9703-090 (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
IN
ate 1 Signature of Co fractor f� r r
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.
CAL CONIP
(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 per 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 proGisionsf Section 3700 of the Labor
Code, I shall fo hwith comply with t • ose pr..ovisi n
J6ate: r r' Applicant—.r
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,-000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees:
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant fo
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void -if
work is not commenced within 180 days from date of issuance of such
kpermit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
• correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned proper�1y_for Inspection purposes.
Vignature (Owner% g x' y p' Date Y
PERMIT # CONTROL #
BUILDING PERMIT �z}.. 4�
� �
DATE ��,3197 VALUATION �1lfA.,.�9�+,.�,li! LOT � TRACT 2Xiyit.tojJOB
SITE
ADDRESS .0
APN 6)tr W 291-06
OWNER
•/
CONTRACTORDESIGNER/'ENGINEER
hi C10 MINUS',
Wall HOME'S COPIP.
11.92 W ,r1likC7W R'kV X'
12,82 ir'►r'. AMW 1MY
OPLAND CA 9.1795
t; LAND CA 9178's
( )0,81-f39)39 -CIBL# . 31.1£
USE OF PERMIT, .
°N Yf i"f�i:►.L7M B OCc R \WALLS OR POUL
LAO 3 x.
iFLAI T 0..)N3TR.U4:,4,r10N
SIF
air�.ft�S�iiJCAf2!•�Cift'i' �tl9tkl SN
'.$"i 9 t�; �4.1D �,` iST' C3 ' .Y'9t�►..'� ►'T4C.€!C'`tt'tE®1a(
101.59,5.30
yy ��j� //�� yY ��yy �� tt � g y� � ,� s; p`
P t�+.K'i.!>i.l.�1!!.' .�,Uq'J SY.i.tV%JVfM H
r.?LAJ f C4-tF.C'.1X la t;1 161 -NO -439-319 &544,911
101A} D-418,000 VA6.50
tU.If,t;'3;i,o1,i�}i���i;,,4"!� •J?3tJt�fiMt2i-tfOc-i $s:6.at�
$I 16.41
4,c1j�0 f\n.l'4�;ia M1 -,RR8Y i IM -MO -24140 fO,Jt
r
��tt/�t�ay�:; ,t� J?.L_ P 3.t-t?t1tJ•N3��3-�f3t3 �2tD.C:�.i
125,0(0-44 �- 4),
APT (hl PUBLIC PL.AC V18 - RLE8113 701-00(}45 -000.
JP
u AL t:ONSTRUMIt.)N t NDJIL_ANC:HECK
LESS K&MI) FLIES
$0.00
APR 0 3 1997
i OT!• L'FER-1\1 Vt.' F00% DU K NOW
63,829.20
ONTY OF LA Q UNTA
RECEIPT
DATE BY r `
D F D
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs 4J
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. .
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
BLOCKWALL APPROVALS
POOLS - SPAS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground PI . Test
Final
Gas Piping
PLUMBING APPROVALS
Gas -Test
Electric Final
Waste Lines 7
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
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
w•
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Residence Address: Dewed Ph d C LA`} 11 Plan 3
l
-7S-P9o Surib e)k l avie.) Lp 011IntG,, C 9Zz�3
A
} CERTIFICATIOM This is to cert4 that attic insulation has been installed in conformance with
the coverage chart recommendations on the opposite side of this card using GS bags to
cover _(meq I sq. fc to obtain an R•vahw of�3 o
t Contraccoes authorized signature l 1'-r C &'Uu &-J&
Dam 611
Installed by: Builder.
MOVER IIMSULKION
2 .7M JONI DRIVE
PALM DESERT, CA 92260
1619) 346-2339
'TNE wSULA WN sPEciausr)
R -PRO -PLUS
(Formerly Cordex)
STABILIZED INSULATION
MANUFACTURED BY
GREENSTONE INDUSTRIES
Atlanta, Georgia • Elkwood, Yrginia • FK Wayne, Indiana
Norfolk, Nebraska • Phoenix, Arizona • Portland, Oregon
ATOMIZED PNEUMATIC APPLICATION COVERAGE CHART
3.5
39.6.
