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0012-258 (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 Prof ssionals Code, and my License, is in full force and effect. License # Lic. Class Exp. Date �}Otat 1 ta+; 16at Signature of Contractor ` /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. (k) 1I 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 worker's' compensatiori 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 subject to the workers' compensation provisions of Section 3700 of the.Labor Code, I shall forthwith comply with.those provision`s. vDate:/'/f�;Applicant— Warning: Failure to secure Workers' Compensation. coverage is unlawful and shall subject an employer to criminal penalties and civil fines up to $100,000,, in addition to the cost of compensation, damages as provided for in Section 3706 of the Labor Code, interest and attorney's fees. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject •to the conditions. and restrictions set forth on._his application. 1. Each person upon whose behalf this application is made & each person at Whose request -and for whose benefit work is performed under or pursuant to any permit issued as a result of this applicaton agrees to, &.shall, indemnify & hold harmless the City of La. Quinta, its officers, agents and employees. 2. Any permit issued as a result.of this application becomes null and'void if work is not commenced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to`cancellation. I certify that I have read this application and state that the above information is correct. I agree to comply with all City, and State laws relating to the building construction, and hereby authorize representatives of this City to enter upon. the/above-mentioned property for inspection purposes. , '-'Signature (Owner/Agent) ?` � 1/ Date BUILDING PERMIT PERMIT# DATE VALUATION LOT bI �i °,�#� TRACT yqq ry n� JOB SITE ADDRESS •� a�r,W Mr\GAO AI/9ltfTe APN 4*1-01.9 OWNER CONTRACTOR / DESIGNER / ENGINEER SA1ri' DF&WARDWO CA 92408 SAN DEM'.WKki?. 40 ! . CA 9N.08 (90081.6007 t"•1;I,X 2120 USE OF PERMIT .�,YD• �L:&AI;�.�xCt i.C17`::XE e�`i�.1`1' iClOw 2�'i3'r 13�lC1.1J1?9� . B1X)CK XrUPO'014D>t.K+''9WAY APP R��f,'K M% PLAN CHEM, FEE "DUCTION YOR 1S., .ANCS OF VAMP- PL A14 ' YPZ 'T RAtT CONIMIMON SP 7?01v'CHIPP�. TIO 4€in SY t; lk,RiAZ$MA RE'0aa;'f (M 2n CONSTOC'I'ION FEE 101-000-4116-000 MUD PLAN C11K.M. Fair, $146.03 T11 iti9ECEi C_i T1 MYT3'iI;PJCAL "Me PLUMOTOO ME :. '101 X419-000 $146.75 W;RONO MOTIONIFFM K231.D 101-0004414000 � ;. C_ MADWO PER $20.00 "' � 17T+;1fiE1,07�ER IMPACT PH, $1,9tJ7.(!A `" � A' PJI. A • �i7.�`3�3 Fes.^Fh•T"��, �f�.C►t7 11,. YL M' 'I 1' MIN DIJ19 N O W Pi,". ?. RECEIPT DATE }� BYE DATE FINALED INSPECTOR INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS, MECHANICAL APPROVALS Set Backs _0 Underground Ducts Forms & Footings 2N -ES Ducts Slab Grade Zh Return Air Steel 1Q 10 Cvx;� Combustion Air Roof Deck Exhaust Fans O.K. to Wrap9 4 Framing Insulation CS F.A.U. Compressor Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall FirewallExter- _ Lath S Drywll Drywall all -Int. Lath � Final% BLOCKWALL APPROVALS Final POOL.: -SPAS Steel Set Hacks 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 2\ $ Ci 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 0-1a Gas Test C� A Appliances Final COMMENTS: ; Final �_� Utility Notice (Gas) j ELECTRICAL APPROVALS Temp. Power Pole Underground Conduit Rough Wiring Low Vottage Wiring Fixtures Main Service Sub Panels 101*1 Exterior Receptacles G.F.I. oe Smoke Detectors Temp. Use of Power Final Utility Notice (Perm) INSULATION CERTIFICATE IC -1 45-930 LA FLOR LANE LA QUINTA Number and Street City Riverside 29563 26 County Tract No Lot Number Description of Installation 1 ROOF Material Brand Name Thickness (inches) Termal Resistance (R -Value) 2 CEILING Batt or Blanket Type BATT Brand Name CERTAINTEED Thickness (inches) 12 Thermal Resistance (R -Value) R38 Loose Fill Type BLOWN IN Brand CERTAINTEED Contractor's min installed weight square ft 0.615 14 3/4 inches Manufacturer's installed weight per square foot to achieve Thermal Resistance (R -Value) R38 3 EXTERIOR WALL Frame Tvoe A. Cavity Insulation. , Material -BATT Thickness (inches) 31/2 B. Exterior Foam Sheathing Material Thickness (inches) 4 FLOOR OVER GARAGE AREA Material ,Thickness (inches) 5 SLAB FLOOR/PERIMETER Material Thickness (inches) 6 FOUNDATION WALL Material Thickness (inches) Brand Name CERTAINTEED Thermal Resistance (R -Value) R13 Brand Name Thermal Resistance (R -Value) Brand Name Thermal Resistance (R -Value) Brand Name Thermal Resistance (R -Value) Brand Name Thermal Resistance (R -Value) Declaration I hereby certify that the above insulation was installed in the building and the above location in conformance with the current Energy Efficiency Standerds for residential buildings (Title 24, part 6, Califronia Code of Regulations) as indicated on the Certificate of Compliance, wherre applicable. 2, 3A V 8/6/01 PARAGON INSULATION Item #s S' U ature, D' to Installing Subcontractor (Co. Name) OR General Contract (Co. Name) OR Owner Item #s Signature, Date Installing Subcontractor (Co. Name) OR General Contract (Co. Name) OR Owner Item #s Signature, Date Installing Subcontractor (Co. Name) OR General Contract (Co. Name) OR Owner