9801-116 (SFD)i RF• LICENSED CONTRACTOR DECLARATION
I hereby affirm"5nder penalty of perjury that I am licensed under provisions of
ChapOt9 (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
✓Date ��b. f f 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.
.,3'A1
(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
Code, I shall fort with comply with those Dlovision
Date: 7—./ N Applicant
Warnin Failure to secure Workers' Compensation—co erage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100',000, in
addition to the cost of compensation, damagesasprovided 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 It,
application.
1. Each person upon whose behalf this application is made & each person ai
whose request and for whose benefit work is performed under or pursuant to, b
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 i
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
"Above-mentioned property for inspection purposes..
7nature (Owner/Agent) � �.
Date_
PERMIT# CONTROL, #'
BUILDING PERMIT
nATF VAI I IATInN S1.,1(k.64,7.40 I nT TRACT, a.is
JOB ADDRESS '�Me?�.71;�'�Vd�.E`�I�Ai.�aK NMt' •.'
APN
464-.SiB2^001
6..�,�f .
OWNERpf�ly
CONTRACTOR
D1(ESIGN9EIR, /IENGINEER
(�
s t„V�IY.i'"..
cm
Iia CO 1-10kl s CORIP
1282 !fir..t Rit(.+'W'HWY .: '
.
12,31.1 W +iKROI 4MY
U11LA,NTND t C'` j 9085
UPLAND CA 9.016
USE OF PERMIT
L C T 1<1, IyL AN 48.. SSE -0 - PE� CZF4Al1 DOE, , WQT INCLUDE #3LOC;K'1+afALLa
CSR,` OOL.• PLAN Cf:t47S:'K.':.R.K7U+,:'1iC)7.5`3'a.r'OR.A6.i.%F.'dIPfX 48fJANCE
OF Mht PLAN TY'M .
f t'':esC.•")' C.'e"iN 'f i '►� "�'& iti1 7.0000 5
PORCHIPAM0 14.00 Sr
GAP.Ae0iYC;FiRK1.t3'1' 5183.00 Si.•'
• Ley „
PURNsi F JRU) SUMMARY
PLAN Cs i3l-CK M- .1 1014M,410-318 $591..f�
Ce►ra,VtziT , 1ON FEU 1.01=refMIMOO V79.ti5
ff-f_'HANJCJiV.,P'1.1i$47.00
'
J,U'WLMfi.fEry 141(4..60-0010 9130,44
'
yLLp8H4NGI�7h x01000-4.13-00 .B S4` •ti��.
.
°MONG W)l ION r, PX - Rryl$M 101-13 V-24.1-000 $ d 21-(0.•
Ai�r�v+� t 101400-423MID � o.01i
1WRA T -I tU I` RE FEE r:25-000-443--342
ART TN PUBLIC Pl f C13» i FS'fl, 701-OttO255-000 $51.62
UL IMIX110NAND PLAN CRECK,
} LESS PRE.' PiUD FEES
M00
X11
AOTAL*Y 'Lt"f. 9�` ,kr{t`,YT C Strl!Yv
.73,8lSe,7.91
• ,�-•'r'- ,iu ,/I.F
RECEIPT
DATE
BY ` `
DAT FI AL
INSPECTOR
-7
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
Set Backs
Forms & Footings
Slab Grade
Steel
Roof Deck
3 - cl - Q ��—
O.K. to Wrap
_ 2 - f(
Framing
/0 -
Insulation
- / -
Fireplace P.L.
Fireplace T.O.
Party Wall Insulation
Party Wall Firewall
Exterior Lath
! 3
Drywall - Int. Lath
4 --2n - 99'
rium 40 wce -
BLOCKWALL APPROVALS
Set Backs
Footings
Bond Beam
OPERATION DATE INSPECTOR
MECHANICAL APPROVALS
Underground Ducts
Ducts
Return Air
Combustion Air
Exhaust Fans
F.A.U.
Compressor
Vents
Grills
Fans & Controls
Condensate Lines
Final
Steel
Electric Bond
Main Drain
Approval to Cover
Equipment Location
Underaround Electric
Final I I Gas Piping
PLUMBING APPROVALS Gas Test
Electric Final
Waste Lines -e o _ Heater Final
Water Piping Plumbing Final
Plumbing Top Out Equipment Enclosure
Shower Pans O.K. for Finish Plaster
Sewer Lateral _ Pool Cover
Sewer Connection 13- - Encapsulation
Gas Piping
Gas Test Eg -ap _ 91? ,$ _
Final
COMMENTS:
Utility Notice (Gas) 1 / -21- Y� I �' -
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G. F.I.