Net Coverage
Gross Coverage
R -Value at
Minimum
No Adjustment for Trusses
Based on 2 x 6•
Maximum
Minimum
75'F Mean
Temperature
Thickness
Trusses on IW
Net
Weight Per
Centers
Coverage
Square Foot -
To Obtain
Installed
Square
MiNmum
The Weight Per
Suare
Bags
an Insulation
Insulation
Feet
Bags
Sq. Ft. o1
Feet
Required
Resistance
Should Not
Per
Required
Installed
Pei
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
352
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)
-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 onty.
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 affecfing 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
;n , In..,er �net�llurl 4_\/�l+.o'fuer may rvw if til IrirnR inctallatinnc q_
.±may i
r -
r• rte• .y ......-
manufacturer's recom-
mendations will provide the full
rated thermal resistance value.
Blanket Insulation
R
Minimum
Value
Thickness
To obtain an
Installed
insulation
insulation
resistance
should
(R) df:
not be less than:
R-38
13" Thick'
R-30
91/4" Thick'
R-26
83'4"Thick
R-22
71/2" Thick
R-19
61/2" Thick'
minimum wt./sq. ft. requirements. Installing the correct number of bags/ 1000 sq. ft. is necessaryto ;
meet the corresponding labeled resistance (R) value. (Based on 40 Ib. nominal net weight bag):'.
Rich -RT" Fiber Glass Blowing
Wool Attic Insulation -40 Ib. Bag.
33'4"Thick 41/4"
R-11 Ve Thick
Rich -RT'" Fiber glass Blowing Wool Sidewall Insulation -40 -lb. Bag.
'Thickness varies, check bag
R-16 161/2 60 sq. ft. 0.667 lbs.
4" Thick 4"
label for producing locations
Average'
R
Bags per
Maximum
Minimum
Minimum
Installed
Valuet
1000 sq. ft
Net Coverage Wt:/sq. ft.
Thickness
Thickness
To obtain
The number of
Contents
The weight
Installed
Averagei' .^
an Insula-
bags per 4000
of this bag
per sq. ft.'of
insulation
installed -: , "
tion resis-
sq. ft. of net
should not
installed insul-
should
thickness '•
tance
area should not
cover
ation should not
not be
will'
(R) of:
be less than:
more than:
be less than:
less than:
typically be:
R-44
291/2
.34 sq. ft.
1.188 Ibs.
1.5" Thick
161/2"
R-38
251/2
39 sq. ft.
1.029 lbs.
13" Thick
141/4" '
R-30
201/2
49 sq. ft.
0.811 lbs.
101/4" Thick
111/4"
R-22
15
67 sq. ft.
0.594 lbs.
71/2" Thick
81/4"
R-19
13
78 sq. ft.
0.514 lbs.
61/2" Thick
71/4"
R-13 3%" Thick"
R-11 71/2 135 sq. ft, 0.297 lbs.
33'4"Thick 41/4"
R-11 Ve Thick
Rich -RT'" Fiber glass Blowing Wool Sidewall Insulation -40 -lb. Bag.
'Thickness varies, check bag
R-16 161/2 60 sq. ft. 0.667 lbs.
4" Thick 4"
label for producing locations
R-14 15 66 sq. ft: 0.604 lbs.
3%" Thick '3W
thickness.
R-14 141/2 68 sq!ft. 0'.583 lbs.
31/2" Thick 31/i
"R-12.7 in a 31/2" cavity.
Pian 3
Average Installed thickness Is provided as a guide to Installers. Actual thickness will vary
De5e,,t ride L.0{ 11
depending on conditions at the time of installation. To obtain a specific
R -value, insulation
g Sq O SU n brtiok lA
should not be applied over a larger area than specified on the coverage chart.
