9801-107 (SFD)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
CS°!tY,t3l1 4 �u
Date= 1 r A Signature of Contractor
" t 1
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.
(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
Su6ect to the workers' compensation provisions of Section 3700 of the Labor
Code, I shall forthwith comply with those provisions.
v
' /bate: -- / < v Applicant– ) —3-
Warning Fit a/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 av
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.
Signature (Owner/Agent) !- ' 1 '+ 1 Date 2�
I BUILDING PERMIT PERMTN °°NTR°`#
�Jtw"JII;+dila
DATF VALUATION LOT TRACT 746
JOB SITEI
ADDRESS C���- S�'D�1�1iIWON �,b��` E
(A�.���• � 1f1}
OWNER
/ D9ESIGNER / ENGINEER
1dd PCONTRrA�CTOR
q("CW,
1 it
t?'Y;' W A_RkiaW [AVV
282 W, iiH<idtW FIWY
('A I'"
UPLAND VA del soli
USE OF PERMIT
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h if �°tf"i't�t"`fes 14 40 S
OAR Af;ft9!.'.AkPt )RT 5330) tifi
%.NTIMA°PED CON11 M C+C7N:r'I°IRUCTION'
a "`.'.6►5;. ifs
it`tr+,UMII°I' V 911 FiIJMivJAtZ�
PLAN k 1490h;9°'11'4
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;;1'I�f?h �. P�iP.t�t4'+C��t»�; = 12i�'Sari �4}► iN#l=�+9��illflf! �.I;^i'�i
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; kT IN !'t.fti 14""' 11,1V Pi's - !_ V.'Ai''0t •000 ,"SS-0MI) `�4l_tia
IR -11 ANO PTAN,
L1 S1; PRETAIDFITS
RECEIPT
DATE
BY/
D!=
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
Set Backs
q
Forms & Footings
Slab Grade
J
Steel
r/;/Ue
Roof Deck
Temp. Power Pole
OX to Wrap
Framing
3 -3 _ ` .
Insulation
Fireplace P.L.
Fireplace T.O.
Party Wall Insulation
Fixtures
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
—
Exterior Receptacles
Final rXl�J
BLOCKWALL APPROVALS
Set Backs
Footings
Smoke Detectors
Bond Beam
PLUMBING APPROVALS
Shower Pans
Sewer Lateral
Sewer Connection
Gas Piping
Gas Test
OPERATION DATE INSPECTOR
MECHANICAL APPROVALS
Underground Ducts
Ducts
Return Air
Combustion Air
Exhaust Fans
F.A.U.
Compressor
Vents
Grills
Fans & Controls
Final
Steel
Electric Bond
Main Drain
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Gas Piping
Gas Test
Electric Final
Heater Final
Plumbing Final
Equipment Enclosure
O.K. for Finish Plaster
POOLS - SPAS
Final
COMMENTS:
J
Final.
Utility Notice (Gas)
r/;/Ue
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
Utifity Notice (Perm)
Residence Address: Desert Pride Lot 6 Plan 4
45-270 Sunbrook La Quinta, Ca
CERTIFICATION: This is to cerrify that attic insulation has been installed in conformance with
the coverage chart recommendations on the opposite side of this card using 71 bags to
cover 1 r 917 sq. ft to obtain an R -value of 38
Contractor's authorized signature -40k 9 &V &1� A.%
Date: May 14, 1998
Installed by: Builder:
ROVER INSULATIdN
74 741 j0NI DRIVE
PALM DESERT, CA 92260
anR -PRO PLUS
(Formerly Cordex)
STABILIZED INSULATION
MANUFACTURED BY
GREENSTONE INDUSTRIES
Atlanta, Georgia • Elkwood, Virginia • Ft. Wayne, Indiana
Norfolk, Nebraska • Phoenix, Arizona • Portland, Oregon
ATOM17FD PNFI IMATIr APPi_ICATION COVERAGE CHART
3.5 39.6
25.3
Net Coverage
R-20 (2 x 6)
R -Value at
39.7
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
(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
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 CertainTeeol,Insulation Statement Lot 6 Plan 4
45-270 Sunbrook
La Quinta, -.-Ca
Insulsafeill�
Fiber Glass Insulation
Insul-6afo OF 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
14,talwr Conuaclor (Sign)
Batts and Blanket
R -Value
Insulation Thickness
R-38
10', 12'
R-30
81/41, 10'
R-22
6'/,'
R-21
5'/i
R-19
8'/4,
R-15
3'/a
R-13
3'/i
R-11
3'/s
Con-plree with ASTM C 866
Fiber glass batts or rolls have been
Installed In accordance with the manu-
facturer's 18reco mendation to provide
an R -value of in the ceiling, 13 in
the exterior walls, . in the floor
awl spa imWer.
ir staller Conua= (Sign) .
cROV�EnR INSULATION 8, ACO[ STTC* Tnr
May N4, 1998
ranm
Bunds (SV)
Company Name
Date
Thermal Performance — Attic Blowing Application
• In rcoordance with the chart below, you must Inatee the nW*nirm number of baps per 1,000 89
of net area for each R -Value sated.
• The maximum net coverage must not exceed that specified for each A -Value.
■ The installed insulation must be 81 or above One specified minimum thickness for east R -Value.
Is Failure to install the required minimum weight per sq. h. of insulation at or above the awtimuln
thickness will result in reduced R -Value.
Is This product ef►ould not be mixed with other blown insulations or the thermal claims ►►iii beoom
invalid.
R -VALUE
BAGS PER
1000 SO. FT.
MAXIMUM
SO. FT. PER BAG
MINIMUM WEIGHT-
POUNDS PER SO Fr.
MINIMUM
TiICKNESS
To obtain aBa
thermal resistants
(R) of:
s par
1lX>$ 64. h.
of net area
conlanis of bap
should not cover
more than: (art. 1L)
weigis W sq. K d
instaYud Ytsulal,on should
ad be 1666 M (rte)
Srould not b
less Iran:
(b ee)
R 80
42.6
23
1.064
23'
R-49
34.3
29
0.868
19 'b'
R-44
31.1
32
0.776
117114'
R-38
26.0
38
0.665
16'/$,
R-30
20.8
46
0.521
12'/a'
R-26
18.1
55
0.452
11'
R-22
15.0
67
0.374
9'b'
R-19
13.2
76
0.330
8'/41
R-13
9.0
111
0.225
5'14'
R-11
7.4
136
0.164
R -Values are detemWW in accordance with ASTM C 687 " 518. Complies with PS -T6 ;7
as Type I insulation.
'R' means resistance to heat flow. The higher the R -Value, the grater the hnsulaUN power.
get the marked R -Value, it is essential that If16 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 Ohould
reduced as follows:
Joist Slee
Bags b Deduct / 1000 sq. L
Joists M.C.
B.gs to Deduct 11000 sq.
Joi tt 2n.c
2' x 4'
0.5
0.4
2' x 6'
0.9
0.5
2-9 6'
1.1
oB
2' x 10'
1:4
1 J)
CertainTeed Corporation, P.O. Box 860, Valley Forge; PA 18482
Coos No.30.2+092 01995 CertainTsea Generation