Smoke Detectors
Temp. Use of Power
Notice (Perm)
L
POOLS - SPAS
Residence Address: Desert Lot 14
45-235 Sunbrook La Quinta, Ca
CERTIFICATION: This is to terrify that attic insulation has been installed in conformance with
the coverage chart recommendations on the opposite side of this card using 53 bags to
cover 1 , 81 sq. ft. to obtain an Rvalue of 30
Contractor's authori:ed signatur�-
nate: May 22, 1998
Inst;illeJ by: RuilJrr
ROVER INSULATION
R -PR
STABILIZED INSULATION
MANUFACTURED BY
GREENSTONE INDUSTRIES
Atlanta, Georgia • Elkwood, Virginia Ft. Wayne, Indiana
Norfolk, Nebraska • Phoenix, Arizona Portland. Oregon
S
ATOMIZED PNEUMATIC APPLICATION COVERAGE CHART
3.5
39.6
Net Coverage
.758
R -Value at
5.5
No Adiustment 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
(R) or
Be Less Than.
Bag
Per 1.000
Insulation Should
Bag
Square Feet
(inches)
Square Feet
Not Be Less
Than: (Ibs)
n•5o
10.5
20.5
48.8
1.4e4
;2t.s
4b.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
1 25.3
.758
R-20 (2 x 6)
5.5
25.2
F 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 an.plication technioues. and may vary as much as 10%
Builders
Insulation Statement Desert Pride L,ot 14
CertainTeed 1:
45-235 Sunbrook
La. Quinta, Ca
InsulSafeill
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.
Date
company Name
Date
Batts and Blanket
R -Value FInsulation Thickness
R-38
10", 12"
R-30
81/4'. 10"
R•22
6,/,"
R-21
5'/:
R-19
6'/;
R-15
3'/;
R-13
3'/*
R-11
3'/;
Complies with ASTM C 665
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, j!jL in
the exterior walls, in the floor
;jaimeter.
r Contractor spaontractor (Sign).
ROVER INSULATION & ACOUS:Ir'Tn�
Company Name
Date
May 22, 1998
Budder(srgn)
Company Name
Date
CoIt de No.30.24-092
Thermal Performance — Attic Blowing Application
■ In accordance with the chart below, you must Install the minlmum number of bags per 1,000 sq. 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-Vs,us.
■ Failue to install the required minimum weight per sq. ft, of insulation at or above the minimum
thickness will result In reduced A -Value.
■ This product should not be mixed with other blown insulations or the thermal claims will becams
invalid.
R -VALUE BAGS PER MAXIMUM MINIMUM WEIGHT- MINIMIPM
1000 SO FT SO F
To obtain a'
thermal resistance
(R) of:
R•60
Fl -49
A-44
R-38
R-30
A-26
R-22
R-13
R-11-..... _.....
Bags per
100 sq. a:
of net area:
42.6
34.3
31.1
26.6
20.8
18.1
15.0
13.2
9.0
_.......74..�......136
. . PER BAG
Contents of bag
should not cover
more than: (sq. ft.)
P3
29
32
38
48
55
67
760.330
1110.225
POUNDS PER SO. Fr..
We M r ft. of
installed Insulation mould
not be less Ilan: (Itis.)
1.064
0.858
0.778
0.665
0.521
0.452
0.374R•19
0.184 ,
THICKNESS
Should nor. be
less than:
(inches:,
23 -
t9'/:
2• x 8"
15'/i
12'h•
1.4
AV/
R -Values are determined in accordance with ASTM C 687 and 518. Complies with ASTM' ',
as Type I insulation.64
"R" means resistance to heat flow. The higher the R -Value, the grater the insulating power. To
get the markod 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 APPLY
TO TYPE IC LIGHT FIXTURES OR TO FLUORESCENT FIXTURES WITH
THERMALLY PROTECTED BALLASTS.
Framing Adjustment
To compe.nsale for framing members the number of bags per 1000 sq. ft. of net area should pe
reduced as follows:
CertainTeed Corporation, P.O. Box 866, Valley Forge, PA 19482
Bags to Deduct /-1000 sq. fi
Joists 2410.0.
01995 CertainTeed Corporation 10/95
Bags to Deduct/ t000sq.fl.
Joist Size
Joists 16-O.C.
2' x 4"
0.5
2' x 6"
--------------
0.9
2• x 8"
}.1
2° x 10"
1.4
CertainTeed Corporation, P.O. Box 866, Valley Forge, PA 19482
Bags to Deduct /-1000 sq. fi
Joists 2410.0.
01995 CertainTeed Corporation 10/95