Net wL/bag, minimum 37 lbs. This product conforms to the performance requirements of
1
.(Q Lit n `a
Federal Specification HH -1-1030B. Type 1, Class B, and DOE RCS
Standards. Also meets the
8225 3
Insulation Quality Standards of the State of California.
Framing Correction for 40 lb.
Framing 16" on center.
Framing 24" on center.*.
Bag Rich -R Blowing Wool
R Joists . Bags per 1000 sq. ft.
Bags per 1000 sq. ft
Valuest Dimensions (gross)
(gross)
When installing in attics of new
R-44 2x8 28.2
28.6
homes or existing homes where
2x6 28.5
28.8
no insulation is present, it is
2x4 28.9
29.1
acceptable to adjust the
coverage figures to compensate
R-38 2x8 24.2
24.6
for the presence of the framing
2x6 24.5
24.8
members as indicated in the
2x4 24.9
25.1 •- .
following table.
R-30 2x8 19.1
19.6
2x6 19.5
19.8
2x4 19.8
20.1
R-22
tR-values indicated obtained =
when properly installed.with R_19
pneumatic equipment
2x8
13.6
2x6
14.0
2x4
14.3
2X8
11.8
2x6
.12.0
14.1
14.3
14.6
12.2
12.3 ... .:
The higher the R -value, the 2x4 12.3 12.6 '
greater the insulating power. R-11 2x8 6.8 7.1
Ask your seller for the fact sheet 2x6 6.8 7.1
on R -values. 2x4 6.8 7.1
Batts and rolls have been installed in conformance with the above Blowing wool has been installed in the ceiling or sidewall in con- .
recommendations to provide a thermal resistance value of formance with the above recommendations to provide an R -value
R- 30 at inches in 9_ sq. ft. of ceiling, R-13 at of R- using bags of this insulation to cover
inches in LOIL sq. ft. of exterior walls, and R- at square feet of area at a
inches in sq. ft. of floors or crawl space perimeter. minimum thickness of inches.
Date Signature
(dl >/97u car lr,
Date Signature
HIG•616 7/66
Insulation Contractor
74-741 Joni Drive
PALM DESERT, CALIFORNIA 92260
(f41q) 346-2339. p,i,;.�;,,usAg
.06/?0/1997' - 11:09 '9096999524
`HOOD PLUMBING
PAGE 07r
Imstallati-o-nCej-tific:a 'Residential
WIN of MIX for?" to idu4fy the raqj
7t KqJ 6"tvuk L
nmL.—.4p •jdod&jqdpo4(*d.
344d Adarw@A QL
I t Numlaer
An installation cohifamo is required 16 be posted at the ijuRal
mg 5-kQ prior lh*' 6V
8auA 00 1P Nola
MAY ho used tb 'MOGI those raquff DIMbri(i. Ag appflartow C4110garws parmit. TMs form
thq:off6oncy and
of thea
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W
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the underzignec.,ykary that the apnillit-3-.10c
aWro st %3L at OCIVIPMOM (114aftd. and
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dorrionst &,�Q3mpjj.anca*3ubmjtod*to
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iate cdiftpoanao wtth the Eno , I
PVi-Eilboncy Standards for residential:
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*.meem
•
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WATER HEATING SYSTEMS
Water keitinig CEO Carl Mod Rated' Tknk*
Systerri TYve '-Ulnul. Make & To%*:
- ' Input (kW fnalllsebn
[worege a&&. bft.)L_ .. Model Plumber -0 ciftfo.11
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F"C= &SHOWERUNEA03
h"wft4bdt Installod am AVOCI In The Corr mitivion's Dinbmq of.c
Marti 10 linla 24. Pagi.d. SUbehSptor 2. 4-jctjgn 111.
110/00"v
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CY`30 1993 06:32AM
On