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0012-265 (SFD)LICENSED CONTRACTOR DECLARATION ,�L hbreby 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 avr/Ab�`Signatuire s V"te 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. (fie 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. �.00I,DZH^LH '�e INS, ' Policy No. (This section need. 'not.be completed if the permit valiiation is for $100.00. or. less). ( ) I certify that)n 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 f�rthwith comply with those provision fj Date:' —7✓ Applicant; Warning: Failure to secure Workers' Compensation coverage is. unlawful and Shall subject an employer to criminal penalties and civil fines up to $100;'000, in addition to the cost of compensation, damages as provided'for in Section 3706 of the Labor Code, interest and attorney's fees. IMPORTANT Application is hereby made to the.Director of Building a'nd Safety' for a permit subject to the conditions and "restrictions setforth on' his application.. 1. Each person upon whose behalf this application is made & each person at whose request and for whose benefit work is- performed under or pursuant to any permit issued as a result of this applicaton agrees to, & shall„ indemnify & hold harmless the City. of La Quinta, its officers, agents and employees. 2. Any permit,issued as a result of this application becomes•null and void°if work is not commenced ,within 180 days 'from date of issuance of such permit,. or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that the above information is correct. I agree to comply with all City, and State laws relating to the building construction, and hereby authorize representatives of this City to enter upon the above-mentioned property for inspection purposes. rature (Owner/Agent) f R`x'- -� �y Date d BUILDING PERMIT PERMIT# DATE VALUATION LOT" TRACT RO 1, tl.l (3 z 29563 JOB SITE APN ADDRESS 4s_,9i' ,,0 ,ICAft]lnNA. CM`OMr OWNER CONTRACTOR / DESIGNER / ENGINEER y�t�?�`gq�grx.. i 335 so, 00 ADISSJ.r.�.+� y �S+'-i 7<i+"��� ;.t ,,ry(E�,(y�i�;r�,�a ♦I 535 00. 1)" �7J. dl0rf, S��.FS7'!P 200 SM:li".l?'kNAFi H0 CA 92408 84W BlEKMAt2T.>;INO CA92408 (IMIX. 2120. USE OF PERMIT SM. P.I. iX3CR 1,0T:19 PVI'.I 1T D,M9'N0) TP3C1 UDE Pt.00ill'.A1:rLSJF'0t3iMWAWAY APP'•IOACII.75%PLAN C IIFC #j'(M RZDUC TICH *P0. l "j"SRJ•ANCE OF SAN.X PL -M4 TYI°Sf,,. TRACT CONS'; UCTICYN 11679,00 3F PORC11WPA.T10 94.00 VF "I;tAGF/C_tARP*RT klF) 3 COST Ole G`OMMUL"MM 100,460.10 r1EblimXMI d�87e. .'�57.fV L'f V.��MS-7i i'•. t.l`1AIe9'S"k,UCTIOd* YEE 101 ,�t100.418­000 PLAN CHFrr,, R8 103 =t1t11 r1 X9•:,1$ .13p , MRC11ANICALFRE lo.t.0 90421.000 -ii ZLt~f:TRSCAL VE9, -- FfJi- O-ntZO l,�il.£s a N.UMi3M0 Fd<Z u 1101'_00b.419-000- $3a8.74 1"; STRONG MOTION ME - ID 101 X000-241•-000 $10.09 < "� t `• • ' ORADINO FER 101 x600-42;x.00©.— DW,Et PER I.MP.,C'T Fft $1,0(x.00 r'n r 7 1 81 M-TC11T.M., CONSMUCTION A14D PIM MT. CK 1 KSS 1DRE-1- AID 11=1 $0, TMAL PXt acJlpX),I � t%�c�ii � i . t► RECEIPT DATE }}ii 1 o! ". If,- BYE• � r •p�p[� %�L CJ ! O7777� INSPECTOR I. \Aa INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs v Underground Ducts Forms &Footings Ducts Slab Grade Return Air Steel 21 Combustion Air Roof Deck O.K. to Wrap L4 Exhaust Fans F.A.U. Framing Insulation hill'2— 11 Compressor Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath�>— Drywall - Int. Lath Final l�L /���-- BLOCKWALL APPROVALS Final POOLS - SPAS 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 2 ��-� o Heater Final Water Piping Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K for Finish Plaster Sewer Lateral 2 \2Z �� Pool Cover Sewer Connection �.tt2Z- �Q Encapsulation Gas Piping Gas Test Appliances - Final COMMENTS-- OMMENTS:Final 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) INSULATION CERTIFICATE 45-910 LA REINA COURT Riverside 29563 LA QUINTA City 19 IC -1 County Tract No Lot Number Description of Installation P. 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 TVDe 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) 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) 6 FOUNDATION WALL Material Brand Name Thickness (inches) Thermal Resistance (R -Value) Declaration ,I 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, where applicable. 2, 3A 8/6/01 PARAGON INSULATION Item is S nature, Dale - 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