
Date.
�M
Installed by.
e:RUVLH INSULA I 11U11
I
74.741 in 1 DRIVE
r� PALM DESERT, CA 92260
1619) 346-2339 .
Builder.
nR PRO PLUS
(Formerly Cordex)
STABILIZED INSULATION
MANUFACTURED BY
GREENSTONE INDUSTRIES
Atlanta, Georgia • Elkwood, Virginia • Tt. Wayne, Indiana
Norfolk, Nebraska • Phoenix, Arizona • Ebrtland, Oregon
ATOMIZED PNEUMATIC APPUCATION COVERAGE CHART
3.5
39.6
Net Coverage
Gross Coverage
R -Value at
5.5
No Adjustment for Tosses
Based on 2 x 6'
75'F Mean
Minimum
Thickness
Trusses on 16'
Maximum
Minimum
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
Feet
Required
Resistance
Should Not
Per
Required
Installed
Per
Per 1.000
(R) of
Be Less Than
Bag
Per 1,000
nsulation Should
Bag
Square Feet
(inches)
Square Feet
Not Be Less
Than: (lbs)
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
Sidewalk (pressure Filled -density 2.6 PPCF)
-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
4.
Builders Desert Pride Lot 15, Plan 1 GertainTeed C�
Insulation Statement 45-255 Sunbrook
La Quinta, CA 92253
Insul-Safelil°
Insul-Safe III@ has been installed with the
manufacturer's recommendations to pro-
vide a value of R using
bagsofinsulation tocover square
feet of area at a minimum thickness of
inches.
Insulation Contractor (Sign)
Company Name
Date
Builder (Sign)
Company Name.
Date
Batts and Blanket
R'
Value
Insulation
Thickness
R-38
12"
R-30
10"
R-22
6'/2"
R-19
61A"
R-13
31/2"
R-11
31/2"
Meets ASTM C 665, replacing
Federal Specification HH -1-521 F.
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, 13 in
the exterior walls, in the floor
or cr bspace perimeter
Insulatio ontractor (Sign)
Rover Insulation & Acoustic, I1
Company Name
June 25, 1998
Date
Builder (Sign)
Company Name
Date
CertainTeed Corporation
P.O. Box 860, Valley Forge, PA 19482
Code No. 30-24-092
Thermal Performance — Attic Blowing Application
• In accordance with the chart below, you must install the minimum number of bags per 1,000 se,. ft.
of net area for each R -Value listed.
• The maximum net coverage must not exceed that specified for each R -Value.
• The installed insulation must be at or above the specified minimum thickness for each R-Valee.
• Failure to install the required minimum weight per sq. ft. of insulation at or above the minimum
thickness will result in reduced R -Value.
• This product should not be mixed with other blown insulations or the thermal claims will beccrne
invalid.
"R" means.resistahce to heat flow. The higher the R -Value, the greater the insulation power. To get
the marked R -Value, it is essential that this insulation be installed properly. If you do-it-yourself, get
instructions and follow them carefully. Instructions do not come with this package.
CAUTION: RECESSED LIGHT FIXTURES—TO PREVENT OVERHEATING, DO NOT INSULATE
ON TOP OR WITHIN 3" OF SUCH DEVICES. DOES NOT APPLY TO TYPE IC LIGciT
FIXTURES OR TO FLUORESCENT FIXTURES WITH THERMALLY PROTECTED
BALLASTS.
R -VALUE
BAGS PER
1000 SO. Fr.
MAXIMUM
SO. Fr. PER BAG
MINIMUM WEIGHT
POUNDS PER SO. Fr.
MINIMUM
THICKNESS
To obtain a
thermal resistance
(R) of:
Bags per
1000 sq. ft.
of net area:
Contents of bag
should not cover
more than: (sq. it.)
Weight per sq. ft. of
installed insulation should
not be less than: (lbs.)
Should not
be less than:
(inches)
R-49
34.3
29
.858
19'/4"
R-44
31.1
32
.778
173/4"
R-38
26.6
38
.665
151/2'
R-30
20.8
48
.521
121/2"
R-26
18.1
55
.452
11 "
R-22
15.0
67
.374
9/4"
R-19
13.2
76
.330
81/4"
R-13
9.0
111
.225
53/4"
R-11
7.4
136
.184
43/4-
R -Values are determined in accordance with ASTM C 687 and C 518. Conforms to ASTM C 754.
which replaces Federal Specification HH -1-1030B.
Framing Adjustment
• To compensate for framing members the number of bags per 1000 sq. ft. of net area should :)e
reduced as follows:
Joist Size
Bags to Deduct / 1000 sq. -ft.
Joists 16"O.C.
Bags to Deduct / 1000 sq. ft.
Joists 24" O.C.
2"X 4"
.7
.5
2" Ix 6"
1.0
.7
2"x 8"
1.3
.9
2"x10"
1.6
1.0
0 1989 CertainTeed Corporation 4.89